Adult-Gerontology Acute Care Nurse Practitioner Certification ENDOCRI
Study online at https://quizlet.com/_fogcze
1. 1. A 25-year-old male patient is admitted to the inten- Answer:2. Order serum
sive care unit after a motor vehicle collision resulting sodium, urine-specific
in an isolated severe traumatic brain injury causing gravity.
elevated intracranial pressure. He is on a ventilator and Rationale: This scenario
minimally responsive. On the second day of hospital- suggests a diagnosis of di-
ization, he has increasing vasopressor requirements abetes insipidus, for which
and hourly urine output of 400 mL. To address this serum sodium and urine
problem, the nurse practitioner would: specific gravity will aid in
1. Order a fluid restriction. the diagnosis.
2. Order serum sodium, urine-specific gravity.
3. Order 24-hour urine protein and creatinine.
4. Order a stat noncontrast computed tomography of
the head.
2. 2. A 25-year-old male patient is admitted to the inten- 1. Order 2 mcg desmo-
sive care unit after a motor vehicle collision resulting pressin (DDAVP) intra-
in an isolated severe traumatic brain injury causing venously (IV) and 1 L 0.9%
elevated intracranial pressure. He is on a ventilator and saline.
minimally responsive. On the second day of hospital- Rationale: This patient has
ization, he has increasing vasopressor requirements central diabetes insipidus
and hourly urine output of 400 mL. His serum sodium from pituitary compres-
increased from 146 to 155 in the last 6 hours and urine sion. Treatment involves
specific gravity (SG) is 1.001. To address this problem, urgent administration of
the nurse practitioner would: desmopressin and fluids
1. Order 2 mcg desmopressin (DDAVP) intravenously to attenuate the hyperna-
(IV) and 1 L 0.9% saline. tremia.
2. Increase maintenance fluids from 75 to 150 mL/hr
and repeat sodium and SG in 6 hours.
3. Order 2 mcg DDAVP IV and fluid restriction.
4. Calculate the free water deficit and order free water
via nasogastric tube.
, Adult-Gerontology Acute Care Nurse Practitioner Certification ENDOCRI
Study online at https://quizlet.com/_fogcze
3. 3. A 68-year-old 70-kg male patient with a history of 3. Institute a fluid restric-
tobacco abuse was admitted with dyspnea. A chest tion.
x-ray revealed a pulmonary mass, flattened bilateral Rationale: The syndrome
diaphragm, and no pulmonary edema. He is alert and of inappropriate antidi-
breathing comfortably after being started on 4 L of uretic hormone is com-
oxygen via nasal cannula. His initial sodium is 128 monly caused by pul-
mEq/L. Based on the nurse practitioner's knowledge monary disease and ma-
of the probable diagnosis, how would the nurse prac- lignancy. First-line treat-
titioner correct his sodium? ment is a fluid restriction in
1. Start 3% saline at 75 mL/hr. the absence of symptoms
2. Start 0.9% saline at 1000 mL/hr. such as seizure, mental
3. Institute a fluid restriction. status change, and falls.
4. Order 40 mg furosemide and repeat sodium in 8
hours.
4. 4. A 55-year-old female patient with a history of type 4. Insulin(R) infusion with
2 diabetes and diverticulitis is admitted to the in- target glucose 140 to 180
tensive care unit following laparotomy for colectomy. mg/dL.
She remains intubated and requires norepinephrine Rationale: Preferred in-
at 0.06 mcg/kg/min to maintain a mean arterial pres- sulin route in the in-
sure greater than 65 mmHg despite adequate intra- tensive care unit set-
operative fluid resuscitation. Her blood glucose is 220 ting is intravenous infu-
mg/dL. The nurse practitioner's initial glucose man- sion with a target of 140
agement strategy will entail starting: to 180 mg/dL to avoid hy-
1. Insulin(R) infusion with target glucose less than 120 poglycemic complications.
mg/dL. Vasoconstriction and ede-
2. Insulin(R) subcutaneous (SQ) sliding scale with tar- ma of subcutaneous tissue
get glucose 140 to 180 mg/dL. can alter absorption.
