Question 1

The nurse caring for a patient weighing 80 kg is preparing an initial dose of insulin as beginning treatment for diabetic ketoacidosis. What are the appropriate dose and route for the nurse to administer the insulin?

Accepted Answer

1. The formula for calculating a bolus dose of insulin is 0.15 units/kg.
2. Bolus dosing is given intravenously, rather than subcutaneously, to begin to reverse DKA.
3. Bolus dosing is given intravenously, rather than subcutaneously, to begin to reverse DKA.
4. Bolus dosing is given intravenously to begin to reverse DKA. The formula for calculating an initial bolus dosage is 0.15 unit/kg; therefore, 80 × 0.15 = 12 units for bolus.

Question 2

A newly admitted patient with HHNK has a serum glucose of 850 mg/dL and a potassium level of 3.9 mEq/L. What is an important nursing consideration that should precede replacement of potassium?

Accepted Answer

1. Prior to the administration of potassium, the nurse should assess urine output and check the serum creatinine to evaluate renal function. Renal insufficiency and renal failure are common complications of patients with diabetes.
2. This assessment does not specifically relate to the assessment preceding replacement of potassium.
3. This assessment does not specifically relate to the assessment preceding replacement of potassium.
4. This calculation does not specifically relate to the assessment preceding replacement of potassium.

Question 3

The nurse cares for a patient with hyperglycemic hyperosmolar nonketotic syndrome (HHNS). What should the nurse realize is a precipitating factor for this health problem?

Accepted Answer

1. Antibiotics do not cause hyperglycemia.
2. HHNS often does develop slowly from poor compliance to medical therapy. This is in contrast to DKA, which often develops rapidly.
3. HHNS would be caused by missed medication, rather than by skipping meals, causing hyperglycemia.
4. Taking additional insulin would cause hypoglycemia.

Question 4

Which medications contribute to hyperglycemia in the patient with diabetes? Select all that apply.

Accepted Answer

1. Digoxin has not been shown to increase blood glucose levels.
2. This type of medication will increase glucose blood levels in the patient with diabetes.
3. This type of medication will increase glucose blood levels in the patient with diabetes.
4. This type of medication will increase glucose blood levels in the patient with diabetes.
5. This type of medication will increase glucose blood levels in the patient with diabetes.

Question 5

A nurse caring for a patient with diabetic ketoacidosis (DKA) should evaluate the patient carefully for which potential complications? Select all that apply.

Accepted Answer

1. Dehydration causes increased viscosity of the blood, which can lead to formation of thromboses, causing a myocardial infarction.
2. Acute respiratory distress syndrome (ARDS) is caused by rapid intracellular fluid shifts during administration of fluids.
3. Dehydration causes increased viscosity of the blood, which can lead to formation of thromboses, causing a pulmonary embolism.
4. The patient with diabetic ketoacidosis is not at an increased risk for pneumonia.
5. Cerebral edema is caused by rapid intracellular fluid shifts during administration of fluids.

Question 6

A patient with type 1 diabetes who is ill seeks advice from the nurse. For which statement should the nurse encourage the patient to seek medical attention? Select all that apply.

Accepted Answer

1. Patients with diabetes should be instructed to seek medical advice when diarrhea is present for more than 6 hours.
2. Patients with diabetes should be instructed to seek medical advice when there are signs of dehydration, such as a dry mouth.
3. The patient should seek medical attention for ketones being present in the urine for more than 12 hours.
4. The patient should seek medical attention for a high fever that lasts for more than one day. A temperature of 99 degrees Fahrenheit is not a high fever.
5. Patients with diabetes should be instructed to seek medical advice when vomiting is present for more than 6 hours.

Question 7

When planning care for a patient in diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS), which goal should be included in the plan of care? Select all that apply.

Accepted Answer

1. For both DKA and HHNS, the goal is to decrease serum glucose by 70-100 mg/dL/hr. 2. One goal is fewer occurrences of HHNS or DKA through self-management. 3. Dehydration is prevalent due to the excessive glucose that causes severe diuresis. Fluid balance needs to be restored through fluid therapy. 4. One goal is to keep the A_1C below 7%. 5. The cause of HHNS or DKA needs to be identified and treated.

Question 8

The nurse is determining if a patient is experiencing DKA or HHNS. Which information should the nurse use to make this determination?

Accepted Answer

1. Patients with DKA exhibit Kussmaul's respirations to blow off CO₂ and reduce pH levels. 2. Patients with DKA are commonly in metabolic acidosis (have lower arterial pH). 3. Patients with HHNS have more visual disturbances due to more severe and sometimes chronic dehydration. 4. Patients with DKA have moderate hyperglycemia, whereas patients with HHNS have more severe hyperglycemia.

