Sem 4 - Unit 2 - AcidBase Balance/Glucose Reg - NCO
The serum potassium level of a client who has diabetic ketoacidosis is 5.4 mEq/L (5.4 mmol/L). What would the nurse expect to see on the ECG tracing monitor? 1 Abnormal P waves and depressed T waves 2 Peaked T waves and widened QRS complexes 3 Abnormal Q waves and prolonged ST segments 4 Peaked P waves and an increased number of T waves
2 Peaked T waves and widened QRS complexes Potassium is the principal intracellular cation, and during ketoacidosis it moves out of cells into the extracellular compartment to replace potassium lost as a result of glucose-induced osmotic diuresis; overstimulation of the cardiac muscle results. The T wave is depressed in hypokalemia. Initially, the QT segment is short, and as the potassium level rises, the QRS complex widens. P waves are abnormal because the PR interval may be prolonged and the P wave may be lost; however, the T wave is peaked, not depressed. The ST segment becomes depressed. The PR interval is prolonged, and the P wave may be lost. QRS complexes and thus T waves become irregular, and the rate does not necessarily change.
A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event should the nurse document in the client's clinical record? Select all that apply. 1 Sweating 2 Retinopathy 3 Acetone breath 4 Increased arterial bicarbonate level 5 Decreased arterial carbon dioxide level
3 Acetone breath 5 Decreased arterial carbon dioxide level A fruity odor to the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis. Metabolic acidosis initiates respiratory compensation in the form of Kussmaul respirations to counteract the effects of ketone buildup, resulting in a decreased arterial carbon dioxide level. As the glucose level decreases in hypoglycemia, the sympathetic nervous system is activated, and epinephrine and norepinephrine are secreted, causing diaphoresis. Retinopathy is a long-term complication of diabetes caused by microvascular changes in the retina; it is not a sign of ketoacidosis. With ketoacidosis, the serum bicarbonate level is decreased, not increased, in an effort to neutralize ketones when seeking acid-base balance.
A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis? 1 Decreased serum glucose levels 2 Decreased serum calcium levels 3 Increased blood urea nitrogen levels 4 Increased serum bicarbonate levels
3 Increased blood urea nitrogen levels With diabetic ketoacidosis blood urea nitrogen level generally is increased because of dehydration. With diabetic ketoacidosis, the serum glucose levels are generally above 300 mg/dL (16.7 mmol/L). The calcium level is unrelated to diabetic ketoacidosis. Serum bicarbonate levels are below 15 mEq/L (15 mmol/L).
A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe? 1 NPH insulin 2 Inhaled insulin 3 Regular insulin 4 Insulin glargine
3 Regular insulin Regular insulin is rapid acting and should be used for diabetic coma. Insulin glargine is long-acting insulin, which is not indicated in an emergency. NPH insulin is intermediate-acting insulin; it is not indicated for use in an emergency. Inhaled insulin has not been approved for management of diabetic ketoacidosis
A client's blood gases reflect diabetic ketoacidosis. Which clinical indicator should the nurse identify when monitoring this client's laboratory values? 1 Increased pH 2 Decreased PO 2 3 Increased PCO 2 4 Decreased HCO 3
4 Decreased HCO 3 The bicarbonate-carbonic acid buffer system helps maintain the pH of body fluids; in metabolic acidosis, there is a decrease in bicarbonate because of an increase of metabolic acids. The pH is decreased. The PO 2 is not decreased in diabetic acidosis. The PCO 2 may be decreased by the body's attempt to eliminate CO 2 to compensate for a decreased pH.
