A patient with Type 2 diabetes is brought into the emergency room in an unresponsive state.
Vital signs include BP: 88/56, HR: 122, RR 16, Sp 95% and glucose of 720 mg/dL. A diagnosis of Hyperosmolar Hyperglycemic Syndrome (HHS) is made.The nurse prepares for the administration of which priority therapy?

Administration of Glucagon.

Dextrose 50%.

0.45% Normal Saline IV.

0.9% saline solution IV.

Answer and Explanation

The Correct Answer is D

Choice D rationale

Hyperosmolar Hyperglycemic Syndrome (HHS) is a serious complication of diabetes that occurs when blood sugar levels are extremely high. The primary treatment for HHS is intravenous fluids and insulin. Specifically, 0.9% saline solution IV is often used initially to restore volume and correct severe dehydration.

Choice A rationale

Administration of Glucagon is not the primary treatment for HHS. Glucagon is a hormone that raises blood glucose levels and would not be beneficial in a situation where blood glucose is already extremely high.

Choice B rationale

Dextrose 50% is a concentrated glucose solution and would not be appropriate in the treatment of HHS, where blood glucose levels are already dangerously high.

Choice C rationale

While IV fluids are a crucial part of the treatment for HHS, 0.45% Normal Saline (also known as half-normal saline) is a hypotonic solution and is not typically the first choice for fluid resuscitation in HHS. The preferred initial fluid is often 0.9% saline (normal saline), which is isotonic.

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Correct Answer is B

Explanation

Choice A rationale

Increasing the nighttime insulin glargine dose may exacerbate the Somogyi effect, a phenomenon where the blood sugar level drops too low overnight, causing a rebound high blood sugar level in the morning.

Choice B rationale

Consuming a snack at bedtime can help prevent the blood sugar level from dropping too low overnight, thus preventing the Somogyi effect.

Choice C rationale

Checking the morning cortisol level is not directly related to managing the Somogyi effect.

Choice D rationale

Checking the glucose level at 2 a.m. and 8 a.m. can help identify the Somogyi effect, but it does not prevent it.

A. Omit green, leafy vegetables from the diet. B. Use over-the-counter pain relief medications. C. Obtain laboratory tests as directed. D. Use an electric razor for shaving. E. Obtain a medical alert bracelet.

Correct Answer is C

Explanation

Choice A rationale

While it is true that warfarin’s effectiveness can be affected by vitamin K, found in green leafy vegetables, it is not necessary to completely omit these from the diet. Instead, maintaining a consistent intake of vitamin K can help keep INR levels stable.

Choice B rationale

Over-the-counter pain relief medications, especially those that are nonsteroidal anti- inflammatory drugs (NSAIDs), can increase the risk of bleeding when taken with warfarin. Therefore, this advice is not correct.

Choice C rationale

Regular laboratory tests, specifically the International Normalized Ratio (INR), are crucial when taking warfarin to monitor its effectiveness and adjust the dosage if necessary.

Choice D rationale

Using an electric razor can help prevent cuts and bleeding, which is important because warfarin is a blood thinner. However, this information is not as critical as obtaining regular laboratory tests.

Choice E rationale

Obtaining a medical alert bracelet can be beneficial for individuals taking warfarin, as it can alert healthcare professionals in an emergency situation about the individual’s use of a blood thinner. However, this information is not as critical as obtaining regular laboratory tests.

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Choice D rationale

Choice A rationale

Choice B rationale

Choice C rationale

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A Type 1 diabetic client with a morning (fasting) glucose of 260 mg/dL has been diagnosed with the Somogyi effect from insulin administration. What intervention should the nurse anticipate including in the plan of care?

Correct Answer is B

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

The nurse is providing teaching to a client who is being discharged with a prescription for warfarin. Which information should be included in the teaching for this medication?

Correct Answer is C

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

Choice E rationale

The client newly diagnosed with Type 1 diabetes is to be discharged in the morning and has received no instruction on diabetes. What should be the nurse’s teaching priority?

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