Question 9

Which type of insulin should the nurse administer for an intravenous bolus and continuous infusion to regulate a patient's blood glucose levels?

Accepted Answer

1. This insulin is not recommended for intravenous usage.
2. For the most reliable and safest method of consistently lowering blood glucose levels, the general consensus is to use regular insulin.
3. This insulin is not recommended for intravenous usage.
4. This insulin is not recommended for intravenous usage.

Question 10

The nurse is caring for a patient in DKA with serum sodium of 130 and serum glucose of 600. After calculating the corrected serum sodium (CSS) [CSS = Serum Na⁺ + {[(Serum glucose (mg/dL) - 100) / 100] × 1.6}], which intravenous fluid should the nurse plan to provide this patient?

Accepted Answer

1. CSS = 130 + {[(600 - 100) / 100] × 1.6}; CSS = 138. Normal serum sodium is
135−145 mEq/L. If the CSS is high or normal, then half-normal saline (0.45% NS) would be expected. If the CSS is low, then normal saline (0.9% NS) would be expected to correct sodium losses.
2. CSS = 130 + {[(600 - 100) / 100] × 1.6}; CSS = 138. Normal serum sodium is
135−145 mEq/L. If the CSS is high or normal, then half-normal saline (0.45% NS) would be expected. If the CSS is low, then normal saline (0.9% NS) would be expected to correct sodium losses.
3. CSS = 130 + {[(600 - 100) / 100] × 1.6}; CSS = 138. Normal serum sodium is
135−145 mEq/L. If the CSS is high or normal, then half-normal saline (0.45% NS) would be expected. If the CSS is low, then normal saline (0.9% NS) would be expected to correct sodium losses.
4. CSS = 130 + {[(600 - 100) / 100] × 1.6}; CSS = 138. Normal serum sodium is
135−145 mEq/L. If the CSS is high or normal, then half-normal saline (0.45% NS) would be expected. If the CSS is low, then normal saline (0.9% NS) would be expected to correct sodium losses.

Question 11

The nurse is comparing diabetic ketoacidosis (DKA) to hyperglycemic hyperosmolar nonketotic syndrome (HHNS). What should the nurse identify as the main difference between the two disorders?

Accepted Answer

1. In both conditions there is too little, rather than too much, insulin.
2. Although high blood sugars are present in both DKA and HHNS, there is still insulin production with HHNS.
3. DKA does result in metabolic acidosis; however, HHNS does not result in metabolic alkalosis.
4. Dehydration is more severe in HHNS than in DKA.

Question 12

A patient with diabetes has a serum osmolarity level of 325 mmol/L. What is the correct interpretation and action for the nurse to take based on this result?

Accepted Answer

1. This result is high and should be reported to the physician.
2. This result is not too low. A normal serum osmolarity is 280 to 300 mmol/L.
3. This result is not somewhat low. A normal serum osmolarity is 280 to 300 mmol/L.
4. Normal serum osmolarity is 280 to 300 mmol/L. A serum osmolarity of 325 mmol/L is very high and the physician should be notified.

Question 13

A patient is admitted with diabetic ketoacidosis. The nurse realizes that which problem caused the cascade to diabetic ketoacidosis (DKA) to occur?

Accepted Answer

1. Ketosis dose not cause diabetic ketoacidosis but is a result of the disorder.
2. If inadequate insulin is present, the cells starve and use fats as an energy source. Ketoacids are released as a waste product. Lactic acids are produced as a result of anaerobic cellular metabolism.
3. Hypoglycemia is not present in diabetic ketoacidosis. Hyperglycemia is present.
4. Dehydration occurs as a result of diabetic ketoacidosis and not as a cause.

Question 14

The nurse monitors the blood glucose levels of a patient being treated with insulin for diabetic ketoacidosis. Why should the nurse ensure glucose levels decline at the rate of 50-70 mg/dL/hour?

Accepted Answer

1. Dehydration is caused by hyperglycemia and osmotic diuresis rather than the infusion of insulin.
2. Rapidly dropping glucose does not result in metabolic alkalosis.
3. A rapid shift in potassium from the serum into the intracellular compartment may result because IV insulin facilitates the transport of glucose into the cells. This rapid electrolyte shift can cause life-threatening cardiac arrhythmias as a result of hypokalemia.
4. Rapidly dropping glucose does not cause the formation of thromboses.

Question 15

When calculating the initial rate of an insulin infusion as treatment for diabetic ketoacidosis in a patient weighing 80 kg, the nurse should expect to administer insulin at what rate?

