A nurse is caring for a client in the emergency department.

Which of the following 3 provider prescriptions does the nurse anticipate?

Initiate cardiac monitoring

Potassium chloride 20 mEq/L intravenous PRN potassium less than 5.0 mEq/L

Regular insulin 20 units subcutaneously

0.9% sodium chloride at 15 ml/kg/hr for 1 hr and then reduce to 10 ml/kg/hr

Dextrose 5% in water (D5W) intravenous at 5 ml/kg/hr for 4 hr

Insert indwelling urinary catheter

Blood glucose checks every 4 hr

Regular insulin continuous intravenous infusion, titrate per diabetic ketoacidosis (DKA) protocol once potassium is greater than 3.3 mEq/L

Answer and Explanation

Correct Answer : A,D,H

A. Initiate cardiac monitoring: Cardiac monitoring is important because the client has hyperkalemia (potassium 5.5 mEq/L) and is at risk for arrhythmias. Monitoring allows early detection of changes in cardiac rhythm, which can occur rapidly in electrolyte imbalances associated with hyperglycemic crises.

B. Potassium chloride 20 mEq/L intravenous PRN potassium less than 5.0 mEq/L: Potassium replacement is not indicated at this time because the client’s serum potassium is elevated at 5.5 mEq/L. Administering potassium now could worsen hyperkalemia and increase the risk of life-threatening cardiac dysrhythmias.

C. Regular insulin 20 units subcutaneously: Subcutaneous insulin is not appropriate for severe hyperglycemia with ketoacidosis risk, as it has a slower onset and may not provide adequate glycemic control. Intravenous insulin infusion is preferred in this setting to allow rapid titration and prompt reduction of blood glucose and ketone levels.

D. 0.9% sodium chloride at 15 ml/kg/hr for 1 hr and then reduce to 10 ml/kg/hr: Aggressive IV fluid resuscitation with isotonic saline is indicated for dehydration from hyperglycemia and osmotic diuresis. Calculated fluid replacement helps restore intravascular volume, improve perfusion, and support renal function.

E. Dextrose 5% in water (D5W) intravenous at 5 ml/kg/hr for 4 hr: Dextrose is not indicated initially because the client’s blood glucose is extremely elevated at 468 mg/dL. Dextrose would worsen hyperglycemia at this stage. Dextrose is added later during insulin therapy when glucose levels fall to prevent hypoglycemia while continuing ketone clearance.

F. Insert indwelling urinary catheter: Routine catheterization is not indicated for this client, as there is no urinary retention or obstruction reported. Inserting a catheter unnecessarily increases the risk of infection without improving outcomes in hyperglycemia management.

G. Blood glucose checks every 4 hr: For a client with severe hyperglycemia and suspected DKA or hyperosmolar state, glucose monitoring every 4 hours is insufficient. Hourly monitoring is needed to safely titrate IV insulin and fluids, allowing rapid response to changing glucose and electrolyte levels.

H. Regular insulin continuous intravenous infusion, titrate per diabetic ketoacidosis (DKA) protocol once potassium is greater than 3.3 mEq/L: Continuous IV insulin infusion is the treatment of choice for severe hyperglycemia with ketones and acidosis. It allows precise titration based on glucose levels while ensuring potassium levels are safe.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"A,B"},"C":{"answers":"A"},"D":{"answers":"A,B"},"E":{"answers":"A"}}

Explanation

• Blood glucose greater than expected reference range: Both DKA and HHS present with significant hyperglycemia. In DKA, glucose is typically moderately elevated (250–600 mg/dL), while HHS usually shows extreme hyperglycemia (>600 mg/dL). Hyperglycemia is a hallmark finding in both conditions, driving osmotic diuresis and dehydration.

• Skin turgor: Dehydration from osmotic diuresis is common in both DKA and HHS, resulting in poor skin turgor. Fluid loss occurs due to polyuria and inadequate intake, contributing to hypotension, tachycardia, and electrolyte imbalances in both conditions.

• Urine ketones: Urine ketones are characteristic of DKA due to lipolysis and ketogenesis caused by insulin deficiency. HHS typically has minimal to absent ketone production because some insulin is present, preventing significant fat breakdown.

• Creatinine greater than expected reference range: Elevated creatinine occurs in both DKA and HHS due to dehydration and pre-renal azotemia from hypovolemia. This reflects impaired renal perfusion and is a marker for severity of fluid deficit in both conditions.

• Blood pH: Metabolic acidosis (low pH) is a defining feature of DKA due to accumulation of ketoacids. HHS usually maintains a near-normal pH because ketosis is minimal, so acidosis is typically absent or mild.

A. "You can discard needles in an empty bleach bottle with a lid." B. "Remove the needle from the syringe before you place it in the trash," C. "Place your storage container in a recycle bin when it is full." D. "Secure the cap tightly over the needle before you discard it."

Correct Answer is A

Explanation

A. "You can discard needles in an empty bleach bottle with a lid.": Rigid, puncture-resistant containers such as bleach or detergent bottles are appropriate for home disposal of sharps. These containers reduce the risk of needle-stick injuries and can be sealed securely before disposal according to local guidelines.

B. "Remove the needle from the syringe before you place it in the trash.": Needles should never be removed or placed directly into household trash because this increases the risk of accidental injury to the client or sanitation workers. Leaving the needle attached and placing the entire device into a proper sharps container is the correct and safe method.

C. "Place your storage container in a recycle bin when it is full.": Sharps containers should never be placed in recycling because they pose a hazard and cannot be processed safely with recyclable materials. Full containers must be disposed of according to local regulations, often by returning them to designated medical waste facilities or drop-off sites.

D. "Secure the cap tightly over the needle before you discard it.": Recapping needles increases the risk of needle-stick injuries and is discouraged in all healthcare and home care settings. Used needles should be placed immediately into a puncture-resistant sharps container without recapping to minimize the chance of accidental exposure.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is caring for a client in the emergency department. Which of the following 3 provider prescriptions does the nurse anticipate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client in the emergency department. For each assessment finding, click to specify if the assessment finding is consistent with diabetic ketoacidosis (DKA) or hyperglycemic-hyperosmolar state (HHS). Each finding may support more than 1 disease process.

Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"A,B"},"C":{"answers":"A"},"D":{"answers":"A,B"},"E":{"answers":"A"}}

Explanation

A nurse is providing discharge teaching to a client who will be self-administering insulin at home. Which of the following information should the nurse include regarding needle disposal?

Correct Answer is A

Explanation

A nurse is admitting a client who reports tightness in their chest that radiates to left arm. Complete the following sentence by using the lists of options. The nurse should first address the client's dropdownfollowed by the client'sdropdown.

A nurse is planning care for a client who is an hr postoperative following a coronary artery bypass grafting. Which of the following assessments should the nurse plan to perform first?

A nurse is assessing a client who has full-thickness burns. The nurse should identify that which of the following findings indicates the client's need for fluid resuscitation?

A home health nurse is planning to use nonpharmacological pain relief measures for a client who has severe chronic back pain. Which of the following pain management guidelines should the nurse use?

A nurse is caring for a client in the emergency department. The nurse is caring for the client in the ED. The nurse understands that the client is at risk of developing which of the following complications? Select all that apply.

A nurse is assessing a client. Which of the following findings indicates a fluid volume deficit?

The nurse is reviewing the client's medical record. A nurse is reviewing the client's diagnostic results and vital signs. Which of the following actions should the nurse take? Select all that apply.

A nurse is caring for a client in the emergency department.

Which of the following 3 provider prescriptions does the nurse anticipate?