The nurse is reviewing arterial blood gas (ABG) results for a client with diabetic ketoacidosis. Which result is consistent with this diagnosis?

pH 7.48, PaCO2 31 mm Hg, HCO3 26 mEq/L

pH 7.42, PaCO2 39 mm Hg, HCO3 25 mEq/L

pH 7.34, PaCO2 40 mm Hg, HCO3 21 mEq/L

pH 7.17, PaCO2 69 mm Hg, HCO3 25 mEq/L

Answer and Explanation

The Correct Answer is D

Choice A reason: A pH of 7.48 is above the normal range (7.35–7.45), indicating a state of alkalosis, not acidosis. A PaCO2 of 31 mm Hg is below the normal range (35–45 mm Hg), which could indicate respiratory alkalosis if it were the primary disorder. An HCO3 level of 26 mEq/L is within the normal range (22–26 mEq/L) and does not suggest metabolic acidosis. Therefore, this choice does not reflect the metabolic acidosis seen in diabetic ketoacidosis (DKA).
Choice B reason: A pH of 7.42 is within the normal range, and a PaCO2 of 39 mm Hg is also within the normal range, suggesting neither acidosis nor alkalosis. An HCO3 level of 25 mEq/L is within the normal range and does not indicate the metabolic acidosis characteristic of DKA. Thus, this choice does not match the expected ABG results for DKA.
Choice C reason: A pH of 7.34 is just below the normal range, indicating a slight acidosis1. A PaCO2 of 40 mm Hg is within the normal range, suggesting that the primary issue is not respiratory. An HCO3 level of 21 mEq/L is slightly below the normal range, which could suggest a mild metabolic acidosis. However, the changes are not as pronounced as typically seen in DKA, where more significant acidosis is expected.
Choice D reason: A pH of 7.17 is significantly below the normal range, indicating severe acidosis1. A PaCO2 of 69 mm Hg is well above the normal range, which would usually suggest respiratory acidosis. However, in the context of DKA, a compensatory respiratory alkalosis often occurs, and the elevated PaCO2 may indicate a mixed acid-base disorder. An HCO3 level of 25 mEq/L is within the normal range, but given the low pH, it suggests that the body has been compensating for an acid-base disturbance. This choice most closely aligns with the metabolic acidosis and the compensatory respiratory changes expected in DKA.

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Correct Answer is A

Explanation

Choice A reason: In sepsis, inflammatory mediators cause vasodilation and increased capillary permeability, leading to fluid leaking out of the vascular space, resulting in hypotension.

Choice B reason: Platelet aggregation and thrombus formation can occur in sepsis but are more related to disseminated intravascular coagulation (DIC) rather than directly causing hypotension.

Choice C reason: Decreased blood glucose and oliguria can be consequences of sepsis but are not the primary pathophysiological processes responsible for hypotension.

Choice D reason: Hypoxemia and anaerobic metabolism may result from the effects of sepsis on the body, including hypotension, but they are not the direct cause of hypotension.

A. Recommend that the client and spouse learn sign language. B. Have the client exaggerate the pronunciation of words. C. Suggest the spouse speak in a louder tone of voice. D. Suggest communication by writing.

Correct Answer is D

Explanation

Choice A reason: Learning sign language can be beneficial but may not be practical or immediately helpful for the client and spouse dealing with communication issues due to PD.

Choice B reason: Exaggerating the pronunciation of words may help some clients with PD, but it can also be tiring and not effective for all, especially if the client has significant speech difficulties.

Choice C reason: Speaking in a louder tone of voice does not necessarily improve communication with a person who has PD, as the issue often lies with the client's ability to speak, not with hearing.

Choice D reason: Writing can be an effective way for clients with PD to communicate, especially if they have difficulty speaking or being understood. It allows for clear communication without the need for verbal articulation.

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The nurse is reviewing arterial blood gas (ABG) results for a client with diabetic ketoacidosis. Which result is consistent with this diagnosis?

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