The nurse is reviewing orders received for a client diagnosed with sepsis. Which order should the nurse question?

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.

Choice A reason: Propylthiouracil (PTU) is an antithyroid medication used to treat hyperthyroidism, which can present with symptoms such as weight loss and heat intolerance. The symptoms listed (periorbital edema, cold intolerance, and weight gain) suggest hypothyroidism, for which PTU is not indicated.

Choice B reason: Providing an electric blanket may offer comfort for cold intolerance but does not address the underlying thyroid disorder.

Choice C reason: Restricting fluids is not a standard intervention for thyroid disorders and could potentially lead to dehydration.

Choice D reason: Monitoring for hypotension is important in thyroid disorders, especially if the client is on antithyroid medications, which can affect blood pressure. However, the symptoms presented suggest hypothyroidism, where hypotension is less of a concern compared to hyperthyroidism.