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A patient with long-standing type 1 diabetes presents to the emergency department with a loss of consciousness and seizure activity. The patient has a history of renal insufficiency, gastroparesis, and peripheral diabetic neuropathy. Emergency personnel reported a blood glucose of 32 mg/dL on scene. When providing discharge teaching for this patient and family, the nurse instructs on the need to do which of the following? (Select all that apply.)

  • A. Administer glucagon 1 mg intramuscularly any time the blood glucose is less than 70 mg/dL.
  • B. Administer 15 grams of carbohydrate orally for severe episodes of hypoglycemia.
  • C. Discontinue the insulin pump by removing the infusion set catheter.
  • D. Increase home blood glucose monitoring and report patterns of hypoglycemia to the provider.
Correct Answer: B

Rationale: The correct answer is B: Administer 15 grams of carbohydrate orally for severe episodes of hypoglycemia. In this scenario, the patient is experiencing severe hypoglycemia (blood glucose of 32 mg/dL) leading to loss of consciousness and seizure activity. Administering 15 grams of carbohydrate orally is crucial to rapidly raise the blood glucose levels and address the hypoglycemia. This immediate intervention can help reverse the symptoms and prevent further complications.

The incorrect choices:
A: Administering glucagon intramuscularly is typically reserved for severe hypoglycemia when the patient cannot take anything by mouth. In this case, oral intake is preferred for faster absorption.
C: Discontinuing the insulin pump is not necessary in this situation since the primary concern is treating the acute hypoglycemia. Removing the infusion set can lead to hyperglycemia if not managed properly.
D: Increasing home blood glucose monitoring and reporting patterns of hyp

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The nurse is caring for an elderly patient who was admitted with renal insufficiency. An expected laboratory finding for this patient may be

  • A. an increased glomerular filtration rate (GFR).
  • B. a normal serum creatinine level.
  • C. increased ability to excrete drugs.
  • D. hypokalemia.
Correct Answer: C

Rationale: Correct Answer: C - Increased ability to excrete drugs.

Rationale:
1. Renal insufficiency impairs kidney function, leading to decreased excretion of drugs.
2. In elderly patients with renal insufficiency, there may be compensatory mechanisms to enhance drug excretion.
3. This increased ability to excrete drugs helps prevent drug accumulation and potential toxicity.

Summary:
A: Increased GFR is not expected in renal insufficiency; it typically decreases.
B: Serum creatinine level would likely be elevated in renal insufficiency, not normal.
D: Hypokalemia is not a typical lab finding in renal insufficiency; hyperkalemia is more common.

The most significant clinical finding of acute adrenal crisis associated with fluid and electrolyte imbalance is

  • A. fluid volume excess.
  • B. hyperglycemia.
  • C. hyperkalemia
  • D. hypernatremia
Correct Answer: C

Rationale: Step-by-step rationale for the correct answer (C: hyperkalemia):
1. Adrenal crisis leads to adrenal insufficiency, causing decreased cortisol levels.
2. Cortisol plays a crucial role in regulating potassium levels.
3. With decreased cortisol, potassium levels can rise, leading to hyperkalemia.
4. Hyperkalemia can result in life-threatening cardiac arrhythmias.
Summary:
A: Fluid volume excess is not typical in adrenal crisis.
B: Hyperglycemia can be present but is not the most significant finding.
D: Hypernatremia is not a typical feature of adrenal crisis.

A normal glomerular filtration rate is

  • A. less than 80 mL/min.
  • B. 80 to 125 mL/min.
  • C. 125 to 180 mL/min.
  • D. more than 189 mL/min.
Correct Answer: B

Rationale: The correct answer is B (80 to 125 mL/min) because this range represents the normal glomerular filtration rate (GFR) for a healthy adult. GFR indicates the rate at which blood is filtered by the kidneys, with 125 mL/min being the average value. Values below 80 mL/min (Choice A) suggest impaired kidney function, while values above 189 mL/min (Choice D) may indicate hyperfiltration or underlying conditions. Choice C (125 to 180 mL/min) falls within the normal range, but the typical average is around 125 mL/min. Thus, choice B is the correct answer as it reflects the standard GFR range for adults.

A patient presents to the emergency department with the following clinical signs: Pulse: 132 beats/min Blood pressure: 88/50 mm Hg Respiratory rate: 32 breaths/min Temperature: 8°F Chest x-ray: Findings consistent with congestive heart failure Cardiac rhythm: Atrial fibrillation with rapid ventricular response These signs are consistent with which disorder?

  • A. Adrenal crisis
  • B. Myxedema coma
  • C. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
  • D. Thyroid storm
Correct Answer: D

Rationale: Rationale: The clinical signs indicate a hypermetabolic state with tachycardia, hypotension, tachypnea, and potential fever, typical of a thyroid storm. The presence of congestive heart failure and atrial fibrillation further support this diagnosis due to the hyperthyroid state exacerbating cardiovascular symptoms. Adrenal crisis (A) would present with hypotension and shock, but not with the hypermetabolic state seen here. Myxedema coma (B) would present with hypothermia, bradycardia, and altered mental status, which are not present in this case. SIADH (C) would typically present with hyponatremia and concentrated urine, which are not seen here.

The nurse is caring for a patient who has a temporary percutaneous dialysis catheter in place. In caring for this patient, the nurse should

  • A. apply a sterile gauze dressing to maintain sterility.
  • B. replace the transparent dressing every 10 days to prevent manipulation.
  • C. assess the catheter site for redness and/or swelling.
  • D. use the catheter for drawing blood samples to reduce patient discomfort.
Correct Answer: C

Rationale: The correct answer is C because assessing the catheter site for redness and/or swelling is essential in monitoring for signs of infection or complications. Redness and swelling can indicate infection, which requires prompt intervention.

A: Applying a sterile gauze dressing is not necessary for a temporary percutaneous dialysis catheter unless specified by the healthcare provider.
B: Transparent dressings are typically left in place for several days unless there is a specific reason to change them more frequently.
D: Using the catheter for drawing blood samples is not recommended as it can increase the risk of infection and may interfere with the dialysis process.

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