AGNP STUDY GUIDE EXAM QUESTIONS WITH ANSWERS
2025/2026 GRADED A+
Patients with special issues 0.7 units/kg
Obese
Metabolic Syndrome
Infections
Open wounds
Diabetic Ketoacidosis (DKA): Differences - Occurs in Type I
Distinguished by metabolic acidosis (ph < 7.3)
Ketones in blood and urine
Develop within 24 hours
Mortality rate <5%
Hyperosmolar Hyperglycemic State (HHS): Differences - Occurs in Type II
Severe hyperglycemia (>600)
Severe dehydration
Insidious onset
Mortality rate 15%
Diabetic Ketoacidosis (DKA): S&S - Hyperglycemia >250
Metabolic acidosis < 7.3
Ketosis (plasma and urine)
Nausea and vomiting
Abdominal pain
Polyuria
Fruity breath
Kussmaul's respirations (severe acidosis)
Hyperosmolar Hyperglycemic State (HHS): S&S - Severe hyperglycemia (600-1,200)
Hyperosmolarity (Serum osmo 320-380)
Severe dehydration (Hemodynamic instability, pre-renal acotemia, decreasing urine
output)
Altered mental status
Mild DKA - Glucose >250
Arterial pH 7.25-7.30
Bicarb 15-18
Anion gap > 10
Ketones +
Serum osmo <320
Serum Na 125-135
Serum K Normal to Increase
Moderate DKA - Glucose >250
,Arterial pH 7.0-7.25
Bicarb 10-14
Anion gap >12
Ketone +
Serum osmo <320
Serum Na: 125-135
Serum K: Normal to Increase
Severe DKA - Glucose: > 250
Arterial pH <7.0
Bicarb < 10
Anion gap >12
Ketones +
Serum osmo <320
Serum Na 125-135
Serum K Normal to Increase
HHS - Glucose: > 600
Arterial pH >7.3
Bicarb > 15
Anion gap Variable
Ketones: Trace/small
Serum osmo: 330-380
Serum Na: 135-145
Serum K: Normal
DKA & HHS Tx - Immediate hospitalization
Insulin
Fluids
Electrolyte replacement
Treating the underlying cause
Insulin - Add 5% dextrose to IVs when glucose < 250mg/dl
When to start insulin - Start subcutaneous insulin when:
-Anion gap is closed (DKA)
-Serum bicarbonate is > 15 mEq/l (DKA)
-Patient is able to eat
-Mental status improves (HHS)
Initial bloodwork - Basic metabolic panel
Arterial blood gases
Magnesium
Phosphorus
, SubQ Insulin - Give short-acting aspart or lispro dose that is twice the current infusion
dose (eg. 4 Units/hr drip; give 8 Units Aspart SQ)
Give long-acting (NPH, glargine, detemir) at 0.2 - 0.3 Units/kg or previous home dose
Blood work q 2-4 hours - Basic metabolic panel
Magnesium
Phosphorus
Electrolyte Management - Na+ low in hyperglycemia
Replace initially with 0.9 N.S 1-3L than 0.45 N.S
Measured Na+ [ Measured BG-100)/100
Electrolyte Management: Bicarb - Replace only with severe acidosis in DKA
-ph <7 stop when >7.1
Treat underlying precipitating factor: DKA/HHS - Infection
Stroke
MI
ETOH abuse
Anorexia or bulemia
Inadequate insulin administration
-Intentional
-Unintentional
-Insulin pump failure
Pancreatitis
Trauma
Osteoarthritis: Incidence/ Prevalence - 50% adults 55-78
Women more than men
Advancing age
Osteoarthritis: Molecular- level pathology - Prolonged period
Associated with initiating events of OA
Changes are only detectable by serologic analyses.
