HOMEOSTASIS - ENDOCRINE Flashcards
The nurse reviews the arterial blood gas results of a client and notes the following:
Pco2: 30mmhg
HCO3-: 20mEq/L
pH: 7.45
The nurse notes this is a sign of: A/ Metabolic Acidosis, compensated B/ Respiratory Alkalosis, compensated C/ Metabolic Alkalosis, uncompensated D/ Respiratory Acidosis, uncompensated
B/ Respiratory Alkalosis
It is compensated because the pH is normal. The Pco2 is low. Therefore it is respiratory Alkalosis and the kidneys have begun to compensate by the excretion of bicarbonate to counteract the expiration of CO2 from the lungs.
The nurse is caring for a client with an NG tube that is attached to low suction. The nurse monitors the client knowing that they are at risk for which acid-base disorder? A/ Metabolic Acidosis B/ Metabolic Alkalosis C/ Respiratory Acidosis D/ Respiratory Alkalosis
B/ Metabolic Alkalosis
A deficit or loss of hydrogen ions or acids or an excess of bicarbonate. This results in conditions such as hypovolemic shock, loss of gastric fluids, excessive bicarbonate intake, massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluids from suctioning or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acids in the stomach.
A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/min. The ECG displays tachycardia, with a heart rate of 120 beats/minute. Arterial blood gasses are drawn and the nurse reviews the results expecting to note which finding? A/ Decreased pH and increased CO2 B/ Increased pH and decreased CO2 C/ Decreased pH and decreased HCO3- D/ Increased pH with increased HCO3-
D/ Increased pH with increased HCO3-
CLients with nausea and vomiting would most likely present is metabolic alkalosis resulting from the loss of gastric juices, thus causing the HCO3 and pH to increase. Symptoms would include hypoventilation and tachycardia to compensate for acid loss.
The nurse is caring for a client with an ileostomy and understandings that the client is most at risk for developing which complication? A/ Metabolic acidosis B/ Metabolic Alkalosis C/ Respiratory Acidosis D/ Respiratory Alkalosis
A/ Metabolic Acidosis
This is because the patient is losing intestinal secretions high in bicarbonate through their drainage tubes or ileostomy or diarrhea. In this case the patient is losing bicarb from their ileostomy.
The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul’s respirations. Which pattern did the nurse observe?
A/ Respirations that cease for several seconds
B/ Regular respirations that are slow
C/ Respirations that are laboured and increased in depth and rate
D/ Abnormally deep respirations that are regular and increased in rate
D/ Abnormally deep, regular and increased
A client is found unresponsive and has an arterial blood gas drawn and the results indicate the following:
pH: 7.12 Pco2: 90 mmhg HCO3-: 22 mEq/L The nurse knows the means which of the following: A/ Metabolic Acidosis, compensated B/ Respiratory Alkalosis, compensated C/ Metabolic Alkalosis, uncompensated D/ Respiratory Acidosis, uncompensated
D/ Respiratory Acidosis uncompensated
Normal Pco2 is 35-45mmhg, and in Respiratory acidosis the Pco2 is elevated with a decreased pH value below 7.35. Normal bicarbonate levels are 22-27 mEq/L, and because the patient’s levels are within normal range, we can identify their condition as uncompensated, especially since their pH level is abnormal.
The nurse notes a client's arterial blood gasses reveal apH of 7.50 and a Pco2 of 30mmhg. The nurse monitors the client for which of the following clinical manifestations associated with these findings? Select all that apply: A/ Nausea B/ Confusion C/ Bradypnea D/ Tachycardia E/ Hyperkalemia F/ Lightheadedness
A/ Nausea
B/ Confusion
D/ Tachycardia
F/ Lightheadedness
Respiratory alkalosis is the deficit of carbonic acid and a decrease in hydrogen ions that result in the accumulation of base or the loss of acid. This occurs in conditions that cause the overstimulation of the respiratory system. Other clinical conditions include: Lethargy Dysrhythmias related to hypokalemia Vomiting Epigastric pain Numbness and tingling Tachypnea
The nurse is caring for a client on a mechanical ventilator. Blood gasses indicate a pH of 7.50 and Pco2 of 30mmhg. The nurse has determined the patient is experiencing respiratory alkalosis. Which lab value is most likely to be noted in this condition? A/ Na 145 mEq/L B/ K 3.0 mEq/L C/ Mg 2.0 mg/L D/ Ph 4.0 mg/L
B/ K 3.0 mEq/L
Respiratory alkalosis occurs with the overstimulation of the respiratory system that causes nausea and vomiting which can lead to hypokalemia.