3. Insulin(R) SQ sliding scale with target glucose less
than 120 mg/dL.
4. Insulin(R) infusion with target glucose 140 to 180
mg/dL.
, Adult-Gerontology Acute Care Nurse Practitioner Certification ENDOCRI
Study online at https://quizlet.com/_fogcze
5. 5. A 55-year-old female patient with a history of type 1. Restart home metformin
2 diabetes and diverticulitis was admitted to the in- and monitor blood glu-
tensive care unit after laparotomy for colectomy. She cose Q achs.
was briefly intubated and on vasopressors. She is Rationale: This patient had
now weaned off norepinephrine and transferred to a adequate glucose control
med/surg floor. She is tolerating oral nutrition with and can be safely transi-
a carbohydrate-controlled diet and is still on insulin tioned back to her home
infusion at 0.5 units/hr with a 24-hour glucose range regimen in the absence of
of 150 to 180 mg/dL. Her home regimen involves met- other contraindications.
formin 1000 mg twice a day (BID) by mouth and a
carbohydrate-controlled diet. Hemoglobin A1c is 7.8%.
The most appropriate next step in the management of
this patient's diabetes is:
1. Restart home metformin and monitor blood glucose
Q achs.
2. Continue the insulin infusion for 24 more hours.
3. Restart and increase metformin to 2000 mg BID.
4. Start insulin glargine 12 units daily and a subcuta-
neous sliding scale.
6. 6. An 85-year-old female patient is admitted to a 2. Initiate a subcutaneous
med/surg floor with a urinary tract infection and con- basal, prandial, correction
fusion. She is tolerating a regular diet and has no histo- regimen.
ry of diabetes. The glucose on her initial chemistry pan- Rationale: Hospitalized
el is 230 mg/dL and hemoglobin A1c is 10%. The most patients with new hyper-
appropriate management of this patient's glucose is: glycemia should be man-
1. Start insulin infusion and follow glucose once every aged with basal, prandial,
hour. correction.
2. Initiate a subcutaneous basal, prandial, correction
regimen.
3. Start metformin 1500 mg twice a day.
Study online at https://quizlet.com/_fogcze
1. 1. A 25-year-old male patient is admitted to the inten- Answer:2. Order serum
sive care unit after a motor vehicle collision resulting sodium, urine-specific
in an isolated severe traumatic brain injury causing gravity.
elevated intracranial pressure. He is on a ventilator and Rationale: This scenario
minimally responsive. On the second day of hospital- suggests a diagnosis of di-
ization, he has increasing vasopressor requirements abetes insipidus, for which
and hourly urine output of 400 mL. To address this serum sodium and urine
problem, the nurse practitioner would: specific gravity will aid in
1. Order a fluid restriction. the diagnosis.
2. Order serum sodium, urine-specific gravity.
3. Order 24-hour urine protein and creatinine.
4. Order a stat noncontrast computed tomography of
the head.
2. 2. A 25-year-old male patient is admitted to the inten- 1. Order 2 mcg desmo-
sive care unit after a motor vehicle collision resulting pressin (DDAVP) intra-
in an isolated severe traumatic brain injury causing venously (IV) and 1 L 0.9%
elevated intracranial pressure. He is on a ventilator and saline.
minimally responsive. On the second day of hospital- Rationale: This patient has
ization, he has increasing vasopressor requirements central diabetes insipidus
and hourly urine output of 400 mL. His serum sodium from pituitary compres-
increased from 146 to 155 in the last 6 hours and urine sion. Treatment involves
specific gravity (SG) is 1.001. To address this problem, urgent administration of
the nurse practitioner would: desmopressin and fluids
1. Order 2 mcg desmopressin (DDAVP) intravenously to attenuate the hyperna-
(IV) and 1 L 0.9% saline. tremia.
2. Increase maintenance fluids from 75 to 150 mL/hr
and repeat sodium and SG in 6 hours.
3. Order 2 mcg DDAVP IV and fluid restriction.
4. Calculate the free water deficit and order free water
via nasogastric tube.
