Lecture 4: Electrolytes Flashcards
A patient with Type 1 Diabetes Mellitus (T1DM) presents to the emergency department with polyuria, polydipsia, nausea, and abdominal pain. The nurse notes fruity-smelling breath and Kussmaul respirations. What is the priority nursing intervention?
A) Administer IV bolus of 50% dextrose
B) Administer subcutaneous regular insulin
C) Start an IV line and administer isotonic fluids
D) Provide a high-carbohydrate oral supplement
C) Start an IV line and administer isotonic fluids
Explanation:
The patient is exhibiting signs of diabetic ketoacidosis (DKA), which requires aggressive fluid resuscitation with isotonic fluids (Normal Saline or Lactated Ringer’s) to correct dehydration.
A) Incorrect: Dextrose is given later in treatment once blood glucose starts to drop and insulin is being administered.
B) Incorrect: Insulin therapy is crucial but should only be started after potassium levels are checked to avoid hypokalemia.
D) Incorrect: Oral intake is inappropriate in severe DKA due to nausea and vomiting.
A patient with Hyperosmolar Hyperglycemic State (HHS) has a blood glucose level of 47 mmol/L. The nurse understands that which factor differentiates HHS from DKA?
A) The presence of ketones in urine
B) Higher risk of developing hypoglycemia
C) More severe dehydration and neurological symptoms
D) Faster onset of symptoms
C) More severe dehydration and neurological symptoms
Explanation: HHS develops gradually over days to weeks and leads to extreme dehydration and neurological impairments (confusion, coma, seizures).
A) Incorrect: Unlike DKA, HHS does not involve ketone production due to some insulin presence preventing lipolysis.
B) Incorrect: HHS involves severe hyperglycemia, not hypoglycemia.
D) Incorrect: DKA develops faster (1-2 days), while HHS takes longer.
A nurse is caring for a patient with DKA receiving IV insulin. The patient’s potassium level is 3.0 mEq/L. What is the nurse’s next action?
A) Continue IV insulin and monitor blood glucose
B) Administer potassium replacement before continuing insulin
C) Stop IV insulin and give oral glucose
D) Start an IV bolus of hypertonic saline
B) Administer potassium replacement before continuing insulin
Explanation: Insulin pushes potassium into cells, leading to severe hypokalemia, which can cause life-threatening dysrhythmias.
A) Incorrect: Continuing insulin without potassium correction worsens hypokalemia.
C) Incorrect: Stopping insulin would allow continued ketone production and worsen DKA.
D) Incorrect: Hypertonic saline is not indicated; isotonic fluids are preferred for initial resuscitation.
A patient with symptomatic hyperglycemia but without biochemical derangement is admitted. What is the primary treatment?
A) IV insulin
B) Oral metformin
C) IV fluids and subcutaneous insulin
D) Administer 50% dextrose IV
C) IV fluids and subcutaneous insulin
Explanation: Symptomatic hyperglycemia (without biochemical derangement like ketones or acidosis) is primarily treated with fluid replacement and insulin to bring glucose levels down.
A) Incorrect: IV insulin is reserved for DKA or HHS.
B) Incorrect: Metformin is not a treatment for acute hyperglycemia.
D) Incorrect: Dextrose is given for hypoglycemia, not hyperglycemia.
Which patient is at highest risk for developing hypoglycemia unawareness?
A) A patient newly diagnosed with Type 1 Diabetes
B) A patient with frequent episodes of hypoglycemia
C) A patient taking an SGLT-2 inhibitor
D) A patient with diabetic neuropathy in the lower extremities
B) A patient with frequent episodes of hypoglycemia
Explanation: Repeated hypoglycemia blunts the autonomic nervous system response, making patients unaware of symptoms and increasing their risk of severe hypoglycemia.
A) Incorrect: Newly diagnosed patients still retain awareness.
C) Incorrect: SGLT-2 inhibitors primarily affect renal glucose excretion, not hypoglycemia risk.
D) Incorrect: Neuropathy affects sensation but does not directly cause hypoglycemia unawareness.
What is the most appropriate nursing action for a patient experiencing hypoglycemia with confusion and diaphoresis?
A) Administer a 15g carbohydrate snack
B) Administer IM glucagon
C) Encourage the patient to rest until symptoms resolve
D) Draw blood glucose and wait for results before treating
A) Administer a 15g carbohydrate snack
Explanation: The 15/15 rule applies: Give 15g of fast-acting carbs, then recheck blood glucose in 15 minutes.
