Question 1

The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy.Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA).Which medical intervention would the nurse expect to be ordered for this patient?
A) Extensive hydration
B) Oral hypoglycemic agents
C) Large doses of intravenous (IV) insulin
D) Limiting food and fluids

Accepted Answer

Rapid IV fluid replacement requires the use of a volumetric pump.Insulin is administered intravenously to patients who are severely dehydrated or have poor peripheral perfusion to ensure effective absorption.Patients with diabetic ketoacidosis (DKA)are kept on NPO (nothing by mouth)status until the hyperglycemia is under control.Critical care nurses are responsible for monitoring the rate of plasma glucose decline in response to insulin.

Question 2

The nurse is caring for a patient with a head injury who has developed diabetes insipidus (DI).What medication would the nurse expect to be prescribed for the patient?
A) Vasopressin
B) Insulin
C) Glucagon
D) Propylthiouracil

Accepted Answer

Patients with central diabetes insipidus (DI)who are unable to synthesize antidiuretic hormone (ADH)require replacement ADH (vasopressin)or an ADH analog.The most commonly prescribed drug is the synthetic analog of ADH,desmopressin (DDAVP).DDAVP can be given intravenously,subcutaneously,or as a nasal spray.A typical DDAVP dose is 1 to 2 mcg intravenously or subcutaneously every 12 hours.

Question 3

Which pathophysiologic mechanism occurs in the patient with type 2 diabetes?
A) Lack of insulin production
B) Imbalance between insulin production and use
C) Overproduction of glucose
D) Increased uptake of glucose in the cells

Accepted Answer

Type 2 diabetes results from a progressive insulin secretory defect in addition to insulin resistance.

Question 4

A patient is admitted with extreme fatigue,vomiting,and headache.This patient has type 1 diabetes that has been well controlled with an insulin pump.The patient states,"I know it could not be my diabetes because my pump gives me 24-hour control." Which reply would be the nurse's best response?
A) "You know a lot about your pump, and you are correct."
B) "You're right. This is probably a virus."
C) "We'll get an abdominal CT and see if your pancreas is inflamed."
D) "We'll check your serum blood glucose and ketones."

Accepted Answer

Subcutaneous insulin pumps can malfunction.It is critical to assess glucose and ketone levels to evaluate for diabetic ketoacidosis.

Question 5

A patient is admitted with diabetic ketoacidosis (DKA).The nurse knows that the dehydration associated with DKA results from which pathophysiologic mechanism?
A) Increased serum osmolality and urea
B) Decreased serum osmolality and hyperglycemia
C) Ketones and potassium shifts
D) Acute renal failure

Accepted Answer

Hyperglycemia increases the plasma osmolality,and the blood becomes hyperosmolar.Cellular dehydration occurs as the hyperosmolar extracellular fluid draws the more dilute intracellular and interstitial fluid into the vascular space in an attempt to return the plasma osmolality to normal.

Question 6

Which pathophysiologic mechanism occurs in the syndrome of inappropriate antidiuretic hormone (SIADH)?
A) Massive diuresis, leading to hemoconcentration
B) Dilutional hyponatremia, reducing sodium concentration to critically low levels
C) Hypokalemia from massive diuresis
D) Serum osmolality greater than 350 mOsm/kg

Accepted Answer

Patients with the syndrome of inappropriate antidiuretic hormone (SIADH)have an excess of antidiuretic hormone secreted into the bloodstream,more than the amount needed to maintain normal blood volume and serum osmolality.Excessive water is resorbed at the kidney tubule,leading to dilutional hyponatremia.

Question 7

Which nursing intervention should be initiated on all patients with the syndrome of inappropriate antidiuretic hormone (SIADH)?
A) Placing the patient on an air mattress
B) Forcing fluids
C) Initiating seizure precautions
D) Applying soft restraints

Accepted Answer

The patient with the syndrome of inappropriate antidiuretic hormone (SIADH)has an excess of ADH secreted into the bloodstream,more than the amount needed to maintain normal blood volume and serum osmolality.Excessive water is resorbed at the kidney tubule,leading to dilutional hyponatremia.Symptoms of severe hyponatremia include an inability to concentrate,mental confusion,apprehension,seizures,a decreased level of consciousness,coma,and death.

Question 8

The nurse is caring for a critically ill patient with type 1 diabetes.The nurse understands that the patient is at risk for developing diabetic ketoacidosis (DKA)secondary to what etiology?
A) Excess insulin administration
B) Inadequate food intake
C) Physiologic and psychologic stress
D) Increased release of antidiuretic hormone (ADH)

Accepted Answer

Major neurologic and endocrine changes occur when an individual is confronted with physiologic stress caused by any critical illness,sepsis,trauma,major surgery,or underlying cardiovascular disease.

