Saunders NCLEX Endocrine Latest
Exam 2023
A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription?
1.
Endotracheal intubation 2.
100 units of NPH insulin 3.
Intravenous infusion of normal saline 4.
Intravenous infusion of sodium bicarbonate - Correct answer Intravenous infusion of normal saline
The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The
use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHS.
An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the nurse about the functioning of the pump, the nurse bases the response on which information about the pump? 1.
1 It is timed to release programmed doses of either short-duration or NPH insulin into the bloodstream at specific intervals. 2.
It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels. 3.
It is surgically attached to the pancreas and infuses regular insulin into the pancreas. This releases insulin into the bloodstream. 4.
It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal. - Correct answer It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal.
An insulin pump provides a small continuous dose of short-duration (rapid- or short-acting) insulin subcutaneously throughout the day and night. The client can self-administer an additional bolus dose from the pump before each meal as needed. Short-duration insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply.
1.
Increase in pH 2.
Comatose state 3.
Deep, rapid breathing 4.
Decreased urine output 5.
Elevated blood glucose level - Correct answer 2.
2 Comatose state 3.
Deep, rapid breathing
5.
Elevated blood glucose level
Because of the profound deficiency of insulin associated with DKA, glucose
cannot be used for energy and the body breaks down fat as a secondary source of energy. Ketones, which are acid byproducts of fat metabolism, build up and the client experiences a metabolic ketoacidosis. High serum glucose contributes to an osmotic diuresis and the client becomes severely dehydrated. If untreated, the client will become comatose due to severe dehydration, acidosis, and electrolyte imbalance. Kussmaul's respirations, the deep rapid breathing associated with DKA, is a compensatory mechanism by the body. The body attempts to correct the acidotic state by blowing off carbon dioxide (CO2), which is an acid. In the absence of insulin, the client will experience severe hyperglycemia. Option 1 is incorrect because in acidosis the pH would be low. Option 4 is incorrect because a high serum glucose will result in an osmotic diuresis and the client will experience polyuria.
The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptom or symptoms develop? Select all that apply.
1.
Polyuria 2.
Shakiness 3.
Palpitations 4.
Blurred vision 5.
3 Lightheadedness 6.
Fruity breath odor - Correct answer 2.
Shakiness 3.
Palpitations 5.
Lightheadedness
Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.
A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the appropriate intervention to decrease the client's anxiety? 1.
Administer a sedative. 2.
Convey empathy, trust, and respect toward the client. 3.
Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear. 4.
Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening. - Correct answer Convey empathy, trust, and respect toward the client.
Anxiety is a subjective feeling of apprehension, uneasiness, or dread. The appropriate intervention is to address the client's feelings related to the anxiety. Administering a sedative is not the most appropriate intervention and does not address the source of the client's anxiety. The nurse should 4
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