B) Incorrect: IM glucagon is for severe hypoglycemia when the patient cannot ingest carbohydrates.
C) Incorrect: Rest does not correct hypoglycemia.
D) Incorrect: Immediate treatment is required—waiting for lab results can delay intervention.
A patient is diagnosed with HHS. Which laboratory findings support this diagnosis?
A) Blood glucose >34 mmol/L and positive urine ketones
B) Blood glucose >34 mmol/L and normal anion gap
C) Blood glucose >14 mmol/L and bicarbonate <18
D) Blood glucose >11 mmol/L and metabolic alkalosis
B) Blood glucose >34 mmol/L and normal anion gap
Explanation: HHS is marked by extreme hyperglycemia (>34 mmol/L) and high serum osmolality but NO ketoacidosis, so the anion gap remains normal.
A) Incorrect: Ketones are not present in HHS.
C) Incorrect: Bicarbonate <18 and anion gap elevation are seen in DKA, not HHS.
D) Incorrect: Metabolic acidosis is seen in DKA, not alkalosis.
Which nursing diagnosis is the highest priority for a patient in HHS?
A) Risk for Decreased Cardiac Output
B) Fluid Volume Deficit
C) Risk for Infection
D) Activity Intolerance
B) Fluid Volume Deficit
Explanation: Profound dehydration is the most critical issue in HHS due to osmotic diuresis.
A) Incorrect: Cardiac output is impacted but is secondary to fluid loss.
C) Incorrect: Infection may be a cause but is not the priority intervention.
D) Incorrect: Fatigue is present but not life-threatening.
A patient with Type 2 Diabetes Mellitus (T2DM) is admitted with confusion, dry mucous membranes, and a blood glucose level of 52 mmol/L. The nurse suspects Hyperosmolar Hyperglycemic State (HHS). What is the priority intervention?
A) Administer IV insulin bolus
B) Initiate IV fluid resuscitation with normal saline
C) Administer subcutaneous glucagon
D) Provide oral fluids and monitor closely
B) Initiate IV fluid resuscitation with normal saline
Explanation: HHS leads to severe dehydration due to osmotic diuresis, making fluid replacement the priority intervention.
A) Incorrect: IV insulin is important after fluid resuscitation.
C) Incorrect: Glucagon is used for hypoglycemia, not hyperglycemia.
D) Incorrect: The patient is in severe hyperglycemia, requiring IV fluids, not oral fluids.
A patient in DKA has a blood glucose of 13 mmol/L after IV insulin therapy. What is the nurse’s next action?
A) Stop the insulin infusion
B) Switch IV fluids to dextrose-containing solution
C) Administer an additional bolus of IV insulin
D) Encourage the patient to eat a high-protein snack
B) Switch IV fluids to dextrose-containing solution
Explanation: Dextrose is added to IV fluids when glucose reaches 14 mmol/L to prevent hypoglycemia while continuing insulin therapy to resolve acidosis.
A) Incorrect: Stopping insulin prematurely can cause a rebound of DKA.
C) Incorrect: Extra insulin is not needed—glucose levels are expected to fall.
D) Incorrect: The patient needs IV fluids, not just oral intake, at this stage.
A nurse is reviewing lab results of a patient with DKA. Which finding requires immediate intervention?
A) Serum potassium of 2.9 mEq/L
B) Blood glucose of 16 mmol/L
C) Serum bicarbonate of 20 mEq/L
D) Serum sodium of 138 mEq/L
A) Serum potassium of 2.9 mEq/L
Explanation: Hypokalemia (<3.3 mEq/L) is a critical concern in DKA because insulin therapy further lowers potassium levels, increasing the risk of life-threatening cardiac arrhythmias.
B) Incorrect: A blood glucose of 16 mmol/L is improving with treatment.
C) Incorrect: Bicarbonate levels improve as DKA resolves. 20 mEq/L is near normal (22-26 mEq/L).
D) Incorrect: Sodium levels in this range are normal.
A patient presents with diaphoresis, tachycardia, and confusion. Blood glucose is 2.8 mmol/L. What is the nurse’s next action?
A) Administer IV dextrose
B) Give 15g of carbohydrates orally
C) Administer IM glucagon
D) Recheck blood glucose in 15 minutes
A) Administer IV dextrose
Explanation: Severe hypoglycemia with altered mental status requires immediate IV dextrose (D50W) to prevent seizures and coma.
