Diabetes Mellitus Complications (HHNS and DKA) NCLEX Exam Test
Questions with Verified Answers Rated A
The elderly patient with type 2 diabetes mellitus treatment of hyperkalemia, which causes peaked
presents to the clinic with a fever and productive T waves on cardiac monitoring. In HHS
cough. The diagnosis of pneumonia is made. hypokalemia may result from insulin moving the
You notice tenting skin, deep tongue furrows, potassium intracellularly. Fluid replacement
and vital signs of 110/80 mm Hg, 120 remains a priority, but it is given with dextrose.
beats/minute, and 24 breaths/minute. What The infusion rate of 40 mL/hour keeps the vein
assessment is important for you to obtain? open, but it is not the appropriate replacement
A. Blood glucose rate.
B. Orthostatic blood pressures
C. Urine ketones
D. Temperature - ANSWER -A. Blood What is a typical finding of hyperosmolar
glucose hyperglycemic syndrome (HHS)?
HHS is typically seen in patients with type 2 A. Occurs in type 1 diabetes as the presenting
diabetes and infection, such as pneumonia. The symptom
main presenting sign is a glucose level above B. Slow onset resulting in a blood glucose level
600 mg/dL. Enough evidence of dehydration greater than 600 mg/dL
already exists that orthostatic vital sign C. Ketone bodies higher than 4+ in urine
assessments are not a priority, and they are D. Signs and symptoms of diabetes insipidus -
often inaccurate in the elderly due to poor ANSWER -B. Slow onset resulting in a
vascular tone. Patients with HHS do not have blood glucose level greater than 600 mg/dL
elevated ketone levels, which is a key distinction HHS has a slower onset than diabetic
between HHS and DKA. Temperature will ketoacidosis. HHS is often related to impaired
eventually be taken but is often blunted in the thirst sensation, inadequate fluid intake, or
elderly and diabetics. An infectious diagnosis has functional inability to replace fluids. Because of
already been made. The glucose level for the slower onset, the blood glucose levels can be
appropriate fluid and insulin treatment is the quite high (more than 600 mg/dL) before
priority. diagnosis. HHS is seen in type 2 diabetics, and
there is enough circulating insulin to prevent
ketoacidosis. Diabetes insipidus is related to
The patient with HHS presented with a glucose inadequate antidiuretic hormone secretion or
level of 800 mg/dL and is started on IV fluids and kidney response with dilute, frequent urination. It
insulin. What action do you anticipate when the is not related to HHS.
patient's glucose reaches 250 mg/dL?
A. Administer an intravenous (IV) solution with
5% dextrose. A diabetic patient has a serum glucose level of
B. Administer sodium polystyrene sulfate 824 mg/dL (45.7 mmol/L) and is unresponsive.
(Kayexalate). After assessment of the patient, you suspect
C. Slow the IV infusion rate to 40 mL/hour. DKA rather than HHS based on the finding of
D. Assess cardiac monitoring for peaked T A. polyuria.
waves. - ANSWER -A. Administer an B. severe dehydration.
intravenous (IV) solution with 5% dextrose. C. rapid, deep respirations.
When blood glucose levels fall to approximately D. decreased serum potassium. -
250 mg/dL, IV fluids containing glucose are ANSWER -C. rapid, deep respirations.
administered to prevent hypoglycemia. Rapid, deep respirations are Kussmaul's and are
Kayexalate (for cation exchange) is used in the are the body's attempt to reverse metabolic
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, Diabetes Mellitus Complications (HHNS and DKA) NCLEX Exam Test
Questions with Verified Answers Rated A
acidosis through exhalation of excess carbon sacral area. The Kussmaul respirations are
dioxide. Symptoms of DKA include expected; crackles auscultated in the lungs are a
manifestations of dehydration, such as poor skin more sensitive indicator. The desired urine output
turgor, dry mucous membranes, tachycardia, and for adequate hydration is 30 to 60 mL/hr.
orthostatic hypotension. Kussmaul respirations
(rapid, deep breathing associated with dyspnea)
are the body's attempt to reverse metabolic The patient presents to the emergency
acidosis through exhalation of excess carbon department with a glucose level of 400 mg/dL,
dioxide. Acetone is detected on the breath as a ketone result of 2+, and rapid respirations with a
sweet, fruity odor. fruity odor. What finding do you anticipate?