A nurse is assessing a client with diabetic ketoacidosis. Which clinical manifestations should the nurse expect? Select all that apply. 1 Dry skin 2 Abdominal pain 3 Kussmaul respirations 4 Absence of ketones in the urine 5 Blood glucose level of less than 72 mg/dL (3.3 mmol/L)
1 Dry skin 2 Abdominal pain 3 Kussmaul respirations Dry skin is a sign of dehydration in response to polyuria associated with the osmotic effect of an elevated serum glucose level. Abdominal pain is associated with diabetic ketoacidosis. In the absence of insulin, glucose cannot enter the cell or be converted to glycogen, so it remains in the blood. Breakdown of fats as an energy source causes an accumulation of ketones, which results in acidosis. The lungs, in an attempt to compensate for lowered pH, will blow off CO 2 (Kussmaul respirations). An absence of ketones in the urine indicates adequate production of glucose for energy. Insulin deficiency stimulates production of ketones as a by-product of fat oxidation for energy. Blood glucose level of less than 72 mg/dL (4 mmol/L) indicates hypoglycemia, not ketoacidosis.
Which blood gas result should the nurse expect an adolescent with diabetic ketoacidosis to exhibit? 1 pH 7.30, CO 2 40 mm Hg, HCO 3 - 20 mEq/L (20 mmol/L) 2 pH 7.35, CO 2 47 mm Hg, HCO 3 - 24 mEq/L (24 mmol/L) 3 pH 7.46, CO 2 30 mm Hg, HCO 3 - 24 mEq/L (24 mmol/L) 4 pH 7.50, CO 2 50 mm Hg, HCO 3 - 22 mEq/L (22 mmol/L)
1 pH 7.30, CO 2 40 mm Hg, HCO 3 - 20 mEq/L (20 mmol/L) A client in diabetic ketoacidosis will have blood gas readings that indicate metabolic acidosis. The pH will be acidic (7.30), and the HCO 3 - will be low (20 mEq/L [20 mmol/L]). The normal pH is 7.35 to 7.45; CO 2 ranges from 35 to 45 mm Hg, and HCO 3 - ranges from 22 to 26 (22 to 26 mmol/L). A pH of 7.35 and a CO 2 of 47 mm Hg indicate respiratory acidosis. pH values of 7.46 and 7.50 represent alkalosis, not acidosis.
A nurse is caring for a postoperative client with diabetes. Which is the most common cause of diabetic ketoacidosis that the nurse needs to consider when caring for this client? 1 Emotional stress 2 Presence of infection 3 Increased insulin dose 4 Inadequate food intake
2 Presence of infection Infection increases the body's metabolic rate, and insulin is not available for increased demands. Although emotional stress will affect glucose levels, diabetic ketoacidosis will rarely result. Increased insulin dose will lead to insulin coma (hypoglycemia) if diet is not increased as well. Inadequate food intake will result in insulin coma.
A nurse adds 20 mEq of potassium chloride to the intravenous solution of a client with diabetic ketoacidosis. What is the primary purpose for administering this drug? 1 Treat hyperpnea 2 Prevent flaccid paralysis 3 Replace excessive losses 4 Treat cardiac dysrhythmias
3 Replace excessive losses Once treatment with insulin for diabetic ketoacidosis is begun, potassium ions reenter the cell, causing hypokalemia; therefore potassium, along with the replacement fluids, is needed. Potassium will not correct hyperpnea. Flaccid paralysis does not occur in diabetic ketoacidosis. Considering the relationship between insulin and potassium, treatment with potassium is prophylactic, preventing the development of dysrhythmias.
The nurse is assessing the client admitted with diabetic ketoacidosis. Which statement made by the client indicates a need for further education on sick day management? 1 "I need to stop taking my insulin when I am ill because I am not eating." 2 "I will check my urine for ketones when my blood sugar is over 250." 3 "I will try and take in Gatorade and water when I am sick." 4 "I will continue all my insulin including my glargine when I am sick."
1 "I need to stop taking my insulin when I am ill because I am not eating." The diabetic client's metabolic needs will require the same amount of insulin and sometimes more when in a stressed state, including illness. The client checking the urine for ketones when blood sugar is over 250, drinking water and Gatorade, and continuing insulin indicate that the client has an understanding of the basic sick day rules.
