Endocrine Disorders and Therapeutic Management
1. A patient with diabetes in the critical care unit is at risk for developing diabetic ketoacidosis (DKA)
... [Show More] secondary to
A. excess insulin administration.
B. inadequate food intake.
C. physiologic and psychologic stress.
D. increased release of antidiuretic hormone (ADH).
ANS C physiologic and psychologic stress.
Major neurologic and endocrine changes occur when an individual is confronted with physiologic stress caused by any critical illness, sepsis, trauma, major surgery, or underlying cardiovascular disease.
2. The hallmark of hyperglycemic hyperosmolar syndrome (HHS) is
A. hyperglycemia with low serum osmolality.
B. severe hyperglycemia with minimal or absent ketosis.
C. little or no ketosis in serum with rapidly escalating ketonuria.
D. hyperglycemia and ketosis.
ANS B severe hyperglycemia with minimal or absent ketosis.
The hallmarks of HHS are extremely high levels of plasma glucose with resulting elevations in serum hyperosmolality and osmotic diuresis. The disorder occurs mainly in patients with type II diabetes.
3. The primary intervention for hyperglycemic hyperosmolar syndrome (HHS) is
A. rapid rehydration.
B. monitoring vital signs.
C. high-dose intravenous (IV) insulin.
D. hourly urine sugar and acetone testing.
ANS A rapid rehydration.
The goals of medical management are rapid rehydration, insulin replacement, and correction of electrolyte abnormalities, specifically potassium replacement. The underlying stimulus of HHS must be discovered and treated. The same basic principles used to treat patients with diabetic ketoacidosis are used for patients with HHS.
4. Characteristics of diabetes insipidus (DI) are
A. hyperglycemia and hyperosmolarity.
B. hyperglycemia and peripheral edema.
C. intense thirst and passage of excessively large quantities of dilute urine.
D. peripheral edema and pulmonary crackles.
ANS C intense thirst and passage of excessively large quantities of dilute urine.
The clinical diagnosis is made by the dramatic increase in dilute urine output in the absence of diuretics, a fluid challenge, or hyperglycemia. Characteristics of DI are intense thirst and the passage of excessively large quantities of very dilute urine.
5. Patients with central DI are treated with
A. vasopressin.
B. insulin.
C. glucagon.
D. propylthiouracil.
ANS A vasopressin.
Patients with central DI who are unable to synthesize antidiuretic hormone (ADH) require replacement ADH (vasopressin) or an ADH analog. The most commonly prescribed drug is the synthetic analog of ADH,desmopressin (DDAVP). DDAVP can be given intravenously, subcutaneously, or as a nasal spray. A typical DDAVP dose is 1 to 2 mcg intravenously or subcutaneously every 12 hours.
6. In the syndrome of inappropriate antidiuretic hormone (SIADH), the physiologic effect is
A. massive diuresis, leading to hemoconcentration.
B. dilutional hyponatremia, reducing sodium concentration to critically low levels.
C. hypokalemia from massive diuresis.
D. serum osmolality greater than 350 mOsm/kg.
ANS B dilutional hyponatremia, reducing sodium concentration to critically low levels.
Patients with SIADH have an excess of antidiuretic hormone secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia.
7. Which of the following nursing interventions should be initiated on all patients with SIADH?
A. Placing the patient on an air mattress
B. Forcing fluids
C. Initiating seizure precautions
D. Applying soft restraints
ANS C Initiating seizure precautions
The patient with SIADH has an excess of ADH secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia. Symptoms of severe hyponatremia include an inability to concentrate, mental confusion, apprehension, seizures, a decreased level of consciousness, coma, and death.
8. A patient has a 10-year history of diabetes mellitus. The patient is admitted to the critical care unit with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which of the following symptoms is most suggestive of DKA?
A. Irritability
B. Excessive thirst
C. Rapid weight gain
D. Peripheral edema
ANS B Excessive thirst
DKA has a predictable clinical presentation. It is usually preceded by patient complaints of malaise, headache, polyuria (excessive urination), polydipsia (excessive thirst), and polyphagia (excessive hunger). Nausea, vomiting, extreme fatigue, dehydration, and weight loss follow. Central nervous system depression, with changes in the level of consciousness, can lead quickly to coma.
9. A patient has a 10-year history of diabetes mellitus. The patient is admitted to the critical care unit with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis.Which of the following statements best describes the rationale for administrating potassium supplements with the patient's insulin therapy?
A. Potassium replaces losses incurred with diuresis.
B. The patient has been in a long-term malnourished state.
C. IV potassium renders the infused solution isotonic.
D. Insulin drives the potassium back into the cells.
ANS D Insulin drives the potassium back into the cells.
Low serum potassium (hypokalemia) occurs as insulin promotes the return of potassium into the cell and metabolic acidosis is reversed. Replacement of potassium by administration of potassium chloride (KCl) begins as soon as the serum potassium falls below normal. Frequent verification of the serum potassium concentration is required for patients with DKA who are receiving fluid resuscitation and insulin therapy.
