Nokea
The nurse is admitting a patient with diabetic ketoacidosis (DKA) who has a serum potassium level of 2.9 mmol/L. Which of the following actions prescribed by the health care provider should the nurse take first?
- A. Infuse regular insulin at 20 units/hour.
- B. Place the patient on a cardiac monitor.
- C. Administer IV potassium supplements.
- D. Obtain urine glucose and ketone levels.
Correct Answer: B
Rationale: Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with ECG monitoring. Since potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring, since insulin infusion will further decrease potassium levels. Urine glucose and ketone levels are not urgently needed to manage the patient's care.
You may also like to solve these questions
The nurse is assessing a patient who is recovering from an episode of diabetic ketoacidosis and the patient reports feeling anxious, nervous, and sweaty. Which of the following actions should the nurse take first?
- A. Administer 1 mg glucagon subcutaneously.
- B. Obtain a glucose reading using a finger stick.
- C. Have the patient drink 120 mL of orange juice.
- D. Give the scheduled dose of lispro insulin.
Correct Answer: B
Rationale: The patient's clinical manifestations are consistent with hypoglycemia and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon might be given if the patient's symptoms become worse or if the patient is unconscious. Administration of lispro would drop the patient's glucose further.
Which of the following questions by the nurse will help identify autonomic neuropathy in a patient with diabetes?
- A. Have you observed any recent skin changes?
- B. Do you notice any bloating feeling after eating?
- C. Do you need to increase your insulin dosage when you are stressed?
- D. Have you noticed any painful new ulcerations or sores on your feet?
Correct Answer: B
Rationale: Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient. The other questions are also appropriate to ask, but would not help in identifying autonomic neuropathy.
The nurse has completed teaching a patient with type 2 diabetes about taking gliclazide. Which of the following patient statements indicate a need for additional teaching?
- A. Other medications besides the gliclazide may affect my blood sugar.
- B. If I overeat at a meal, I will still take just the usual dose of medication.
- C. When I become ill, I may have to take insulin to control my blood sugar.
- D. My diabetes is not as likely to cause complications as if I needed to take insulin.
Correct Answer: D
Rationale: The patient should understand that type 2 diabetes places the patient at risk for many complications and that good glucose control is as important when taking oral agents as when using insulin. The other statements are accurate and indicate good understanding of the use of gliclazide.
The nurse is admitting a patient with diabetic ketoacidosis. Which of the following prescriptions should the nurse implement first?
- A. Administer regular IV insulin 30 units.
- B. Infuse 1 L of normal saline per hour.
- C. Give sodium bicarbonate 50 mEq IV push.
- D. Start an infusion of regular insulin at 50 units/hour.
Correct Answer: B
Rationale: The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be accomplished after the infusion of normal saline is initiated.
A diagnosis of hyperglycemic hyperosmolar state (HHS) is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. Which of the following actions should the nurse anticipate?
- A. Give 50% dextrose as a bolus.
- B. Insert a large-bore IV catheter.
- C. Initiate oxygen by nasal cannula.
- D. Administer glargine insulin.
Correct Answer: B
Rationale: HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires oxygen. Dextrose solutions will increase the patient's blood glucose and would be contraindicated.