Endocrine Disorders and Therapeutic Management

The most common maintenance dose of intravenous insulin for a patient with hyperglycemic hyperosmolar syndrome (HHS) would be a. 0.1 U/kg/hr. b. 1.0 U/kg/hr. c. 2.0 U/kg/hr. d. 5.0 U/kg/hr.

a. 0.1 U/kg/hr.

The neuroendocrine stress response produces which of the following? (Select all that apply.) a. Elevated blood pressure b. Decreased gastric motility c. Tachycardia d. Heightened pain awareness e. Increased glucose

a. Elevated blood pressure b. Decreased gastric motility c. Tachycardia e. Increased glucose

A patient was admitted to the critical care unit with diabetic ketoacidosis (DKA). Glucose is 349 mg/dL, K+ is 3.7 mEq/L, and pH is 7.10. Which of the following interventions would you expect? (Select all that apply.) a. NS 1.5 L IV fluid bolus b. Insulin infusion at 5 units/hr c. Sodium bicarbonate 50 mmol IV push d. Vasopressin 10 units IM every 3 hr e. Potassium 20 mEq/L of IV fluid

a. NS 1.5 L IV fluid bolus b. Insulin infusion at 5 units/hr e. Potassium 20 mEq/L of IV fluid

As a patient with diabetic ketoacidosis receives insulin and fluids, the nurse knows careful assessment must be given to which of the following electrolytes? a. Potassium b. Sodium c. Phosphorus d. Calcium

a. Potassium

A patient has a 10-year history of diabetes mellitus. The patient is admitted to the critical care unit with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). The treatment of DKA involves a. extensive hydration. b. oral hypoglycemic agents. c. large doses of IV insulin. d. limiting food and fluids.

a. extensive hydration.

After a patient has been diagnosed with SIADH, the nurse would expect the first line of treatment to include a. fluid restriction. b. hypotonic intravenous fluid. c. D5W. d. fluid bolus.

a. fluid restriction.

A patient presenting with diabetes insipidus (DI) exhibits a. hyperosmolality and hypernatremia. b. hyperosmolality and hyponatremia. c. hypo-osmolality and hypernatremia. d. hypo-osmolality and hyponatremia.

a. hyperosmolality and hypernatremia.

The nurse knows that the dehydration associated with diabetic ketoacidosis results from a. increased serum osmolality and urea. b. decreased serum osmolality and hyperglycemia. c. ketones and potassium shifts. d. acute renal failure.

a. increased serum osmolality and urea.

To assist the nurse in evaluating the patients hydration status, assessment would include a. orthostatic hypotension and neck vein filling. b. pupil checks and Kernig sign. c. Chvostek and Trousseau signs. d. S4 gallop and edema.

a. orthostatic hypotension and neck vein filling.

The primary intervention for hyperglycemic hyperosmolar syndrome (HHS) is a. rapid rehydration. b. monitoring vital signs. c. high-dose intravenous (IV) insulin. d. hourly urine sugar and acetone testing.

a. rapid rehydration.

A nondiabetic patient presents ketoacidosis. Reasons may include a. starvation and alcoholism. b. drug overdose. c. severe vomiting. d. hyperaldosteronism.

a. starvation and alcoholism.

Patients with central DI are treated with a. vasopressin. b. insulin. c. glucagon. d. propylthiouracil.

a. vasopressin.

During the first 24 hours when the nurse administers hypertonic saline in a patient with SIADH, the serum sodium should be raised no more than a. 5 mEq/day. b. 12 mEq/day. c. 20 mEq/day. d. 25 mEq/day.

b. 12 mEq/day.

A patient has a 10-year history of diabetes mellitus. The patient is admitted to the critical care unit with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which of the following symptoms is most suggestive of DKA? a. Irritability b. Excessive thirst c. Rapid weight gain d. Peripheral edema

b. Excessive thirst

In evaluating the patients hyponatremia, the nurse understands the problem is a. increased cortisol release. b. decreased aldosterone release. c. increased glucocorticoid release. d. decreased glucagon release.

b. decreased aldosterone release.

