Chapter 14 My Nursing Test Banks

Perrin, Understanding the Essentials of Critical Care Nursing, 2/e
Chapter 14

Question 1

Type: MCSA

A patient is admitted with diabetic ketoacidosis. The nurse realizes that which problem caused the cascade to diabetic ketoacidosis (DKA) to occur?

1. Ketosis

2. Insulin deficiency

3. Hypoglycemia

4. Dehydration

Correct Answer: 2

Rationale 1: Ketosis dose not cause diabetic ketoacidosis but is a result of the disorder.

Rationale 2: If inadequate insulin is present, the cells starve and use fats as an energy source. Ketoacids are released as a waste product. Lactic acids are produced as a result of anaerobic cellular metabolism.

Rationale 3: Hypoglycemia is not present in diabetic ketoacidosis. Hyperglycemia is present.

Rationale 4: Dehydration occurs as a result of diabetic ketoacidosis and not as a cause.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-6: Describe the pathophysiology associated with diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS).

Question 2

Type: MCSA

The nurse is explaining the pathophysiology of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which statement will the nurse include when teaching? HHNS:

1. Is accompanied by severe metabolic acidosis

2. Results in cellular overhydration and interstitial space dehydration

3. Causes severe dehydration from very high osmolarity

4. Causes a severe decline in glucose production, resulting in increased metabolic rates to burn fat for energy

Correct Answer: 3

Rationale 1: If present at all, metabolic acidosis is minimal in HHNS because there is some insulin present to allow glucose into the cells for cellular metabolism.

Rationale 2: Cells are not over-hydrated but instead are dehydrated.

Rationale 3: HHNS is a hyperglycemic state. The body removes glucose with water through the kidneys via osmotic diuresis. This causes severe vascular, interstitial, and cellular water losses, resulting in severe dehydration.

Rationale 4: Glucose production is increased rather than decreased.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 14-6: Describe the pathophysiology associated with diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS).

Question 3

Type: MCSA

The nurse is comparing diabetic ketoacidosis (DKA) to hyperglycemic hyperosmolar nonketotic syndrome (HHNS). What does the nurse identify as the main difference between the two disorders?

1. DKA and HHNS are caused by too much insulin in the body.

2. No insulin is present in DKA, whereas some insulin is present in HHNS.

3. DKA results in metabolic acidosis; HHNS results in metabolic alkalosis.

4. Dehydration is greater or more severe in DKA than in HHNS.

Correct Answer: 2

Rationale 1: In both conditions there is too little, rather than too much, insulin.

Rationale 2: Although high blood sugars are present in both DKA and HHNS, there is still insulin production with HHNS.

Rationale 3: DKA does result in metabolic acidosis; however, HHNS does not result in metabolic alkalosis.

Rationale 4: Dehydration is more severe in HHNS than in DKA.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-6: Describe the pathophysiology associated with diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS).

Question 4

Type: MCSA

The nurse is caring for a patient with hyperglycemic hyperosmolar nonketotic syndrome (HHNS). The nurse realizes that this health problem could develop because of:

1. Certain antibiotics that can induce HHNS in those with type 2 diabetes

2. Poor compliance to medical therapy

3. Skipping meals, especially during illness

4. Taking too much insulin during illness

Correct Answer: 2

Rationale 1: Antibiotics do not cause hyperglycemia.

Rationale 2: HHNS often does develop slowly from poor compliance to medical therapy. This is in contrast to DKA, which often develops rapidly.

Rationale 3: HHNS would be caused by missed medication, rather than by skipping meals, causing hyperglycemia.

Rationale 4: Taking additional insulin would cause hypoglycemia.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-7: Identify five precipitating factors associated with DKA and HHNS.

Question 5

Type: MCSA

The nurse is determining if a patient is experiencing DKA or HHNS. Which information would help the nurse in making this determination?

1. Patients with DKA exhibit Kussmauls respirations to blow off CO2 and reduce pH levels.

2. Patients with HHNS have lower arterial pH levels than those with DKA.

3. Patients with DKA have more visual disturbances than patients with HHNS.

4. Patients with HHNS have moderate hyperglycemia, whereas patients with DKA have more severe hyperglycemia.

Correct Answer: 1

Rationale 1: Patients with DKA exhibit Kussmauls respirations to blow off CO2 and reduce pH levels.

