A nurse is teaching a client who is newly diagnosed with type 2 diabetes mellitus about insulin therapy. Which of the following insulin combinations should the nurse instruct the client to mix?

A. A client who has aspiration pneumonia: Pneumonia leads to hypoventilation and carbon dioxide retention, which causes respiratory acidosis. It does not typically result in metabolic alkalosis since it affects gas exchange rather than acid-base balance at the metabolic level.

B. A client who is receiving continuous gastric suctioning: Prolonged removal of gastric secretions depletes hydrochloric acid, leading to an excess of bicarbonate in the blood and resulting in metabolic alkalosis. This is a common cause of alkalosis, along with excessive vomiting or diuretic use.

C. A client who is experiencing an opioid overdose: Opioids depress the respiratory system, reducing ventilation and causing carbon dioxide buildup, leading to respiratory acidosis. This does not cause metabolic alkalosis, as the issue originates in the lungs, not metabolism.

D. A client who has uncontrolled diabetes mellitus: Diabetic ketoacidosis results in excessive production of acidic ketone bodies, which lower blood pH and cause metabolic acidosis. The acid-base disturbance in diabetes is typically acidosis, not alkalosis.

• Pain level: Chest pain rated at 7/10 with radiation to the left arm, along with diaphoresis and nausea, indicates a potential acute coronary syndrome, likely a myocardial infarction. Immediate intervention is necessary to relieve pain and address the underlying cause, as this could prevent further complications and potential cardiac damage.
• Electrocardiogram findings: ST-segment elevation and T wave changes suggest an ST-elevation myocardial infarction (STEMI), which requires urgent medical attention. Prompt identification and activation of treatment protocols, such as percutaneous coronary intervention (PCI) or thrombolytic therapy, are critical to restore blood flow and minimize myocardial damage.
• Troponin T level: An elevated troponin T level (0.40 ng/mL, with a normal range <0.1 ng/mL) indicates myocardial injury, supporting the diagnosis of an acute myocardial infarction. Immediate management is essential to mitigate further cardiac injury and ensure appropriate treatment is initiated based on the severity of the elevation.
• Blood pressure: While the blood pressure reading of 164/80 mm Hg indicates hypertension, it is not critically high and does not require immediate intervention like the other findings. However, elevated blood pressure in the context of a myocardial infarction can increase myocardial oxygen demand, leading to further complications, thus it should be monitored closely.

• Blood glucose level: The blood glucose level of 103 mg/dL is within normal limits (74-106 mg/dL) and does not indicate an immediate concern. Although monitoring blood glucose is essential in clients with diabetes, it is not a priority in the context of acute coronary syndrome.
• Bowel sounds: The presence of bowel sounds indicates gastrointestinal function and does not require immediate follow-up in this context. While it’s important to assess overall health, bowel sounds are not a priority when addressing acute cardiac symptoms.
• Lung sounds: Clear lung sounds indicate that there is no pulmonary congestion or other respiratory complications at this time. While lung assessment is essential for overall patient evaluation, clear lung sounds do not require immediate follow-up in this acute setting.