A patient is admitted to the intensive care unit with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (52.9 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.3 mmol/L). The nurse would next prepare to administer which medication?
Phenytoin for the prevention of seizures
IV fluids containing dextrose
NPH insulin subcutaneously
An ampule of 50% dextrose
The Correct Answer is B
Choice A reason: Phenytoin is not indicated in DKA, as seizures are not a common complication. DKA causes acidosis and dehydration, managed with insulin and fluids. Phenytoin addresses neurological conditions, not metabolic derangements. Administering it here is irrelevant, as the focus is on glucose control and preventing hypoglycemia.
Choice B reason: IV fluids with dextrose are appropriate when glucose drops to 240 mg/dL in DKA, as insulin continues to lower glucose, risking hypoglycemia. Dextrose maintains euglycemia while insulin corrects acidosis. Normal saline with 5% dextrose prevents rapid glucose drops, ensuring safe continuation of insulin therapy and metabolic stabilization.
Choice C reason: NPH insulin, a long-acting insulin, is not used in acute DKA management. Short-acting IV insulin is preferred for rapid, titratable glucose control. NPH is for long-term diabetes management, not acute crises, as it lacks the flexibility needed to manage rapidly changing glucose levels in DKA.
Choice D reason: An ampule of 50% dextrose is used for acute hypoglycemia, not when glucose is 240 mg/dL. This level is above the hypoglycemic threshold, and insulin is still needed to correct acidosis. Administering concentrated dextrose risks rebound hyperglycemia, undermining DKA treatment, making it inappropriate at this stage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Delaying the transfusion and notifying the provider is critical, as a fever of 100.7°F suggests possible infection or inflammation. Transfusing blood in a febrile patient risks exacerbating underlying infection or causing transfusion reactions. The provider must evaluate the fever’s cause to ensure safe administration and prevent complications like sepsis or hemolytic reactions.
Choice B reason: Administering an antihistamine and starting the transfusion is inappropriate, as antihistamines address allergic reactions, not fever. A temperature of 100.7°F indicates potential infection, requiring investigation before transfusion. Proceeding without addressing the fever risks worsening an underlying condition or causing transfusion-related complications, making this an unsafe action.
Choice C reason: Administering acetaminophen to reduce fever and starting the transfusion is incorrect, as it masks the fever without identifying its cause. A temperature of 100.7°F may indicate infection, which must be evaluated before transfusion to avoid complications like sepsis. Treating symptoms without investigation compromises patient safety in this scenario.
Choice D reason: Beginning the transfusion as prescribed is unsafe with a fever of 100.7°F, as it may indicate infection or inflammation. Transfusing without investigating the fever risks exacerbating underlying conditions or causing transfusion reactions. Delaying and notifying the provider ensures the cause is addressed, prioritizing patient safety and appropriate management.
Correct Answer is B
Explanation
Choice A reason: Small, frequent oral feedings are contraindicated in acute peritonitis, as the inflamed peritoneum requires bowel rest to reduce irritation and prevent perforation. Feeding can exacerbate inflammation and bacterial spread, worsening the condition. Patients are typically kept NPO (nothing by mouth) with IV fluids to support recovery.
Choice B reason: Inserting a nasogastric tube is standard in acute peritonitis to decompress the stomach, reducing pressure on the inflamed peritoneum and preventing vomiting. It removes gastric contents, minimizing the risk of further contamination or perforation in the abdominal cavity, supporting healing and reducing complications in this serious condition.
Choice C reason: Flattening the head of the bed is not appropriate for peritonitis. Semi-Fowler’s position (head elevated 30–45 degrees) reduces abdominal pressure and improves respiratory comfort. A flat position may increase intra-abdominal pressure, exacerbating pain and risking complications like perforation, making this an incorrect intervention for peritonitis management.
Choice D reason: Blood transfusion of PRBCs is not routinely indicated for peritonitis unless significant blood loss or anemia is present, which is not typical. Peritonitis management focuses on antibiotics, fluid therapy, and surgical intervention if needed. Transfusions address hemorrhagic complications, not the inflammatory or infectious aspects of peritonitis, making this inappropriate.
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