Rationale 2: Patients with DKA are commonly in metabolic acidosis (have lower arterial pH).

Rationale 3: Patients with HHNS have more visual disturbances due to more severe and sometimes chronic dehydration.

Rationale 4: Patients with DKA have moderate hyperglycemia, whereas patients with HHNS have more severe hyperglycemia.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-9: Define two differences in assessment between DKA and HHNS.

Question 6

Type: MCSA

A patient with diabetes has a serum osmolarity level of 325 mmol/L. What is the correct interpretation and action for the nurse to take based on this result?

1. The result is somewhat high but no immediate action is necessary.

2. The result is very low and the physician should be notified of the result.

3. The result is somewhat low but no immediate action is necessary.

4. The result is very high and the physician should be notified of the result.

Correct Answer: 4

Rationale 1: This result is high and should be reported to the physician.

Rationale 2: This result is not too low. A normal serum osmolarity is 280 to 300 mmol/L.

Rationale 3: This result is not somewhat low. A normal serum osmolarity is 280 to 300 mmol/L.

Rationale 4: Normal serum osmolarity is 280 to 300 mmol/L. A serum osmolarity of 325 mmol/L is very high and the physician should be notified.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 14-8: List six essential elements of a focused assessment for a patient with DKA and HHNS.

Question 7

Type: MCMA

When planning care for a patient in diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS), which goals would be included in the plan of care?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Stabilize blood glucose levels to within normal limits.

2. Increase understanding of self-management to prevent future episodes.

3. Reestablish fluid balance through rehydration.

4. Restore A1C blood levels to at or above 8%.

5. Effectively treat the precipitating cause for DKA or HHNS.

Correct Answer: 1,2,3,5

Rationale 1:

Rationale 2: One goal is fewer occurrences of HHNS or DKA through self-management.

Rationale 3: Dehydration is prevalent due to the excessive glucose that causes severe diuresis. Fluid balance needs to be restored through fluid therapy.

Rationale 4: One goal is to keep the A1C below 6.5%.

Rationale 5: The cause of HHNS or DKA needs to be identified and treated.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 14-11: Describe five complications that may occur during the management of DKA or HHNS.

Question 8

Type: MCSA

Which nursing diagnosis would not be applicable when planning care for a patient with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

1. Excessive fluid volume related to (RT) fluid shifts from hyperosmolarity

2. Imbalanced nutrition, less than body requirements RT inability to utilize glucose

3. Ineffective tissue perfusion RT hypovolemia and decreased peripheral blood flow

4. Risk for infection RT increased blood glucose and decreased peripheral blood flow

Correct Answer: 1

Rationale 1: The patient will have severe dehydration, not fluid overload. High osmolarity is present in HHNS; therefore, this diagnosis is incorrect.

Rationale 2: This diagnosis is applicable to patients with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS).

Rationale 3: This diagnosis is applicable to patients with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS).

Rationale 4: This diagnosis is applicable to patients with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS).

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 14-11: Describe five complications that may occur during the management of DKA or HHNS.

Question 9

Type: MCSA

The nurse is caring for a patient in DKA with serum sodium of 130 and serum glucose of 600. After calculating the corrected serum sodium (CSS) [CSS = Serum Na+ + {[(Serum glucose (mg/dL) 100)/100] 1.6}], which intravenous fluid would the nurse plan to provide this patient?

1. D5 NS

2. 0.45 NS

3. 0.9 NS

4. Lactated Ringers (LR)

Correct Answer: 2

Rationale 1: CSS = 130 + {[(600 100)/100] 1.6}; CSS = 138. Normal serum sodium is
135 145 mEq/L. If the CSS is high or normal, then half-normal saline (0.45% NS) would be expected. If the CSS is low, then normal saline (0.9% NS) would be expected to correct sodium losses.

