C HAPTER 32: E NDOCRINE D ISORDERS AND
T HERAPEUTIC M ANAGEMENT
Urden: Critical Care Nursing, 9th Edition
MULTIPLE CHOICE
1. A patient with diabetic ketoacidosis (DKA) has an insulin drip infusing,
and the nurse has just administered subcutaneous insulin. The nurse is
alert for signs of h ypogl ycemia, which would include what findings?
a. Kussmaul respirations and flushed skin
b. Irritabilit y and paresthesia
c. Abdominal cramps and nausea
d. Hypotension and itching
ANS: B
Irritabilit y and paresthesia are seen in hypogl ycemia.
PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 742 |
Box 32-8 OBJ: Nursing Process Step: Assessment TOP:
Endocrine MSC: NC LEX: Physiologic Integrit y
2. A patient was admitted with diabetic ketoacidosis (DKA) an hour ago and
is on an insulin drip. Suddenl y, the nurse notices freq uent premature
ventricular contractions (PVCs) on the electrocardiogram. The nurse
, notifies the practitioner. The nurse would anticipate an order for which
intervention?
a. A lidocaine bolus
b. Stopping the insulin drip
c. Synchronizing cardioversion
d. Obtaining serum electrol ytes
ANS: D
Hypokalemia can occur within the first hours of rehydration and
insulin treatment. Continuous cardiac monitoring is required, because
low serum potassium (hypokalemia) can cause ventricular
dysrhythmias.
PTS: 1 DIF: Cognitive Leve l: Appl ying REF: p. 741
OBJ: Nursing Process Step: Intervention TOP:
Endocrine MSC: NC LEX: Physiologic Integrit y
3. A patient with t ype 2 diabetes is admitted. He is very lethargic and
hypotensive. A diagnosis of hypergl ycemic hyperosmolar syndrome (HHS)
is given. Which findings support this diagnosis?
a. Decreased serum glucose and increased serum ketones
b. Increased urine ketones and decreased serum osmolalit y
c. Increased serum osmolalit y and increased serum potassium
d. Increased serum osmolalit y and increased s erum glucose
ANS: D
Laboratory findings are used to establish the definitive diagnosis of
hypergl ycemic hyperosmolar syndrome (HHS). Plasma glucose levels
, are strikingl y elevated (greater than 600 mg/dL). Serum osmolalit y is
greater than 320 mOsm/kg.
PTS: 1 DIF: Cognitive Level: Understanding REF: p.
743 OBJ: Nursing Process Step: Diagnosis TOP:
Endocrine MSC: NC LEX: Physiologic Integrit y
4. An older patient presents with a serum glucose level of 900 mg/dL,
hematocrit of 55%, and no serum ketones. Immediate attention must be
given to which intervention?
a. Evaluating clotting factors
b. Fluid administration
c. Insulin administration
d. Sodium replacement
ANS: B
The physical examination may reveal a profound fluid deficit. Signs of
severe dehydration include longitudi nal wrinkles in the tongue,
decreased salivation, and decreased central venous pressure, with
increases in heart rate and rapid respirations (Kussmaul air hunger does
not occur). In older patients, assessment of clinical signs of
dehydration is challenging .
PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 745
OBJ: Nursing Process Step: Assessment TOP:
Endocrine MSC: NC LEX: Physiologic Integrit y
, 5. A patient with hypergl ycemic hyperosmolar state (HHS) has a serum
glucose level of 400 mg/dL and a serum sodium le vel of 138 mEq/L. What
is the intravenous fluid of choice?
a. D5W
b. 0.45% NS
c. 0.9% NS
d. D5/NS
ANS: A
The fluid deficit may be as much as 150 mL/kg of body weight. The
average 150-lb adult can lose more than 7 to 10 L of fluid. Physiologic
saline solution (0.9%) is infused at 1 L/h, especiall y for patients in
hypovolemic shock if there is no cardiovascular contraindication.
Several liters of volume replacement may be required to achieve a
blood pressure and central venous pressure within normal range.
Infusion volumes are adjusted according to the patient’s hydration state
and sodium level.
PTS: 1 DIF: Cognitive Level: Understanding REF: p.
