The patient has 1000 mL ordered over 10 hours. Using an IV pump, how many milliliters per hour should the IV fluids be infused?

Choice A rationale: Hemoglobin levels, which are the total amount of hemoglobin protein in the blood, are primarily used to assess for anemia. While chronic hyperglycemia can lead to protein glycation, including hemoglobin, the direct measurement of total hemoglobin does not provide a long-term average of blood glucose control. Normal hemoglobin levels for adults range from 13.5 to 17.5 g/dL for men and 12.0 to 15.5 g/dL for women.
Choice B rationale: Hemoglobin A1C measures the percentage of hemoglobin that has become glycated, or bound to glucose, over the lifespan of red blood cells. Since red blood cells live for approximately 120 days, this test provides an average of blood glucose levels over the preceding two to three months. This makes it a reliable indicator for assessing a patient's long-term glycemic control and adherence to antidiabetic therapy. Normal A1C levels are below 5.7%.
Choice C rationale: A fingerstick fasting blood glucose level provides an immediate snapshot of the patient's blood glucose at a single point in time after a period of fasting. While useful for daily monitoring and adjusting medication dosages, it is not a reliable indicator of long-term glycemic control or adherence to therapy over the past several months. The normal range for fasting blood glucose is 70 to 100 mg/dL.
Choice D rationale: Serum insulin levels reflect the amount of insulin circulating in the blood at the time of the test. This measurement can be used to assess pancreatic function and determine if the patient is producing insulin. However, it does not provide a historical average of blood glucose control over an extended period. Its utility in monitoring long-term therapy adherence is limited compared to A1C.

Choice A rationale: Encouraging incentive spirometry is a pulmonary intervention designed to prevent atelectasis and pneumonia by promoting deep breathing. While important post-surgically, it does not address the metabolic emergency indicated by the fruity breath odor, which is a classic sign of excessive ketone production from fat metabolism due to severe insulin deficiency.
Choice B rationale: Increasing intravenous fluids could worsen fluid overload in a dehydrated client without addressing the underlying metabolic imbalance. Although fluid resuscitation is part of the treatment for severe hyperglycemia, the primary intervention involves insulin administration to correct the metabolic derangement and halt ketone production, which is the root cause of the fruity odor.
Choice C rationale: The fruity breath odor is caused by the exhalation of acetone, a type of ketone body produced during lipolysis when glucose is unavailable for cellular energy. This indicates the body is in a state of ketoacidosis, a life-threatening complication of uncontrolled diabetes. Consulting the provider for immediate testing and treatment is the priority action.
Choice D rationale: Performing meticulous pulmonary hygiene, such as suctioning and chest physiotherapy, is indicated for clients with respiratory secretions or compromised lung function. While important for general post-operative care, it does not address the specific metabolic emergency of ketoacidosis indicated by the fruity breath odor, which requires immediate medical intervention.