Rationale 2: CSS = 130 + {[(600 100)/100] 1.6}; CSS = 138. Normal serum sodium is
135 145 mEq/L. If the CSS is high or normal, then half-normal saline (0.45% NS) would be expected. If the CSS is low, then normal saline (0.9% NS) would be expected to correct sodium losses.

Rationale 3: CSS = 130 + {[(600 100)/100] 1.6}; CSS = 138. Normal serum sodium is
135 145 mEq/L. If the CSS is high or normal, then half-normal saline (0.45% NS) would be expected. If the CSS is low, then normal saline (0.9% NS) would be expected to correct sodium losses.

Rationale 4: CSS = 130 + {[(600 100)/100] 1.6}; CSS = 138. Normal serum sodium is
135 145 mEq/L. If the CSS is high or normal, then half-normal saline (0.45% NS) would be expected. If the CSS is low, then normal saline (0.9% NS) would be expected to correct sodium losses.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 14-11: Describe five complications that may occur during the management of DKA or HHNS.

Question 10

Type: MCSA

What would the nurse assess before beginning insulin therapy in a patient with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

1. Sodium level (Na+)

2. Previous history of cardiac dysrhythmias

3. Potassium level (K+)

4. Arterial blood gas results

Correct Answer: 3

Rationale 1: This laboratory value does not need to be specifically assessed before starting insulin therapy.

Rationale 2: This does not need to be specifically assessed before starting insulin therapy.

Rationale 3: Potassium levels need to be monitored before insulin is given to avoid hypokalemia from developing because insulin facilitates intracellular transport of glucose and potassium. The rapid shift of the K+ could leave the serum potassium levels dangerously low.

Rationale 4: This does not need to be specifically assessed before starting insulin therapy.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-10: Explain five important considerations related to the administration of insulin.

Question 11

Type: MCSA

Which type of insulin would the nurse administer for an intravenous bolus and continuous infusion to regulate a patients blood glucose levels?

1. Lantus

2. Regular

3. Lente

4. NPH

Correct Answer: 2

Rationale 1: This insulin is not recommended for intravenous usage.

Rationale 2: For the most reliable and safest method of consistently lowering blood glucose levels, the general consensus is to use Regular insulin.

Rationale 3: This insulin is not recommended for intravenous usage.

Rationale 4: This insulin is not recommended for intravenous usage.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 14-10: Explain five important considerations related to the administration of insulin.

Question 12

Type: MCSA

The nurse, caring for a patient weighing 80 kg, is preparing an initial dose of insulin as beginning treatment for diabetic ketoacidosis. What are the appropriate dose and route for the nurse administer the insulin?

1. 8 units IV

2. 8 units subcutaneous

3. 12 units subcutaneous

4. 12 units IV

Correct Answer: 4

Rationale 1: The formula for calculating a bolus dose of insulin is 0.15 units/kg.

Rationale 2: Bolus dosing is given intravenously, rather than subcutaneously, to begin to reverse DKA.

Rationale 3: Bolus dosing is given intravenously, rather than subcutaneously, to begin to reverse DKA.

Rationale 4: Bolus dosing is given intravenously to begin to reverse DKA. The formula for calculating an initial bolus dosage is 0.15 unit/kg; therefore, 80 0.15 = 12 units for bolus.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 14-10: Explain five important considerations related to the administration of insulin.

Question 13

Type: MCSA

When calculating the initial rate of an insulin infusion as treatment for diabetic ketoacidosis in a patient weighing 80 kg, the nurse would expect to administer insulin at what rate?

1. 120 units per hour

2. 80 units per hour

3. 8 units per hour

4. 12 units per hour

Correct Answer: 3

Rationale 1: The formula for continuous infusion of insulin is 0.1 unit/kg/hour;
0.1 80 = 8 units/hour.

Rationale 2: The formula for continuous infusion of insulin is 0.1 unit/kg/hour;
0.1 80 = 8 units/hour.

Rationale 3: The formula for continuous infusion of insulin is 0.1 unit/kg/hour;
0.1 80 = 8 units/hour.

Rationale 4: The formula for continuous infusion of insulin is 0.1 unit/kg/hour;
0.1 80 = 8 units/hour.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 14-10: Explain five important considerations related to the administration of insulin.