Question 9

The nurse has admitted a patient with hyperglycemic hyperosmolar state (HHS).Which medical intervention would the nurse expect to see ordered for this patient?
A) Rapid rehydration with intravenous fluids
B) Insertion of a pulmonary artery catheter
C) Administration of high-dose intravenous insulin
D) Hourly monitoring of urine glucose and ketone levels

Accepted Answer

The goals of medical management are rapid rehydration,insulin replacement,and correction of electrolyte abnormalities,specifically potassium replacement.The underlying stimulus of the hyperglycemic hyperosmolar state (HHS)must be discovered and treated.The same basic principles used to treat patients with diabetic ketoacidosis are used for patients with HHS.

Question 10

A patient is admitted with diabetic ketoacidosis (DKA)and is experiencing polyuria.Which electrolyte disturbances would the nurse expect to see at this phase of DKA?
A) Decreased calcium and increased phosphorus levels
B) Decreased potassium and sodium levels.
C) Increased sodium and decreased phosphorus levels
D) Decreased calcium and potassium levels.

Accepted Answer

Polyuria results in large volumes of water,along with sodium,potassium,and phosphorus,being excreted in the urine,causing a fluid volume deficit.

Question 11

The nurse has admitted a patient with hyperglycemic hyperosmolar state (HHS).Which findings would the nurse expect to observe in this patient?
A) Hyperglycemia with low serum osmolality
B) Severe hyperglycemia with minimal or absent ketosis
C) Little or no ketosis in serum with rapidly escalating ketonuria
D) Hyperglycemia and ketosis

Accepted Answer

The hallmarks of HHS are extremely high levels of plasma glucose with resulting elevations in serum hyperosmolality and osmotic diuresis.The disorder occurs mainly in patients with type 2 diabetes.

Question 12

The nursing management plan for a patient with thyrotoxicosis would include which intervention?
A) Providing diversional stimuli
B) Restricting fluids
C) Maintaining a quiet, restful environment
D) Administering thyroid supplements at the same time each day

Accepted Answer

Patients in thyroid storm are agitated,anxious,and unable to rest,and they benefit from an environment that is calm.Gradually,the effects of the antithyroid medications,iodides,and β-adrenergic blocking drugs will decrease the neurologic symptoms related to the catecholamine sensitivity.Frequent reassurance and clear,simple explanations of the patient's condition help decrease the fear brought on by the onset thyroid storm.

Question 13

A patient is admitted with diabetic ketoacidosis (DKA).The nurse knows that the lack of insulin results in which process?
A) Decreased glucagon release
B) Decreased glycogenolysis
C) Decreased ketone production
D) Increased gluconeogenesis

Accepted Answer

The release of glucagon from the liver is stimulated when insulin is ineffective in providing the cells with glucose for energy.Glucagon increases the amount of glucose in the bloodstream by breaking down stored glucose (glycogenolysis).In insulin deficiency states,fat is rapidly converted into glucose (gluconeogenesis).Ketoacidosis occurs when free fatty acids are metabolized into ketones: Acetoacetate,â-hydroxybutyrate,and acetone are the three ketone bodies that are produced.

Question 14

A patient has been admitted after surgery for removal of a brain tumor.The nurse suspects the patient may be developing diabetes insipidus (DI).Which findings would confirm the nurse's suspicion?
A) Hyperglycemia and hyperosmolarity
B) Hyperglycemia and peripheral edema
C) Intense thirst and passage of excessively large quantities of dilute urine
D) Peripheral edema and pulmonary crackles

Accepted Answer

The clinical diagnosis is made by the dramatic increase in dilute urine output in the absence of diuretics,a fluid challenge,or hyperglycemia.Characteristics of DI are intense thirst and the passage of excessively large quantities of very dilute urine.

Question 15

A patient with a history of type 2 diabetes was admitted after aneurysm repair.The patient's serum glucose levels have been elevated for the past 2 days,and the patient is concerned about becoming dependent on insulin.Which statement is the nurse's best response to the patient's concerns?
A) "This surgery may have damaged your pancreas. We will have to do more evaluation."
B) "Perhaps your diabetes was more serious from the beginning."
C) "You will need to discuss this with your physician."
D) "The stress on your body has temporarily increased your blood sugar levels."

Accepted Answer

Adrenal hormones released during stress elevate blood sugar by increasing insulin resistance and increasing hepatic gluconeogenesis.

Question 16

A patient weighs 140 kg and is 60 inches tall.The patient's blood sugar is being controlled by glipizide.Which topic would be important for the nurse to include in the patient's discharge education plan?
A) Signs of hyperglycemia
B) Proper injection technique
C) Weight loss
D) Increased caloric intake

Accepted Answer

This patient weighs 308 lb and is 5 feet tall.Diet management and exercise are interventions to facilitate weight loss in patients with type 2 diabetes.

