HESI Case Study: Diabetes Mellitus rated A 2023

What is the mechanism that results in Kussmaul respirations? A. To compensate for metabolic acidosis, the respirations are deep and rapid. B. To overcome respiratory acidosis, the respirations are fast and shallow. C. Injury to the brain's respiratory center results in periods of apnea. D. Hypoxemia causes labored, gasping, and irregular respirations. - answer A. To compensate for metabolic acidosis, the respirations are deep and rapid. Rationale: To compensate for the ketoacidosis (metabolic acidosis), the lungs attempt to remove CO2 through a pattern of deep, rapid respirations referred to as Kussmaul respirations. To achieve the goal of restoring the client's fluid volume, the nurse would expect to implement which intervention? A. Insert a saline lock for PRN diuretic administration. B. Administer an albumin/furosemide continuous infusion. C. Maintain an infusion of normal saline solution. D. Obtain a type and crossmatch for 2 units of packed RBCs. - answer C. Maintain an infusion of normal saline solution. Rationale: The treatment of hyperglycemia includes fluid replacement to correct dehydration caused by the increased concentration of glucose in the blood. Isotonic fluids, such as normal saline, are used initially to treat the dehydration. To restore the client's blood glucose to a normal level, what should the nurse prepare to administer? A. An IV infusion containing regular insulin. B. Humulin-N insulin SC before meals. C. 50% dextrose IV push. D. Glucagon subcutaneously PRN per sliding scale. - answer A. An IV infusion containing regular insulin. Rationale: Continuous IV infusions containing regular insulin are used to reduce the client's blood glucose level. The client's IV solution will be changed to one that contains glucose when her blood glucose level reaches 250 mg/dl. In addition to monitoring the client's blood glucose level, what additional lab values should the nurse monitor carefully? (Select all that apply. One, some, or all options may be correct.) A. Uric acid. B. Hemoglobin. C. Calcium. D. Potassium. E. Blood Urea Nitrogen (BUN). - answer B, C, D, E. Rationale: Though blood glucose and potassium are the most critical lab values to assess, hemoglobin levels may be altered related to the state of hydration and should be monitored. Treatment with an IV insulin infusion will cause the potassium to return to the cells and may result in hypokalemia. Lara should be closely monitored for symptoms of hypokalemia. Supplemental potassium may be added to the IV infusion to prevent or correct this. Dehydration that occurs with DKA can lead to an increased BUN and should be monitored for signs of renal insufficiency. Ethical-Legal Issues: Client I