Question 14

Type: MCSA

The nurse monitors the blood glucose levels of a patient being treated with insulin for diabetic ketoacidosis to ensure glucose levels decline at the rate of 50-70 mg/dL/hour because:

1. When blood glucose drops rapidly fluids shift out of the cell, which increases dehydration, causing severe hypovolemic shock.

2. When blood glucose drops rapidly severe damage to the brain results from metabolic alkalosis.

3. A rapid drop in blood glucose can result in hypokalemia, causing life-threatening arrhythmias.

4. A rapid drop in blood glucose can result in formation of thromboses as a result of dehydration.

Correct Answer: 3

Rationale 1: Dehydration is caused by hyperglycemia and osmotic diuresis rather than the infusion of insulin.

Rationale 2: Rapidly dropping glucose does not result in metabolic alkalosis.

Rationale 3: A rapid shift in potassium from the serum into the intracellular compartment may result because IV insulin facilitates the transport of glucose into the cells. This rapid electrolyte shift can cause life-threatening cardiac arrhythmias as a result of hypokalemia.

Rationale 4: Rapidly dropping glucose does not cause the formation of thromboses.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 14-10: Explain five important considerations related to the administration of insulin.

Question 15

Type: MCMA

Which medications contribute to hyperglycemia in the patient with diabetes?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Digoxin (Lanoxin)

2. Calcium channel blockers such as nifedipine

3. Sympathomimetics such as dopamine

4. Glucocorticoids such as dexamethasone

5. Thiazide diuretics such as hydrochlorothiazide/HCTZ

Correct Answer: 2,3,4,5

Rationale 1: Digoxin has not been shown to increase blood glucose levels.

Rationale 2: This type of medication will increase glucose blood levels in the patient with diabetes.

Rationale 3: This type of medication will increase glucose blood levels in the patient with diabetes.

Rationale 4: This type of medication will increase glucose blood levels in the patient with diabetes.

Rationale 5: This type of medication will increase glucose blood levels in the patient with diabetes.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-2: List five risk factors associated with metabolic syndrome.

Question 16

Type: MCMA

A nurse caring for a patient with diabetic ketoacidosis (DKA) would evaluate the patient carefully for which potential complications?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Myocardial infarction

2. Acute respiratory distress syndrome

3. Pulmonary embolism

4. Pneumonia

5. Cerebral edema

Correct Answer: 1,2,3,5

Rationale 1: Dehydration causes increased viscosity of the blood that can lead to formation of thromboses, causing a myocardial infarction.

Rationale 2: Acute respiratory distress syndrome (ARDS) is caused by rapid intracellular fluid shifts during administration of fluids.

Rationale 3: Dehydration causes increased viscosity of the blood that can lead to formation of thromboses causing a pulmonary embolism.

Rationale 4: The patient with diabetic ketoacidosis is not at an increased risk for pneumonia.

Rationale 5: Cerebral edema is caused by rapid intracellular fluid shifts during administration of fluids.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 14-3: Explain the pathophysiology associated with hyperglycemia during critical illness.

Question 17

Type: MCSA

Why would the nurse implement seizure precautions in a patient with diabetic ketoacidosis (DKA)? The patient may be at risk for seizures because:

1. Potassium shifts may cause cerebral ischemia.

2. Intracellular fluid shifts may cause cerebral edema.

3. High blood glucose levels overstimulate brain cells.

4. Drugs used to treat the DKA have a side effect of seizures.

Correct Answer: 2

Rationale 1: Potassium shifts do not cause cerebral ischemia.

Rationale 2: Rapid fluid shifts into the cell can cause swelling of brain tissues. This puts the patient at risk for seizures.

Rationale 3: This is not the cause for seizures in this patient.

Rationale 4: Drugs used to treat DKA do not have a side effect of seizures.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 14-3: Explain the pathophysiology associated with hyperglycemia during critical illness.