10. A patient has a 10-year history of diabetes mellitus. The patient is admitted to the critical care unit with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). The treatment of DKA involves
A. extensive hydration.
B. oral hypoglycemic agents.
C. large doses of IV insulin.
D. limiting food and fluids.
ANS A extensive hydration.
Rapid IV fluid replacement requires the use of a volumetric pump. Insulin is administered intravenously to patients who are severely dehydrated or have poor peripheral perfusion to ensure effective absorption. Patients with DKA are kept on NPO (nothing by mouth) status until the hyperglycemia is under control. Critical care nurses are responsible for monitoring the rate of plasma glucose decline in response to insulin.
11. The most common problem in the patient with type 2 diabetes is a(n)
A. lack of insulin production.
B. imbalance between insulin production and use.
C. overproduction of glucose.
D. increased uptake of glucose in the cells.
ANS B imbalance between insulin production and use.
Type 2 diabetes results from a progressive insulin secretory defect in addition to insulin resistance.
12. A patient weighs 140 kg and is 60 in. tall. The patient's blood sugar is being controlled by glipizide. As the nurse discusses discharge instructions, the primary treatment goal with this type 2 diabetes patient would be
A. signs of hypoglycemia.
B. proper injection technique.
C. weight loss.
D. increased caloric intake.
ANS C weight loss.
This patient weighs 308 lb and is 5 feet tall. Diet management and exercise are interventions to facilitate weight loss in patients with type 2 diabetes.
13. A patient is admitted to the unit with extreme fatigue, vomiting, and headache. This patient has type 1 diabetes but has been on an insulin pump for 6 months. He states, "I know it could not be my diabetes because my pump gives me 24-hour control." The nurse's best response would be
A. "You know a lot about your pump, and you are correct."
B. "You're right. This is probably a virus."
C. "We'll get an abdominal CT and see if your pancreas is inflamed."
D. "We'll check your serum blood glucose and ketones."
ANS D "We'll check your serum blood glucose and ketones."
Subcutaneous insulin pumps can malfunction. It is critical to assess glucose and ketone levels to evaluate for diabetic ketoacidosis.
14. A patient who has type 2 diabetes is on the unit after aneurysm repair. His serum glucose levels have been elevated for the past 2 days. He is concerned that he is becoming dependent on insulin. The best response for the nurse would be
A. "This surgery may have damaged your pancreas. We will have to do more evaluation."
B. "Perhaps your diabetes was more serious from the beginning."
C. "You will need to discuss this with your physician."
D. "The stress on your body has temporarily increased your blood sugar levels."
ANS D "The stress on your body has temporarily increased your blood sugar levels."
Adrenal hormones released during stress elevate blood sugar by increasing insulin resistance and increasing hepatic gluconeogenesis.
15. The nurse knows that the dehydration associated with diabetic ketoacidosis results from
A. increased serum osmolality and urea.
B. decreased serum osmolality and hyperglycemia.
C. ketones and potassium shifts.
D. acute renal failure.
ANS A increased serum osmolality and urea.
Hyperglycemia increases the plasma osmolality, and the blood becomes hyperosmolar. Cellular dehydration occurs as the hyperosmolar extracellular fluid draws the more dilute intracellular and interstitial fluid into the vascular space in an attempt to return the plasma osmolality to normal.
16. The nurse knows that the dehydration in diabetic ketoacidosis stimulates catecholamine release, which results in
A. decreased glucose release.
B. increased insulin release.
C. decreased cardiac contractility.
D. increased gluconeogenesis.
=ANS D
Dehydration stimulates catecholamine production in an effort to provide emergency support. Catecholamine output stimulates further glycogenolysis, lipolysis, and gluconeogenesis, pouring glucose into the bloodstream.
17. The major electrolyte disturbances that result from diuresis are
A. low calcium and high phosphorus levels.
B. low potassium and low sodium levels.
C. high sodium and low phosphorus levels.
D. low calcium and low potassium levels.
ANS B low potassium and low sodium levels.
Serum sodium may be low as a result of the movement of water from the intracellular space into the extracellular (vascular) space. The serum potassium level is often normal; a low serum potassium level in diabetic ketoacidosis suggests that a significant potassium deficiency may be present.
18. The patient admitted in diabetic ketoacidosis has dry, cracked lips and is begging for something to drink. The nurse's best response would be to
A. keep the patient NPO.
B. allow the patient a cup of coffee.
C. allow the patient water.
D. allow the patient to drink anything he chooses.
ANS C allow the patient water.
The thirst sensation is the body's attempt to correct the fluid deficit. Water is the best replacement.
19. A patient in diabetic ketoacidosis has the following arterial blood gasses: pH 7.25; pCO2 30 mm Hg; HCO3- 16. The patient has rapid, regular respirations. The nurse's best response would be to
A. ask the patient to breathe into a paper bag to retain CO2.
B. administer sodium bicarbonate.
C. administer insulin and fluids intravenously.
D. prepare for intubation.
ANS C administer insulin and fluids intravenously. [Show Less]