Accepted Answer

1. The formula for continuous infusion of insulin is 0.1 unit/kg/hour;
0.1 × 80 = 8 units/hour.
2. The formula for continuous infusion of insulin is 0.1 unit/kg/hour;
0.1 × 80 = 8 units/hour.
3. The formula for continuous infusion of insulin is 0.1 unit/kg/hour;
0.1 × 80 = 8 units/hour.
4. The formula for continuous infusion of insulin is 0.1 unit/kg/hour;
0.1 × 80 = 8 units/hour.

Question 16

The nurse explains the pathophysiology of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) to a group of clients. Which statement should the nurse include when teaching about this health problem?

Accepted Answer

1. If present at all, metabolic acidosis is minimal in HHNS because there is some insulin present to allow glucose into the cells for cellular metabolism.
2. Cells are not over-hydrated but instead are dehydrated.
3. HHNS is a hyperglycemic state. The body removes glucose with water through the kidneys via osmotic diuresis. This causes severe vascular, interstitial, and cellular water losses, resulting in severe dehydration.
4. Glucose production is increased rather than decreased.

Question 17

What increases the risk for seizures in a patient with diabetic ketoacidosis (DKA)?

Accepted Answer

1. Potassium shifts do not cause cerebral ischemia.
2. Rapid fluid shifts into the cell can cause swelling of brain tissues. This puts the patient at risk for seizures.
3. This is not the cause for seizures in this patient.
4. Drugs used to treat DKA do not have a side effect of seizures.

Question 18

Which nursing diagnosis would be least appropriate when planning care for a patient with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

Accepted Answer

1. The patient will have severe dehydration, not fluid overload. High osmolarity is present in HHNS; therefore, this diagnosis is incorrect.
2. This diagnosis is applicable to patients with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS).
3. This diagnosis is applicable to patients with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS).
4. This diagnosis is applicable to patients with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS).

Question 19

What should the nurse assess before beginning insulin therapy in a patient with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

Accepted Answer

1. This laboratory value does not need to be specifically assessed before starting insulin therapy.
2. This does not need to be specifically assessed before starting insulin therapy.
3. Potassium levels need to be monitored before insulin is given to avoid hypokalemia from developing because insulin facilitates intracellular transport of glucose and potassium. The rapid shift of the K+ could leave the serum potassium levels dangerously low.
4. This does not need to be specifically assessed before starting insulin therapy.

Question 20

A patient is admitted to the hospital with acute myocardial infarction and has a blood sugar of 180 mg/dL. The patient has never been diagnosed with diabetes. What is the best explanation for a high glucose in a patient without diabetes? Select all that apply.

Accepted Answer

1. The blood glucose does not normally elevate to 180 mg/dL, even after a large meal.
2. During a critical illness, pro-inflammatory factors cause insulin resistance, which also leads to hyperglycemia.
3. Beta blockers do mask the signs of hypoglycemia, but neither beta blockers nor nitroglycerin cause hyperglycemia.
4. A critical illness such as a myocardial infarction causes a physiologic stress response that causes the body to enter a hypermetabolic state in an attempt to heal.
5. In a critical illness, the reaction to counterregulatory hormones such as epinephrine, cortisol, and glucagon has a direct hormonal effect to produce hyperglycemia.

Quiz 14: Care of the Patient With Problems in Glucose Metabolism

The nurse caring for a patient weighing 80 kg is preparing an initial dose of insulin as beginning treatment for diabetic ketoacidosis. What are the appropriate dose and route for the nurse to administer the insulin?

A newly admitted patient with HHNK has a serum glucose of 850 mg/dL and a potassium level of 3.9 mEq/L. What is an important nursing consideration that should precede replacement of potassium?

The nurse cares for a patient with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) . What should the nurse realize is a precipitating factor for this health problem?

Which medications contribute to hyperglycemia in the patient with diabetes? Select all that apply.

A nurse caring for a patient with diabetic ketoacidosis (DKA) should evaluate the patient carefully for which potential complications? Select all that apply.

A patient with type 1 diabetes who is ill seeks advice from the nurse. For which statement should the nurse encourage the patient to seek medical attention? Select all that apply.

When planning care for a patient in diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS) , which goal should be included in the plan of care? Select all that apply.

The nurse is determining if a patient is experiencing DKA or HHNS. Which information should the nurse use to make this determination?

Which type of insulin should the nurse administer for an intravenous bolus and continuous infusion to regulate a patient's blood glucose levels?

The nurse is caring for a patient in DKA with serum sodium of 130 and serum glucose of 600. After calculating the corrected serum sodium (CSS) [CSS = Serum Na⁺ + {[(Serum glucose (mg/dL) - 100) / 100] × 1.6}], which intravenous fluid should the nurse plan to provide this patient?

