NUR 326 Exam 1- jennifer fox/Lewis 10th
Chapter 63 Musculoskeletal Problems Evolve
NCLEX practice
"Unlock Academic Excellence with Expert-
Reviewed Content"
A diabetic client comes into the emergency room with the following manifestations: Lethargy,
symptoms of dehydration, orthostatic hypotension, abdominal pain, and Kussmaul respirations. Which
complication of diabetes do you suspect this client of experiencing? - -correct ans- -DKA
What are the laboratory findings for DKA? Include BG, blood pH, and serum bicarbonate level. - -correct
ans- -BG > 250 mg/dL
pH <7.30
Bicarbonate < 15 mEq/L
Emergency treatment for a pt. experiencing DKA/HHS (bc they are similar). (5) - -correct ans- -1. Oxygen
administration!
2. Correct fluid/electrolyte imbalance, such as potassium
3. Make sure to add 5% dextrose to regimen once BG is nearing 250 to prevent hypoglycemia.
4. Insulin therapy WITHHELD until fluid resuscitation has begun.
5. Administer fluid bolus after insulin drip to prevent depletion of vascular volume.
-Only difference between DKA and HHS is that HHS requires a greater fluid replacement.
,Hyperosmolar hyperglycemic syndrome is more common in patients with ___ __ diabetes. - -correct
ans- -Type 2
List 2 common causes of HHS. - -correct ans- -1. UTI, pneumonia, any acute illness
2. Newly diagnosed type 2 diabetes
Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this
measure is important to identify:
1. Dysrhythmias resulting from hypokalemia.
2. Fluid overload resulting from aggressive fluid replacement.
3. The presence of hypovolemic shock related to osmotic diuresis.
4. Cardiovascular collapse resulting from the effects of excess glucose on cardiac cells. - -correct ans- -A
(Electrolytes are depleted in diabetic ketoacidosis. Osmotic diuresis occurs with depletion of sodium,
potassium, chloride, magnesium, and phosphate. Hypokalemia may lead to ventricular dysrhythmias
such as premature ventricular complexes and bradycardia.)
Patients recovering from DKA/HHS should be closely monitored. Which three organ systems should be
monitored? - -correct ans- -1. Renal status (Kidneys)
2. Cardiopulmonary status (Heart and lungs)
3. LOC (Neurological)
Which complication of diabetes is most common in older adult clients? >65 - -correct ans- -HHS
With comparing DKA and HHS, a client with DKA will have a pH of ___ __ ___ and a client with HHS will
have a pH of ____ __ ___. - -correct ans- -Less than 7.35. Greater than 7.45.
A nurse is assessing a client who has DKA and ketones in the urine. The nurse should expect which of the
following findings? (Select all that apply.)
, a. Weight gain
b. Fruity odor of breath
c. Abdominal pain
d. Kussmaul respirations
e. Metabolic acidosis - -correct ans- -B C D E
A nurse is reviewing lab results of a client who has HHS. The nurse should expect which of the following
findings?
a. Serum pH 7.2
b. Serum osmolarity 350 mOsm/L
c. Serum potassium 3.8 mg/dL
d. Serum creatinine 0.8 mg/dL - -correct ans- -B (The pH would be alkaline. The potassium would be low.
The serum creatinine would be greater than 1.5 mg/dL.)
A nurse is preparing to administer IV fluids to a client who has diabetic ketoacidosis. Which of the
following actions should the nurse take?
a. Administer an IV infusion of regular insulin at 0.3 unit/kg/hr
b. Administer an IV infusion of 0.45% sodium chloride
c. Rapidly administer an IV infusion of 0.9% sodium chloride
d. Add glucose to the IV infusion when serum glucose is 350 mg/dL - -correct ans- -C (The nurse should
rapidly administer and IV infusion of 0.9% sodium chloride, an isotonic fluid, as prescribed to maintain
blood profusion to vital organs.)
A nurse is providing discharge teaching to a client who has experienced diabetic ketoacidosis. Which of
the following information should the nurse include in the teaching? (Select all that apply.)
