Nokea
In the management of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome, when is an intravenous (IV) solution that contains dextrose started?
- A. Never; normal saline is the only appropriate solution in diabetes management
- B. When the blood sugar reaches 70 mg/dL
- C. When the blood sugar reaches 150 mg/dL
- D. When the blood glucose reaches 250 mg/dL
Correct Answer: D
Rationale: Correct Answer: D
Rationale: In diabetic emergencies, starting IV dextrose at 250 mg/dL prevents hypoglycemia while resolving ketoacidosis. Below 250 mg/dL, the body can use endogenous glucose, so IV dextrose is not necessary.
Summary:
A: Incorrect. Normal saline may be used for initial fluid resuscitation but does not address the need for glucose.
B: Incorrect. Starting dextrose at 70 mg/dL may lead to unnecessary hyperglycemia and complications.
C: Incorrect. Waiting until 150 mg/dL delays the provision of necessary glucose for metabolic functions.
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Which of the following laboratory values would be found in a patient with syndrome of inappropriate secretion of antidiuretic hormone?
- A. Fasting blood glucose 156 mg/dL
- B. Serum potassium 5.8 mEq/L
- C. Serum sodium 115 mEq/L
- D. Serum sodium 152 mEq/L
Correct Answer: C
Rationale: The correct answer is C, Serum sodium 115 mEq/L. In syndrome of inappropriate secretion of antidiuretic hormone (SIADH), there is excess release of ADH leading to water retention and dilutional hyponatremia. Low serum sodium levels (hyponatremia) are characteristic of SIADH due to water retention without proportional sodium retention. Choices A and B are not indicative of SIADH. Choice D, high serum sodium, is more likely in conditions causing dehydration or excessive sodium intake.
Which of the following laboratory values would be more common in patients with diabetic ketoacidosis?
- A. Blood glucose >1000 mg/dL
- B. Negative ketones in the urine
- C. Normal anion gap
- D. pH 7.24
Correct Answer: A
Rationale: The correct answer is A (Blood glucose >1000 mg/dL) because diabetic ketoacidosis is characterized by severe hyperglycemia. High blood glucose levels (>1000 mg/dL) are common due to insulin deficiency leading to increased glucose production.
B: Negative ketones in the urine would be incorrect as DKA results in ketone production, leading to ketonuria.
C: Normal anion gap would be incorrect as DKA typically presents with an elevated anion gap metabolic acidosis due to ketone accumulation.
D: pH 7.24 would be incorrect as DKA would present with a lower pH due to metabolic acidosis.
Which of the following would be seen in a patient with myxedema coma?
- A. Decreased reflexes
- B. Hyperthermia
- C. Hyperventilation
- D. Tachycardia
Correct Answer: A
Rationale: The correct answer is A: Decreased reflexes. In myxedema coma, a severe form of hypothyroidism, patients often present with decreased mental status, hypothermia, and bradycardia. Decreased reflexes are a common neurological manifestation due to the slowing of metabolic processes and the central nervous system depression associated with this condition. Hyperthermia (B) is not typically seen in myxedema coma, as patients usually have low body temperature. Hyperventilation (C) is also unlikely, as respiratory depression is more common. Tachycardia (D) is incorrect because bradycardia is more characteristic of myxedema coma.
The critical care nurse knows that in critically ill patients, renal dysfunction
- A. is a very rare problem.
- B. affects nearly two thirds of patients.
- C. has a low mortality rate once renal replacement therapy has been initiated.
- D. has little effect on morbidity, mortality, or quality of life.
Correct Answer: B
Rationale: The correct answer is B because renal dysfunction is a common issue in critically ill patients due to factors like sepsis or hypoperfusion. This affects nearly two thirds of patients, leading to potential complications. Choice A is incorrect as renal dysfunction is common, not rare. Choice C is incorrect as mortality rates can still be high even with renal replacement therapy. Choice D is incorrect as renal dysfunction can significantly impact morbidity, mortality, and quality of life in critically ill patients.
A patient presents to the emergency department with suspected thyroid storm. The nurse should be alert to which of the following cardiac rhythms while providing care to this patient?
- A. Atrial fibrillation
- B. Idioventricular rhythm
- C. Junctional rhythm
- D. Sinus bradycardia
Correct Answer: A
Rationale: The correct answer is A: Atrial fibrillation. In thyroid storm, excess thyroid hormone levels can lead to increased sympathetic activity, causing tachycardia and arrhythmias like atrial fibrillation. Atrial fibrillation is common in thyroid storm due to the hypermetabolic state and increased risk of atrial arrhythmias. Other choices are incorrect: B (Idioventricular rhythm) is not typically associated with thyroid storm, C (Junctional rhythm) is less likely since atrial arrhythmias are more common, and D (Sinus bradycardia) is unlikely due to the hypermetabolic state causing tachycardia.