A. pH below 7.30
B. Urine specific gravity below 1.005
What is a finding in DKA that is not seen in C. High sodium bicarbonate levels
hyperosmolar hyperglycemic syndrome (HHS)? D. Low blood urea nitrogen (BUN) level -
A. Glucose level above 400 mg/dL ANSWER -A. pH below 7.30
B. Hyperkalemia The patient is in metabolic acidosis, which is a
C. Ketones in blood pH below 7.35. Dehydration results in a high
D. Urine output of 30 mL/hr - ANSWER -C. urine specific gravity (at the upper end of the
Ketones in blood normal range, or above 1.025 to 1.030). Sodium
The main difference between the two conditions bicarbonate levels are low in metabolic acidosis.
is that ketone bodies are absent or minimal in The dehydration that occurs with DKA elevates
HHS because the body has enough insulin to the BUN level.
prevent ketoacidosis. Both have high glucose
levels, although the level in HHS tends to be
higher (above 600 mg/dL). Hypokalemia is The patient in the emergency department is
possible in both, although it is more likely and diagnosed with diabetic ketoacidosis. Which
serious in DKA. Urine output of 30 mL/hr is laboratory value is essential for you to monitor?
normal obligatory output; both conditions are A. Magnesium (Mg)
likely to have dehydration and decreased output. B. Hemoglobin (Hb)
C. White blood cells (WBCs)
D. Potassium (K) - ANSWER -D. Potassium
Which assessment is the most sensitive indicator (K)
that the IV fluid administration may be too rapid Even if the patient has normal potassium levels,
when treating a patient with DKA and a history of there can be significant hypokalemia when insulin
renal disease? is administered as it pushes the serum potassium
A. Pedal edema intracellularly. This can lead to life-threatening
B. Tachypnea hypokalemia. The other options are not as
C. Urine output of 40 mL/hour significant.
D. Change in the level of consciousness -
ANSWER -D. Change in the level of
consciousness The patient with type 1 diabetes arrives in the
Too rapid fluid replacement can lead to emergency department with a glucose level of
hyponatremia and cerebral edema. Pedal edema 390 mg/dL and positive result for ketones. Vital
is a later and relatively insignificant sign. In a signs are 110/70 mm Hg, 120 beats/minute, and
bedridden patient, edema is more evident in the 28 deep, sighing respirations/minute. What is the
2/6
Questions with Verified Answers Rated A
The elderly patient with type 2 diabetes mellitus treatment of hyperkalemia, which causes peaked
presents to the clinic with a fever and productive T waves on cardiac monitoring. In HHS
cough. The diagnosis of pneumonia is made. hypokalemia may result from insulin moving the
You notice tenting skin, deep tongue furrows, potassium intracellularly. Fluid replacement
and vital signs of 110/80 mm Hg, 120 remains a priority, but it is given with dextrose.
beats/minute, and 24 breaths/minute. What The infusion rate of 40 mL/hour keeps the vein
assessment is important for you to obtain? open, but it is not the appropriate replacement
A. Blood glucose rate.
B. Orthostatic blood pressures
C. Urine ketones
D. Temperature - ANSWER -A. Blood What is a typical finding of hyperosmolar
glucose hyperglycemic syndrome (HHS)?
HHS is typically seen in patients with type 2 A. Occurs in type 1 diabetes as the presenting
diabetes and infection, such as pneumonia. The symptom
main presenting sign is a glucose level above B. Slow onset resulting in a blood glucose level
600 mg/dL. Enough evidence of dehydration greater than 600 mg/dL
already exists that orthostatic vital sign C. Ketone bodies higher than 4+ in urine
assessments are not a priority, and they are D. Signs and symptoms of diabetes insipidus -
often inaccurate in the elderly due to poor ANSWER -B. Slow onset resulting in a
vascular tone. Patients with HHS do not have blood glucose level greater than 600 mg/dL
elevated ketone levels, which is a key distinction HHS has a slower onset than diabetic
between HHS and DKA. Temperature will ketoacidosis. HHS is often related to impaired
eventually be taken but is often blunted in the thirst sensation, inadequate fluid intake, or
elderly and diabetics. An infectious diagnosis has functional inability to replace fluids. Because of
already been made. The glucose level for the slower onset, the blood glucose levels can be
appropriate fluid and insulin treatment is the quite high (more than 600 mg/dL) before
priority. diagnosis. HHS is seen in type 2 diabetics, and
there is enough circulating insulin to prevent
ketoacidosis. Diabetes insipidus is related to
The patient with HHS presented with a glucose inadequate antidiuretic hormone secretion or
level of 800 mg/dL and is started on IV fluids and kidney response with dilute, frequent urination. It
insulin. What action do you anticipate when the is not related to HHS.
patient's glucose reaches 250 mg/dL?