B) Incorrect: Oral glucose is only used for mild hypoglycemia in alert patients.
C) Incorrect: IM glucagon is used if IV access is unavailable.
D) Incorrect: The nurse must act immediately before rechecking glucose.
A nurse is caring for a patient with DKA. Which assessment finding suggests worsening acidosis?
A) Decreased urine output
B) Deep, rapid respirations
C) Blood glucose rising above 25 mmol/L
D) Increased blood pressure
B) Deep, rapid respirations
Explanation: Kussmaul respirations (deep, rapid breathing) indicate worsening metabolic acidosis as the body tries to compensate by exhaling CO2.
A) Incorrect: Decreased urine output suggests dehydration but not worsening acidosis.
C) Incorrect: High blood glucose contributes to DKA but does not confirm worsening acidosis.
D) Incorrect: Blood pressure usually drops due to dehydration in DKA.
A patient with Type 1 Diabetes is found unconscious at home. Their roommate reports the patient was confused earlier. What is the most likely cause?
A) Diabetic ketoacidosis
B) Hyperosmolar Hyperglycemic State
C) Hypoglycemia
D) Hyperkalemia
C) Hypoglycemia
Explanation: Severe hypoglycemia can cause unconsciousness, confusion, and coma if blood sugar drops too low.
A) Incorrect: DKA causes altered mental status but does not usually lead to unconsciousness this quickly.
B) Incorrect: HHS occurs in Type 2 Diabetes and takes longer to develop.
D) Incorrect: Hyperkalemia can occur with DKA, but it does not cause unconsciousness this quickly.
A nurse is administering IV potassium to a patient in DKA. What precaution should be taken?
A) Administer IV potassium as a rapid bolus
B) Ensure the patient has adequate urine output
C) Mix potassium with dextrose-containing fluids
D) Monitor for signs of hyperglycemia
B) Ensure the patient has adequate urine output
Explanation: Potassium should not be given unless urine output is adequate to prevent hyperkalemia and cardiac complications.
A) Incorrect: IV potassium should never be given as a bolus due to risk of fatal dysrhythmias.
C) Incorrect: Potassium is not mixed with dextrose, as it may increase insulin release and further drop potassium levels.
D) Incorrect: Potassium infusion does not directly cause hyperglycemia.
A nurse is assessing a patient in HHS. Which finding differentiates HHS from DKA?
A) Presence of ketones in urine
B) Higher blood glucose levels
C) Development of Kussmaul’s respirations
D) Rapid onset of symptoms
B) Higher blood glucose levels
Explanation: HHS often presents with glucose levels >34 mmol/L, higher than typical DKA cases.
A) Incorrect: Ketones are present in DKA, not HHS.
C) Incorrect: Kussmaul’s respirations occur in DKA due to metabolic acidosis.
D) Incorrect: HHS has a gradual onset over days to weeks, while DKA develops quickly.
Which patient is at highest risk for developing HHS?
A) A young adult with Type 1 Diabetes
B) A child recently diagnosed with diabetes
C) An elderly patient with undiagnosed Type 2 Diabetes
D) A patient with hypoglycemia unawareness
C) An elderly patient with undiagnosed Type 2 Diabetes
Explanation: HHS is most common in older adults with undiagnosed or poorly managed Type 2 Diabetes, often triggered by illness or dehydration.
A & B) Incorrect: DKA is more common in Type 1 Diabetes, not HHS.
D) Incorrect: Hypoglycemia unawareness increases the risk of low blood sugar episodes, not HHS.
A patient with HHS has a serum osmolality of 320 mOsm/kg. What clinical sign correlates with this finding?
A) Severe neurological symptoms
B) Ketone-positive urine
C) Increased urine output
D) Kussmaul respirations
A) Severe neurological symptoms
Explanation: High serum osmolality (>295 mOsm/kg) causes severe neurological symptoms like confusion, seizures, and coma in HHS.
B) Incorrect: Ketones are absent in HHS.
C) Incorrect: Polyuria is common, but neurological impairment is the key distinguishing feature.
D) Incorrect: Kussmaul respirations occur in DKA, not HHS.
A patient with Type 1 Diabetes presents with nausea, abdominal pain, and a blood glucose of 21 mmol/L. The nurse suspects Diabetic Ketoacidosis (DKA). Which laboratory result would confirm this diagnosis?
