Chapter 32

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

0.1 U/kg/h

The nurse is developing a discharge education plan for apatient w/sundrom of inappropriate secretion of antidiuretic hormone (SIADH). Which topic should be included in the plan?

Measuring intake and output

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

Acute pancreatitis

A patient is admitted w/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?

Administer insulin and fluids intravenously

The nurse knows that during the resuscitation of a patient w/DKA, the IV line should be changed to a solution containing glucose when what happens?

Blood glucose drops to 200 mg/dL

A patient is presenting w/signs of DI. Which finding would confirm this diagnosis?

Hyperosmolality and hypernatremia

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

Physiologic and psychologic stress

The nurse is caring for a patient w/myxedema coma. The patient's temperature is 93 F. Which intervention would the nurse include in plan of care for this patient?

Use warm blankets to slowly warm the patient

The nurse is caring for a patient w/a head injury who has developed DI. What medication would the nurse expect to be prescribed for the patient?

Vasopressin

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 is most appropriate?

"Take Tylenol rather than aspirin because aspirin increases the amount of free thyroid hormone in circulation."

A patient w/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?

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

A patient is admitted w/extreme fatigue, vomiting, and headache. This patient has type 1 diabetes that has been well controlled w/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?

"We'll check your serum blood glucose and ketones."

A patient is admitted w/DKA and is experiencing polyuria. Which electrolyte disturbances would the nurse expect to see at this phase of DKA?

Decreased potassium and sodium levels

The nurse is caring for a patient with type I diabetes who was admitted w/complaints of increased lethargy. Serum laboratory values validate the diagnosis of DKA. Which symptom is most suggestive of DKA?

Excessive thirst

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

Extensive hydration

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

Fluid administration

A patient w/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?

Increased serum osmolality and increased serum glucose

A patient is admitted w/DKA. The nurse knows that the dehydration associated w/DKA results from which pathophysiologic mechanism?

Increased serum osmolality and urea

A patient in DKA is comatose w/a temperature of 102.2 F. The nurse suspects the patient may have which secondary disorder?

Infection

The nurse is caring for a patient with type I diabetes who was admitted w/complaints of increased lethargy. Serum laboratory values validate the diagnosis of DKA. Which statement best describes the rationale for administrating potassium supplements w/the patient's insulin therapy?

Insulin drives the potassium bank into the cells

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?

Intense thirst and passage of excessively large quantities of dilute urine

A patient w/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?

Irritability and paresthesia

As a patient w/DKA receives insulin and fluids, the nurse knows careful assessment must be given to which electrolyte?

Potassium

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

Rapid rehydration with intravenous fluids

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

Severe hyperglycemia w/minimal or absent ketosis

A patient w/bronchogenic oat cell carcinoma has a drop in urine output. The laboratory reports 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?

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

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

Tachycardia