A client is admitted to the hospital with diabetic ketoacidosis. The nurse concludes that the client's elevated ketone level is caused by incomplete oxidation of which nutrient? 1 Fats 2 Protein 3 Potassium 4 Carbohydrates
1 Fats Incomplete oxidation of fat results in fatty acids that further break down to ketones. Protein metabolism produces nitrogenous waste, causing elevated blood urea nitrogen (BUN), not ketones. Potassium is not oxidized; potassium is not directly associated with ketones. Carbohydrates do not contain fatty acids that are broken down into ketones.
The nurse is caring for a client with type 1 diabetes who is developing ketoacidosis. Which arterial blood gas report is indicative of diabetic ketoacidosis? 1 PCO 2: 49, HCO 3: 32, pH: 7.50 2 PCO 2: 26, HCO 3: 20, pH: 7.52 3 PCO 2: 54, HCO 3: 28, pH: 7.30 4 PCO 2: 28, HCO 3: 18, pH: 7.28
4 PCO 2: 28, HCO 3: 18, pH: 7.28 Decreased pH and bicarbonate values reflect metabolic acidosis; a decreased PCO 2 value indicates compensatory hyperventilation. Increased pH and bicarbonate values reflect metabolic alkalosis; an increased PCO 2 value indicates compensatory hypoventilation. Increased pH and decreased PCO 2 values reflect hyperventilation and respiratory alkalosis. Decreased pH and increased PCO 2 values reflect hypoventilation and respiratory acidosis.
A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin reports tingling and numbness of the fingers and toes, and shortness of breath. The nurse identifies a U wave on the cardiac monitor. What should the nurse conclude is causing these clinical findings? 1 Hypokalemia 2 Hyponatremia 3 Hyperglycemia 4 Hypercalcemia
1 Hypokalemia These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Clinical manifestations of hyponatremia include nausea, malaise, and changes in mental status. Clinical manifestations of hyperglycemia include weakness, dry skin, flushing, polyuria, and thirst. Clinical manifestations of hypercalcemia include lethargy, nausea, vomiting, paresthesias, and personality changes.
The nurse is caring for a client with a diagnosis of diabetic ketoacidosis. Which arterial blood gas results are associated with this diagnosis? 1 pH: 7.28; PCO 2: 28; HCO 3: 18 2 pH: 7.30; PCO 2: 54; HCO 3: 28 3 pH: 7.50; PCO 2: 49; HCO 3: 32 4 pH: 7.52; PCO 2: 26; HCO 3: 20
1 pH: 7.28; PCO 2: 28; HCO 3: 18 A low pH and bicarbonate reflect metabolic acidosis; a low PCO 2 indicates compensatory hyperventilation. A low pH and elevated PCO 2 reflect hypoventilation and respiratory acidosis. An elevated pH and bicarbonate reflect metabolic alkalosis; an elevated PCO 2 indicates compensatory hypoventilation. An elevated pH and low PCO 2 reflect hyperventilation and respiratory alkalosis.
A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin complains of tingling and numbness of the fingers and toes and shortness of breath. The cardiac monitor shows the appearance of a U wave. What complication does the nurse suspect? 1 Hypokalemia 2 Hypoglycemia 3 Hypernatremia 4 Hypercalcemia
1 Hypokalemia These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Symptoms of hypoglycemia are weakness, nervousness, tachycardia, diaphoresis, irritability, and pallor. Symptoms of hypernatremia are thirst, orthostatic hypotension, dry mouth and mucous membranes, concentrated urine, tachycardia, irregular heartbeat, irritability, fatigue, lethargy, labored breathing, and muscle twitching or seizures. Symptoms of hypercalcemia are lethargy, nausea, vomiting, paresthesias, and personality changes.
