You are educating the staff nurses on your unit about ketoacidosis. The evaluate this group's understanding, you ask" Which sign or symptom would not be consistent with ketoacidosis? Which group gives which correct answer?
Blood glucose level of 60 mg/dL
Ketones in the urine
Acidosis
Blood glucose level of 600 mg/dL
The Correct Answer is A
A. A blood glucose level of 60 mg/dL indicates hypoglycemia, which is not consistent with diabetic ketoacidosis (DKA). DKA occurs due to insulin deficiency, which prevents glucose from entering cells. As a result, blood glucose levels rise, leading to hyperglycemia, rather than the low blood glucose seen in hypoglycemia. Patients with DKA typically present with blood glucose levels well above normal (often >250 mg/dL). Hypoglycemia is a completely opposite metabolic state and would suggest insulin overdose or other causes unrelated to DKA.
B. Ketones in the urine are a hallmark of DKA. When the body cannot use glucose for energy due to lack of insulin, it breaks down fats, producing ketone bodies (acetone, acetoacetate, beta-hydroxybutyrate). The accumulation of ketones leads to ketonuria, which is a key diagnostic sign of DKA and contributes to the metabolic acidosis observed.
C. Acidosis is a defining characteristic of DKA. The ketone bodies are acidic, and their accumulation lowers blood pH, resulting in metabolic acidosis. Laboratory findings typically show low serum bicarbonate levels and decreased pH. Acidosis is a core feature that differentiates DKA from hyperglycemia without ketoacidosis.
D. Blood glucose levels of 600 mg/dL are consistent with severe hyperglycemia in DKA. While glucose levels in DKA can vary, they are usually markedly elevated, often ranging from 250–600 mg/dL or higher. Such hyperglycemia contributes to osmotic diuresis, dehydration, and electrolyte imbalances, all common complications of DKA.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. While adherence is important, questioning the patient about taking medication may feel accusatory and is not the most appropriate initial response. Many patients do take their medication correctly but still do not feel better immediately due to the drug’s pharmacokinetics.
B. Diet can affect absorption (e.g., calcium or iron supplements), but this is not typically the primary reason a patient would not feel better after only 1 week of therapy. Focusing on diet at this early stage is premature.
C. Levothyroxine requires time to reach steady-state levelsin the blood, and clinical improvement is gradual. Most patients experience full therapeutic effects in 3 to 4 weeks. Early weeks may not show significant symptom relief, which is normal and should be explained to the patient to prevent unnecessary concern.
D. Surgery is not requiredfor typical hypothyroidism. The standard treatment is lifelong thyroid hormone replacement, and surgery is only indicated in specific conditions, such as large goiters or thyroid cancer.
Correct Answer is A
Explanation
A. Sulfonylureasare oral hypoglycemic agents that stimulate pancreatic beta cells to release insulin. They are used exclusively in type 2 diabetes, as type 1 diabetes patients lack functional beta cells. A notable adverse effect of some first-generation sulfonylureas (e.g., chlorpropamide) is a disulfiram-like reactionwhen alcohol is consumed, causing flushing, nausea, vomiting, and hypotension. Examples include glipizide, glyburide, and glimepiride(second-generation sulfonylureas), which are safer but still can cause hypoglycemia.
B. Biguanides(e.g., metformin) do not stimulate insulin release; instead, they reduce hepatic glucose production and improve insulin sensitivity. They are used in type 2 diabetes but do not cause a disulfiram-like reaction.
C. Meglitinides(e.g., repaglinide, nateglinide) also stimulate insulin release, but they have a shorter duration of actionand do not typically cause a disulfiram-like reaction.
D. Thiazolidinediones(e.g., pioglitazone, rosiglitazone) increase insulin sensitivityin peripheral tissues rather than stimulating insulin release. They are used only for type 2 diabetes and do not cause a disulfiram-like reaction.
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