Deck 33: Diabetic Crises

Question 1

A patient with type 2 diabetes reports that she can always tell when her blood sugar is low because "my fingers tingle." How should the nurse interpret this information?

A)This is a central nervous system effect of hypoglycemia.
B)The patient is experiencing increased blood glucose rather than decreased blood glucose.
C)This patient is developing hypoglycemia unawareness.
D)This is a common catecholamine effect of hypoglycemia.

Answer 1

This is a common catecholamine effect of hypoglycemia.

Question 2

A patient presents to the emergency department in acute diabetic ketoacidosis.The nurse administers insulin to correct metabolism of which substance that is directly causative of this condition?

A)Protein
B)Vitamin D
C)Fat
D)Potassium

Answer 2

Fat

Question 3

A patient diagnosed with hyperglycemic hyperosmolar syndrome (HHS)will be started on rehydration fluids.How will the nurse anticipate managing this treatment? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Initial treatment will be with rapidly infused lactated Ringer's solution.
B)Once the patient's blood glucose has decreased to around 300 mg/dL,a glucose-containing solution will be used for the remaining hydration.
C)The patient will be encouraged to drink as much fluid as possible.
D)The nurse will monitor the patient's lungs for signs of overload.
E)The fluid used for resuscitation will contain insulin.

Answer 3

Once the patient's blood glucose has decreased to around 300 mg/dL,a glucose-containing solution will be used for the remaining hydration.
The nurse will monitor the patient's lungs for signs of overload.

Question 4

A patient with diabetic retinopathy is admitted to the intensive care unit.Which nursing interventions are indicated?

A)Keep the room light dimmed.
B)Provide a braille board for communication.
C)Offer frequent reorientation to the environment.
D)Limit visitors to immediate family only.

Question 5

A patient with type 2 diabetes mellitus,lethargy,and a blood glucose level of 650 mg/dL has been diagnosed with hyperglycemic hyperosmolar syndrome (HHS).The nurse monitors this patient for the development of which complication?

A)Hyperkalemia
B)Seizures
C)Metabolic acidosis
D)Fluid volume overload

Question 6

A patient with long-standing type 2 diabetes may be developing diabetic ketoacidosis (DKA).Which assessment findings would the nurse evaluate as supporting that diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)A sweet smell to the breath
B)Ketonuria
C)Blood pH of 7.48
D)WBC of 28,000
E)Potassium of 3.4 mEq/L

Question 7

The nurse is planning the care for a patient admitted with diabetic ketoacidosis.How does the nurse anticipate this condition will be medically managed?

A)BID dosing of NPH insulin and PRN coverage with regular insulin
B)A continuous low-dose intravenous infusion of regular insulin
C)Once-per-evening dose of Lantus insulin with daytime coverage with regular insulin
D)Sliding scale coverage with regular insulin

Question 8

A patient with type 1 diabetes mellitus is admitted with hyperglycemia and dehydration,and is being evaluated for diabetic ketoacidosis.The nurse recognizes that which laboratory finding would support this diagnosis?

A)Potassium of 4.5 mEq/L
B)Anion gap of 20 mEq/L
C)Sodium of 140 mEq/L
D)Bicarbonate level of 36 mmol/L

Question 9

Just after being admitted to the emergency department for symptoms of influenza,the patient loses consciousness.His wife reports that he is diabetic but has not taken his oral medications for a "couple of days." Which nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Check the patient's blood glucose using a fingerstick monitor.
B)Place 1.5 tubes of 40% glucose gel under the patient's tongue.
C)Obtain intravenous access.
D)Administer 50% dextrose subcutaneously.
E)Administer regular insulin subcutaneously.

Question 10

A patient receiving an insulin injection for the first time asks the nurse how it works to reduce the blood glucose.Which of the following would be the best response for the nurse to make to the patient?

