The nurse in the emergency department is caring for a client with diabetic ketoacidosis and has the following prescriptions. Which of these prescriptions should the nurse clarify?
Regular insulin IV at 0.1 unit/kg/hr
5% dextrose in water 100 mL/hour
Arterial blood gases every 2 hours
Mix insulin in 0.9% normal saline solution
The Correct Answer is B
A. Regular insulin IV at 0.1 unit/kg/hr is a standard prescription for managing diabetic ketoacidosis (DKA). Regular insulin is administered intravenously to reduce blood glucose and correct the acidosis in DKA.
B. The nurse should clarify this prescription. In the initial management of DKA, the focus is on correcting fluid deficits, and a typical intravenous fluid for this purpose is 0.9% normal saline (not dextrose). Once blood glucose levels start to decrease and are near 200 mg/dL, dextrose may be introduced to prevent hypoglycemia, but it should not be started too early in the treatment of DKA.
C. Monitoring arterial blood gases (ABGs) is crucial in DKA to assess the severity of acidosis and monitor the effectiveness of treatment, typically done every 1 to 2 hours.
D. Regular insulin is typically mixed with 0.9% normal saline for intravenous administration in DKA. This solution helps deliver the insulin slowly and safely while rehydrating the client.
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Related Questions
Correct Answer is D
Explanation
A. A needle biopsy of the thyroid is typically done under local anesthesia, not general anesthesia. The client would be awake during the procedure, although they may be given a sedative to help them relax.
B. A needle biopsy is used to obtain a sample of tissue for testing, not to remove the cancer. The procedure helps diagnose the presence of cancer, but further treatment like surgery would be necessary to remove any cancer.
C. While a needle biopsy can confirm the presence of cancer, it does not provide information about the stage of cancer. Additional imaging and tests would be required to determine the stage.
D. Although the procedure typically involves inserting a needle through the skin (often without making a large incision), the biopsy involves removing a small sample of tissue for examination. This is the correct understanding of a needle biopsy.
Correct Answer is C
Explanation
A. Methimazole (Tapazole) 15 mg, PO, now and every 4 hours is an appropriate treatment for thyroid storm. Methimazole is an antithyroid medication that inhibits the synthesis of thyroid hormones and helps control the symptoms of thyroid storm.
B. Applying humidified oxygen as needed is appropriate because clients in thyroid storm can develop respiratory distress due to high metabolic demands. Providing humidified oxygen can help maintain adequate oxygenation.
C. Aspirin is contraindicated in thyroid storm. It can increase the release of thyroid hormones from the thyroid gland and may also increase the risk of severe complications like bleeding. Furthermore, aspirin can interfere with the binding of thyroid hormones to proteins, exacerbating the condition. Instead, acetaminophen (Tylenol) should be used to reduce fever in thyroid storm.
D. This is an appropriate intervention to manage hyperthermia, which is a common symptom of thyroid storm. A hypothermia mattress can help reduce the client's elevated body temperature in a controlled manner
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