An elderly patient has had hip surgery and will be receiving heparin, 4000 units subcutaneously every 12 hours. The heparin is available in vials of 5000 units/mL. Calculate how much heparin the nurse will administer for this dose.

Choice A rationale: Encouraging incentive spirometry is a pulmonary intervention designed to prevent atelectasis and pneumonia by promoting deep breathing. While important post-surgically, it does not address the metabolic emergency indicated by the fruity breath odor, which is a classic sign of excessive ketone production from fat metabolism due to severe insulin deficiency.
Choice B rationale: Increasing intravenous fluids could worsen fluid overload in a dehydrated client without addressing the underlying metabolic imbalance. Although fluid resuscitation is part of the treatment for severe hyperglycemia, the primary intervention involves insulin administration to correct the metabolic derangement and halt ketone production, which is the root cause of the fruity odor.
Choice C rationale: The fruity breath odor is caused by the exhalation of acetone, a type of ketone body produced during lipolysis when glucose is unavailable for cellular energy. This indicates the body is in a state of ketoacidosis, a life-threatening complication of uncontrolled diabetes. Consulting the provider for immediate testing and treatment is the priority action.
Choice D rationale: Performing meticulous pulmonary hygiene, such as suctioning and chest physiotherapy, is indicated for clients with respiratory secretions or compromised lung function. While important for general post-operative care, it does not address the specific metabolic emergency of ketoacidosis indicated by the fruity breath odor, which requires immediate medical intervention.

Choice A rationale: The initial administration of orange juice, a simple carbohydrate, is the correct first step for mild hypoglycemia. Since the client's symptoms have not resolved within five minutes, it is appropriate to administer another dose of 15 grams of a simple carbohydrate to raise blood glucose levels. A half-cup of orange juice provides approximately 15 grams of carbohydrates.
Choice B rationale: Dextrose 50% IV is a hypertonic glucose solution administered for severe hypoglycemia when a client is unable to swallow or is unconscious. Since the client is awake and alert, they can safely ingest oral carbohydrates, and IV administration is not yet indicated.
Choice C rationale: Administering insulin, which lowers blood glucose, would worsen the client's hypoglycemic state and is contraindicated. The client's symptoms of shakiness, diaphoresis, and weakness are classic signs of hypoglycemia, indicating a need for glucose, not insulin.
Choice D rationale: Glucagon is a hormone that raises blood glucose by stimulating the liver to release stored glucose. It is typically used for severe hypoglycemia in unconscious clients or those who cannot receive oral glucose. Since the client is conscious, an oral carbohydrate is the preferred and safer option.