Question 1

A patient with hyperglycemic hyperosmolar state (HHS)has a serum glucose level of 400 mg/dL and a serum sodium level of 138 mEq/L.What is the intravenous fluid of choice?

Accepted Answer

The fluid deficit may be as much as 150 mL/kg of body weight.The average 150-lb adult can lose more than 7 to 10 L of fluid.Physiologic saline solution (0.9%)is infused at 1 L/h,especially for patients in hypovolemic shock if there is no cardiovascular contraindication.Several liters of volume replacement may be required to achieve a blood pressure and central venous pressure within normal range.Infusion volumes are adjusted according to the patient's hydration state and sodium level.

Question 2

When a patient with diabetic ketoacidosis (DKA)has insulin infusing intravenously,the nurse expects a drop in the serum levels of which electrolytes?

Accepted Answer

Frequent verification of the serum potassium concentration is required for patients with DKA receiving fluid resuscitation and insulin therapy.The serum phosphate level is sometimes low (hypophosphatemia)in DKA.Insulin treatment may make this more obvious as phosphate is returned to the interior of the cell.If the serum phosphate level is less than 1 mg/dL,phosphate replacement is recommended.

Question 3

A patient was admitted with diabetic ketoacidosis (DKA)an hour ago and is on an insulin drip.Suddenly,the nurse notices frequent premature ventricular contractions (PVCs)on the electrocardiogram.The nurse notifies the practitioner.The nurse would anticipate an order for which intervention?

Accepted Answer

Hypokalemia can occur within the first hours of rehydration and insulin treatment.Continuous cardiac monitoring is required,because low serum potassium (hypokalemia)can cause ventricular dysrhythmias.

Question 4

A patient with diabetic ketoacidosis (DKA)has an insulin drip infusing,and the nurse has just administered subcutaneous insulin.The nurse is alert for signs of hypoglycemia,which would include what findings?

Accepted Answer

Irritability and paresthesia are seen in hypoglycemia.

Question 5

The nurse understands that the onset of seizures in the patient with diabetes insipidus (DI)is indicative of which situation?

Accepted Answer

This excessive intake of water reduces the serum osmolality to a more normal level and prevents dehydration.In the person with a decreased level of consciousness,the polyuria leads to severe hypernatremia,dehydration,decreased cerebral perfusion,seizures,loss of consciousness,and death.

Question 6

A patient presents with ketoacidosis and a blood glucose level of 125 mg/dL.Diabetic ketoacidosis has been ruled out.The nurse knows that ketoacidosis can occur in which condition?

Accepted Answer

Ketoacidosis also occurs with acute pancreatitis,starvation,and alcoholic ketoacidosis.

Question 7

A patient is admitted with diabetic ketoacidosis (DKA).The patient's arterial blood gas indicates the patient has an uncompensated metabolic acidosis.The patient has rapid,regular respirations.Which medical intervention would the nurse expect to initiate to correct the acidosis?

Accepted Answer

Replacement of fluid volume and insulin interrupts the ketotic cycle and reverses the metabolic acidosis.In the presence of insulin,glucose enters the cells,and the body ceases to convert fats into glucose.

Question 8

A patient has been admitted with diabetic ketoacidosis (DKA).The nurse knows that the top priority in the initial treatment of DKA is which intervention?

Accepted Answer

A patient with diabetic ketoacidosis (DKA)is dehydrated and may have lost 5% to 10% of his or her body weight in fluids.A fluid deficit up to 6 L can exist in severe dehydration.Aggressive fluid replacement is provided to rehydrate both the intracellular and the extracellular compartments and prevent circulatory collapse.

Question 9

A patient is admitted with severe hyperglycemia.The patient is very lethargic and has a "fruity" odor to his breath.The nurse knows the odor on the patient's breath is indicative of which situation?

Accepted Answer

Acid ketones dissociate and yield hydrogen ions (H⁺)that accumulate and precipitate a decrease in serum pH.The level of serum bicarbonate also decreases,consistent with a diagnosis of metabolic acidosis.Breathing becomes deep and rapid (Kussmaul respirations)to release carbonic acid in the form of carbon dioxide.Acetone is exhaled,giving the breath its characteristic "fruity" odor.

