DIABETES [DKA/HHS FINAL EXAM
QUESTIONS AND ANSWERS VERIFIED
2023/2024
1. A patient with diabetes in the critical care unit is at risk for developing diabetic
ketoacidosis (DKA) 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?
QUESTIONS AND ANSWERS VERIFIED
2023/2024
1. A patient with diabetes in the critical care unit is at risk for developing diabetic
ketoacidosis (DKA) 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?