The nurse is comparing diabetic ketoacidosis (DKA) to hyperglycemic hyperosmolar nonketotic syndrome (HHNS) . What should the nurse identify as the main difference between the two disorders?

A patient with diabetes has a serum osmolarity level of 325 mmol/L. What is the correct interpretation and action for the nurse to take based on this result?

A patient is admitted with diabetic ketoacidosis. The nurse realizes that which problem caused the cascade to diabetic ketoacidosis (DKA) to occur?

The nurse monitors the blood glucose levels of a patient being treated with insulin for diabetic ketoacidosis. Why should the nurse ensure glucose levels decline at the rate of 50-70 mg/dL/hour?

When calculating the initial rate of an insulin infusion as treatment for diabetic ketoacidosis in a patient weighing 80 kg, the nurse should expect to administer insulin at what rate?

The nurse explains the pathophysiology of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) to a group of clients. Which statement should the nurse include when teaching about this health problem?

What increases the risk for seizures in a patient with diabetic ketoacidosis (DKA) ?

Which nursing diagnosis would be least appropriate when planning care for a patient with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS) ?

What should the nurse assess before beginning insulin therapy in a patient with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) ?

A patient is admitted to the hospital with acute myocardial infarction and has a blood sugar of 180 mg/dL. The patient has never been diagnosed with diabetes. What is the best explanation for a high glucose in a patient without diabetes? Select all that apply.

Quiz 14: Care of the Patient With Problems in Glucose Metabolism

The nurse caring for a patient weighing 80 kg is preparing an initial dose of insulin as beginning treatment for diabetic ketoacidosis. What are the appropriate dose and route for the nurse to administer the insulin?

A newly admitted patient with HHNK has a serum glucose of 850 mg/dL and a potassium level of 3.9 mEq/L. What is an important nursing consideration that should precede replacement of potassium?

The nurse cares for a patient with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) . What should the nurse realize is a precipitating factor for this health problem?

Which medications contribute to hyperglycemia in the patient with diabetes? Select all that apply.

A nurse caring for a patient with diabetic ketoacidosis (DKA) should evaluate the patient carefully for which potential complications? Select all that apply.

A patient with type 1 diabetes who is ill seeks advice from the nurse. For which statement should the nurse encourage the patient to seek medical attention? Select all that apply.

When planning care for a patient in diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS) , which goal should be included in the plan of care? Select all that apply.

The nurse is determining if a patient is experiencing DKA or HHNS. Which information should the nurse use to make this determination?

Which type of insulin should the nurse administer for an intravenous bolus and continuous infusion to regulate a patient's blood glucose levels?

The nurse is caring for a patient in DKA with serum sodium of 130 and serum glucose of 600. After calculating the corrected serum sodium (CSS) [CSS = Serum Na+ + {[(Serum glucose (mg/dL) - 100) / 100] × 1.6}], which intravenous fluid should the nurse plan to provide this patient?

The nurse is comparing diabetic ketoacidosis (DKA) to hyperglycemic hyperosmolar nonketotic syndrome (HHNS) . What should the nurse identify as the main difference between the two disorders?

A patient with diabetes has a serum osmolarity level of 325 mmol/L. What is the correct interpretation and action for the nurse to take based on this result?

A patient is admitted with diabetic ketoacidosis. The nurse realizes that which problem caused the cascade to diabetic ketoacidosis (DKA) to occur?

The nurse monitors the blood glucose levels of a patient being treated with insulin for diabetic ketoacidosis. Why should the nurse ensure glucose levels decline at the rate of 50-70 mg/dL/hour?

When calculating the initial rate of an insulin infusion as treatment for diabetic ketoacidosis in a patient weighing 80 kg, the nurse should expect to administer insulin at what rate?

The nurse explains the pathophysiology of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) to a group of clients. Which statement should the nurse include when teaching about this health problem?

What increases the risk for seizures in a patient with diabetic ketoacidosis (DKA) ?

Which nursing diagnosis would be least appropriate when planning care for a patient with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS) ?

What should the nurse assess before beginning insulin therapy in a patient with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) ?

A patient is admitted to the hospital with acute myocardial infarction and has a blood sugar of 180 mg/dL. The patient has never been diagnosed with diabetes. What is the best explanation for a high glucose in a patient without diabetes? Select all that apply.

The nurse is caring for a patient in DKA with serum sodium of 130 and serum glucose of 600. After calculating the corrected serum sodium (CSS) [CSS = Serum Na⁺ + {[(Serum glucose (mg/dL) - 100) / 100] × 1.6}], which intravenous fluid should the nurse plan to provide this patient?