Question 10

A patient is presenting with signs of diabetes insipidus (DI).Which findings would confirm this diagnosis?

Accepted Answer

In central diabetes insipidus (DI),there is an inability to secrete an adequate amount of antidiuretic hormone (arginine vasopressin)in response to an osmotic or nonosmotic stimuli,resulting in inappropriately dilute urine.Hypernatremia is usually associated with serum hyperosmolality.

Question 11

A patient is admitted with a long history of mental illness.The patient's spouse states the patient has been drinking up to 10 gallons of water each day for the past 2 days and refuses to eat.The patient is severely dehydrated and soaked with urine.The nurse suspects the patient has which problem?

Accepted Answer

Psychogenic diabetes insipidus (DI)is a rare form of the disease that occurs with compulsive drinking of more than 5 L of water a day.Long-standing psychogenic DI closely mimics nephrogenic DI because the kidney tubules become less responsive to antidiuretic hormone as a result of prolonged conditioning to hypotonic urine.

Question 12

A patient has been admitted with diabetic ketoacidosis,and treatment has been initiated.Which findings would lead the nurse to suspect the patient is dehydrated?

Accepted Answer

Poor skin turgor and flat neck veins are indicative of dehydration.Dyspnea,crackles,extra heart sounds,and 3+ edema are signs of fluid overload.Chvostek and Trousseau signs are indicative of hypocalcemia.

Question 13

A patient in diabetic ketoacidosis (DKA)is comatose with a temperature of 102.2° F.The nurse suspects the patient may have which secondary disorder?

Accepted Answer

A patient in diabetic ketoacidosis can experience a variety of complications,including fluid volume overload,hypoglycemia,hypokalemia or hyperkalemia,hyponatremia,cerebral edema,and infection.

Question 14

A patient with bronchogenic oat cell carcinoma has a drop in urine output.The laboratory reports a serum sodium level of 120 mEq/L,a serum osmolality level of 220 mOsm/kg,and urine specific gravity of 1.035.The nurse suspects the patient may be developing what problem?

Accepted Answer

A decreased urine output,hyponatremia,hypoosmolality,and high urine specific gravity are classic signs of syndrome of inappropriate secretion of antidiuretic hormone (SIADH).Oat cell carcinoma is a precipitating factor for SIADH.

Question 15

A patient has been admitted with hyperosmolar hyperglycemic state (HHS).The nurse knows that intravenous insulin is usually administered at what dosage?

Accepted Answer

Regular insulin infusing at an initial rate calculated as 0.1 unit per kg hourly (7 U/h for a person weighing 70 kg)should lower the plasma glucose by 50 to 70 mg/dL in the first hour of treatment.If the measured glucose does not decrease by this amount,the insulin infusion rate may be doubled until the blood glucose is declining at a rate of 50 to 70 mg/dL/h.

Question 16

The nurse is developing a discharge education plan for a patient with syndrome of inappropriate secretion of antidiuretic hormone (SIADH).Which topic should be included in the plan?

Accepted Answer

Patient and family education about syndrome of inappropriate secretion of antidiuretic hormone (SIADH),its effect on water balance,and the reasons for fluid restrictions using the teach back method should include how to measure intake and output.

Question 17

An older patient presents with a serum glucose level of 900 mg/dL,hematocrit of 55%,and no serum ketones.Immediate attention must be given to which intervention?

Accepted Answer

The physical examination may reveal a profound fluid deficit.Signs of severe dehydration include longitudinal wrinkles in the tongue,decreased salivation,and decreased central venous pressure,with increases in heart rate and rapid respirations (Kussmaul air hunger does not occur).In older patients,assessment of clinical signs of dehydration is challenging.

Question 18

As a patient with diabetic ketoacidosis (DKA)receives insulin and fluids,the nurse knows careful assessment must be given to which electrolyte?

Accepted Answer

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 the patient with diabetic ketoacidosis receiving fluid resuscitation and insulin therapy.

Question 19

The nurse knows that during the resuscitation of a patient with diabetic ketoacidosis (DKA),the intravenous (IV)line should be changed to a solution containing glucose when what happens?

