PCCN Revision Questions 2023

Blood-sugar elevation in the critically ill adult is common. Which of the following mechanisms explain this increase in blood sugar in the non-diabetic patient? A. medications such as epinephrine B. shivering C. temperature elevation D. change in position Correct Answers A. medications such as epinephrine Epinephrine is a pure catecholamine. This activates the sympathetic nervous system thereby increasing blood sugar by the fight or flight mechanism. Shivering, temperature elevation and changes in position may cause drops in serum glucose as the patient is utilizing energy. A 45-year old woman is admitted with type 1 diabetic mellitus. She is hyperventilating, has signs of dehydration (increased urine output and increased thirst), and is tachycardic. Initial treatment would include: A. Diazoxide (Hyperstat) to inhibit the release of insulin B. glucose for hypoglycemia C. insulin therapy for ketoacidosis, fluid and electrolyte replacement D. intravenous fluids for dehydration and glucose for hypoglycemia Correct Answers C. insulin therapy for ketoacidosis, fluid and electrolyte replacement The patient is exhibiting the signs and symptoms of diabetic ketoacidosis (DKA). Signs of dehydration, such as polydipsia and polyphagia, are due to large urine output, increased thirst is secondary to dehydration and tachycardia is due to sympathetic nervous system stimulation from an increased glucose level and ketosis. Initial treatment would include insulin therapy, re-hydration with fluids and electrolyte replacement. Diazoxide would not be used since it inhibits insulin release (this patient requires insulin to lower glucose). The patient is not hypoglycemia. Signs and symptoms of hypoglycemia are similar; tachycardia, change in behavior (irritability) or level of consciousness, sweating and shaking. To evaluate the outcomes of nutritional intervention for a patient with type 2 diabetes with a dating blood sugar of 130 mg/dL three months ago, which laboratory result would best indicate dietary compliance? A. fasting blood sugar of 106 mg/dL or less B. hemoglobin A1C of 6.6% C. hemoglobin A1C of 1.5% D. fasting blood sugar of 150 mg/dL Correct Answers B. hemoglobin A1C of 6.6% Hemoglobin A1C best describes the patient's blood sugars over a 3 month period. Hemoglobin A1C comprises hemoglobin A with a glucose molecule: because hemoglobin holds onto excess blood glucose, it demonstrates the average blood glucose levels over a 3 month period and between describes diet and medication compliance over time. Fasting blood sugar only demonstrates the patient's last 12 hour dietary discretion. The criteria for the diagnosis of metabolic syndrome include: A. hyperglycemia, hypertension, increased abdominal fat B. low blood sugar, obesity, history of STEMI C. low blood sugar, increased triglycerides, normal lipid panel D. hyperglycemia, normal lipid panel, malnutrition Correct AnswersA. hyperglycemia, hypertension, increased abdominal fat Metabolic syndrome is a constellation of medical disorders that, when occurring together, increase the risk of developing diabetes and cardiovascular disease, according to the 2005 NCEP update. This list of disorders include: hypertension (BP> 130/85), high blood sugar (fasting blood sugar>100), men with HDL less than 40, women with an HDL<50, high triglycerides(>150), and men with an abdominal girth greater than 40 inches and women with an abdominal girl greater than 30 inches. Dehydration in hyperosmolar hyperglycemia syndrome (HHS) is primary due to which event? A. lack of anti-diuretic hormone (ADH) B. inability of the kidneys to concentrate urine C. nausea and vomiting D. osmotic diuresis from very high blood glucose Correct Answers D. osmotic diuresis from very high blood glucose In HHS, the patient's blood sugar is extremely high, causing a severe fluid deficit. This dehydration is significant. Mortality is approximately 15% and its typically associated with a concurrent catastrophic illness such as a MI or sepsis or complications such as arrhymias or cerebral edemas. In hyperosmolar hyperglycemic syndrome (HHS) the patient has an initial hypokalemia. The nurse should: A. check the patient's potassium level before giving insulin B. monitor the heart rate before giving insulin C. monitor the patient's level of pain before administration of insulin D. no precautions are necessary Correct Answers A. check the patient's potassium level before giving insulin The patient in HHS will have low potassium initially and may require electrolyte replacement therapy before insulin is started. Insulin drives potassium out of the serum and into the cells. The resulting serum hypokalemia can lead to cardiac arrhythmias. Once insulin is given and a drip is started, close monitoring of potassium is required. The patient with HHS will have cardiac monitoring, and all patients will have close heart rate and rhythm monitoring, however, insulin does not require a heart rate requirement before administration. Monitoring the patient's level of pain is listed as a distracter. Which of the following laboratory diagnostic findings will most likely be seen in a disseminated intravascular coagulation (DIC)? A. PT and PTT prolonged B. fibrinogen increased C. platelet count increased D. D-dimer within normal limits Correct Answers A. PT and PTT prolonged In DIC, the patient has used up all his or her coagulation factors in making thrombus, so the PT and PTT are prolonged. Fibrinogen will be decreased (the body is using up all the clotting factors), platelet count is also decreased (must be below 100,00) and the D-dimer is elevated due to the thrombus formation in the microvascular space.