A nurse is assessing a client who has type 1 diabetes mellitus and has a blood glucose level of 550 mg/dL. Which of the following should the nurse assess the client for if diabetic ketoacidosis (DKA) is suspected?

Choice A rationale Diabetic ketoacidosis is characterized by extreme hyperglycemia, typically >250 mg/dL, metabolic acidosis, and ketonuria. High levels of ketones and severe dehydration lead to cerebral intracellular fluid shifts and metabolic disturbances. This often manifests as altered mental status, ranging from confusion and lethargy to coma. In a client with a blood glucose of 550 mg/dL, the nurse must prioritize neurological assessments to detect early signs of brain dysfunction caused by the hyperosmolar state and acidosis. Choice B rationale Dizziness is a non-specific symptom that can occur in many conditions, but it is more commonly associated with hypoglycemia or orthostatic hypotension. While a patient with diabetic ketoacidosis might feel lightheaded due to profound dehydration and osmotic diuresis, mental status changes provide a more definitive and critical indicator of the severity of the ketotic state. The nurse should focus on signs of metabolic collapse and central nervous system depression rather than general dizziness when DKA is suspected. Choice C rationale Cool, clammy skin is a classic sign of hypoglycemia, often referred to as insulin shock. In contrast, patients with diabetic ketoacidosis usually present with warm, flushed, and dry skin. This is due to the peripheral vasodilation associated with metabolic acidosis and the severe dehydration resulting from osmotic diuresis caused by the high glucose levels. Finding cool and clammy skin would lead a nurse to investigate low blood sugar rather than a hyperglycemic crisis like DKA. Choice D rationale Nervousness and tremors are primary symptoms of the adrenergic response triggered during hypoglycemia, where the body releases epinephrine to mobilize glucose. In diabetic ketoacidosis, the patient is more likely to exhibit signs of exhaustion, air hunger known as Kussmaul respirations, and a fruity odor on the breath. Nervousness is not a hallmark of the hyperosmolar, acidotic state seen when blood glucose reaches 550 mg/dL; instead, the patient typically becomes increasingly obtunded and weak.