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    Ati pn adult medical surgical 2023 proctored exam
    Select All That Apply

    Select the 5 findings that indicate the client is progressing as expected.

    Explanation & Rationale

    Brief Introduction: The client is recovering from diabetic ketoacidosis, evidenced by normalization of clinical and laboratory parameters. Success is marked by the resolution of ketoacidosis, restoration of hemodynamic and metabolic stability, and the return of normal consciousness, confirming that the treatment plan is effective and discharge-appropriate. Choice A rationale: Blood glucose has decreased from 700 to 140 milligrams per deciliter. While still slightly above the 74 to 106 range, this significant decline indicates the insulin therapy is effectively reversing the hyperglycemic state, demonstrating positive progress toward baseline stability. Choice B rationale: The temperature has remained stable at 37 degrees Celsius throughout the admission. While stability is good, it is a static finding and not a dynamic indicator of improvement or recovery from the acute metabolic crisis of diabetic ketoacidosis. Choice C rationale: The magnesium level of 1.1 milliequivalents per liter remains below the 1.3 to 2.1 range. Despite clinical improvement, the persistence of hypomagnesemia indicates that this specific electrolyte deficit has not yet fully resolved, so it does not indicate expected progress. Choice D rationale: The sodium level of 135 milliequivalents per liter is just below the lower limit of the 136 to 145 range. While improved, it has not yet reached the normal reference range, making it a less definitive indicator of full physiological recovery than other parameters. Choice E rationale: The transition from drowsy to awake and alert indicates a resolution of metabolic acidosis and restored neurologic function. This is a primary clinical indicator that the brain's environment has stabilized and the underlying ketoacidotic process is successfully reversing. Choice F rationale: Urine ketones have transitioned from positive to negative. The absence of ketones is a definitive marker that the body has shifted from pathologic fat metabolism back to efficient carbohydrate metabolism, confirming the resolution of the ketoacidosis itself. Choice G rationale: The anion gap decreased from 22 to 18 milliequivalents per liter. While 18 is slightly above the 12 plus or minus 4 range, the downward trend is a key indicator that the metabolic acidosis is actively correcting as the patient recovers. Choice H rationale: The respiratory rate improved from 32 to 18 breaths per minute. This indicates the resolution of Kussmaul respirations, which were compensatory for metabolic acidosis. Returning to this normal rate shows the body no longer needs to aggressively blow off carbon dioxide. Choice I rationale: Oxygen saturation is 92 percent, which is lower than the 97 percent observed on admission. This finding suggests a new respiratory concern or potential complication rather than the expected progression of recovery from diabetic ketoacidosis, thus it is not an indicator of success.

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