Question 18

Type: MCSA

A newly admitted patient with HHNK has a serum glucose of 850 mg/dL and a potassium level of 3.9 mEq/L. An important nursing consideration that should precede replacement of potassium includes:

1. Assessment of urine output.

2. Assessment of lung sounds.

3. Assessment of dehydration.

4. Calculation of serum osmolarity.

Correct Answer: 1

Rationale 1: Prior to the administration of potassium the nurse should assess urine output and check the serum creatinine to evaluate renal function. Renal insufficiency and renal failure are common complications of patients with diabetes.

Rationale 2: This assessment does not specifically relate to the assessment preceding replacement of potassium.

Rationale 3: This assessment does not specifically relate to the assessment preceding replacement of potassium.

Rationale 4: This calculation does not specifically relate to the assessment preceding replacement of potassium.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-11: Describe five complications that may occur during the management of DKA or HHNS.

Question 19

Type: MCMA

A patient with type 1 diabetes who is ill is seeking advice from the nurse. The nurse would highly encourage the patient to seek medical attention if the patient states:

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. I have had diarrhea for more than a day.

2. My mouth feels very dry from the flu.

3. I have had ketones in my urine for more than 4 hours.

4. I have had a fever of 99 degrees all day.

5. I have been vomiting all night.

Correct Answer: 1,2,5

Rationale 1: Patients with diabetes should be instructed to seek medical advice when diarrhea is present for more than 6 hours.

Rationale 2: Patients with diabetes should be instructed seek medical advice when there are signs of dehydration such as a dry mouth.

Rationale 3: The patient should seek medical attention for ketones being present in the urine for more than 12 hours.

Rationale 4: The patient should seek medical attention for a high fever that lasts for more than one day. A temperature of 99 degrees Fahrenheit is not a high fever.

Rationale 5: Patients with diabetes should be instructed to seek medical advice when vomiting is present for more than 6 hours.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 14-4: Differentiate short-term complications from long-term complications associated with hyperglycemia.

Question 20

Type: MCMA

A patient is admitted to the hospital with acute myocardial infarction and has a blood sugar of 180 mg/dL. The patient has never been diagnosed with diabetes. What is the best explanation for a high glucose in a patient without diabetes?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The physiologic stress of a large meal plus a myocardial infarction causes hyperglycemia.

2. Insulin resistance is caused by pro-inflammatory factors.

3. Insulin resistance is caused by beta blockers and nitroglycerin, which are commonly used to treat myocardial infarction.

4. Myocardial infarction causes a physiologic stress response that causes the body to enter a hypermetabolic state.

5. Glucagon, cortisol, and epinephrine cause hyperglycemia.

Correct Answer: 2,4,5

Rationale 1: The blood glucose does not normally elevate to 180 mg/dL even after a large meal.

Rationale 2: During a critical illness, pro-inflammatory factors cause insulin resistance, which also leads to hyperglycemia.

Rationale 3: Beta blockers do mask the signs of hypoglycemia, but neither beta blockers nor nitroglycerin cause hyperglycemia.

Rationale 4: A critical illness such as a myocardial infarction causes a physiologic stress response that causes the body to enter a hypermetabolic state in an attempt to heal.

Rationale 5: In a critical illness the reaction to counterregulatory hormones such as epinephrine, cortisol, and glucagon has a direct hormonal effect to produce hyperglycemia.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-5: Describe three essential elements to teach a patient who has experienced hyperglycemia during a critical illness.

Question 21

Type: MCSA

When instructing a patient about metabolic syndrome, what will the nurse include?

1. It is also called insulin resistance syndrome.

2. Fasting blood sugars are over 140 mg/dL.

3. It is seen more frequently in people who carry extra weight in their hips and legs.

4. It affects about 10% of the U.S. population.

Correct Answer: 1

Rationale 1: Metabolic syndrome is also known as insulin resistance syndrome.

Rationale 2: Metabolic syndrome is characterized by fasting blood glucose greater than 110 mg/dL (rather than 140 mg/dL).

Rationale 3: Central obesity is a characteristic of this disorder.

Rationale 4: Estimates indicate that 23.7% of the U.S. population is affected by metabolic syndrome.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 14-2: List five risk factors associated with metabolic syndrome.

Question 22

Type: MCSA

When instructing a patient about metabolic syndrome, the nurse would include that which finding is a risk factor for the development of diabetes?