A) Serum bicarbonate 26 mEq/L
B) Serum osmolality 280 mOsm/kg
C) Blood pH 7.28 and positive urine ketones
D) Blood glucose 14 mmol/L and normal anion gap
Blood pH 7.28 and positive urine ketones
Explanation: DKA is characterized by metabolic acidosis (pH <7.30) and the presence of ketones in urine or blood.
A) Incorrect: Bicarbonate in DKA is low (<18 mEq/L), not normal (22-26 mEq/L).
B) Incorrect: Serum osmolality is typically elevated (>295 mOsm/kg) in DKA, not normal.
D) Incorrect: DKA presents with a high anion gap, indicating metabolic acidosis.
Which of the following findings is most concerning in a patient being treated for DKA?
A) Blood glucose has decreased from 22 mmol/L to 16 mmol/L
B) Serum potassium has dropped from 4.5 mEq/L to 3.0 mEq/L
C) The patient reports mild nausea
D) Urine output has increased from 30 mL/hr to 45 mL/hr
B) Serum potassium has dropped from 4.5 mEq/L to 3.0 mEq/L
Explanation: Hypokalemia (<3.3 mEq/L) is life-threatening because insulin therapy shifts potassium into cells, increasing the risk of cardiac dysrhythmias.
A) Incorrect: A decrease in glucose is expected with insulin therapy.
C) Incorrect: Mild nausea is common and not an immediate concern.
D) Incorrect: Increasing urine output suggests improving renal function and is not a warning sign.
A patient with HHS is receiving IV fluids and insulin. Which of the following indicates treatment is effective?
A) Blood glucose decreases from 42 mmol/L to 25 mmol/L
B) Serum osmolality increases from 315 mOsm/kg to 330 mOsm/kg
C) Patient develops Kussmaul respirations
D) Serum potassium increases from 4.2 mEq/L to 5.8 mEq/L
A) Blood glucose decreases from 42 mmol/L to 25 mmol/L
Explanation: A gradual decrease in blood glucose indicates effective management of HHS.
B) Incorrect: Serum osmolality should decrease, not increase.
C) Incorrect: Kussmaul respirations occur in DKA, not HHS.
D) Incorrect: Hyperkalemia (K+ >5.5) is a complication, not a sign of improvement.
The nurse is caring for a patient with DKA. Which IV fluid should be initiated first?
A) 5% Dextrose in Water (D5W)
B) 0.45% Normal Saline (Hypotonic Saline)
C) 0.9% Normal Saline (Isotonic Saline)
D) 3% Normal Saline (Hypertonic Saline)
C) 0.9% Normal Saline (Isotonic Saline)
Explanation: Initial treatment of DKA requires isotonic fluids (NS) to correct dehydration before adding insulin or potassium
A) Incorrect: D5W is given later when glucose approaches 14 mmol/L.
B) Incorrect: Hypotonic saline can cause cerebral edema.
D) Incorrect: Hypertonic saline is not used in DKA.
A patient with Type 1 Diabetes develops hypoglycemia overnight. Which counter-regulatory hormone is responsible for increasing blood glucose?
A) Insulin
B) Glucagon
C) Amylin
D) Aldosterone
B) Glucagon
Explanation: Glucagon raises blood glucose by stimulating glycogenolysis and gluconeogenesis in the liver.
A) Incorrect: Insulin lowers blood glucose.
C) Incorrect: Amylin slows gastric emptying but does not raise glucose.
D) Incorrect: Aldosterone regulates sodium and fluid balance, not glucose.
A patient with a history of alcohol use disorder is at risk for severe hypoglycemia. Why might glucagon administration be ineffective in this patient?
A) Alcohol blocks glucagon receptors in the pancreas
B) Alcohol depletes liver glycogen stores
C) Alcohol increases insulin production
D) Alcohol causes rapid glucose absorption
B) Alcohol depletes liver glycogen stores
Explanation: Glucagon raises glucose by stimulating glycogen breakdown in the liver. If glycogen stores are depleted (e.g., due to alcohol use), glucagon is ineffective.
A) Incorrect: Alcohol does not block glucagon receptors.
C) Incorrect: Alcohol does not increase insulin production.
D) Incorrect: Alcohol slows, rather than accelerates, glucose absorption.
A patient is receiving IV insulin for DKA. The nurse should monitor for which serious complication?
A) Rebound hyperglycemia
B) Cerebral edema
C) Metabolic alkalosis
D) Respiratory depression
B) Cerebral edema
Explanation: A rapid drop in blood glucose (>3-5 mmol/L/hr) can cause fluid shifts, leading to cerebral edema.