A. Administer an intravenous (IV) solution with
5% dextrose. A diabetic patient has a serum glucose level of
B. Administer sodium polystyrene sulfate 824 mg/dL (45.7 mmol/L) and is unresponsive.
(Kayexalate). After assessment of the patient, you suspect
C. Slow the IV infusion rate to 40 mL/hour. DKA rather than HHS based on the finding of
D. Assess cardiac monitoring for peaked T A. polyuria.
waves. - ANSWER -A. Administer an B. severe dehydration.
intravenous (IV) solution with 5% dextrose. C. rapid, deep respirations.
When blood glucose levels fall to approximately D. decreased serum potassium. -
250 mg/dL, IV fluids containing glucose are ANSWER -C. rapid, deep respirations.
administered to prevent hypoglycemia. Rapid, deep respirations are Kussmaul's and are
Kayexalate (for cation exchange) is used in the are the body's attempt to reverse metabolic
1/6
, Diabetes Mellitus Complications (HHNS and DKA) NCLEX Exam Test
Questions with Verified Answers Rated A
acidosis through exhalation of excess carbon sacral area. The Kussmaul respirations are
dioxide. Symptoms of DKA include expected; crackles auscultated in the lungs are a
manifestations of dehydration, such as poor skin more sensitive indicator. The desired urine output
turgor, dry mucous membranes, tachycardia, and for adequate hydration is 30 to 60 mL/hr.
orthostatic hypotension. Kussmaul respirations
(rapid, deep breathing associated with dyspnea)
are the body's attempt to reverse metabolic The patient presents to the emergency
acidosis through exhalation of excess carbon department with a glucose level of 400 mg/dL,
dioxide. Acetone is detected on the breath as a ketone result of 2+, and rapid respirations with a
sweet, fruity odor. fruity odor. What finding do you anticipate?
A. pH below 7.30
B. Urine specific gravity below 1.005
What is a finding in DKA that is not seen in C. High sodium bicarbonate levels
hyperosmolar hyperglycemic syndrome (HHS)? D. Low blood urea nitrogen (BUN) level -
A. Glucose level above 400 mg/dL ANSWER -A. pH below 7.30
B. Hyperkalemia The patient is in metabolic acidosis, which is a
C. Ketones in blood pH below 7.35. Dehydration results in a high
D. Urine output of 30 mL/hr - ANSWER -C. urine specific gravity (at the upper end of the
Ketones in blood normal range, or above 1.025 to 1.030). Sodium
The main difference between the two conditions bicarbonate levels are low in metabolic acidosis.
is that ketone bodies are absent or minimal in The dehydration that occurs with DKA elevates
HHS because the body has enough insulin to the BUN level.
prevent ketoacidosis. Both have high glucose
levels, although the level in HHS tends to be
higher (above 600 mg/dL). Hypokalemia is The patient in the emergency department is
possible in both, although it is more likely and diagnosed with diabetic ketoacidosis. Which
serious in DKA. Urine output of 30 mL/hr is laboratory value is essential for you to monitor?
normal obligatory output; both conditions are A. Magnesium (Mg)
likely to have dehydration and decreased output. B. Hemoglobin (Hb)
C. White blood cells (WBCs)
D. Potassium (K) - ANSWER -D. Potassium
Which assessment is the most sensitive indicator (K)
that the IV fluid administration may be too rapid Even if the patient has normal potassium levels,
when treating a patient with DKA and a history of there can be significant hypokalemia when insulin
renal disease? is administered as it pushes the serum potassium
A. Pedal edema intracellularly. This can lead to life-threatening
B. Tachypnea hypokalemia. The other options are not as
C. Urine output of 40 mL/hour significant.
D. Change in the level of consciousness -
ANSWER -D. Change in the level of
consciousness The patient with type 1 diabetes arrives in the
Too rapid fluid replacement can lead to emergency department with a glucose level of
hyponatremia and cerebral edema. Pedal edema 390 mg/dL and positive result for ketones. Vital
is a later and relatively insignificant sign. In a signs are 110/70 mm Hg, 120 beats/minute, and
bedridden patient, edema is more evident in the 28 deep, sighing respirations/minute. What is the
2/6
