The nurse is caring for a patient with hyperosmolar hyperglycemic syndrome. The patient is receiving intravenous fluids of normal saline with 20 mEq of potassium chloride and a continuous insulin infusion. Which finding will indicate to the nurse that the treatment is effective?

Normal blood pressure, deep respirations

Increased alertness, normal heart rhythm

High urine specific gravity, normal temperature

Blood glucose of 250 mg/dL, disorientation

Answer and Explanation

The Correct Answer is B

Choice A reason: Normal blood pressure and deep respirations do not necessarily indicate that hyperosmolar hyperglycemic syndrome is resolving. Deep respirations, also known as Kussmaul respirations, can occur in response to severe hyperglycemia.

Choice B reason: Increased alertness and a normal heart rhythm suggest that the patient's neurological status and cardiovascular system are stabilizing, which are positive indicators that the treatment is effective in managing hyperosmolar hyperglycemic syndrome.

Choice C reason: High urine specific gravity and normal temperature do not directly indicate the effectiveness of treatment for hyperosmolar hyperglycemic syndrome. High urine specific gravity can result from dehydration.

Choice D reason: A blood glucose level of 250 mg/dL with disorientation still indicates poorly controlled hyperglycemia and ongoing metabolic disturbance, which means the treatment is not yet effective.

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Correct Answer is A

Explanation

Choice A reason: The ABG results of pH 7.21, PaCO2 36, HCO3 14 indicate metabolic acidosis, which is common in patients with end-stage kidney disease (ESKD). In ESKD, the kidneys lose their ability to excrete acid and maintain bicarbonate levels, leading to an accumulation of acid in the blood. This condition results in a low pH (acidic), normal PaCO2 (as the respiratory system attempts to compensate), and low HCO3 (bicarbonate).

Choice B reason: The ABG results of pH 7.50, PaCO2 29, HCO3 22 indicate respiratory alkalosis, which is not typically associated with ESKD. Respiratory alkalosis occurs when there is excessive exhalation of carbon dioxide, leading to a higher pH (alkaline). This condition is more likely to be seen in situations such as hyperventilation, anxiety, or certain lung diseases.

Choice C reason: The ABG results of pH 7.47, PaCO2 45, HCO3 33 indicate metabolic alkalosis, which is not typically associated with ESKD. Metabolic alkalosis occurs when there is an excess of bicarbonate or a loss of acid. This condition can result from factors such as vomiting, diuretic use, or excessive antacid consumption. It is not a common finding in patients with ESKD.

Choice D reason: The ABG results of pH 7.31, PaCO2 48, HCO3 24 indicate respiratory acidosis, which is not typically associated with ESKD. Respiratory acidosis occurs when there is an accumulation of carbon dioxide due to impaired respiratory function. This condition is more likely to be seen in chronic obstructive pulmonary disease (COPD) or other respiratory disorders. It is not a common finding in patients with ESKD.

A. "It's important for me to avoid foods that are high in sodium such as canned soups and processed meats." B. "I should limit my intake of high-potassium foods like bananas and tomatoes." C. "I will eat a high-protein diet with lots of dark green, leafy vegetables." D. "I need to monitor my fluid intake to prevent fluid overload."

Correct Answer is C

Explanation

Choice A reason: Avoiding foods that are high in sodium such as canned soups and processed meats is correct. High sodium intake can worsen fluid retention and hypertension, which are concerns in chronic kidney disease.

Choice B reason: Limiting intake of high-potassium foods like bananas and tomatoes is correct. High potassium levels can lead to dangerous cardiac arrhythmias in patients with chronic kidney disease.

Choice C reason: Eating a high-protein diet with lots of dark green, leafy vegetables is incorrect. While protein is important, excessive protein intake can increase the workload on the kidneys. Patients with chronic kidney disease often need to limit protein intake to prevent further kidney damage. Additionally, dark green, leafy vegetables are high in potassium, which should be limited.

Choice D reason: Monitoring fluid intake to prevent fluid overload is correct. Fluid overload can lead to hypertension, edema, and heart failure in patients with chronic kidney disease.

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The nurse is caring for a patient with hyperosmolar hyperglycemic syndrome. The patient is receiving intravenous fluids of normal saline with 20 mEq of potassium chloride and a continuous insulin infusion. Which finding will indicate to the nurse that the treatment is effective?

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