NURS 2207 Endocrine EAQ Quiz – Questions & Answers
The nurse adds 20 mEq of potassium chloride to the intravenous solution of a
client with diabetic ketoacidosis. Which purpose would this medication serve?
1. Treats hyperpnea
2. Prevents flaccid paralysis
3. Prevents hypokalemia
4. Treats cardiac dysrhythmias Right Ans - 3
Rationale:
Once treatment with insulin for diabetic ketoacidosis is begun, potassium ions
reenter the cell, causing hypokalemia; therefore potassium, along with
replacement fluids, is needed to prevent hypokalemia. Potassium will not
correct hyperpnea. Flaccid paralysis does not occur in diabetic ketoacidosis.
There is no mention of dysrhythmias in the scenario; they are not a universal
finding in diabetic ketoacidosis (and are commonly absent) and hypokalemia
does not always cause these to occur.
Which rationale explains why intravenous (IV) potassium is prescribed in
addition to regular insulin for clients in diabetic ketosis?
1. Potassium loss occurs rapidly from diaphoresis present during coma.
2. Potassium is carried with glucose to the kidneys to be excreted in the urine
in increased amounts.
3. Potassium is quickly used up during the rapid series of catabolic reactions
stimulated by insulin and glucose.
4. Serum potassium levels will decrease as potassium ions shift from the
extracellular fluid to the intracellular fluid compartment. Right Ans - 4
Serum potassium levels will decrease as potassium ions shift from the
extracellular fluid to the intracellular fluid compartment.
,Rationale:
Insulin stimulates cellular uptake of glucose and stimulates the
sodium/potassium pump, leading to the influx of potassium into cells. The
resulting hypokalemia is offset by parenteral administration of potassium.
Potassium is not lost from the body by profuse diaphoresis. Potassium moves
from the extracellular to the intracellular compartment rather than being
excreted in the urine. Anabolic reactions are stimulated by insulin and glucose
administration; potassium is drawn into the intracellular compartment,
necessitating a replenishment of extracellular potassium.
Intravenous fluids and insulin are prescribed to treat a client's diabetic
ketoacidosis. The client develops peripheral paresthesias and shortness of
breath. The cardiac monitor shows the appearance of a U wave. Which
complication would the nurse suspect?
1. Hypokalemia
2. Hypoglycemia
3. Hypernatremia
4. Hypercalcemia Right Ans - 1
Hypokalemia
Rationale:
These are classic signs of hypokalemia that occur when potassium levels are
reduced as potassium reenters cells with glucose. Symptoms of hypoglycemia
are weakness, nervousness, tachycardia, diaphoresis, irritability, and pallor.
Symptoms of hypernatremia are thirst, orthostatic hypotension, dry mouth
and mucous membranes, concentrated urine, tachycardia, irregular heartbeat,
irritability, fatigue, lethargy, labored breathing, and muscle twitching or
seizures. Symptoms of hypercalcemia are lethargy, nausea, vomiting,
paresthesias, and personality changes.
,Which unique response is associated with diabetic ketoacidosis (DKA) that is
not exhibited with hyperglycemic hyperosmolar nonketotic syndrome
(HHNS)?
1. Fluid loss
2. Glycosuria
3. Kussmaul respirations
4. Increased blood glucose level Right Ans - 3
Kussmaul respirations
Rationale:
Kussmaul respirations occur in diabetic ketoacidosis (DKA) as the body
attempts to correct a low pH caused by accumulation of ketones
(ketoacidosis). HHNS affects people with type 2 diabetes who still have some
insulin production; the insulin prevents the breakdown of fats into ketones.
Fluid loss is common to both because an increased blood glucose level
ultimately leads to polyuria. Glycosuria is common to both conditions.
Hyperglycemia is common to both conditions.
A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis.
Which clinical findings related to this event would the nurse document in the
client's clinical record? Select all that apply.
1. Diaphoresis
2. Retinopathy
3. Acetone breath
4. Increased arterial bicarbonate level
5. Decreased arterial carbon dioxide level Right Ans - 3, 5
Rationale:
, A fruity odor to the breath (acetone breath) occurs when the ketone level is
elevated in ketoacidosis. Metabolic acidosis initiates respiratory
compensation in the form of Kussmaul respirations to counteract the effects of
ketone buildup, resulting in a decreased arterial carbon dioxide level. As the
glucose level decreases in hypoglycemia, the sympathetic nervous system is
activated, and epinephrine and norepinephrine are secreted, causing
diaphoresis. Retinopathy is a long-term complication of diabetes caused by
microvascular changes in the retina; it is not a sign of ketoacidosis. With
ketoacidosis, the serum bicarbonate level is decreased, not increased, in an
effort to neutralize ketones when seeking acid-base balance.
The nurse is assessing a client admitted with diabetic ketoacidosis. Which
statement made by the client indicates a need for further education on sick
day management?
1. "I will stop taking my insulin when I am ill because I am not eating."
2. "I will check my urine for ketones when my blood sugar is over 250."
3. "I will alternate drinking Gatorade and water throughout the day while ill."
4. "I will continue all my insulin including my glargine when I am sick."
Right Ans - 1
"I will stop taking my insulin when I am ill because I am not eating."
Rationale:
The diabetic client's metabolic needs will require the same amount of insulin
and sometimes more when in a stressed state, including illness. The client
checking the urine for ketones when blood sugar is more than 250, alternating
water and Gatorade intake, and continuing insulin indicate that the client has
an understanding of the basic sick day rules. Alternating the intake of water
and Gatorade throughout the day provides noncarbohydrate water and fluids
containing glucose and electrolytes while reducing the risk of consuming too
much sugar.