The nurse is planning care for a client with COPD. Understanding that they are likely to experience what type of acid-base imbalance? A/ Metabolic Acidosis B/ Metabolic Alkalosis C/ Respiratory Acidosis D/ Respiratory Alkalosis
C/ Respiratory Acidosis
Respiratory acidosis is caused by hypoventilation in a client with COPD. Respiratory Alkalosis is associated with hyperventilation and is unlikely in a client with COPD.
A school-aged child with type i Diabetes has soccer practice three afternoons per week. The nurse provides instructions regarding how to prevent hypoglycemia during practice. What should to nurse tell the child to do?
A/ Eat twice the amount normally eaten at lunch
B/ Take half the amount of prescribed insulin on practice days
C/ Take the prescribed insulin at noon rather than in the morning
D/ Eat a small box of raisins or drink a cup of orange juice before practice.
D/ Have a sugar snack before practice
Hypoglycemia is a low blood sugar, so an extra snack of 15-30g of carbohydrates before activity would help prevent hypoglycemia.
Insulin should not be adjusted nor should meal amounts change.
The mother of a 6-year-old with Type 1 diabetes calls the clinic nurse and states her child is sick and reports ketones in the child’s urine. What should the nurse instruct the mother to do?
A/ Hold next dose of insulin
B/ Come to the clinic immediately
C/ Encourage the child to drink liquids
D/ Administer additional dose of regular insulin
C/ Drink fluids
When the child is sick, the mother should check urinary ketones with each voiding. If ketones are present, it is essential to aid in the clearing of ketones; therefore they should drink fluids.
Bringing them to the clinic is unnecessary. Insulin should not be adjusted!
A HCP prescribes IV infusion of D5W in 0.45% Normal Saline with 40 mEq of KCl for a child with hypotonic dehydration. The nurse performs which priority assessment before administration? A/ Obtain a weight B/ Take temperature C/ Takes their Blood pressure D/ Checks amount of urinary output
D/ Urinary output
In hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment before administering KCl IV woul;d be to assess the status of the urine output. Never administer KCl in the presence of oliguria or anuria. If less than 1-2 mL/kg/hour, hold KCl.
1,2,3 are correct for the diagnosis, they do not specifically relate to the administration of this medication.
An adolescent with type 1 Diabetes is admitted to the ER for treatment of Diabetic Ketoacidosis. Which assessment finding is expected?
A/ Sweating and tremors
B/ Hunger and Hypertension
C/ Cold, Clammy skin and irritability
D/ Fruity breath odour and decreasing LOC
D/ Fruity and LOC changes
Complication of Diabetes that occurs when severe insulin deficiency occurs known as Hyperglycemia.
Hunger can be a sign of both Hypo and Hyperglycemia
Hypertension is not a sign of DKA. Hypotension occurs because of decreased blood volume related to the dehydrated state that occurs during DKA.
Cold, clammy, irritability, sweating and tremors are all signs of Hypoglycemia.
A mother brings her 3-week-old infant to a clinic for a phenylketonuria re-screening blood test. The test indicates a serum phenylalanine level of 1 mg/dL. The nurse reviews this result and makes which interpretation?
A/ it is positive
B/ It is negative
C/ It is inconclusive
D/ It requires re-screening at 6 weeks of age
- Negative reading
phenylketonuria is a genetic disorder that results in CNS damage from toxic levels of Phenylalanine in the blood. Characterized by Phenylalanine levels greater than 20mg/dL
A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion? A/ K+ Infusion B/ NPH Insulin Infusion C/ D5W infusion D/ Normal Saline Infusion
D/ NS 0.9% infusion
DKA is a complication of Hyperglycemia where re-hydration is the initial step in resolving the issue.
