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Assess the heart rate frequently: While changes in fluid volume can affect heart rate, monitoring heart rate alone does not provide a direct measure of desmopressin’s effectiveness in controlling diabetes insipidus. Heart rate may remain normal even if polyuria persists.

Check for daily bowel movement: Desmopressin primarily affects water reabsorption in the kidneys and does not influence gastrointestinal motility. Monitoring bowel movements does not reflect the therapeutic effect of the drug in diabetes insipidus.

Review the serum glucose level: Serum glucose levels are relevant in diabetes mellitus, not diabetes insipidus. Desmopressin’s action is unrelated to glucose metabolism, so checking glucose does not assess its effectiveness.

Abnormal clots and emboli will develop in blood vessels: While glucocorticoids can affect coagulation factors slightly, abrupt withdrawal is not primarily associated with the development of clots or emboli. This is not the main risk of stopping high-dose therapy suddenly.

Drug resistance to corticosteroids can occur: Resistance to glucocorticoids develops over long-term receptor or cellular changes, but abrupt cessation does not cause resistance. The primary concern is physiological dependence, not loss of drug efficacy.

Blood pressure elevation and hypertensive crisis will develop: High-dose glucocorticoids can cause hypertension while being administered, but sudden withdrawal typically does not result in hypertensive crises. Instead, hypotension may occur due to adrenal insufficiency.

Naloxone: Naloxone is an opioid antagonist used to reverse opioid toxicity, including respiratory depression and sedation. The client’s symptoms are consistent with anticholinergic toxicity from scopolamine, not opioids, naloxone would not be effective.

Flumazenil: Flumazenil is a benzodiazepine antagonist used to reverse sedative effects of benzodiazepines. The client’s presentation of dry flushed skin, urinary retention, and tachycardia indicates anticholinergic toxicity rather than benzodiazepine overdose, making flumazenil inappropriate.

Atropine: Atropine is an anticholinergic agent that further blocks muscarinic receptors. Since scopolamine toxicity already produces anticholinergic effects, administering atropine would worsen symptoms rather than reverse them.

The nurse administers NPH 40 Units and Regular Insulin 12 Units: Administering 12 units of sliding-scale insulin would exceed the prescribed sliding-scale dose for a pre-lunch blood glucose of 180 mg/dL, which is 4 units. Overdosing could cause hypoglycemia.

The nurse administers NPH 40 Units: NPH insulin is scheduled for 0800 and 1600 and is not typically repeated at 1100. Administering only NPH at 1100 would not address the elevated pre-lunch blood glucose or follow the sliding-scale protocol.

NPH 40 Units and regular insulin 2 units: The sliding-scale protocol specifies 4 units of regular insulin for a blood glucose between 151–200 mg/dL. Administering only 2 units would underdose the client and may leave hyperglycemia inadequately corrected.

Glargine: Glargine is a long-acting basal insulin that provides a steady background insulin level over 24 hours. It is not suitable for acute management of DKA because it has a slow onset and cannot rapidly reduce the high blood glucose and ketone levels seen in this emergency.

Lispro: Lispro is a rapid-acting insulin used to control postprandial glucose spikes. While effective for meal-related glucose management, it does not provide the continuous, titratable insulin needed in the intravenous management of DKA.

NPH: NPH is an intermediate-acting insulin with a delayed onset and peak at 4–12 hours, making it unsuitable for the immediate insulin needs in DKA. Its pharmacokinetics do not allow for rapid correction of hyperglycemia or ketoacidosis.

Phenobarbital: Phenobarbital is a barbiturate that can be used for seizure control, particularly in refractory cases, but it has a slower onset of action when given intravenously. It is not the first-line agent for stopping an active seizure due to the need for rapid seizure termination.

Levetiracetam: Levetiracetam is an anticonvulsant used for long-term seizure management and can be given intravenously. However, it does not act as quickly as benzodiazepines and is not the first-choice medication for terminating an ongoing seizure.

Carbamazepine: Carbamazepine is an oral or intravenous anticonvulsant primarily used for chronic seizure control, trigeminal neuralgia, and bipolar disorder. It has a slow onset and is not effective for terminating an active seizure acutely.

Add an additional dose of basal insulin in the afternoon: Basal insulin is intended to provide a steady background insulin level to control fasting and between-meal glucose. Adding an extra dose can increase the risk of hypoglycemia without specifically targeting postprandial hyperglycemia, so it is not the most appropriate approach for elevated post-lunch and dinner glucose.

Increase the dose of basal insulin: Increasing basal insulin primarily lowers fasting and pre-meal glucose by maintaining background insulin levels. Since the client’s fasting glucose is already at target, increasing basal insulin may lead to hypoglycemia during the night or between meals, without adequately addressing postprandial spikes.

Shift the basal insulin timing to bedtime: Changing the timing of basal insulin may slightly alter overnight glucose control, but it does not significantly impact postprandial hyperglycemia after lunch and dinner. Timing adjustments alone are unlikely to correct elevated post-meal glucose levels.