A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis? 1 Increased serum lipids 2 Decreased hematocrit level 3 Increased serum calcium levels 4 Decreased blood urea nitrogen level
1 Increased serum lipids With diabetic ketoacidosis, serum lipid levels are high because of the increased breakdown of fat. Serum lipid levels can go so high that the serum appears opalescent and creamy. With diabetic ketoacidosis the hematocrit level generally is increased because of dehydration. The calcium level is unrelated to diabetic ketoacidosis. With diabetic ketoacidosis the blood urea nitrogen level generally is increased because of dehydration.
A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis. What is the initial intervention the nurse should expect the primary healthcare provider to prescribe for this client? 1 Intravenous (IV) fluids 2 Potassium 3 NPH insulin (Novolin N) 4 Sodium polystyrene sulfonate (Kayexalate)
1 Intravenous (IV) fluids IV fluids are given to combat dehydration in ketoacidosis and to keep an IV line open for administration of medications. After electrolyte levels are evaluated, potassium may be added along with insulin. In acidosis, potassium ions initially shift from the intracellular to extracellular compartment, resulting in hyperkalemia; as acidosis is corrected, hypokalemia may occur, and then potassium may be administered. NPH insulin is an intermediate-acting insulin; rapid-acting insulin is indicated in an emergency. Sodium polystyrene sulfonate is not indicated; abnormally high serum potassium levels will revert once dehydration is corrected.
The nurse caring for a client with diabetic ketoacidosis (DKA) can expect to implement which intervention? 1 Intravenous administration of regular insulin 2 Administer insulin glargine subcutaneously at hour of sleep 3 Maintain nothing prescribed orally (NPO) status 4 Intravenous administration of 10% dextrose
1 Intravenous administration of regular insulin A client admitted with DKA will have a blood glucose value greater than 250 and blood ketones. Intravenous (IV) administration of regular insulin is needed to rid the body of ketones and regulate blood glucose. Administration of insulin glargine is not going to reverse the ketoacidosis. The client will be allowed fluids to maintain hydration. Administration of 10% dextrose IV will increase the client's blood glucose.
A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion? 1 Nervousness and tachycardia 2 Erythema toxicum rash and pruritus 3 Diaphoresis and altered mental state 4 Deep respirations and fruity odor to the breath
4 Deep respirations and fruity odor to the breath Deep respirations and a fruity odor to the breath are classic signs of DKA, because of the respiratory system's attempt to compensate by blowing off excess carbon dioxide, a component of carbonic acid. Nervousness and tachycardia are indicative of an insulin reaction (diabetic hypoglycemia). When the blood glucose level decreases, the sympathetic nervous system is stimulated, resulting in an increase in epinephrine and norepinephrine; this causes clinical findings such as nervousness, tachycardia, palpitations, sweating, tremors, and hunger. Erythema toxicum rash and pruritus are unrelated to diabetes; they indicate a hypersensitivity reaction. Although an altered mental state is associated with both hypoglycemia and DKA, diaphoresis is associated only with hypoglycemia. Diaphoresis occurs when the blood glucose level decreases and stimulates an increase in epinephrine and norepinephrine.
A nurse administers the prescribed regular insulin to a client in diabetic ketoacidosis. In addition, an intravenous (IV) solution with potassium is prescribed even though the serum potassium level is within normal limits. What does the nurse recognize as the reason for potassium administration? 1 Potassium loss occurs rapidly from diaphoresis present during coma. 2 Potassium is carried with glucose to the kidneys to be excreted in the urine in increased amounts. 3 Potassium is quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose. 4 Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment.
4 Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment. Insulin stimulates cellular uptake of glucose and stimulates the sodium/potassium pump, leading to the influx of potassium into cells. The resulting hypokalemia is offset by parenteral administration of potassium. Potassium is not lost from the body by profuse diaphoresis. Potassium moves from the extracellular to the intracellular compartment rather than being excreted in the urine. Anabolic reactions are stimulated by insulin and glucose administration; potassium is drawn into the intracellular compartment, necessitating a replenishment of extracellular potassium.
