Nokea
Which of the following statements is true about the medical management of diabetic ketoacidosis?
- A. Serum lactate levels are used to guide insulin administration.
- B. Sodium bicarbonate is a first-line medication for treatment.
- C. The degree of acidosis is assessed through continuous pulse oximetry.
- D. Volume replacement and insulin infusion often correct the acidosis.
Correct Answer: D
Rationale: The correct answer is D. Volume replacement and insulin infusion often correct the acidosis in diabetic ketoacidosis (DKA) because volume depletion and insulin deficiency are key factors in its pathophysiology. Volume replacement helps correct dehydration and improve tissue perfusion, while insulin infusion helps lower blood glucose levels and inhibit ketone production, ultimately correcting the acidosis.
A is incorrect because serum lactate levels are not typically used to guide insulin administration in DKA. B is incorrect as sodium bicarbonate is not a first-line medication for DKA treatment as it can worsen metabolic acidosis. C is incorrect as the degree of acidosis in DKA is typically assessed through blood gas analysis, not continuous pulse oximetry.
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The nurse is caring for a patient who has sustained blunt trauma to the left flank area, and is evaluating the patient’s urinalysis results. The nurse should become concerned when
- A. creatinine levels in the urine are similar to blood levels of creatinine.
- B. sodium and chloride are found in the urine.
- C. urine uric acid levels have the same values as serum levels.
- D. red blood cells and albumin are found in the urine.
Correct Answer: D
Rationale: The correct answer is D because the presence of red blood cells and albumin in the urine indicates kidney damage, as these are not normally found in urine. A: Creatinine levels should be similar in blood and urine for proper kidney function. B: Sodium and chloride are normal components of urine. C: Uric acid levels can vary in urine and serum. Therefore, D is the correct answer as it signals potential kidney injury.
The nurse is assessing a patient with a new arteriovenous fistula, but does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable. The nurse should
- A. reassess the patient in an hour.
- B. raise the arm above the level of the patient’s heart.
- C. notify the provider immediately.
- D. apply warm packs to the fistula site and reassess.
Correct Answer: C
Rationale: The correct answer is C: notify the provider immediately. Lack of bruit, thrill, and distal pulse indicates potential complications like thrombosis or occlusion in the arteriovenous fistula. Prompt provider notification is crucial for timely intervention to prevent further complications such as ischemia or access failure. Reassessing the patient in an hour (A) may delay necessary intervention. Raising the arm above the level of the patient's heart (B) does not address the underlying issue. Applying warm packs (D) could worsen the situation if there is a clot present.
The patient is admitted to the unit with the diagnosis of rhabdomyolysis. The patient is started on intravenous (IV) fluids and IV mannitol. What action by the nurse is best?
- A. Assess the patient’s hearing.
- B. Assess the patient’s lungs.
- C. Decrease IV fluids once the diuretic has been administered.
- D. Give extra doses before giving radiological contrast agents.
Correct Answer: B
Rationale: The correct answer is B: Assess the patient's lungs. In rhabdomyolysis, muscle breakdown releases myoglobin which can cause kidney damage. Mannitol is given to prevent kidney damage by promoting diuresis. However, mannitol can also cause fluid overload and pulmonary edema. Therefore, assessing the patient's lungs is crucial to monitor for signs of fluid overload and prevent complications.
A: Assessing the patient's hearing is not directly related to the management of rhabdomyolysis and mannitol administration.
C: Decreasing IV fluids after administering a diuretic like mannitol can lead to inadequate fluid resuscitation and worsening kidney injury.
D: Giving extra doses before radiological contrast agents is not necessary in the context of rhabdomyolysis and mannitol administration.
A patient is admitted to the critical care unit with a diagnosis of diabetic ketoacidosis. Following aggressive fluid resuscitation and intravenous (IV) insulin administration, the blood glucose begins to normalize. In addition to glucose monitoring, which of the following electrolytes requires close monitoring?
- A. Calcium
- B. Chloride
- C. Potassium
- D. Sodium
Correct Answer: C
Rationale: The correct answer is C: Potassium. During treatment of diabetic ketoacidosis, as blood glucose levels decrease, potassium levels can quickly drop due to insulin therapy driving potassium into cells. Monitoring potassium levels closely is crucial to prevent hypokalemia, which can lead to life-threatening cardiac arrhythmias.
Choice A: Calcium - Calcium levels are not typically affected by diabetic ketoacidosis treatment and do not require immediate monitoring in this context.
Choice B: Chloride - Chloride levels are usually not significantly impacted by diabetic ketoacidosis treatment and do not need close monitoring in this case.
Choice D: Sodium - While sodium levels can be affected by dehydration in diabetic ketoacidosis, they are not as critical to monitor as potassium levels during treatment.
The nurse is caring for a patient with a diagnosis of head trauma. The nurse notes that the patient’s urine output has increased tremendously over the past 18 hours. The nurse suspects that the patient may be developing
- A. diabetes insipidus.
- B. diabetic ketoacidosis.
- C. hyperosmolar hyperglycemic syndrome.
- D. syndrome of inappropriate secretion of antidiuretic hormone.
Correct Answer: A
Rationale: Rationale: A patient with head trauma may develop diabetes insipidus due to damage to the hypothalamus or pituitary gland, leading to decreased secretion of antidiuretic hormone (ADH). This results in excessive urine output and thirst. Other options are incorrect because:
B: Diabetic ketoacidosis is associated with high blood sugar and ketones, not increased urine output.
C: Hyperosmolar hyperglycemic syndrome is characterized by extreme hyperglycemia, not increased urine output.
D: Syndrome of inappropriate secretion of antidiuretic hormone results in decreased urine output due to excess ADH.