1. Central obesity

2. Decreased triglycerides

3. Low LDL levels

4. Low insulin levels

Correct Answer: 1

Rationale 1: Central obesity is present in metabolic syndrome and is a risk factor for the development of diabetes.

Rationale 2: Triglycerides are elevated in this syndrome.

Rationale 3: LDL levels are elevated in this syndrome.

Rationale 4: Insulin levels are high because insulin becomes more resistant.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 14-2: List five risk factors associated with metabolic syndrome.

Question 23

Type: MCSA

An older patient being treated for pneumonia has signs of metabolic syndrome but denies the presence of diabetes. Serum glucose is 220 mg/dL and the hemoglobin A1C is 5%. What can be induced from these findings?

1. The nurse should anticipate discharge teaching related to insulin to manage blood sugars at home.

2. The nurse anticipates that the doctor will diagnose the patient with type 1 diabetes.

3. The nurse would anticipate treatment with sliding scale insulin even though diabetes is not yet evident.

4. The nurse anticipates that the doctor will diagnose the patient with type 2 diabetes.

Correct Answer: 3

Rationale 1: The patient would not require insulin at home. If treatment became necessary, oral agents are initiated in the patient with type 2 diabetes.

Rationale 2: Type 1 diabetes mellitus is not usually diagnosed in older patients.

Rationale 3: High glucose would be treated with sliding scale insulin to prevent or reduce short-term complications of hyperglycemia. As the infection is treated, the nurse would expect glucose to return to normal.

Rationale 4: Though the serum glucose is elevated, the hemoglobin A1C is normal, meaning the blood glucose has been normal over approximately the past 3 months. The patient does not have diabetes but is at high risk for the development of type 2 diabetes.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 14-2: List five risk factors associated with metabolic syndrome.

Question 24

Type: MCSA

The certified diabetes educator (CDE) has encouraged a patient with metabolic syndrome who experienced hyperglycemia during hospitalization to attend outpatient diabetes education classes. The patient asks why the classes are needed if diabetes is not a health problem. What is the nurses best response?

1. The certified diabetes educator (CDE) saw that you had high blood sugars while in the ICU. I will let her know that you are not diabetic.

2. You will learn about healthy diet, weight management, and exercise. This knowledge can delay the onset of type 2 diabetes.

3. If you maintain a healthy diet, correct weight, and exercise you can delay the onset of type 2 diabetes.

4. The class is only for those with diabetes. If you become diabetic you may attend the class.

Correct Answer: 3

Rationale 1: The patient would benefit from attending these classes since the risk of developing type 2 diabetes is high.

Rationale 2: Knowledge itself does not delay the onset of diabetes.

Rationale 3: This patient would benefit from diabetes education because healthy diet, weight management, and types of exercise are taught during the class. The patient will need to actually maintain a healthy diet, correct weight, and exercise in order to delay the onset of type 2 diabetes.

Rationale 4: Most people would benefit from attending this class.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 14-12: Define 10 elements of diabetic teaching that are important to assess in order to assist the patient in the prevention of another episode of DKA or HHNS.

Question 25

Type: MCSA

A patient, admitted with cellulitis, has hemoglobin A1C level that revealed the patients average blood sugars prior to admission were 300 mg/dL. The patient has been started on insulin in addition to oral diabetes medications. Which teaching point is essential for this patient to understand before discharge? It will be important for you to:

1. Decrease your weight in order to decrease your hemoglobin A1C.

2. Eat for 60 minutes each morning after taking your insulin.

3. Change the types of carbohydrates you eat to complex carbohydrates.

4. Use the glucose meter to check your blood sugars before you take your insulin.

Correct Answer: 4

Rationale 1: Though weight management is important, the hemoglobin A1C is not directly related to weight management.

Rationale 2: The patient should not be taught to eat for an hour. Instead the patient should eat within 15 to 30 minutes of taking insulin (depending on the type of insulin).

Rationale 3: Complex carbohydrates do stabilize the blood sugar, but the patient may eat some simple carbohydrates, especially with meals.

