, Question 1
A patient with type 1 diabetes is admitted with diabetic ketoacidosis (DKA).
After initiating an insulin infusion, the serum potassium is 4.1 mEq/L. Which
action should the nurse anticipate?
A. Administer potassium chloride 20 mEq IV over 1 hour.
B. Hold insulin and recheck potassium in 2 hours.
C. Continue insulin infusion and monitor potassium closely.
D. Administer sodium bicarbonate to correct acidosis.
Correct Answer: C - Continue insulin infusion and monitor
potassium closely.
RATIONALE
In DKA, insulin drives potassium into cells, causing serum potassium
to fall; with a potassium of 4.1 mEq/L, continued monitoring is
essential and potassium replacement may be needed if it drops below
3.5 mEq/L. Holding insulin would worsen hyperglycemia and ketosis.
IV potassium is not indicated at 4.1 mEq/L unless levels fall.
Bicarbonate is reserved for severe acidosis (pH < 6.9).
Question 2
A patient with syndrome of inappropriate antidiuretic hormone (SIADH) has a
serum sodium of 118 mEq/L. Which intervention is the priority?
A. Administer 3% hypertonic saline via central line.
B. Restrict fluid intake to 800 mL/day.
C. Administer furosemide 40 mg IV push.
D. Initiate seizure precautions and monitor neurologic status.
Correct Answer: D - Initiate seizure precautions and monitor
neurologic status.
Page 2
, RATIONALE
Severe hyponatremia (<120 mEq/L) poses a high risk for seizures and
cerebral edema, making neurologic monitoring and seizure
precautions the priority. Hypertonic saline is indicated for
symptomatic hyponatremia but must be given cautiously to avoid
osmotic demyelination; it is not the first independent nursing action.
Fluid restriction is a treatment for SIADH but is not the immediate
priority in a symptomatic patient. Furosemide may be used but is not
first-line in this acute presentation.
Question 3
Which assessment finding best differentiates diabetic ketoacidosis (DKA) from
hyperglycemic hyperosmolar state (HHS)?
A. Blood glucose >600 mg/dL
B. Serum osmolality >320 mOsm/kg
C. Presence of ketonuria and metabolic acidosis
D. Profound dehydration and neurologic deficits
Correct Answer: C - Presence of ketonuria and metabolic acidosis
RATIONALE
DKA is characterized by ketone production and metabolic acidosis,
whereas HHS typically lacks significant ketosis and acidosis.
Hyperglycemia and hyperosmolality can be present in both but are
more pronounced in HHS. Neurologic deficits are more common in
HHS due to severe hyperosmolality. The presence of ketonuria and
acidosis is the key differentiator.
Question 4
A patient with Addisonian crisis is receiving IV hydrocortisone. Which nursing
action is essential during the acute phase?
A. Monitor blood glucose every 6 hours.
B. Assess for signs of hyperkalemia and hypotension.
C. Restrict sodium intake to prevent fluid overload.
Page 3
, D. Administer insulin to manage hyperglycemia.
Correct Answer: B - Assess for signs of hyperkalemia and
hypotension.
RATIONALE
Addisonian crisis involves cortisol and aldosterone deficiency, leading
to hyperkalemia, hyponatremia, and hypotension; monitoring for these
is critical. Blood glucose may be low, not high, so insulin is not
indicated. Sodium restriction is contraindicated; sodium and fluid
replacement are needed. Glucose monitoring is important but less
specific than electrolyte and hemodynamic assessment.
Question 5
A patient with type 2 diabetes on metformin is scheduled for a
contrast-enhanced CT scan. Which instruction should the nurse provide?
A. Continue metformin as prescribed.
B. Hold metformin for 48 hours before the procedure.
C. Hold metformin on the day of the procedure and resume after 48 hours
if renal function is normal.
D. Take an extra dose of metformin after the procedure.
Correct Answer: C - Hold metformin on the day of the procedure
and resume after 48 hours if renal function is normal.
RATIONALE
Metformin should be withheld at the time of contrast administration
and for 48 hours afterward due to the risk of contrast-induced
nephropathy and lactic acidosis; resumption depends on stable renal
function. Continuing metformin increases risk. Holding for 48 hours
before is unnecessary and may cause hyperglycemia. Taking an extra
dose is unsafe.
