The nurse is caring for a patient with diabetes.
The client is at highest risk for developing
The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"D"}
- Diabetic ketoacidosis (DKA): The client exhibits a history of type 1 diabetes, a markedly elevated blood glucose level (420 mg/dL), and a fruity odor on breath, which suggests ketosis. The clinical picture includes nausea, vomiting, and dehydration as evidenced by tachycardia (HR 122) and hypotension (BP 90/54), all classic for DKA.
- pH of 7.25 and HCO₃ of 15: The arterial blood gas shows a decreased pH and bicarbonate level, indicating a metabolic acidosis consistent with ketoacid accumulation. These ABG values confirm the acid-base disturbance diagnostic of DKA rather than other hyperglycemic states.
Rationale for Incorrect Answers:
- Hypoglycemia: The patient’s hyperglycemia (glucose 420 mg/dL) is inconsistent with hypoglycemia, which involves low blood glucose and typically presents with altered consciousness, not the current findings.
- Acute kidney injury: BUN and creatinine are within or slightly above normal range (BUN 21 mg/dL, creatinine 0.77 mg/dL), insufficient to diagnose acute kidney injury in this patient.
- Hyperosmolar hyperglycemic state (HHS): HHS is characterized by severe hyperglycemia without ketosis or acidosis; however, this patient’s positive ketones and metabolic acidosis exclude HHS.
- Capillary blood glucose of 140 mg/dL: This value is a post-treatment reading and does not reflect the patient's initial presentation with severe hyperglycemia and metabolic derangement.
- Oxygen saturation of 98% on room air: Normal oxygen saturation is not relevant to the diagnosis or the acid-base status related to the patient’s diabetic crisis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Insulin detemir: Insulin detemir is a long-acting basal insulin used to maintain baseline insulin levels. It is not appropriate for immediate correction of hyperglycemia or diabetic ketoacidosis (DKA) because it has a slow onset of action.
B. Insulin glargine: Insulin glargine is also a long-acting insulin that provides steady insulin levels over 24 hours. Like detemir, it is unsuitable for acute treatment of DKA due to its delayed onset and prolonged duration.
C. NPH insulin: NPH insulin is an intermediate-acting insulin used for basal coverage but not for rapid correction of hyperglycemia. Its onset and peak times are too slow for emergency DKA management.
D. Regular insulin: Regular insulin is short-acting and the insulin of choice for treating diabetic ketoacidosis. It can be administered intravenously for rapid onset, allowing effective reduction of blood glucose and correction of metabolic acidosis in acute settings.
Correct Answer is ["B","D"]
Explanation
A. Dizziness: Dizziness may be due to anesthesia recovery, fluid shifts, or low blood pressure but is not specifically linked to complications following thyroid and parathyroid removal. While it should be monitored, it does not require immediate intervention unless accompanied by other symptoms.
B. Hand tremors: Hand tremors can be an early indicator of hypocalcemia, a serious complication after parathyroid gland removal. The parathyroids regulate calcium, and their removal can cause calcium levels to drop quickly, resulting in neuromuscular irritability, which must be addressed promptly.
C. Earache: Earache is not typically associated with thyroid or parathyroid surgery and is not an expected or urgent postoperative concern. It could be referred pain or unrelated, and although it may be documented, it doesn’t require immediate follow-up.
D. Foot cramps: Foot cramps are another classic sign of hypocalcemia following parathyroid gland removal. They result from increased neuromuscular excitability due to low calcium levels and can progress to tetany if untreated. Immediate evaluation and calcium replacement may be necessary.
E. Increased appetite: An increase in appetite is not a common complication of thyroid or parathyroid surgery and does not indicate an urgent issue. It is not typically associated with calcium imbalance or other immediate post-op concerns and does not require urgent follow-up.
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