A.G. final

A patient is presenting with signs of diabetes insipidus (DI). Which findings would confirm this diagnosis? a. Hyperosmolality and hypernatremia b. Hyperosmolality and hyponatremia c. Hypoosmolality and hypernatremia d. Hypoosmolality and hyponatremia

ANS: A 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.

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. Acute pancreatitis b. Drug overdose c. Hyperglycemic hyperosmolar state d. Hyperaldosteronism

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

A patient has been diagnosed with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse would expect the first line treatment to include which intervention? a. Fluid restriction b. Hypotonic intravenous fluid administration c. Administration of D5W d. Administration of vasopressin

ANS: A Reduction in fluid intake is one component of the treatment plan for syndrome of inappropriate secretion of antidiuretic hormone (SIADH).

A patient has been admitted with hyperosmolar hyperglycemic state (HHS). The nurse knows that intravenous insulin is usually administered at what dosage? a. 0.1 U/kg/h b. 1.0 U/kg/h c. 2.0 U/kg/h d. 5.0 U/kg/h

ANS: A 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.

A patient was admitted 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/h c. Sodium bicarbonate 50 mmol IV push d. Vasopressin 10 units IM every 3 hours e. Potassium 20 mEq/L of IV fluid

ANS: A, B, E Dehydration is a common presenting issue in diabetic ketoacidosis (DKA), so the administration of fluids and insulin will help correct the hyperglycemia and acidosis. Sodium bicarbonate is not recommended unless the pH is less than 6.9. As dehydration is reversed, potassium moves back into the cells, and hypokalemia can result, so administration of replacement potassium is necessary.

Which finding is expected in the patient with hypothyroidism? a. Increased T4 b. Anemia c. Decreased thyroid stimulating hormone d. Hyperglycemia

ANS: B Anemia is a common problem that is present in 25% to 50% of patients with hypothyroidism. Symptoms of fatigue and depression are associated. Erythropoiesis (red blood cell production) is impaired and inadequate. Coagulation abnormalities may coexist.

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

ANS: B 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.

A patient has thyroid storm. The nurse is providing medication instruction for home. The patient asks, "If I have a fever, should I take Tylenol or aspirin?" Which response would be the most appropriate? a. "Either one is fine because they do not affect the antithyroid medication." b. "Take Tylenol rather than aspirin because aspirin increases the amount of free thyroid hormone in circulation." c. "Take aspirin rather than Tylenol because Tylenol increases the amount of free thyroid hormone in circulation." d. "They both prevent the antithyroid medication from working correctly. I would recommend an NSAID."

ANS: B For management or elevated temperature, patients are instructed to use acetaminophen rather than salicylates because salicylates increase the amount of free thyroid hormone in circulation.

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? a. Kussmaul respirations and flushed skin b. Irritability and paresthesia c. Abdominal cramps and nausea d. Hypotension and itching

ANS: B Irritability and paresthesia are seen in hypoglycemia.

Patients discharged with antithyroid medications should be alerted to which potential side effect? a. Hyperthermia b. Agranulocytosis c. Tachypnea d. Diaphoresis

ANS: B Patients discharged with antithyroid medications are alerted to the potential side effect of agranulocytosis. Symptoms of agranulocytosis include sudden cough, fever, rash, and inflammation.

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

ANS: B 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.

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.

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

A patient has been diagnosed with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse is administering hypertonic saline. The nurse knows that the serum sodium should not be raised more than how many milliequivalents per day? a. 5 mEq/day b. 10 mEq/day c. 20 mEq/day d. 25 mEq/day

ANS: B Serum sodium levels must be evaluated at least every 4 hours during the acute phase of sodium replacement. The serum sodium should not be raised more than 10 mEq/L in 24 hours.

The nurse is caring for a patient with myxedema coma. The patient's temperature is 93° F. Which intervention would the nurse include in the plan of care for this patient? a. Give aggressive therapy that includes warm peritoneal lavage. b. Allow the patient to maintain this body temperature to decrease oxygen demands. c. Use warming blankets to slowly warm the patient. d. Wait until the patient shivers to start warming.

ANS: C Hypothermia will gradually improve as the patient is treated with thyroid hormone. Several warm blankets comfortably wrapped around the patient (with mild hypothermia) may be sufficient to help raise the body temperature to normal. Active warming devices are also used. Continuous assessments are important to avoid too-rapid heating and vasodilation.

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. Central diabetes insipidus (DI) b. Nephrogenic DI c. Dipsogenic DI d. Iatrogenic DI

ANS: C 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.

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. Initiate oxygen therapy via a face mask. b. Administer sodium bicarbonate. c. Administer insulin and fluids intravenously. d. Prepare for intubation.

ANS: C 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.

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? a. D5W c. 0.9% NS b. 0.45% NS d. D5/NS

ANS: C 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.

The nurse understands that the onset of seizures in the patient with diabetes insipidus (DI) is indicative of which situation? a. Increased potassium levels b. Hyperosmolality c. Severe dehydration d. Toxic ammonia levels

ANS: C 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.

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

ANS: C 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.

Which medication can place a patient at risk for developing syndrome of inappropriate secretion of antidiuretic hormone (SIADH)? a. Adenosine b. Diltiazem c. Heparin sodium d. Acetaminophen

ANS: D Acetaminophen increases the release of antidiuretic hormone.

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

ANS: D 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.