The nurse is monitoring a client who was diagnosed with Type 1 Diabetes Mellitus and is being treated with NPH and regular insulin. Which manifestations alert the nurse to the presence of a possible hypoglycemic reaction? (SELECT ALL THAT APPLY)

A. Respiratory acidosis:
This occurs when there is inadequate ventilation, leading to an accumulation of carbon dioxide (CO2) in the blood. In the context of a nasogastric tube attached to low suction, respiratory acidosis is not the primary concern. It is more associated with conditions like respiratory depression or lung diseases.

B. Metabolic acidosis:
Metabolic acidosis results from an excess of acid or a loss of bicarbonate. It is not the typical outcome of a nasogastric tube attached to low suction. Conditions like diarrhea or renal failure are more commonly associated with metabolic acidosis.

C. Respiratory alkalosis:
Respiratory alkalosis occurs when there is excessive loss of carbon dioxide from the body, often due to hyperventilation. This is not a typical consequence of a nasogastric tube attached to low suction.

D. Metabolic alkalosis:
Metabolic alkalosis is characterized by an excess of bicarbonate or a loss of acid. In the given context, with the nasogastric tube attached to low suction, there is a potential loss of gastric acid, contributing to metabolic alkalosis.

A. Stress has likely caused an increase in the client's blood sugar levels:
This statement is accurate. Stress, especially related to surgery, can lead to increased levels of stress hormones, such as cortisol and catecholamines, which can elevate blood sugar levels. Surgery is a physiological stressor that can impact glucose metabolism.

B. The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars:
This is the most appropriate choice. Surgery, anesthesia, and changes in fluid balance can affect blood glucose levels. The stress response to surgery can lead to fluctuations in blood sugar, and patients may need insulin during this period.

C. The client has likely overstimulated her ability to control her diabetes using non-pharmacologic measures:
This statement is not accurate. Overstimulation is not a common cause of the need for insulin in the context of surgery. The stress and physiological changes associated with surgery are more likely contributors.

D. Alterations in bile metabolism and release have likely caused hyperglycemia:
While alterations in metabolism can impact glucose regulation, in the context of surgery, the primary factors are the stress response, changes in fluid balance, and potential alterations in the ability to eat or drink normally rather than specific effects on bile metabolism.