Chapter 63 Musculoskeletal Problems Evolve
NCLEX practice
"Unlock Academic Excellence with Expert-
Reviewed Content"
A diabetic client comes into the emergency room with the following manifestations: Lethargy,
symptoms of dehydration, orthostatic hypotension, abdominal pain, and Kussmaul respirations. Which
complication of diabetes do you suspect this client of experiencing? - -correct ans- -DKA
What are the laboratory findings for DKA? Include BG, blood pH, and serum bicarbonate level. - -correct
ans- -BG > 250 mg/dL
pH <7.30
Bicarbonate < 15 mEq/L
Emergency treatment for a pt. experiencing DKA/HHS (bc they are similar). (5) - -correct ans- -1. Oxygen
administration!
2. Correct fluid/electrolyte imbalance, such as potassium
3. Make sure to add 5% dextrose to regimen once BG is nearing 250 to prevent hypoglycemia.
4. Insulin therapy WITHHELD until fluid resuscitation has begun.
5. Administer fluid bolus after insulin drip to prevent depletion of vascular volume.
-Only difference between DKA and HHS is that HHS requires a greater fluid replacement.
,Hyperosmolar hyperglycemic syndrome is more common in patients with ___ __ diabetes. - -correct
ans- -Type 2
List 2 common causes of HHS. - -correct ans- -1. UTI, pneumonia, any acute illness
2. Newly diagnosed type 2 diabetes
Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this
measure is important to identify:
1. Dysrhythmias resulting from hypokalemia.
2. Fluid overload resulting from aggressive fluid replacement.
3. The presence of hypovolemic shock related to osmotic diuresis.
4. Cardiovascular collapse resulting from the effects of excess glucose on cardiac cells. - -correct ans- -A
(Electrolytes are depleted in diabetic ketoacidosis. Osmotic diuresis occurs with depletion of sodium,
potassium, chloride, magnesium, and phosphate. Hypokalemia may lead to ventricular dysrhythmias
such as premature ventricular complexes and bradycardia.)
Patients recovering from DKA/HHS should be closely monitored. Which three organ systems should be
monitored? - -correct ans- -1. Renal status (Kidneys)
2. Cardiopulmonary status (Heart and lungs)
3. LOC (Neurological)
Which complication of diabetes is most common in older adult clients? >65 - -correct ans- -HHS
With comparing DKA and HHS, a client with DKA will have a pH of ___ __ ___ and a client with HHS will
have a pH of ____ __ ___. - -correct ans- -Less than 7.35. Greater than 7.45.
A nurse is assessing a client who has DKA and ketones in the urine. The nurse should expect which of the
following findings? (Select all that apply.)
, a. Weight gain
b. Fruity odor of breath
c. Abdominal pain
d. Kussmaul respirations
e. Metabolic acidosis - -correct ans- -B C D E
A nurse is reviewing lab results of a client who has HHS. The nurse should expect which of the following
findings?
a. Serum pH 7.2
b. Serum osmolarity 350 mOsm/L
c. Serum potassium 3.8 mg/dL
d. Serum creatinine 0.8 mg/dL - -correct ans- -B (The pH would be alkaline. The potassium would be low.
The serum creatinine would be greater than 1.5 mg/dL.)
A nurse is preparing to administer IV fluids to a client who has diabetic ketoacidosis. Which of the
following actions should the nurse take?
a. Administer an IV infusion of regular insulin at 0.3 unit/kg/hr
b. Administer an IV infusion of 0.45% sodium chloride
c. Rapidly administer an IV infusion of 0.9% sodium chloride
d. Add glucose to the IV infusion when serum glucose is 350 mg/dL - -correct ans- -C (The nurse should
rapidly administer and IV infusion of 0.9% sodium chloride, an isotonic fluid, as prescribed to maintain
blood profusion to vital organs.)
A nurse is providing discharge teaching to a client who has experienced diabetic ketoacidosis. Which of
the following information should the nurse include in the teaching? (Select all that apply.)