Question 17

A patient is admitted after surgery with a history of hyperthyroidism.The nurse suspects the patient may be developing thyroid storm.Which finding would confirm this suspicion?
A) Tachycardia
B) Hypotension
C) Decreased appetite
D) Hypothermia

Accepted Answer

Thyroid storm,also called thyroid crisis,is a rare and life-threatening exacerbation of hyperthyroidism.The pathophysiology underlying the transition from hyperthyroidism to thyroid storm is not fully understood because thyroid hormone levels are not necessarily different from patients with hyperthyroidism.Atrial fibrillation is the most common dysrhythmia in patients with hyperthyroidism,and tachydysrhythmias should be anticipated in thyroid storm,especially in patients with underlying heart disease.

Question 18

The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy.Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA).Which statement best describes the rationale for administrating potassium supplements with the patient's insulin therapy?
A) Potassium replaces losses incurred with diuresis.
B) The patient has been in a long-term malnourished state.
C) Intravenous (IV) potassium renders the infused solution isotonic.
D) Insulin drives the potassium back into the cells.

Accepted Answer

Low serum potassium (hypokalemia)occurs as insulin promotes the return of potassium into the cell and metabolic acidosis is reversed.Replacement of potassium by administration of potassium chloride (KCl)begins as soon as the serum potassium falls below normal.Frequent verification of the serum potassium concentration is required for patients with diabetic ketoacidosis (DKA)who are receiving fluid resuscitation and insulin therapy.

Question 19

A patient is admitted with diabetic ketoacidosis (DKA).The patient presents with dry,cracked lips and is begging for something to drink.What reply would be the nurse's best response?
A) "We can't give you anything to drink until we get your blood sugar under control."
B) "You can have one cup of coffee without sugar."
C) "You can drink anything you want as long as it's sugar free."
D) "You can drink as much water has you can handle."

Accepted Answer

Patients with diabetic ketoacidosis (DKA)are kept on NPO status (nothing by mouth)until the hyperglycemia is under control.

Question 20

The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy.Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA).Which symptom is most suggestive of DKA?
A) Irritability
B) Excessive thirst
C) Rapid weight gain
D) Peripheral edema

Accepted Answer

Diabetic ketoacidosis (DKA)has a predictable clinical presentation.It is usually preceded by patient complaints of malaise,headache,polyuria (excessive urination),polydipsia (excessive thirst),and polyphagia (excessive hunger).Nausea,vomiting,extreme fatigue,dehydration,and weight loss follow.Central nervous system depression,with changes in the level of consciousness,can lead quickly to coma.

Quiz 32: Endocrine Disorders and Therapeutic Management

The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy.Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA) .Which medical intervention would the nurse expect to be ordered for this patient?

The nurse is caring for a patient with a head injury who has developed diabetes insipidus (DI) .What medication would the nurse expect to be prescribed for the patient?

Which pathophysiologic mechanism occurs in the patient with type 2 diabetes?

A patient is admitted with extreme fatigue,vomiting,and headache.This patient has type 1 diabetes that has been well controlled with an insulin pump.The patient states,"I know it could not be my diabetes because my pump gives me 24-hour control." Which reply would be the nurse's best response?

A patient is admitted with diabetic ketoacidosis (DKA) .The nurse knows that the dehydration associated with DKA results from which pathophysiologic mechanism?

Which pathophysiologic mechanism occurs in the syndrome of inappropriate antidiuretic hormone (SIADH) ?

Which nursing intervention should be initiated on all patients with the syndrome of inappropriate antidiuretic hormone (SIADH) ?

The nurse is caring for a critically ill patient with type 1 diabetes.The nurse understands that the patient is at risk for developing diabetic ketoacidosis (DKA) secondary to what etiology?

The nurse has admitted a patient with hyperglycemic hyperosmolar state (HHS) .Which medical intervention would the nurse expect to see ordered for this patient?

A patient is admitted with diabetic ketoacidosis (DKA) and is experiencing polyuria.Which electrolyte disturbances would the nurse expect to see at this phase of DKA?

The nurse has admitted a patient with hyperglycemic hyperosmolar state (HHS) .Which findings would the nurse expect to observe in this patient?

The nursing management plan for a patient with thyrotoxicosis would include which intervention?

A patient is admitted with diabetic ketoacidosis (DKA) .The nurse knows that the lack of insulin results in which process?

A patient has been admitted after surgery for removal of a brain tumor.The nurse suspects the patient may be developing diabetes insipidus (DI) .Which findings would confirm the nurse's suspicion?

A patient with a history of type 2 diabetes was admitted after aneurysm repair.The patient's serum glucose levels have been elevated for the past 2 days,and the patient is concerned about becoming dependent on insulin.Which statement is the nurse's best response to the patient's concerns?

A patient weighs 140 kg and is 60 inches tall.The patient's blood sugar is being controlled by glipizide.Which topic would be important for the nurse to include in the patient's discharge education plan?

A patient is admitted after surgery with a history of hyperthyroidism.The nurse suspects the patient may be developing thyroid storm.Which finding would confirm this suspicion?

A patient is admitted with diabetic ketoacidosis (DKA) .The patient presents with dry,cracked lips and is begging for something to drink.What reply would be the nurse's best response?

The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy.Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA) .Which symptom is most suggestive of DKA?