N5334 Diabetic case study
What is the mechanism that results in Kussmaul respirations?
A. To compensate for metabolic acidosis, the respirations are deep and rapid.
B. To overcome respiratory acidosis, the respirations are fast and shallow.
C. Injury to the brain's respiratory center results in periods of apnea.
D. Hypoxemia causes labored, gasping, and irregular respirations. - A. To compensate for metabolic
acidosis, the respirations are deep and rapid.
Rationale: To compensate for the ketoacidosis (metabolic acidosis), the lungs attempt to remove CO2
through a pattern of deep, rapid respirations referred to as Kussmaul respirations.
To achieve the goal of restoring the client's fluid volume, the nurse would expect to implement which
intervention?
A. Insert a saline lock for PRN diuretic administration.
B. Administer an albumin/furosemide continuous infusion.
C. Maintain an infusion of normal saline solution.
D. Obtain a type and crossmatch for 2 units of packed RBCs. - C. Maintain an infusion of normal saline
solution.
Rationale: The treatment of hyperglycemia includes fluid replacement to correct dehydration caused
by the increased concentration of glucose in the blood. Isotonic fluids, such as normal saline, are used
initially to treat the dehydration.
To restore the client's blood glucose to a normal level, what should the nurse prepare to administer?
A. An IV infusion containing regular insulin.
B. Humulin-N insulin SC before meals.
C. 50% dextrose IV push.
D. Glucagon subcutaneously PRN per sliding scale. - A. An IV infusion containing regular insulin.
,N5334 Diabetic case study
Rationale: Continuous IV infusions containing regular insulin are used to reduce the client's blood
glucose level. The client's IV solution will be changed to one that contains glucose when her blood
glucose level reaches 250 mg/dl.
In addition to monitoring the client's blood glucose level, what additional lab values should the nurse
monitor carefully? (Select all that apply. One, some, or all options may be correct.)
A. Uric acid.
B. Hemoglobin.
C. Calcium.
D. Potassium.
E. Blood Urea Nitrogen (BUN). - B, C, D, E.
Rationale: Though blood glucose and potassium are the most critical lab values to assess, hemoglobin
levels may be altered related to the state of hydration and should be monitored. Treatment with an IV
insulin infusion will cause the potassium to return to the cells and may result in hypokalemia. Lara
should be closely monitored for symptoms of hypokalemia. Supplemental potassium may be added to
the IV infusion to prevent or correct this. Dehydration that occurs with DKA can lead to an increased
BUN and should be monitored for signs of renal insufficiency.
Ethical-Legal Issues: Client Information
The client's blood glucose level stabilizes, and they begin taking oral fluids. IV solutions are switched
to dextrose 5% in sodium chloride 0.45% at a keep-open rate, and the insulin infusion is
discontinued.While hospitalized, family members and many of the client's college friends call the
nursing unit to check on the client's condition.
The nurse's decision about what to tell these callers should be based on what primary consideration?
A. The instructions of the nursing unit supervisor.
B. The nature of the caller's relationship to the client.
C. The seriousness of the client's condition at the time of the call.
, N5334 Diabetic case study
D. The client's right to privacy regarding her health information. - D. The client's right to privacy
regarding her health information.
Rationale: The Health Information Privacy Protection Act (HIPAA) stipulates that a client has the right
to privacy regarding health information and must give permission for the release of that information.
A student nurse is assigned to work with the charge nurse in caring for the client during their acute
illness. The student tells the nurse that they plan to present information about the client to fellow
students during a post-clinical conference, and asks the charge nurse for permission to copy the
client's lab data to take to the conference.
Which response is best for the charge nurse to provide?
A. Information about the client cannot be removed from the nursing unit.
B. The lab values can be copied as long as there is no identifying client data.
C. Since this is for educational purposes, you can remove any information you need.
D. Your instructor should tell you what information you are allowed to copy. - B. The lab values can be
copied as long as there is no identifying client data.
Rationale: Information used for educational purposes may be shared, as long as the data does not
permit identification of the client.
Manifestations: Once the acute ketoacidosis is controlled, the client is told that they have Type 1
diabetes mellitus. The nurse obtains the client's history. The client states that prior to the flu, they had
been healthy. However, the client had noticed that they had been eating more than normal, but had
not been gaining any weight. The client also states that they had been drinking a lot of diet colas and
that got up at night frequently to go to the bathroom.
The nurse identifies that the client has experienced classic symptoms of diabetes, which are:
A. Dysuria, dyspepsia, and dysphagia.
B. Polyuria, polyphagia, and polydipsia.
What is the mechanism that results in Kussmaul respirations?