Osteoarthritis: Pre-radiographic - Joint abnormalities are detectable only by MRI
Osteoarthritis: Radiographic - Stage where joint fails
i.e joint replacement
Osteoarthritis: Tx focus - Reducing pain
Maintaining or improving joint mobility
Limiting functional impairment
Improving Health Related Quality Of Life
2025/2026 GRADED A+
Patients with special issues 0.7 units/kg
Obese
Metabolic Syndrome
Infections
Open wounds
Diabetic Ketoacidosis (DKA): Differences - Occurs in Type I
Distinguished by metabolic acidosis (ph < 7.3)
Ketones in blood and urine
Develop within 24 hours
Mortality rate <5%
Hyperosmolar Hyperglycemic State (HHS): Differences - Occurs in Type II
Severe hyperglycemia (>600)
Severe dehydration
Insidious onset
Mortality rate 15%
Diabetic Ketoacidosis (DKA): S&S - Hyperglycemia >250
Metabolic acidosis < 7.3
Ketosis (plasma and urine)
Nausea and vomiting
Abdominal pain
Polyuria
Fruity breath
Kussmaul's respirations (severe acidosis)
Hyperosmolar Hyperglycemic State (HHS): S&S - Severe hyperglycemia (600-1,200)
Hyperosmolarity (Serum osmo 320-380)
Severe dehydration (Hemodynamic instability, pre-renal acotemia, decreasing urine
output)
Altered mental status
Mild DKA - Glucose >250
Arterial pH 7.25-7.30
Bicarb 15-18
Anion gap > 10
Ketones +
Serum osmo <320
Serum Na 125-135
Serum K Normal to Increase
Moderate DKA - Glucose >250
,Arterial pH 7.0-7.25
Bicarb 10-14
Anion gap >12
Ketone +
Serum osmo <320
Serum Na: 125-135
Serum K: Normal to Increase
Severe DKA - Glucose: > 250
Arterial pH <7.0
Bicarb < 10
Anion gap >12
Ketones +
Serum osmo <320
Serum Na 125-135
Serum K Normal to Increase
HHS - Glucose: > 600
Arterial pH >7.3
Bicarb > 15
Anion gap Variable
Ketones: Trace/small
Serum osmo: 330-380
Serum Na: 135-145
Serum K: Normal
DKA & HHS Tx - Immediate hospitalization
Insulin
Fluids
Electrolyte replacement
Treating the underlying cause
Insulin - Add 5% dextrose to IVs when glucose < 250mg/dl
When to start insulin - Start subcutaneous insulin when:
-Anion gap is closed (DKA)
-Serum bicarbonate is > 15 mEq/l (DKA)
-Patient is able to eat
-Mental status improves (HHS)
Initial bloodwork - Basic metabolic panel
Arterial blood gases
Magnesium
Phosphorus
, SubQ Insulin - Give short-acting aspart or lispro dose that is twice the current infusion
dose (eg. 4 Units/hr drip; give 8 Units Aspart SQ)
Give long-acting (NPH, glargine, detemir) at 0.2 - 0.3 Units/kg or previous home dose
Blood work q 2-4 hours - Basic metabolic panel
Magnesium
Phosphorus
Electrolyte Management - Na+ low in hyperglycemia
Replace initially with 0.9 N.S 1-3L than 0.45 N.S
Measured Na+ [ Measured BG-100)/100
Electrolyte Management: Bicarb - Replace only with severe acidosis in DKA
-ph <7 stop when >7.1
Treat underlying precipitating factor: DKA/HHS - Infection
Stroke
MI
ETOH abuse
Anorexia or bulemia
Inadequate insulin administration
-Intentional
-Unintentional
-Insulin pump failure
Pancreatitis
Trauma
Osteoarthritis: Incidence/ Prevalence - 50% adults 55-78
Women more than men
Advancing age
Osteoarthritis: Molecular- level pathology - Prolonged period
Associated with initiating events of OA
Changes are only detectable by serologic analyses.
Osteoarthritis: Pre-radiographic - Joint abnormalities are detectable only by MRI
Osteoarthritis: Radiographic - Stage where joint fails
i.e joint replacement
Osteoarthritis: Tx focus - Reducing pain
Maintaining or improving joint mobility
Limiting functional impairment
Improving Health Related Quality Of Life