Accepted Answer

When the serum glucose level decreases to 200 mg/dL,the infusing solution is changed to a 50/50 mix of hypotonic saline and 5% dextrose.Dextrose is added to replenish depleted cellular glucose as the circulating serum glucose level falls.

Question 20

A patient with type 2 diabetes is admitted.He is very lethargic and hypotensive.A diagnosis of hyperglycemic hyperosmolar syndrome (HHS)is given.Which findings support this diagnosis?

Accepted Answer

Laboratory findings are used to establish the definitive diagnosis of hyperglycemic hyperosmolar syndrome (HHS).Plasma glucose levels are strikingly elevated (greater than 600 mg/dL).Serum osmolality is greater than 320 mOsm/kg.

Quiz 32: Endocrine Disorders and Therapeutic Management

A patient with hyperglycemic hyperosmolar state (HHS) has a serum glucose level of 400 mg/dL and a serum sodium level of 138 mEq/L.What is the intravenous fluid of choice?

When a patient with diabetic ketoacidosis (DKA) has insulin infusing intravenously,the nurse expects a drop in the serum levels of which electrolytes?

A patient was admitted with diabetic ketoacidosis (DKA) an hour ago and is on an insulin drip.Suddenly,the nurse notices frequent premature ventricular contractions (PVCs) on the electrocardiogram.The nurse notifies the practitioner.The nurse would anticipate an order for which intervention?

A patient with diabetic ketoacidosis (DKA) has an insulin drip infusing,and the nurse has just administered subcutaneous insulin.The nurse is alert for signs of hypoglycemia,which would include what findings?

The nurse understands that the onset of seizures in the patient with diabetes insipidus (DI) is indicative of which situation?

A patient presents with ketoacidosis and a blood glucose level of 125 mg/dL.Diabetic ketoacidosis has been ruled out.The nurse knows that ketoacidosis can occur in which condition?

A patient is admitted with diabetic ketoacidosis (DKA) .The patient's arterial blood gas indicates the patient has an uncompensated metabolic acidosis.The patient has rapid,regular respirations.Which medical intervention would the nurse expect to initiate to correct the acidosis?

A patient has been admitted with diabetic ketoacidosis (DKA) .The nurse knows that the top priority in the initial treatment of DKA is which intervention?

A patient is admitted with severe hyperglycemia.The patient is very lethargic and has a "fruity" odor to his breath.The nurse knows the odor on the patient's breath is indicative of which situation?

A patient is presenting with signs of diabetes insipidus (DI) .Which findings would confirm this diagnosis?

A patient is admitted with a long history of mental illness.The patient's spouse states the patient has been drinking up to 10 gallons of water each day for the past 2 days and refuses to eat.The patient is severely dehydrated and soaked with urine.The nurse suspects the patient has which problem?

A patient has been admitted with diabetic ketoacidosis,and treatment has been initiated.Which findings would lead the nurse to suspect the patient is dehydrated?

A patient in diabetic ketoacidosis (DKA) is comatose with a temperature of 102.2° F.The nurse suspects the patient may have which secondary disorder?

A patient with bronchogenic oat cell carcinoma has a drop in urine output.The laboratory reports a serum sodium level of 120 mEq/L,a serum osmolality level of 220 mOsm/kg,and urine specific gravity of 1.035.The nurse suspects the patient may be developing what problem?

A patient has been admitted with hyperosmolar hyperglycemic state (HHS) .The nurse knows that intravenous insulin is usually administered at what dosage?

The nurse is developing a discharge education plan for a patient with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) .Which topic should be included in the plan?

An older patient presents with a serum glucose level of 900 mg/dL,hematocrit of 55%,and no serum ketones.Immediate attention must be given to which intervention?

As a patient with diabetic ketoacidosis (DKA) receives insulin and fluids,the nurse knows careful assessment must be given to which electrolyte?

The nurse knows that during the resuscitation of a patient with diabetic ketoacidosis (DKA) ,the intravenous (IV) line should be changed to a solution containing glucose when what happens?

A patient with type 2 diabetes is admitted.He is very lethargic and hypotensive.A diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is given.Which findings support this diagnosis?