Decreased urine osmolality is a sign of a. hyperglycemia. b. diabetes insipidus. c. thyroid crisis. d. SIADH.

b. diabetes insipidus

In the syndrome of inappropriate antidiuretic hormone (SIADH), the physiologic effect is 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.

b. dilutional hyponatremia, reducing sodium concentration to critically low levels

The top priority in the initial treatment of diabetic ketoacidosis (DKA) is a. lowering the blood sugar. b. giving fluids. c. giving sodium bicarbonate to reverse the acidosis. d. determining the reason for the DKA.

b. giving fluids.

The most common problem in the patient with type 2 diabetes is a(n) a. lack of insulin production. b. imbalance between insulin production and use. c. overproduction of glucose. d. increased uptake of glucose in the cells.

b. imbalance between insulin production and use.

A patient with diabetic ketoacidosis has an insulin drip infusing, and the nurse has just administered subcutaneous insulin. The nurse is alert for signs of hypoglycemia, which would include a. Kussmaul respirations and flushed skin. b. irritability and paresthesia. c. abdominal cramps and nausea. d. hypotension and itching.

b. irritability and paresthesia.

The major electrolyte disturbances that result from diuresis are a. low calcium and high phosphorus levels. b. low potassium and low sodium levels. c. high sodium and low phosphorus levels. d. low calcium and low potassium levels.

b. low potassium and low sodium levels.

When a patient in diabetic ketoacidosis (DKA) has insulin infusing intravenously, the nurse expects a drop in the serum levels of a. sodium and potassium. b. potassium and phosphate. c. bicarbonate and calcium. d. sodium and phosphate.

b. potassium and phosphate.

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 a. clotting factors. b. rehydration. c. administration of insulin. d. sodium replacement.

b. rehydration.

The hallmark of hyperglycemic hyperosmolar syndrome (HHS) is 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.

b. severe hyperglycemia with minimal or absent ketosis

A patient with hyperglycemic hyperosmolar syndrome (HHS) has a serum glucose level of 400 mg/dL and a serum sodium level of 138 mEq/L. The intravenous fluid of choice would be a. D5W. b. 0.45% NS. c. 0.9% NS. d. D5/NS.

c. 0.9% NS.

Patients who have sustained head trauma or have undergone resection of a pituitary tumor have an increased risk of developing a. type 1 diabetes. b. type 2 diabetes. c. DI. d. myxedema coma.

c. DI.

Which of the following nursing interventions should be initiated on all patients with SIADH? a. Placing the patient on an air mattress b. Forcing fluids c. Initiating seizure precautions d. Applying soft restraints

c. Initiating seizure precautions

A patient in diabetic ketoacidosis has the following arterial blood gasses: pH 7.25; pCO2 30 mm Hg; HCO3 16. The patient has rapid, regular respirations. The nurses best response would be to a. ask the patient to breathe into a paper bag to retain CO2. b. administer sodium bicarbonate. c. administer insulin and fluids intravenously. d. prepare for intubation.

c. administer insulin and fluids intravenously.

The patient admitted in diabetic ketoacidosis has dry, cracked lips and is begging for something to drink. The nurses best response would be to a. keep the patient NPO. b. allow the patient a cup of coffee. c. allow the patient water. d. allow the patient to drink anything he chooses.

c. allow the patient water.

The nurse knows that during the resuscitation of a patient with diabetic ketoacidosis, the IV line should be changed to a solution containing glucose when the a. patient becomes more alert. b. IV insulin has been infusing for 4 hours. c. blood glucose drops to 200 mg/dL. d. blood glucose drops to 100 mg/dL.

c. blood glucose drops to 200 mg/dL.

A patient in diabetic ketoacidosis is comatose with a temperature of 102.2 F. The nurse would suspect a. head injury. b. infarct of the hypothalamus. c. infection. d. heat stroke.

c. infection.

Characteristics of diabetes insipidus (DI) are 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.

c. intense thirst and passage of excessively large quantities of dilute urine.

A patient with diabetes in the critical care unit is at risk for developing diabetic ketoacidosis (DKA) secondary to a. excess insulin administration. b. inadequate food intake. c. physiologic and psychologic stress. d. increased release of antidiuretic hormone (ADH).

c. physiologic and psychologic stress.

A patient is admitted with a long history of mental illness. Her husband states she 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 a. central diabetes insipidus (DI). b. nephrogenic DI. c. psychogenic (dipsogenic) DI. d. iatrogenic DI.

c. psychogenic (dipsogenic) DI.