A) Incorrect: Rebound hyperglycemia occurs with overcorrection but is not life-threatening.
C) Incorrect: DKA is associated with metabolic acidosis, not alkalosis.
D) Incorrect: Respiratory depression is not a common complication of insulin therapy.
A patient with DKA is started on an insulin infusion. The nurse understands that blood glucose must be maintained at which level before stopping the infusion?
A) <10 mmol/L
B) 14-16 mmol/L
C) 7-8 mmol/L
D) 4-6 mmol/L
B) 14-16 mmol/L
Explanation: IV insulin is continued until blood glucose reaches ~14 mmol/L, at which point D5W is added to prevent hypoglycemia while resolving ketosis.
A, C, & D) Incorrect: Stopping insulin too soon can cause a rebound into DKA.
A nurse is providing education to a patient with hypoglycemia unawareness. What is the most important teaching point?
A) Always carry a source of fast-acting glucose
B) Check blood glucose only when symptoms occur
C) Skip insulin doses if blood sugar is <7 mmol/L
D) Increase carbohydrate intake before meals
A) Always carry a source of fast-acting glucose
Explanation: Patients with hypoglycemia unawareness do not feel typical low blood sugar symptoms, making it essential to carry glucose at all times.
B) Incorrect: They should check glucose regularly, not just with symptoms.
C) Incorrect: Skipping insulin doses can lead to hyperglycemia and DKA.
D) Incorrect: Carbohydrate intake should be balanced, not increased indiscriminately.
A patient with HHS is experiencing worsening confusion and lethargy. What is the most likely cause?
A) Increasing ketone production
B) Increased serum osmolality
C) Insufficient insulin
D) Low sodium levels
B) Increased serum osmolality
Explanation: HHS leads to extreme dehydration and high serum osmolality (>320 mOsm/kg), which can cause severe neurological impairment.
A) Incorrect: Ketones are absent in HHS.
C) Incorrect: Insulin insufficiency is a cause, but high osmolality drives neurological symptoms.
D) Incorrect: Sodium levels may be altered but do not directly cause confusion.
A nurse is caring for a patient with DKA who has been on IV insulin therapy for 6 hours. Which assessment finding requires immediate intervention?
A) Blood glucose has decreased from 24 mmol/L to 14 mmol/L
B) Serum potassium has dropped from 4.0 mEq/L to 3.1 mEq/L
C) The patient reports mild nausea and thirst
D) Urine output is 50 mL/hr
B) Serum potassium has dropped from 4.0 mEq/L to 3.1 mEq/L
Explanation: Potassium levels must be monitored closely during insulin therapy because insulin shifts potassium into cells, leading to hypokalemia (<3.3 mEq/L), which can cause cardiac dysrhythmias.
A) Incorrect: A drop in glucose is expected and shows treatment effectiveness.
C) Incorrect: Mild nausea and thirst are common and do not require immediate intervention.
D) Incorrect: Adequate urine output (≥30 mL/hr) is a good sign of kidney perfusion.
A patient in DKA has been receiving IV insulin and fluids. The nurse notes that the blood glucose is now 12 mmol/L, but the anion gap remains elevated. What is the next action?
A) Stop IV insulin and switch to subcutaneous insulin
B) Continue IV insulin until the anion gap normalizes
C) Administer 50% dextrose IV push
D) Switch IV fluids to 0.45% saline without dextrose
B) Continue IV insulin until the anion gap normalizes
Explanation: The goal of DKA treatment is not just glucose correction but also resolution of metabolic acidosis (measured by the anion gap). IV insulin should continue until the anion gap is normal.
A) Incorrect: Stopping insulin too soon can cause a rebound into DKA.
C) Incorrect: Dextrose is added only when glucose reaches ~14 mmol/L but insulin must continue.
D) Incorrect: Fluid adjustments are made based on electrolyte needs, not arbitrarily.
A nurse is evaluating a patient’s response to treatment for HHS. Which finding indicates the treatment is effective?
A) Blood glucose has dropped from 48 mmol/L to 20 mmol/L
B) Serum osmolality has increased from 300 to 350 mOsm/kg
C) The patient develops Kussmaul’s respirations
D) The patient has worsening confusion and lethargy
A) Blood glucose has dropped from 48 mmol/L to 20 mmol/L
Explanation: A gradual decrease in blood glucose indicates that insulin therapy and fluid resuscitation are working effectively in HHS.
