The nurse is caring for a patient with diabetes who presents with a hyperglycemic emergency. The patient's lab values are in the chart below. Which healthcare provider's (HCP) order will the nurse implement?

Administer intravenous normal saline 300 mL/hour

Administer regular insulin 20 units subcutaneously

Start bicarbonate infusion intravenously

Administer potassium chloride 40 mEq orally

Answer and Explanation

The Correct Answer is A

Choice A reason: Administering intravenous normal saline at 300 mL/hour is the appropriate initial intervention for a patient presenting with a hyperglycemic emergency. Fluid replacement is crucial to correct dehydration and improve circulatory volume, which will help improve renal perfusion and facilitate the excretion of excess glucose and ketones.

Choice B reason: Administering regular insulin 20 units subcutaneously is not the immediate priority. Intravenous insulin is preferred in a hyperglycemic emergency to ensure rapid and effective lowering of blood glucose levels.

Choice C reason: Starting a bicarbonate infusion intravenously is not indicated unless there is severe acidosis (pH < 7.0) or the patient is in shock. The pH of 7.20, while low, can typically be corrected with fluid and insulin therapy.

Choice D reason: Administering potassium chloride 40 mEq orally is not necessary at this point. The potassium level of 3.6 mEq/L is within the normal range, and potassium should be monitored and replaced as needed during ongoing treatment, especially when insulin therapy is initiated.

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Correct Answer is B

Explanation

Choice A reason: Acute hemolytic reactions are severe and typically present with symptoms such as fever, chills, flank pain, hemoglobinuria, and shock. The patient's mild symptoms of itching and a localized rash do not match the severe presentation of an acute hemolytic reaction.

Choice B reason: Allergic reactions to blood transfusions are common and usually present with symptoms such as itching, hives, and localized rash. The patient's vital signs and physical assessment showing mild itching and a rash on the arms are consistent with an allergic reaction.

Choice C reason: Anaphylactic reactions are severe allergic reactions that involve respiratory distress, hypotension, and shock. The patient's mild symptoms do not indicate an anaphylactic reaction.

Choice D reason: Circulatory overload presents with symptoms such as dyspnea, orthopnea, hypertension, and pulmonary edema. The patient's symptoms of itching and a rash do not align with circulatory overload.

A. pH 7.46, PaCO2 30, HCO3 24 B. pH 7.48, PaCO2 42, HCO3 29 C. pH 7.31, PaCO2 34, HCO3 18

Correct Answer is B

Explanation

Choice A reason: The lab results pH 7.46, PaCO2 30, HCO3 24 suggest a slightly alkaline state with normal bicarbonate levels, which could indicate respiratory alkalosis with compensation. However, for a patient with a small bowel obstruction and nasogastric suction, this is less likely.

Choice B reason: The lab results pH 7.48, PaCO2 42, HCO3 29 indicate metabolic alkalosis. This is a common finding in patients with small bowel obstruction who have been on nasogastric suction, which removes stomach acids and leads to an increase in bicarbonate levels. The elevated pH and bicarbonate levels are consistent with this condition.

Choice C reason: The lab results pH 7.31, PaCO2 34, HCO3 18 indicate metabolic acidosis. This finding is inconsistent with the expected results for a patient with small bowel obstruction and nasogastric suction, which typically leads to metabolic alkalosis due to loss of gastric acid.

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The nurse is caring for a patient with diabetes who presents with a hyperglycemic emergency. The patient's lab values are in the chart below. Which healthcare provider's (HCP) order will the nurse implement?

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