NUR 445 Exam 3 Practice Questions and
Correct Answers
What are some factors that contribute to hyperglycemia? ✅increased cortisol
production, release of cytokines/mediators in response to stress/infection/trauma,
invasive devices and mechanical ventilation, overfeeding combined with immobility
Why is hyperglycemia an issue for critically ill patients? ✅at risk for poor wound
healing, impaired immune response to infection, increased inflammation, precipitates
endothelial dysfunction
What range is considered "tight" glycemic control? ✅80-110 mg/dL
What stressors precipitate a hypermetabolic state? ✅MI, trauma, burns, surgery,
severe illness
What blood glucose range is recommended for the critically ill patient with persistent
hyperglycemia on insulin therapy? ✅140-180 mg/dL
Why is interrupting nutrition a concern in the critically ill patient on an insulin drip?
✅can lead to hypoglycemia
What are some recommendations for treating hyperglycemia and decreasing risk of
hypoglycemia? ✅treated with IV insulin, BS range of 140-180, glucose calorie source
and Q1/2 BS checks and then Q4, low fingerstick BS should be confirmed with blood or
plasma sample
When transitioning a patient from an IV insulin drip to SQ long acting insulin, when must
the SQ insulin be given? ✅at least 2 hours prior to discontinuation of the infusion
What are the treatment goals for hyperglycemic crises? ✅restore F/E balance, IV
insulin, replace glucose if BS <250, identify cause
What does DKA result from? ✅absolute or relative deficiency in insulin
What is the patient profile for DKA? ✅T1DM, can develop in T2DM, younger than 45,
non-white, female
What are some precipitating factors for DKA? ✅insufficient insulin therapy coverage,
insufficient food intake, infection, stroke, MI, trauma, alcohol abuse, thiazide diuretics,
corticosteroids, pentamidine, sympathomimetic agents, etc.
,What is the most common factor causing DKA? ✅infection
How can infection cause DKA? ✅increased production of glucocorticoids by adrenal
gland, stimulating gluconeogenesis by liver
What effect does stress have on production of epinephrine, growth hormone and
cortisol? ✅increases epinephrine/growth hormone/cortisol, which increases BS
What are the major characteristics of DKA? ✅hyperglycemia, ketosis, high anion-gap
metabolic acidosis, osmotic diuresis
What pH, BS, and anion gap is required for DKA? ✅pH < 7.3; BS > 250; anion gap >
10
When is HHS typically seen in patients? ✅older adults with new onset or previously
diagnosed T2DM
What two characteristics are seen with HHS? ✅extreme hyperglycemia and severe
osmotic diuresis
What age group is most common for DKA? ✅<45 years old
What type of diabetic is most affected by DKA? ✅T1DM
What blood sugar range is common with DKA? ✅>250 but <600
What level of bicarb is common in patients with DKA? ✅10-18 (low)
Does DKA present negative or positive for ketone bodies? ✅positive for ketone bodies
What is the normal arterial pH in DKA? ✅6.8-7.3
What is a normal serum osmolality for patients in DKA? ✅300-320
Is mortality common in DKA? ✅No; Less than 1%
What is the subsequent course of DKA? ✅required insulin therapy
What is the common anion gap in DKA? ✅high
What age group is most common for HHS? ✅<60 years old
What type of diabetes is affected by HHS? ✅T2DM
,What is a typical BS for a patient with HHS? ✅>600
How is mental status affected in HHS? ✅stupor or comatose
What level of bicarb is common in patients with HHS? ✅normal levels
Does HHS present negative or positive for ketone bodies? ✅negative or low ketone
bodies
What is the normal arterial pH for a patient with HHS? ✅>7.3
What are normal serum osmolality levels for a patient with HHS? ✅>320
What is the mortality rate for HHS? ✅5-20%
What is the subsequent course for HHS? ✅insulin therapy may not be required
What is the typical anion gap for a patient with HHS? ✅normal or slightly elevated
What is important to know regarding IV fluids for DKA/HHS? ✅manages mild
dehydration, severe hypovolemia, cardiogenic shock, or 5% dextrose in 0.45% saline
when BS reaches 200 (DKA) or 300 (HHS)
At what pH is it appropriate to administer bicarb for a patient with DKA/HHS? ✅pH <
6.9
How should potassium therapy be initiated for a patient with DKA/HHS? ✅high = check
Q2 hours; low = hold insulin, run KCl; endpoint therapy
What nursing diagnoses would apply to the patient in hyperglycemic crisis? ✅regain
normovolemic state, normalize glucose and ketones, normalize electrolytes, and
prevent future hyperglycemic crisis
What are some nursing interventions for a patient in a hyperglycemic state? ✅VS,
hemodynamic monitoring, I/Os, labs (CBC and electrolytes), jugular vein flat/collapsed,
large bore IV (or central line), fluid replacement, vasopressors, BS checks, serum and
urine ketones, ABGs, anion gap, assess LOC, Kussmaul respirations, initiate insulin
therapy, identify etiology, learning needs, and deficits
What is important to know regarding insulin therapy? ✅insulin therapy varies with
continuous drips and sliding scales to SQ sliding scales, but do not need to memorize
any particular doses
, What two organs are at risk with microvascular disease? ✅retina (eyes) and kidneys
What are acute care implications for peripheral vascular disease and increased risk for
infection in the patient in hyperglycemic crisis? ✅development of pressure ulcers,
infection, gangrene, or possible amputation
What are some common precipitating factors of hypoglycemic crisis in the critically ill
patient? ✅tachycardia, palpitations, hunger, sweating, nervous/anxiety, tremors,
cold/clammy skin, hyperventilation, tingling extremities, N/V, slowed thinking, change in
mental status, emotional lability, headache, dizziness, slurred speech, loss of
coordination/proprioception, numbness, drowsiness, convulsions, coma
What two factors influence the type of symptoms that predominate in the patient
experiencing hypoglycemic crisis? ✅the rate of onset and patient's age
What interventions are major goals for the patient experiencing a hypoglycemic crisis?
✅rapid restoration of intravascular fluid levels and normal BS levels, treat the
underlying cause
What 4 collaborative interventions are recommended for the hospitalized patient who is
experiencing acute onset mental alterations or hypoglycemia? ✅ABCs, IV access,
side-lying position, STAT blood glucose level, policy/procedure per agency
What are some nursing interventions for conscious patients with hypoglycemia?
✅glucose replacement, assess safety of medication administration, repeat BS Q15
until normal and then as ordered, monitor for relapse, encourage meals/snacks, report
episodes, document occurrences/assessments/interventions
What are some nursing interventions for unconscious patients with hypoglycemia?
✅glucose replacement (IV bolus of D5W, IV glucose infusion, or glucagon IM, BS Q30
and as ordered, monitor LOC and VS, report episodes, and document
occurence/assesments/interventions
What are dextrose and glucagon used for? ✅hypoglycemia treatment
What is the difference between dextrose and glucagon? ✅glucagon stimulates glucose
production, where dextrose directly increases BS
What is the normal dose for dextrose? ✅15-20g for mild, or 0.5-1g/kg in IV D5W if
altered LOC
What is the normal dose for glucagon? ✅1-2 mg SQ or IV
What are some side effects of dextrose? ✅hyperglycemia