Page 4
A patient with type 1 diabetes is admitted with diabetic ketoacidosis (DKA).
After initiating an insulin infusion, the serum potassium is 4.1 mEq/L. Which
action should the nurse anticipate?
A. Administer potassium chloride 20 mEq IV over 1 hour.
B. Hold insulin and recheck potassium in 2 hours.
C. Continue insulin infusion and monitor potassium closely.
D. Administer sodium bicarbonate to correct acidosis.
Correct Answer: C - Continue insulin infusion and monitor
potassium closely.
RATIONALE
In DKA, insulin drives potassium into cells, causing serum potassium
to fall; with a potassium of 4.1 mEq/L, continued monitoring is
essential and potassium replacement may be needed if it drops below
3.5 mEq/L. Holding insulin would worsen hyperglycemia and ketosis.
IV potassium is not indicated at 4.1 mEq/L unless levels fall.
Bicarbonate is reserved for severe acidosis (pH < 6.9).
Question 2
A patient with syndrome of inappropriate antidiuretic hormone (SIADH) has a
serum sodium of 118 mEq/L. Which intervention is the priority?
A. Administer 3% hypertonic saline via central line.
B. Restrict fluid intake to 800 mL/day.
C. Administer furosemide 40 mg IV push.
D. Initiate seizure precautions and monitor neurologic status.
Correct Answer: D - Initiate seizure precautions and monitor
neurologic status.
Page 2
, RATIONALE
Severe hyponatremia (<120 mEq/L) poses a high risk for seizures and
cerebral edema, making neurologic monitoring and seizure
precautions the priority. Hypertonic saline is indicated for
symptomatic hyponatremia but must be given cautiously to avoid
osmotic demyelination; it is not the first independent nursing action.
Fluid restriction is a treatment for SIADH but is not the immediate
priority in a symptomatic patient. Furosemide may be used but is not
first-line in this acute presentation.
Question 3
Which assessment finding best differentiates diabetic ketoacidosis (DKA) from
hyperglycemic hyperosmolar state (HHS)?
A. Blood glucose >600 mg/dL
B. Serum osmolality >320 mOsm/kg
C. Presence of ketonuria and metabolic acidosis
D. Profound dehydration and neurologic deficits
Correct Answer: C - Presence of ketonuria and metabolic acidosis
RATIONALE
DKA is characterized by ketone production and metabolic acidosis,
whereas HHS typically lacks significant ketosis and acidosis.
Hyperglycemia and hyperosmolality can be present in both but are
more pronounced in HHS. Neurologic deficits are more common in
HHS due to severe hyperosmolality. The presence of ketonuria and
acidosis is the key differentiator.
Question 4
A patient with Addisonian crisis is receiving IV hydrocortisone. Which nursing
action is essential during the acute phase?
A. Monitor blood glucose every 6 hours.
B. Assess for signs of hyperkalemia and hypotension.
C. Restrict sodium intake to prevent fluid overload.
Page 3
, D. Administer insulin to manage hyperglycemia.
Correct Answer: B - Assess for signs of hyperkalemia and
hypotension.
RATIONALE
Addisonian crisis involves cortisol and aldosterone deficiency, leading
to hyperkalemia, hyponatremia, and hypotension; monitoring for these
is critical. Blood glucose may be low, not high, so insulin is not
indicated. Sodium restriction is contraindicated; sodium and fluid
replacement are needed. Glucose monitoring is important but less
specific than electrolyte and hemodynamic assessment.
Question 5
A patient with type 2 diabetes on metformin is scheduled for a
contrast-enhanced CT scan. Which instruction should the nurse provide?
A. Continue metformin as prescribed.
B. Hold metformin for 48 hours before the procedure.
C. Hold metformin on the day of the procedure and resume after 48 hours
if renal function is normal.
D. Take an extra dose of metformin after the procedure.
Correct Answer: C - Hold metformin on the day of the procedure
and resume after 48 hours if renal function is normal.
RATIONALE
Metformin should be withheld at the time of contrast administration
and for 48 hours afterward due to the risk of contrast-induced
nephropathy and lactic acidosis; resumption depends on stable renal
function. Continuing metformin increases risk. Holding for 48 hours
before is unnecessary and may cause hyperglycemia. Taking an extra
dose is unsafe.
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