Rationale 4: It is essential that this patient check his or her blood sugars with a meter when taking insulin.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Teaching and Learning

Learning Outcome: 14-12: Define 10 elements of diabetic teaching that are important to assess in order to assist the patient in the prevention of another episode of DKA or HHNS.

Question 26

Type: MCMA

The nurse is reviewing the purpose of insulin with a patient newly diagnosed with type 2 diabetes mellitus. What will the nurse teach the patient about the function of insulin in the body?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. It moves glucose from the blood into the body cells to be used as fuel.

2. It stimulates the liver to store extra glucose.

3. It is used to create energy.

4. It helps to bind oxygen to the blood.

5. It aids in the digestion of protein.

Correct Answer: 1,2

Rationale 1: One function of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be metabolized into fuel.

Rationale 2: A function of insulin is to stimulate the liver to store excess glucose in the form of glycogen.

Rationale 3: Insulin is not used to create energy. Glucose is used to create energy.

Rationale 4: Insulin does not assist in the binding of oxygen to the red blood cell.

Rationale 5: Insulin does not play a role in digestion.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Teaching and Learning

Learning Outcome: 14-1: Review the physiology of normal metabolism and the pathology of type 1 and type 2 diabetes.

Question 27

Type: MCMA

When creating the care plan for a patient in the critical care unit, the nurse includes checking capillary blood glucose levels every morning. Even though the patient does not have diabetes, checking the blood glucose levels daily and maintaining them at normal levels will:

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Prevent inflammation

2. Improve immunity

3. Improve lipid levels

4. Protect endothelial tissue

5. Improve oxygenation

Correct Answer: 1,2,3,4

Rationale 1: Maintaining normal blood glucose levels during critical illness has been proven to prevent inflammation.

Rationale 2: Maintaining normal blood glucose levels during critical illness has been proven to improve immunity.

Rationale 3: Maintaining normal blood glucose levels during critical illness has been proven to improve lipid profiles.

Rationale 4: Maintaining normal blood glucose levels during critical illness has been proven to protect endothelial tissue.

Rationale 5: Maintaining normal blood glucose levels during critical illness has no effect on oxygenation.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 14-3: Explain the pathophysiology associated with hyperglycemia during critical illness.

Question 28

Type: MCMA

The nurse is concerned that a patient in the critical care area is experiencing short-term complications of diabetes. What did the nurse find when assessing this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Infected leg wound

2. Declining hourly urine output

3. Numb feet

4. Vision changes

5. Dropping oxygen saturation level

Correct Answer: 1,2

Rationale 1: Short-term complications of hyperglycemia include an increased risk for infection.

Rationale 2: Short-term complications of hyperglycemia include an increased risk of organ failure. A declining hourly urine output could be an indication that the patient is developing acute renal failure.

Rationale 3: Peripheral neuropathy is considered a long-term complication of hyperglycemia.

Rationale 4: Retinopathy is considered a long-term complication of hyperglycemia.

Rationale 5: A drop in oxygen saturation levels may or may not be related to hyperglycemia.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-4: Differentiate short-term complications from long-term complications associated with hyperglycemia.

Question 29

Type: MCMA

The nurse, preparing instruction for a patient recovering from a critical illness, will include ways to prevent the onset of type 2 diabetes. What caused the nurse to provide this patient teaching?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Patient is obese.

2. Patients triglyceride level is elevated.

3. Patient is 55 years old.

4. Patient has high blood pressure.

5. Patient is Caucasian.

Correct Answer: 1,2,3,4

Rationale 1: One risk factor for the development of type 2 diabetes mellitus is obesity.

Rationale 2: One risk factor for the development of type 2 diabetes mellitus is an elevated triglyceride level.

Rationale 3: Age greater than 45 years is a risk factor for the development of type 2 diabetes mellitus.

Rationale 4: One risk factor for the development of type 2 diabetes mellitus is hypertension.

Rationale 5: The rates of type 2 diabetes mellitus are higher in African, Hispanic, and Native Americans.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 14-5: Describe three essential elements to teach a patient who has experienced hyperglycemia during a critical illness.