NPH Insulin is NEVER administered IV.
Dextrose Solutions are added to treat decreased glucose levels… not increased like in DKA.
IV K+ may be required, but is not part of initial treatment
The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 3.3mmol/L? SELECT ALL THAT APPLY
A/ Administer Regular Insulin
B/ Encourage child to ambulate
C/ Give Child Teaspoon of Honey
D/ Provide Electrolyte replacement therapy IV
E/ Wait 30 minutes and confirm Blood glucose testing
F/ Prepare to administer Glucagon SC if unconsciousness occurs
C/ Honey
F/ Glucagon
Child is hypoglycemic and needs sugars. If possible, the nurse should confirm hypoglycemia with a blood glucose reading. Glucose is administered orally immediately; rapid-releasing glucose is followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker.
If the child becomes unconscious, cake frosting or glucose paste is squeezed onto the gums, and the blood glucose level is retested in 15 minutes; if the reading remains low, additional glucose is administered. If the child remains unconscious, administration of glucagon may be necessary, and the nurse should be prepared for this intervention.
Encouraging the child to ambulate and administering regular insulin would result in a lowered blood glucose level. Providing electrolyte replacement therapy intravenously is an intervention to treat diabetic ketoacidosis. Waiting 30 minutes to confirm the blood glucose level delays necessary intervention.
A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which anticipated health care provider’s prescription?
A/ Endotracheal intubation
B/ 100 units of NPH insulin
C/ Intravenous infusion of normal saline
D/ Intravenous infusion of sodium bicarbonate
C/ IV NS
The primary goal of treatment in (HHNS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHNS.
An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on which information about the pump?
A/ Is timed to release programmed doses of short-duration or NPH insulin into the bloodstream at specific intervals
B/ Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels
C/ Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream
D/ Gives a small continuous dose of short-duration insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal
D/ Continuous dose of Short-duration insulin, with the option for elective bolus from client
An insulin pump provides a small continuous dose of short-duration (rapid or short-acting) insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with an additional dose from the pump before each meal as needed. Short-duration insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings would the nurse expect to note as CONFIRMING this diagnosis? SELECT ALL THAT APPLY
- Increase in pH
- Comatose state
- Deep, rapid breathing
- Decreased urine output
- Elevated blood glucose level
- Low plasma bicarbonate level
- Deep, rapid breathing
- Elevated blood glucose level
- Low plasma bicarbonate level
In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmaul’s respirations (deep and rapid breathing pattern) would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis.
The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop?
SELECT ALL THAT APPLY
- Polyuria
- Shakiness
- Palpitations
- Blurred vision
- Lightheadedness
- Fruity breath odor
- Shakiness
- Palpitations
- Lightheadedness
Shakiness, palpitations, and lightheadedness are signs of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are signs of hyperglycemia.
A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 53 mmol/L. A continuous intravenous infusion of short-acting insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 13.3 mmol/L. The nurse would next prepare to administer which item?
A/ Ampule of 50% dextrose
B/ NPH insulin subcutaneously
C/ Intravenous fluids containing dextrose
D/ Phenytoin (Dilantin) for the prevention of seizures
C/ Intravenous fluids containing dextrose
During management of DKA, when the blood glucose level falls to 13.8 to 16.6 mmol/L, the infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 13.8 mmol/L, or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin (Dilantin) is not a usual treatment measure
for DKA.
The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign, if exhibited in the client, would indicate hyperglycemia? A/ Polyuria B/ Diaphoresis C/ Hypertension D/ Increased pulse rate
A/ Polyuria
Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia.
Remember the 3 P’s with hyperglycemia
Gotta pee, gotta eat, gotta drink.
The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places highest priority on which client problem? A/ Lack of knowledge B/ Inadequate fluid volume C/ Compromised family coping D/ Inadequate consumption of nutrients
B/ Inadequate fluid volume
An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe.
Fluid loss is a major complication in hyperglycemia (Polyuria)
