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Exhibits

Select the 2 findings that indicate the client's condition is improving.

Temperature

Blood glucose

WBC

Heart rate

Urinary frequency

Blood pressure

Wound appearance

Answer and Explanation

Correct Answer : B,E

Rationale for Correct Choices

Blood glucose: The client’s blood glucose decreased from 250 mg/dL to 140 mg/dL, indicating a positive response to diabetes management through medication and dietary adherence. This is a key marker of metabolic control in diabetes.
Urinary frequency: Two weeks ago, the client reported "frequent urination" (polyuria), which is a classic symptom of uncontrolled hyperglycemia. Today, this symptom is not reported, and given the improvement in blood glucose, it's highly probable that the polyuria has resolved or significantly decreased.

Rationale for Incorrect Choices

Temperature: The client’s temperature increased from 38.3°C to 39.0°C, suggesting a worsening or persistent infection. An increasing fever is a negative trend and does not indicate improvement.
WBC: The WBC count rose from 9,500/mm³ to 11,200/mm³, exceeding the normal upper limit. This may reflect an active or worsening infection, especially in the context of a draining foot wound and elevated temperature.
Heart rate: The heart rate remains elevated at 106/min (tachycardia) compared to the previous 104/min. Persistent tachycardia can be a sign of systemic infection or dehydration and is not a sign of clinical improvement.
Blood pressure: The blood pressure decreased from 98/74 mm Hg to 90/68 mm Hg, which may suggest worsening hemodynamic status and possible sepsis. Hypotension is not an indicator of improvement.

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Correct Answer is B

Explanation

A. Partial pressure of CO2 50 mm Hg (35 to 45 mm Hg): In DKA the partial pressure of CO2 decreases due to hyperventilation, which is the body’s compensatory mechanism to blow off CO2 and correct metabolic acidosis. A CO2 level of 50 mm Hg would suggest insufficient compensation.

B. Serum bicarbonate 9 mEq/L (21 to 28 mEq/L): In DKA, serum bicarbonate levels decrease due to the accumulation of ketoacids, leading to metabolic acidosis. A level of 9 mEq/L is significantly lower than the normal range and indicates the severity of acidosis.

C. Blood glucose 230 mg/dL (74 to 106 mg/dL): Blood glucose levels in DKA are typically much higher than 230 mg/dL. Blood glucose levels in DKA can exceed 250 mg/dL, often reaching 600 mg/dL or higher, due to insufficient insulin.

D. pH 7.5 (7.35 to 7.45): The pH in DKA is usually low, indicating acidosis. A pH of 7.5 is higher than the normal range, suggesting alkalosis, which is not consistent with DKA. Typically, the pH in DKA is below 7.35 due to metabolic acidosis.

A. Administer digoxin by IV bolus. B. Prepare the client for temporary pacing. C. Instruct the client to perform the Valsalva maneuver. D. Perform carotid sinus massage.

Correct Answer is B

Explanation

A. Administer digoxin by IV bolus: Digoxin slows conduction through the AV node and can worsen a complete heart block. It is contraindicated in this condition and may lead to further bradycardia or cardiac arrest.
B. Prepare the client for temporary pacing:Third-degree (complete) heart block results in electrical dissociation between atria and ventricles, leading to dangerously low heart rates and inadequate perfusion. The definitive treatment is temporary pacing to stabilize the cardiac rhythm until permanent pacing can be arranged.
C. Instruct the client to perform the Valsalva maneuver: This maneuver is used to terminate supraventricular tachycardias by stimulating the vagus nerve. It is not indicated in bradyarrhythmias like third-degree heart block and could further lower the heart rate.
D. Perform carotid sinus massage: This is another vagal maneuver used to treat tachycardias, not bradycardias. Performing it in a client with third-degree heart block could dangerously reduce the heart rate further and is therefore inappropriate.

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Exhibits Select the 2 findings that indicate the client's condition is improving.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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Exhibits

Select the 2 findings that indicate the client's condition is improving.