Question 30

Type: MCMA

The nurse identifies that a patient with type 2 diabetes mellitus is at risk for developing hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which health problems did the nurse identify in the patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Patient recovering from surgery

2. Patient prescribed prednisone

3. Patient receiving antibiotics for a skin infection

4. Patient receiving NSAIDs

5. Patient receiving enteral supplements

Correct Answer: 1,2,3

Rationale 1: Surgery is a precipitating factor for the development of HHNS in the patient with type 2 diabetes mellitus.

Rationale 2: Glucocorticoids such as prednisone can be a precipitating factor for the development HHNS in the patient with type 2 diabetes mellitus.

Rationale 3: Infection is a precipitating factor for the development of HHNS in the patient with type 2 diabetes mellitus.

Rationale 4: The use of NSAIDs is not a precipitating factor for the development of HHNS in the patient with type 2 diabetes mellitus.

Rationale 5: Enteral supplements do not precipitate the development of HHNS in the patient with type 2 diabetes mellitus.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-7: Identify five precipitating factors associated with DKA and HHNS.

Question 31

Type: MCMA

While recovering from injuries obtained in a motor vehicle crash, a patient with type 1 diabetes mellitus begins to demonstrate signs of developing diabetic ketoacidosis (DKA). What findings would suggest to the nurse that the patient was developing DKA?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Abdominal pain

2. Nausea and vomiting

3. Deep rapid respirations

4. Ketones in the urine

5. Capillary refill 5 seconds

Correct Answer: 1,2,3,4

Rationale 1: Abdominal pain is an indication of metabolic acidosis, which is seen in DKA.

Rationale 2: Nausea and vomiting are indications of metabolic acidosis, which is seen in DKA.

Rationale 3: Kussmauls respirations are an indication of metabolic acidosis, which is seen in DKA.

Rationale 4: Ketones in the urine are seen in DKA.

Rationale 5: A change in capillary refill is not an indication of developing DKA.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-9: Define two differences in assessment between DKA and HHNS.

Question 32

Type: MCMA

A patient is brought to the emergency department with manifestations of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). What will the nurse assess to determine the patients hydration status?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Vision

2. Weight loss

3. Respiratory rate

4. Oxygen saturation level

5. Urine for ketones

Correct Answer: 1,2

Rationale 1: The patient in HHNS should be assessed for visual disturbances and blurred vision since these are signs of severe dehydration complicated by high blood osmolarity and high blood glucose.

Rationale 2: The patient in HHNS should be assessed for weight loss since this is a sign of severe dehydration complicated by high blood osmolarity and high blood glucose.

Rationale 3: The patient in HHNS will not have a change in respirations as a result of dehydration.

Rationale 4: The patient in HHNS will not have a change in oxygen saturation level as a result of dehydration.

Rationale 5: The patient in HHNS will not have ketones in the urines as a result of dehydration.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-8: List six essential elements of a focused assessment for a patient with DKA and HHNS.

Question 33

Type: MCMA

The nurse is planning to instruct a patient with type 1 diabetes mellitus on ways to prevent the onset of diabetic ketoacidosis (DKA). What will the nurse assess prior to teaching this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Ability to self-administer insulin

2. Performance of blood glucose testing

3. Current adjustments to diet during exercise

4. Frequency of eye examinations

5. Daily foot inspections

Correct Answer: 1,2,3

Rationale 1: The nurse should assess the patients ability to self-administer insulin prior to teaching the patient on prevention of DKA.

Rationale 2: The nurse should assess if the patient is testing blood glucose levels prior to teaching on the prevention of DKA.

Rationale 3: The nurse should assess what adjustments the patient makes to the diet for exercise prior to teaching on the prevention of DKA.

Rationale 4: The frequency of eye examinations will not help prevent the development of DKA.

Rationale 5: Daily foot inspections will not help prevent the development of DKA.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 14-12: Define 10 elements of diabetic teaching that are important to assess in order to assist the patient in the prevention of another episode of DKA or HHNS.

Perrin, Understanding the Essentials of Critical Care Nursing, 2/e Test Bank

Copyright 2012 by Pearson Education, Inc.

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