The nurse adds 20 mEq of potassium chloride to the intravenous solution of a
client with diabetic ketoacidosis. Which purpose would this medication serve?
1. Treats hyperpnea
2. Prevents flaccid paralysis
3. Prevents hypokalemia
4. Treats cardiac dysrhythmias Right Ans - 3
Rationale:
Once treatment with insulin for diabetic ketoacidosis is begun, potassium ions
reenter the cell, causing hypokalemia; therefore potassium, along with
replacement fluids, is needed to prevent hypokalemia. Potassium will not
correct hyperpnea. Flaccid paralysis does not occur in diabetic ketoacidosis.
There is no mention of dysrhythmias in the scenario; they are not a universal
finding in diabetic ketoacidosis (and are commonly absent) and hypokalemia
does not always cause these to occur.
Which rationale explains why intravenous (IV) potassium is prescribed in
addition to regular insulin for clients in diabetic ketosis?
1. Potassium loss occurs rapidly from diaphoresis present during coma.
2. Potassium is carried with glucose to the kidneys to be excreted in the urine
in increased amounts.
3. Potassium is quickly used up during the rapid series of catabolic reactions
stimulated by insulin and glucose.
4. Serum potassium levels will decrease as potassium ions shift from the
extracellular fluid to the intracellular fluid compartment. Right Ans - 4
Serum potassium levels will decrease as potassium ions shift from the
extracellular fluid to the intracellular fluid compartment.
,Rationale:
Insulin stimulates cellular uptake of glucose and stimulates the
sodium/potassium pump, leading to the influx of potassium into cells. The
resulting hypokalemia is offset by parenteral administration of potassium.
Potassium is not lost from the body by profuse diaphoresis. Potassium moves
from the extracellular to the intracellular compartment rather than being
excreted in the urine. Anabolic reactions are stimulated by insulin and glucose
administration; potassium is drawn into the intracellular compartment,
necessitating a replenishment of extracellular potassium.
Intravenous fluids and insulin are prescribed to treat a client's diabetic
ketoacidosis. The client develops peripheral paresthesias and shortness of
breath. The cardiac monitor shows the appearance of a U wave. Which
complication would the nurse suspect?
1. Hypokalemia
2. Hypoglycemia
3. Hypernatremia
4. Hypercalcemia Right Ans - 1
Hypokalemia
Rationale:
These are classic signs of hypokalemia that occur when potassium levels are
reduced as potassium reenters cells with glucose. Symptoms of hypoglycemia
are weakness, nervousness, tachycardia, diaphoresis, irritability, and pallor.
Symptoms of hypernatremia are thirst, orthostatic hypotension, dry mouth
and mucous membranes, concentrated urine, tachycardia, irregular heartbeat,
irritability, fatigue, lethargy, labored breathing, and muscle twitching or
seizures. Symptoms of hypercalcemia are lethargy, nausea, vomiting,
paresthesias, and personality changes.
,Which unique response is associated with diabetic ketoacidosis (DKA) that is
not exhibited with hyperglycemic hyperosmolar nonketotic syndrome
(HHNS)?
1. Fluid loss
2. Glycosuria
3. Kussmaul respirations
4. Increased blood glucose level Right Ans - 3
Kussmaul respirations
Rationale:
Kussmaul respirations occur in diabetic ketoacidosis (DKA) as the body
attempts to correct a low pH caused by accumulation of ketones
(ketoacidosis). HHNS affects people with type 2 diabetes who still have some
insulin production; the insulin prevents the breakdown of fats into ketones.
Fluid loss is common to both because an increased blood glucose level
ultimately leads to polyuria. Glycosuria is common to both conditions.
Hyperglycemia is common to both conditions.
A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis.
Which clinical findings related to this event would the nurse document in the
client's clinical record? Select all that apply.
1. Diaphoresis
2. Retinopathy
3. Acetone breath
4. Increased arterial bicarbonate level
5. Decreased arterial carbon dioxide level Right Ans - 3, 5
Rationale:
, A fruity odor to the breath (acetone breath) occurs when the ketone level is
elevated in ketoacidosis. Metabolic acidosis initiates respiratory
compensation in the form of Kussmaul respirations to counteract the effects of
ketone buildup, resulting in a decreased arterial carbon dioxide level. As the
glucose level decreases in hypoglycemia, the sympathetic nervous system is
activated, and epinephrine and norepinephrine are secreted, causing
diaphoresis. Retinopathy is a long-term complication of diabetes caused by
microvascular changes in the retina; it is not a sign of ketoacidosis. With
ketoacidosis, the serum bicarbonate level is decreased, not increased, in an
effort to neutralize ketones when seeking acid-base balance.
The nurse is assessing a client admitted with diabetic ketoacidosis. Which
statement made by the client indicates a need for further education on sick
day management?
1. "I will stop taking my insulin when I am ill because I am not eating."
2. "I will check my urine for ketones when my blood sugar is over 250."
3. "I will alternate drinking Gatorade and water throughout the day while ill."
4. "I will continue all my insulin including my glargine when I am sick."
Right Ans - 1
"I will stop taking my insulin when I am ill because I am not eating."
Rationale:
The diabetic client's metabolic needs will require the same amount of insulin
and sometimes more when in a stressed state, including illness. The client
checking the urine for ketones when blood sugar is more than 250, alternating
water and Gatorade intake, and continuing insulin indicate that the client has
an understanding of the basic sick day rules. Alternating the intake of water
and Gatorade throughout the day provides noncarbohydrate water and fluids
containing glucose and electrolytes while reducing the risk of consuming too
much sugar.
