A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this client's teaching? (Select all that apply).

Choice A rationale: A quiet, dark environment is part of supportive care for a patient with hyperthyroidism, as it can reduce anxiety and sympathetic nervous system stimulation. However, a 1-degree Fahrenheit increase in temperature is a critical early sign of a developing thyroid storm, a life-threatening condition. This action is not the most urgent and is supportive, not a direct intervention.
Choice B rationale: An elevation in temperature, even a slight one, in a patient with Graves disease is a hallmark sign of an impending thyroid storm, a hypermetabolic state that can lead to cardiac dysrhythmias and death. An immediate ECG is crucial to assess for cardiac complications such as tachycardia, atrial fibrillation, and other life-threatening dysrhythmias that can develop rapidly in this emergency.
Choice C rationale: The apical-radial pulse deficit is a measure of the difference between the apical and radial pulse rates. While a significant deficit can indicate a dysrhythmia like atrial fibrillation, which is a concern with Graves disease, assessing the heart's electrical activity via an ECG is a more direct and immediate action to identify and manage the root cause of the cardiac instability.
Choice D rationale: Administering acetaminophen can help reduce fever, a symptom of thyroid storm. However, it does not address the underlying hypermetabolic state or the critical cardiac complications that are the primary danger. It is not the first or most critical action, as a full cardiac assessment via ECG is paramount to guide definitive treatment and prevent a fatal outcome.

Choice A rationale: Diabetic ketoacidosis (DKA) is a severe complication characterized by hyperglycemia, metabolic acidosis, and ketosis. Elevated glucose levels (typically >250 mg/dL) result from insufficient insulin. The body then breaks down fat for energy, producing ketones which lower the blood pH, resulting in metabolic acidosis. The expected finding is a low plasma bicarbonate level (normal range 22-29 mEq/L) reflecting the metabolic acidosis.
Choice B rationale: Decreased urine output is an incorrect finding. In DKA, hyperglycemia leads to osmotic diuresis, where excess glucose pulls water out of the body, leading to polyuria (increased urine output) and dehydration. The kidneys attempt to excrete the excess glucose and ketones, resulting in frequent and copious urination.
Choice C rationale: Increased respirations (Kussmaul respirations) are a compensatory mechanism for metabolic acidosis, but they lead to a decrease in pH, not an increase. The deep, rapid breathing attempts to blow off carbon dioxide, a form of carbonic acid, to raise the pH back to the normal range of 7.35-7.45.
Choice D rationale: While coma can be a late and severe complication of DKA, it is not a confirming diagnostic finding. DKA is confirmed by the specific biochemical triad of hyperglycemia, ketonemia/ketonuria, and metabolic acidosis. Patients are often awake and responsive in the early stages, experiencing symptoms like nausea, abdominal pain, and lethargy.