The onset of seizures in the patient with DI indicates a. increased potassium levels. b. hyperosmolality. c. severe dehydration. d. toxic ammonia levels.

c. severe dehydration.

The nurse knows that the patient with DKA will need a. subcutaneous insulin. b. IV insulin. c. subcutaneous and IV insulin. d. combination 70%/30% insulin.

c. subcutaneous and IV insulin.

A patient weighs 140 kg and is 60 in. tall. The patients blood sugar is being controlled by glipizide. As the nurse discusses discharge instructions, the primary treatment goal with this type 2 diabetes patient would be a. signs of hypoglycemia. b. proper injection technique. c. weight loss. d. increased caloric intake.

c. weight loss.

The diagnosis of SIADH is made when which of the following conditions is present? a. Decreased ADH level and hyperkalemia b. Decreased ADH level and hypernatremia c. Increased ADH level and serum ketones d. Increased ADH level and low serum osmolality

d. Increased ADH level and low serum osmolality

A patient has a 10-year history of diabetes mellitus. The patient is admitted to the critical care unit with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis.Which of the following statements best describes the rationale for administrating potassium supplements with the patients insulin therapy? a. Potassium replaces losses incurred with diuresis. b. The patient has been in a long-term malnourished state. c. IV potassium renders the infused solution isotonic. d. Insulin drives the potassium back into the cells.

d. Insulin drives the potassium back into the cells.

A patient who has type 2 diabetes is on the unit after aneurysm repair. His serum glucose levels have been elevated for the past 2 days. He is concerned that he is becoming dependent on insulin. The best response for the nurse would be 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.

d. The stress on your body has temporarily increased your blood sugar levels.

A patient is admitted to the unit with extreme fatigue, vomiting, and headache. This patient has type 1 diabetes but has been on an insulin pump for 6 months. He states, I know it could not be my diabetes because my pump gives me 24-hour control. The nurses best response would be a. You know a lot about your pump, and you are correct. b. Youre right. This is probably a virus. c. Well get an abdominal CT and see if your pancreas is inflamed. d. Well check your serum blood glucose and ketones.

d. Well check your serum blood glucose and ketones.

The patient at risk for developing SIADH may be taking a. adenosine (Adenocard). b. diltiazem (Cardizem). c. heparin sodium. d. acetaminophen.

d. acetaminophen.

A patient in diabetic ketoacidosis is very lethargic and has a funny odor to his breath. The nurse would suspect this to be a result of a. alcohol intoxication. b. hyperglycemia. c. hyperphosphatemia. d. acetone.

d. acetone.

A priority for patient education when discharged with long-term antidiuretic hormone deficiency is a. daily intake and output. b. attention to thirst. c. a low-sodium diet. d. daily weights.

d. daily weights.

A patient was admitted with diabetic ketoacidosis 1 hour ago and is on an insulin drip. Suddenly, the nurse notices frequent premature ventricular contractions (PVCs) on the electrocardiogram. The expected intervention would be to a. administer a lidocaine bolus. b. administer a lidocaine drip. c. synchronize cardioversion. d. evaluate electrolytes.

d. evaluate electrolytes.

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 would suspect a. diuresis. b. DI. c. SIADH. d. hyperaldosteronism.

d. hyperaldosteronism.

While a patient with SIADH is receiving hypertonic saline, the nurse assesses for signs that the saline must be stopped. These signs would include a. decreased CVP and decreased PAP. b. bradycardia and thirst. c. hypotension and wheezing. d. hypertension and lung crackles.

d. hypertension and lung crackles.

The nurse knows that the dehydration in diabetic ketoacidosis stimulates catecholamine release, which results in a. decreased glucose release. b. increased insulin release. c. decreased cardiac contractility. d. increased gluconeogenesis.

d. increased gluconeogenesis.

A patient with type 2 diabetes is admitted. He is very lethargic and hypotensive. A diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made based on laboratory values of a. decreased serum glucose and increased serum ketones. b. increased urine ketones and decreased serum osmolality. c. increased serum osmolality and increased serum potassium. d. increased serum osmolality and increased serum glucose.

d. increased serum osmolality and increased serum glucose.