745 OBJ: Nursing Process Step: Intervention TOP:
Endocrine MSC: NC LEX: Physiologic Integrit y
6. A patient has been admitted with hyperosmolar hypergl ycemic state
(HHS). The nurse knows that intravenous insulin is usuall y administered
at what dosage?
a. 0.1 U/kg/h
b. 1.0 U/kg/h
c. 2.0 U/kg/h
d. 5.0 U/kg/h
T HERAPEUTIC M ANAGEMENT
Urden: Critical Care Nursing, 9th Edition
MULTIPLE CHOICE
1. A patient with diabetic ketoacidosis (DKA) has an insulin drip infusing,
and the nurse has just administered subcutaneous insulin. The nurse is
alert for signs of h ypogl ycemia, which would include what findings?
a. Kussmaul respirations and flushed skin
b. Irritabilit y and paresthesia
c. Abdominal cramps and nausea
d. Hypotension and itching
ANS: B
Irritabilit y and paresthesia are seen in hypogl ycemia.
PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 742 |
Box 32-8 OBJ: Nursing Process Step: Assessment TOP:
Endocrine MSC: NC LEX: Physiologic Integrit y
2. A patient was admitted with diabetic ketoacidosis (DKA) an hour ago and
is on an insulin drip. Suddenl y, the nurse notices freq uent premature
ventricular contractions (PVCs) on the electrocardiogram. The nurse
, notifies the practitioner. The nurse would anticipate an order for which
intervention?
a. A lidocaine bolus
b. Stopping the insulin drip
c. Synchronizing cardioversion
d. Obtaining serum electrol ytes
ANS: D
Hypokalemia can occur within the first hours of rehydration and
insulin treatment. Continuous cardiac monitoring is required, because
low serum potassium (hypokalemia) can cause ventricular
dysrhythmias.
PTS: 1 DIF: Cognitive Leve l: Appl ying REF: p. 741
OBJ: Nursing Process Step: Intervention TOP:
Endocrine MSC: NC LEX: Physiologic Integrit y
3. A patient with t ype 2 diabetes is admitted. He is very lethargic and
hypotensive. A diagnosis of hypergl ycemic hyperosmolar syndrome (HHS)
is given. Which findings support this diagnosis?
a. Decreased serum glucose and increased serum ketones
b. Increased urine ketones and decreased serum osmolalit y
c. Increased serum osmolalit y and increased serum potassium
d. Increased serum osmolalit y and increased s erum glucose
ANS: D
Laboratory findings are used to establish the definitive diagnosis of
hypergl ycemic hyperosmolar syndrome (HHS). Plasma glucose levels
, are strikingl y elevated (greater than 600 mg/dL). Serum osmolalit y is
greater than 320 mOsm/kg.
PTS: 1 DIF: Cognitive Level: Understanding REF: p.
743 OBJ: Nursing Process Step: Diagnosis TOP:
Endocrine MSC: NC LEX: Physiologic Integrit y
4. An older patient presents with a serum glucose level of 900 mg/dL,
hematocrit of 55%, and no serum ketones. Immediate attention must be
given to which intervention?
a. Evaluating clotting factors
b. Fluid administration
c. Insulin administration
d. Sodium replacement
ANS: B
The physical examination may reveal a profound fluid deficit. Signs of
severe dehydration include longitudi nal wrinkles in the tongue,
decreased salivation, and decreased central venous pressure, with
increases in heart rate and rapid respirations (Kussmaul air hunger does
not occur). In older patients, assessment of clinical signs of
dehydration is challenging .
PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 745
OBJ: Nursing Process Step: Assessment TOP:
Endocrine MSC: NC LEX: Physiologic Integrit y
, 5. A patient with hypergl ycemic hyperosmolar state (HHS) has a serum
glucose level of 400 mg/dL and a serum sodium le vel of 138 mEq/L. What
is the intravenous fluid of choice?
a. D5W
b. 0.45% NS
c. 0.9% NS
d. D5/NS
ANS: A
The fluid deficit may be as much as 150 mL/kg of body weight. The
average 150-lb adult can lose more than 7 to 10 L of fluid. Physiologic
saline solution (0.9%) is infused at 1 L/h, especiall y for patients in
hypovolemic shock if there is no cardiovascular contraindication.
Several liters of volume replacement may be required to achieve a
blood pressure and central venous pressure within normal range.
Infusion volumes are adjusted according to the patient’s hydration state
and sodium level.
PTS: 1 DIF: Cognitive Level: Understanding REF: p.
745 OBJ: Nursing Process Step: Intervention TOP:
Endocrine MSC: NC LEX: Physiologic Integrit y
6. A patient has been admitted with hyperosmolar hypergl ycemic state
(HHS). The nurse knows that intravenous insulin is usuall y administered
at what dosage?
a. 0.1 U/kg/h
b. 1.0 U/kg/h
c. 2.0 U/kg/h
d. 5.0 U/kg/h