, Adult-Gerontology Acute Care Nurse Practitioner Certification ENDOCRI
Study online at https://quizlet.com/_fogcze
3. 3. A 68-year-old 70-kg male patient with a history of 3. Institute a fluid restric-
tobacco abuse was admitted with dyspnea. A chest tion.
x-ray revealed a pulmonary mass, flattened bilateral Rationale: The syndrome
diaphragm, and no pulmonary edema. He is alert and of inappropriate antidi-
breathing comfortably after being started on 4 L of uretic hormone is com-
oxygen via nasal cannula. His initial sodium is 128 monly caused by pul-
mEq/L. Based on the nurse practitioner's knowledge monary disease and ma-
of the probable diagnosis, how would the nurse prac- lignancy. First-line treat-
titioner correct his sodium? ment is a fluid restriction in
1. Start 3% saline at 75 mL/hr. the absence of symptoms
2. Start 0.9% saline at 1000 mL/hr. such as seizure, mental
3. Institute a fluid restriction. status change, and falls.
4. Order 40 mg furosemide and repeat sodium in 8
hours.
4. 4. A 55-year-old female patient with a history of type 4. Insulin(R) infusion with
2 diabetes and diverticulitis is admitted to the in- target glucose 140 to 180
tensive care unit following laparotomy for colectomy. mg/dL.
She remains intubated and requires norepinephrine Rationale: Preferred in-
at 0.06 mcg/kg/min to maintain a mean arterial pres- sulin route in the in-
sure greater than 65 mmHg despite adequate intra- tensive care unit set-
operative fluid resuscitation. Her blood glucose is 220 ting is intravenous infu-
mg/dL. The nurse practitioner's initial glucose man- sion with a target of 140
agement strategy will entail starting: to 180 mg/dL to avoid hy-
1. Insulin(R) infusion with target glucose less than 120 poglycemic complications.
mg/dL. Vasoconstriction and ede-
2. Insulin(R) subcutaneous (SQ) sliding scale with tar- ma of subcutaneous tissue
get glucose 140 to 180 mg/dL. can alter absorption.
3. Insulin(R) SQ sliding scale with target glucose less
than 120 mg/dL.
4. Insulin(R) infusion with target glucose 140 to 180
mg/dL.
, Adult-Gerontology Acute Care Nurse Practitioner Certification ENDOCRI
Study online at https://quizlet.com/_fogcze
5. 5. A 55-year-old female patient with a history of type 1. Restart home metformin
2 diabetes and diverticulitis was admitted to the in- and monitor blood glu-
tensive care unit after laparotomy for colectomy. She cose Q achs.
was briefly intubated and on vasopressors. She is Rationale: This patient had
now weaned off norepinephrine and transferred to a adequate glucose control
med/surg floor. She is tolerating oral nutrition with and can be safely transi-
a carbohydrate-controlled diet and is still on insulin tioned back to her home
infusion at 0.5 units/hr with a 24-hour glucose range regimen in the absence of
of 150 to 180 mg/dL. Her home regimen involves met- other contraindications.
formin 1000 mg twice a day (BID) by mouth and a
carbohydrate-controlled diet. Hemoglobin A1c is 7.8%.
The most appropriate next step in the management of
this patient's diabetes is:
1. Restart home metformin and monitor blood glucose
Q achs.
2. Continue the insulin infusion for 24 more hours.
3. Restart and increase metformin to 2000 mg BID.
4. Start insulin glargine 12 units daily and a subcuta-
neous sliding scale.
6. 6. An 85-year-old female patient is admitted to a 2. Initiate a subcutaneous
med/surg floor with a urinary tract infection and con- basal, prandial, correction
fusion. She is tolerating a regular diet and has no histo- regimen.
ry of diabetes. The glucose on her initial chemistry pan- Rationale: Hospitalized
el is 230 mg/dL and hemoglobin A1c is 10%. The most patients with new hyper-
appropriate management of this patient's glucose is: glycemia should be man-
1. Start insulin infusion and follow glucose once every aged with basal, prandial,
hour. correction.
2. Initiate a subcutaneous basal, prandial, correction
regimen.
3. Start metformin 1500 mg twice a day.