A)"Insulin makes sure that fat is used as the body's main energy source."
B)"Insulin helps prevent fluid overload in the cells."
C)"Insulin helps break down protein."
D)"Insulin helps with cellular uptake of glucose."

Question 11

The nurse is preparing to administer an intravenous insulin drip to a patient admitted with diabetic ketoacidosis.Which laboratory result is of most concern to the nurse?

A)Phosphorus level of 2.8 mEq/L
B)Bicarbonate level of 16 mEq/L
C)Sodium level of 130 mEq/L
D)Potassium level of 3.2 mEq/L

Question 12

The nurse is preparing to administer an intravenous infusion containing regular insulin for a patient diagnosed with diabetic ketoacidosis.Which nursing intervention added to the patient's plan of care has the highest priority?

A)Check urine for ketone bodies every shift.
B)Check blood glucose levels every 2 hours.
C)Monitor serum calcium levels closely.
D)Adjust infusion rate according to glucose readings.

Question 13

A patient tells the nurse that there is a history of diabetes in the family,and even though she has always tried to keep her blood glucose level on the "low side" she still developed diabetes.What information should the nurse provide?

A)"Body weight is a big contributor to the development of both types of diabetes."
B)"There is no way to stop the development of diabetes."
C)"Diabetes can be caused by taking some medications."
D)"It is thought that genetics is involved with the development of both type 1 and type 2 diabetes."

Question 14

A patient will receive insulin as treatment for diabetic ketoacidosis.The patient weighs 225 pounds and has a pretreatment serum glucose of 288 mg/dL.Which prescription would the nurse be comfortable administering?

A)Administer regular insulin 102 units/hr by intravenous infusion.
B)Administer NPH insulin 20 units twice daily.
C)Administer regular insulin intravenously at 10 units/hr.
D)Administer regular insulin 100 units in 1000 mL NS at 28.8 mL/hr.

Question 15

Despite the inherent risks,the patient with diabetic ketoacidosis will be given sodium bicarbonate to reverse severe metabolic acidosis.How does the nurse expect to administer this medication?

A)In enema form
B)As a 50-mL bolus injection intravenously
C)Along with potassium chloride
D)Over at least an 8-hour period

Question 16

The nurse comes to the cardiac patient's room to administer subcutaneous insulin.The patient says,"I have always taken pills for my diabetes.Am I getting worse?" What should the nurse consider when formulating a response to this question? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Some cardiac diseases cause oral antidiabetic medications to be less effective.
B)The stress of illness makes it difficult to control glucose with oral medications.
C)The changes associated with hospitalization make it difficult to control glucose with oral medications.
D)The patient will likely need to take insulin to control glucose even after release from the hospital.
E)Once discharged the patient can use urine dipstick measurements to guide insulin therapy.

Question 17

The nurse is caring for a patient with a history of type 2 diabetes who has recently experienced a myocardial infarction.The nurse would increase monitoring for findings of diabetic ketoacidosis (DKA)when which medication is added to the patient's drug regimen?

A)Warfarin sodium
B)Hydrochlorothiazide diuretic
C)Aspirin
D)Calcium channel blocker

Question 18

A patient with type 2 diabetes mellitus experiences a hypoglycemic reaction.The capillary blood glucose level is 60 mg/dL,and the patient is given 4 ounces of apple juice.What should the nurse do next?

A)Recheck the patient's blood glucose in 15 minutes.
B)Mark the medication administration record to hold the next scheduled dose of insulin.
C)Recheck the blood glucose before the next meal.
D)Give the patient another 4 ounces of apple juice in 30 minutes.

Question 19

The patient with diabetic neuropathy has been admitted to the intensive care unit after major abdominal surgery.Which nursing intervention is indicated because of this neuropathy?

A)Keep the skin clean and dry.
B)Place the arms and legs in the patient's position of comfort.
C)Instruct the patient to cough and take deep breaths every 2 hours.
D)Place a warming blanket under the patient to prevent hypothermia.