A. To compensate for metabolic acidosis, the respirations are deep and rapid.
B. To overcome respiratory acidosis, the respirations are fast and shallow.
C. Injury to the brain's respiratory center results in periods of apnea.
D. Hypoxemia causes labored, gasping, and irregular respirations. - A. To compensate for metabolic
acidosis, the respirations are deep and rapid.
Rationale: To compensate for the ketoacidosis (metabolic acidosis), the lungs attempt to remove CO2
through a pattern of deep, rapid respirations referred to as Kussmaul respirations.
To achieve the goal of restoring the client's fluid volume, the nurse would expect to implement which
intervention?
A. Insert a saline lock for PRN diuretic administration.
B. Administer an albumin/furosemide continuous infusion.
C. Maintain an infusion of normal saline solution.
D. Obtain a type and crossmatch for 2 units of packed RBCs. - C. Maintain an infusion of normal saline
solution.
Rationale: The treatment of hyperglycemia includes fluid replacement to correct dehydration caused
by the increased concentration of glucose in the blood. Isotonic fluids, such as normal saline, are used
initially to treat the dehydration.
To restore the client's blood glucose to a normal level, what should the nurse prepare to administer?
A. An IV infusion containing regular insulin.
B. Humulin-N insulin SC before meals.
C. 50% dextrose IV push.
D. Glucagon subcutaneously PRN per sliding scale. - A. An IV infusion containing regular insulin.
,N5334 Diabetic case study
Rationale: Continuous IV infusions containing regular insulin are used to reduce the client's blood
glucose level. The client's IV solution will be changed to one that contains glucose when her blood
glucose level reaches 250 mg/dl.
In addition to monitoring the client's blood glucose level, what additional lab values should the nurse
monitor carefully? (Select all that apply. One, some, or all options may be correct.)
A. Uric acid.
B. Hemoglobin.
C. Calcium.
D. Potassium.
E. Blood Urea Nitrogen (BUN). - B, C, D, E.
Rationale: Though blood glucose and potassium are the most critical lab values to assess, hemoglobin
levels may be altered related to the state of hydration and should be monitored. Treatment with an IV
insulin infusion will cause the potassium to return to the cells and may result in hypokalemia. Lara
should be closely monitored for symptoms of hypokalemia. Supplemental potassium may be added to
the IV infusion to prevent or correct this. Dehydration that occurs with DKA can lead to an increased
BUN and should be monitored for signs of renal insufficiency.
Ethical-Legal Issues: Client Information
The client's blood glucose level stabilizes, and they begin taking oral fluids. IV solutions are switched
to dextrose 5% in sodium chloride 0.45% at a keep-open rate, and the insulin infusion is
discontinued.While hospitalized, family members and many of the client's college friends call the
nursing unit to check on the client's condition.
The nurse's decision about what to tell these callers should be based on what primary consideration?
A. The instructions of the nursing unit supervisor.
B. The nature of the caller's relationship to the client.
C. The seriousness of the client's condition at the time of the call.
, N5334 Diabetic case study
D. The client's right to privacy regarding her health information. - D. The client's right to privacy
regarding her health information.
Rationale: The Health Information Privacy Protection Act (HIPAA) stipulates that a client has the right
to privacy regarding health information and must give permission for the release of that information.
A student nurse is assigned to work with the charge nurse in caring for the client during their acute
illness. The student tells the nurse that they plan to present information about the client to fellow
students during a post-clinical conference, and asks the charge nurse for permission to copy the
client's lab data to take to the conference.
Which response is best for the charge nurse to provide?
A. Information about the client cannot be removed from the nursing unit.
B. The lab values can be copied as long as there is no identifying client data.
C. Since this is for educational purposes, you can remove any information you need.
D. Your instructor should tell you what information you are allowed to copy. - B. The lab values can be
copied as long as there is no identifying client data.
Rationale: Information used for educational purposes may be shared, as long as the data does not
permit identification of the client.
Manifestations: Once the acute ketoacidosis is controlled, the client is told that they have Type 1
diabetes mellitus. The nurse obtains the client's history. The client states that prior to the flu, they had
been healthy. However, the client had noticed that they had been eating more than normal, but had
not been gaining any weight. The client also states that they had been drinking a lot of diet colas and
that got up at night frequently to go to the bathroom.
The nurse identifies that the client has experienced classic symptoms of diabetes, which are:
A. Dysuria, dyspepsia, and dysphagia.
B. Polyuria, polyphagia, and polydipsia.
