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: Atherosclerosis is a common complication of diabetes, but it's a macrovascular complication, not a direct result of diabetic neuropathy. Neuropathy affects the nerves, while atherosclerosis involves the hardening and narrowing of arteries due to plaque buildup, which is a separate but related long-term complication of hyperglycemia. Choice B rationale: Diabetic retinopathy is a microvascular complication of diabetes that affects the blood vessels in the retina of the eye. It is not caused by neuropathy. Neuropathy affects peripheral nerves, leading to sensory, motor, or autonomic dysfunction, and is a distinct complication of diabetes. Choice C rationale: Diabetic neuropathy, particularly peripheral sensory neuropathy, causes a loss of protective sensation in the feet. Patients cannot feel pain, pressure, or temperature, making them unaware of injuries, blisters, or cuts. This lack of sensation places them at high risk for undetected foot injuries, which can lead to ulcers, infections, and even amputation. Choice D rationale: Kidney failure is a complication of diabetic nephropathy, which involves damage to the small blood vessels in the kidneys (glomeruli). It is not a direct result of diabetic neuropathy. While both are microvascular complications of diabetes, they affect different organ systems and have different pathophysiological mechanisms.

Choice A rationale: Tetany is a neuromuscular hyperexcitability disorder caused by hypocalcemia, which can be a complication of a thyroidectomy due to accidental removal or damage to the parathyroid glands. Symptoms include tingling sensations, muscle spasms, and carpopedal spasms. While a possible post-surgical complication, the client’s signs of high temperature, tachycardia, and restlessness point to a different, more severe condition.
Choice B rationale: Hypoglycemia is a state of low blood glucose, typically below 70 mg/dL. Symptoms include sweating, shakiness, confusion, and hunger. The client’s signs of a high temperature, tachycardia, and extreme restlessness are not classic symptoms of hypoglycemia. Furthermore, hypoglycemia is not typically a complication of a thyroidectomy unless the client has a pre-existing diabetic condition.
Choice C rationale: A thyroid crisis, or thyroid storm, is a life-threatening complication of hyperthyroidism that can be precipitated by surgery, particularly a thyroidectomy, in an inadequately prepared client. It is characterized by a massive release of thyroid hormones, leading to a hypermetabolic state with symptoms including extremely high fever, severe tachycardia, altered mental status, and cardiovascular collapse. The client's symptoms are classic signs of this condition.
Choice D rationale: Diabetic ketoacidosis (DKA) is a severe complication of uncontrolled diabetes mellitus characterized by hyperglycemia, metabolic acidosis, and ketone body production. Symptoms include fruity breath, abdominal pain, and Kussmaul respirations. A thyroidectomy is not a direct cause of DKA. The client’s signs and symptoms, particularly the very high temperature, are not typical of DKA.