The nurse is triaging a client with type 1 diabetes mellitus who presented to the emergency department with increased lethargy and Kussmaul respirations. A blood glucose test reveals a level of 525 mg/dL (28 mmol/L). Which laboratory results are consistent with diabetic ketoacidosis (DKA)?

Reference Ranges

Blood Glucose [74 to 106 mg/dL (4.1 to 5.9 mmol/L)]

pH [7.35 to 7.45]

HCO3- [21 to 28 mEq/L (21 to 28 mmol/L)]

Arterial blood pH 7.5 and bicarbonate level 32 mEq/L (32 mmol/L).

Arterial blood pH 7.42 and bicarbonate level 18 mEq/L (18 mmol/L).

Arterial blood pH 7.25 and bicarbonate level 10 mEq/L (10 mmol/L).

Arterial blood pH 7.38 and bicarbonate level 29 mEq/L (29 mmol/L).

Answer and Explanation

The Correct Answer is C

DKA is a serious complication of diabetes mellitus characterized by hyperglycemia, ketosis, and metabolic acidosis. The laboratory results consistent with DKA include:

Elevated blood glucose level: A blood glucose level of 525 mg/dL (28 mmol/L) is significantly elevated and consistent with DKA.

Low arterial blood pH: A decreased arterial blood pH indicates acidosis, which is characteristic of DKA. Normal arterial blood pH ranges from 7.35 to 7.45.

Low bicarbonate (HCO3-) level: A low bicarbonate level indicates metabolic acidosis, which is also characteristic of DKA. Normal bicarbonate levels range from 21 to 28 mEq/L (21 to 28 mmol/L).

Among the options provided:

A) Arterial blood pH 7.5 and bicarbonate level 32 mEq/L (32 mmol/L):

This pH and bicarbonate level are indicative of alkalosis, which is not consistent with DKA.

B) Arterial blood pH 7.42 and bicarbonate level 18 mEq/L (18 mmol/L):

This pH is within the normal range, and the bicarbonate level is slightly decreased but not indicative of metabolic acidosis consistent with DKA.

C) Arterial blood pH 7.25 and bicarbonate level 10 mEq/L (10 mmol/L):

Correct. This pH is decreased, indicating acidosis, and the bicarbonate level is significantly below the normal range, consistent with metabolic acidosis characteristic of DKA.

D) Arterial blood pH 7.38 and bicarbonate level 29 mEq/L (29 mmol/L):

While the pH is within the normal range, the bicarbonate level is elevated, which is not consistent with metabolic acidosis seen in DKA.

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Correct Answer is B

Explanation

Leukotrienes are inflammatory mediators derived from arachidonic acid metabolism, primarily produced by leukocytes (white blood cells) such as mast cells, eosinophils, and basophils. In the context of asthma, leukotrienes play a significant role in the pathophysiology of the disease by contributing to airway inflammation and bronchoconstriction. Here's a breakdown of their immune response:

A) Produce the sensation of itching:

Leukotrienes are not directly involved in producing the sensation of itching. Itching is often associated with histamine release rather than leukotrienes.

B) Tighten airway and produce mucous:

Correct. Leukotrienes are potent bronchoconstrictors that cause smooth muscle contraction in the airways, leading to narrowing (constriction) of the bronchioles. Additionally, they stimulate the secretion of mucus from goblet cells in the airway epithelium, contributing to airway obstruction and mucus production, which are characteristic features of asthma exacerbations.

C) Causes formation of bradykinin:

Bradykinin is a peptide mediator that is generated from the plasma protein kininogen and is involved in vasodilation, pain sensation, and inflammation. Leukotrienes are not directly responsible for the formation of bradykinin.

D) Serves as a receptor for antigen:

Leukotrienes do not serve as receptors for antigens. Instead, they are lipid mediators released in response to various stimuli, including allergens, infections, and irritants, and they act on specific receptors (e.g., leukotriene receptors) to exert their effects, such as bronchoconstriction and inflammation

A. Nerve degeneration due to chronic gastric reflux. B. Volvulus that occurred during an appendectomy. C. Esophagitis due to reflux of gastric contents. D. A history of having Helicobacter pylori infection.

Correct Answer is B

Explanation

A) Nerve degeneration due to chronic gastric reflux:

Nerve degeneration due to chronic gastric reflux may lead to conditions such as gastroesophageal reflux disease (GERD) or esophagitis, but it is not directly related to the clinical presentation of intestinal obstruction. Symptoms of GERD or esophagitis typically include heartburn, regurgitation, and dysphagia rather than severe, colicky abdominal pain, nausea, vomiting, and abdominal distention.

B) Volvulus that occurred during an appendectomy:

Correct. Volvulus refers to the twisting of a segment of the intestine around its mesentery, leading to obstruction of the bowel lumen and compromising blood flow to the affected area. In this scenario, the client's clinical presentation of severe, colicky abdominal pain, nausea, vomiting, and abdominal distention is consistent with symptoms of intestinal obstruction, which can occur secondary to volvulus. Volvulus may result from various factors, including prior abdominal surgeries, such as an appendectomy, leading to abnormal positioning or adhesions within the abdomen.

C) Esophagitis due to reflux of gastric contents:

Esophagitis due to reflux of gastric contents can cause symptoms such as heartburn, chest pain, and difficulty swallowing, but it is not typically associated with severe, colicky abdominal pain, nausea, vomiting, and abdominal distention characteristic of intestinal obstruction.

D) A history of having Helicobacter pylori infection:

Helicobacter pylori infection is associated with conditions such as peptic ulcer disease and gastritis, but it is not directly related to the clinical presentation of intestinal obstruction. Symptoms of H. pylori infection may include abdominal pain, nausea, and vomiting, but they are not typically colicky and severe as those seen in intestinal obstruction.

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A client who has asthma (a reactive airway disease) asks the nurse about the role of leukotrienes in this process. Leukotrienes have which immune response?

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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