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Which of the following patients is at the highest risk for hyperosmolar hyperglycemic syndrome?
- A. An 18-year-old college student with type 1 diabetes who exercises excessively
- B. A 45-year-old woman with type 1 diabetes who forgets to take her insulin in the morning
- C. A 75-year-old man with type 2 diabetes and coronary artery disease who has recently started on insulin injections
- D. An 83-year-old, long-term care resident with type 2 diabetes and advanced Alzheimer’s disease who recently developed influenza
Correct Answer: D
Rationale: The correct answer is D because the 83-year-old long-term care resident with type 2 diabetes and advanced Alzheimer's disease who recently developed influenza is at the highest risk for hyperosmolar hyperglycemic syndrome (HHS). This patient has multiple risk factors for HHS, including age, type 2 diabetes, advanced Alzheimer's disease, and the added stress of influenza, which can exacerbate hyperglycemia. The combination of these factors can lead to severe hyperglycemia, dehydration, and electrolyte imbalances characteristic of HHS.
Choice A is incorrect because although excessive exercise can lead to hypoglycemia in individuals with type 1 diabetes, it is not a risk factor for HHS. Choice B is incorrect as forgetting to take insulin can lead to diabetic ketoacidosis in type 1 diabetes, not HHS. Choice C is incorrect as starting insulin injections in a patient with type 2 diabetes and coronary artery disease does not automatically increase the risk
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The nurse is caring for a patient with head trauma who was admitted to the surgical intensive care unit following a motorcycle crash. What is an important assessment that will assist the nurse in early identification of an endocrine disorder commonly associated with this condition?
- A. Daily weight
- B. Fingerstick glucose
- C. Lung sound auscultation
- D. Urine osmolality
Correct Answer: D
Rationale: The correct answer is D: Urine osmolality. In head trauma patients, the risk of developing diabetes insipidus (DI) is high due to damage to the posterior pituitary. Monitoring urine osmolality helps identify DI early, as low urine osmolality indicates impaired concentration ability. This is crucial for prompt treatment to prevent dehydration. Choices A and B are important but not specific to endocrine disorders. Choice C is relevant for respiratory assessment, not endocrine disorders.
An individual with type 2 diabetes who takes glipizide has begun a formal exercise program at a local gym. While exercising on the treadmill, the individual becomes pale, diaphoretic, shaky, and has a headache. The individual feels as though she is going to pass out. What is the individual’s priority action?
- A. Drink additional water to prevent dehydration.
- B. Eat something with 15 g of simple carbohydrates.
- C. Go to the first-aid station to have glucose checked.
- D. Take another dose of the oral agent.
Correct Answer: B
Rationale: The correct answer is B: Eat something with 15 g of simple carbohydrates. In this scenario, the individual is exhibiting signs of hypoglycemia due to the combination of glipizide (which can lower blood sugar) and exercise. The priority action is to raise blood sugar levels quickly to prevent further complications. Consuming simple carbohydrates, like glucose tablets or juice, will rapidly increase blood sugar levels. This is crucial to prevent the individual from passing out or experiencing more serious consequences.
Choice A is incorrect because while hydration is important, it is not the immediate priority in this situation. Choice C is incorrect as going to the first-aid station may waste valuable time when immediate action is needed. Choice D is incorrect as taking another dose of the oral agent can further lower blood sugar levels and worsen the hypoglycemia.
The critical care nurse is responsible for monitoring the patient receiving continuous renal replacement therapy (CRRT). In doing so, the nurse should
- A. assess that the blood tubing is warm to the touch.
- B. assess the hemofilter every 6 hours for clotting.
- C. cover the dialysis lines to protect them from light.
- D. use clean technique during vascular access dressing changes.
Correct Answer: B
Rationale: Correct Answer: B
Rationale:
1. Hemofilter clotting can affect CRRT efficiency.
2. Assessing every 6 hours allows early detection and intervention.
3. Clotting can lead to treatment interruptions or complications.
4. Regular assessment ensures optimal therapy delivery.
Other Choices:
A: Assessing tubing warmth is not a reliable indicator of CRRT function or complications.
C: Covering dialysis lines to protect from light is not a standard practice in CRRT monitoring.
D: Using clean technique is not sufficient for vascular access dressing changes; aseptic technique is required for infection prevention.
The nurse is assigned to care for a patient who presented to the emergency department with diabetic ketoacidosis. A continuous insulin intravenous infusion is started, and hourly bedside glucose monitoring is ordered. The targeted blood glucose value after the first hour of therapy is
- A. 70 to 120 mg/dL.
- B. a decrease of 25 to 50 mg/dL compared with admitting values.
- C. a decrease of 35 to 90 mg/dL compared with admitting values.
- D. less than 200 mg/dL.
Correct Answer: C
Rationale: The correct answer is C: a decrease of 35 to 90 mg/dL compared with admitting values. In diabetic ketoacidosis, there is severe hyperglycemia which needs to be corrected gradually to prevent complications like cerebral edema. A rapid decrease in glucose levels can lead to osmotic shifts and neurological issues. The targeted decrease of 35 to 90 mg/dL is considered safe and effective in managing hyperglycemia in these patients. This range ensures a controlled reduction in blood glucose levels without causing harm.
Choice A (70 to 120 mg/dL) is too broad and may lead to overly aggressive treatment. Choice B (a decrease of 25 to 50 mg/dL) is too conservative and may not adequately address the high glucose levels seen in diabetic ketoacidosis. Choice D (less than 200 mg/dL) does not provide a specific target range for glucose reduction, which is essential in managing diabetic ketoacidosis effectively.
The patient undergoes a cardiac catheterization that requires the use of contrast dyes during the procedure. To detect signs of contrast-induced kidney injury, the nurse should
- A. not be concerned unless urine output decreases.
- B. evaluate the patient’s serum creatinine for up to 72 hours after the procedure.
- C. obtain an order for a renal ultrasound.
- D. evaluate the patient’s postvoid residual volume to detect intrarenal injury.
Correct Answer: B
Rationale: Correct Answer: B
Rationale:
1. Contrast dyes can cause kidney injury due to their nephrotoxic effects.
2. Serum creatinine levels are a reliable indicator of kidney function.
3. Evaluating serum creatinine for up to 72 hours after the procedure allows detection of any contrast-induced kidney injury.
4. Monitoring serum creatinine helps in early identification and intervention for renal complications.
Summary:
A: Incorrect. Urine output alone is not a definitive indicator of kidney injury.
C: Incorrect. Renal ultrasound is not typically used for detecting contrast-induced kidney injury.
D: Incorrect. Postvoid residual volume is not specific for contrast-induced kidney injury.