B) Incorrect: Serum osmolality should decrease, not increase.
C) Incorrect: Kussmaul’s respirations occur in DKA, not HHS.
D) Incorrect: Worsening confusion suggests worsening dehydration and hyperosmolarity, indicating ineffective treatment.
A patient with hypoglycemia has a blood glucose of 2.9 mmol/L and is confused. The nurse is unable to obtain IV access. What is the best next action?
A) Give 15g of oral glucose tablets
B) Administer intramuscular (IM) glucagon
C) Start an IV and administer D50W
D) Encourage the patient to drink juice
B) Administer intramuscular (IM) glucagon
Explanation: If the patient cannot safely swallow, IM glucagon is the best option because it stimulates glycogen breakdown to increase blood glucose.
A & D) Incorrect: The patient is confused and at risk of aspiration, making oral glucose unsafe.
C) Incorrect: IV dextrose is preferred but IV access is unavailable.
The nurse is teaching a newly diagnosed Type 1 Diabetes patient about insulin administration. Which statement by the patient indicates a need for further teaching?
A) “I will inject my insulin into my thigh before I exercise.”
B) “I should rotate my insulin injection sites to prevent lipodystrophy.”
C) “I can mix rapid-acting insulin with long-acting insulin in the same syringe.”
D) “If I experience shakiness or dizziness, I should check my blood sugar right away.”
C) “I can mix rapid-acting insulin with long-acting insulin in the same syringe.”
Explanation: Long-acting insulin (e.g., glargine, detemir) should not be mixed with other insulins.
A) Incorrect: Injecting insulin in an active muscle before exercise can increase absorption and lead to hypoglycemia.
B) Correct: Rotating injection sites prevents lipodystrophy.
D) Correct: Symptoms of hypoglycemia should prompt immediate blood glucose checks.
A patient in DKA is receiving IV insulin therapy. The nurse notes that urine output has decreased to 10 mL/hr. What is the most concerning potential complication?
A) Fluid volume overload
B) Acute kidney injury (AKI)
C) Hyperkalemia
D) Rebound hyperglycemia
B) Acute kidney injury (AKI)
Explanation: A urine output <30 mL/hr suggests decreased kidney perfusion, which can lead to AKI.
A) Incorrect: Fluid overload is not common in DKA.
C) Incorrect: Hyperkalemia is possible but not the most immediate concern.
D) Incorrect: Rebound hyperglycemia occurs if insulin is stopped too soon, but the bigger concern here is renal function.
The nurse is preparing to administer IV potassium to a patient recovering from DKA. What is the most important safety measure?
A) Administer potassium as a rapid IV bolus
B) Ensure the patient has adequate urine output
C) Give potassium only if the patient’s blood glucose is below 14 mmol/L
D) Monitor for signs of hypoglycemia
B) Ensure the patient has adequate urine output
Explanation: Potassium should not be given unless the patient has sufficient urine output (>30 mL/hr) to avoid dangerous hyperkalemia.
A) Incorrect: Rapid IV bolus potassium can cause fatal arrhythmias.
C) Incorrect: Blood glucose levels do not determine potassium administration.
D) Incorrect: Hypoglycemia is important but not directly related to potassium administration.
A patient with newly diagnosed Type 2 Diabetes asks how exercise affects blood glucose. What is the best response?
A) “Exercise decreases insulin production, so you may need to increase your dose.”
B) “Exercise increases blood glucose levels, so you should check your sugar after workouts.”
C) “Exercise helps your body use insulin more effectively and lowers blood glucose.”
D) “Exercise has no effect on your blood glucose levels.”
C) “Exercise helps your body use insulin more effectively and lowers blood glucose.”
Explanation: Exercise increases insulin sensitivity and helps lower blood glucose naturally.
A) Incorrect: Exercise does not decrease insulin production.
B) Incorrect: Exercise typically lowers, not raises, blood sugar.
D) Incorrect: Exercise directly affects glucose metabolism.
The nurse is assessing a patient with HHS. Which finding is expected?
A) Positive ketones in urine
B) Blood glucose >34 mmol/L
C) pH <7.30
D) Kussmaul’s respirations
B) Blood glucose >34 mmol/L
Explanation: HHS is marked by extremely high blood glucose (>34 mmol/L) and severe dehydration.
A) Incorrect: Ketones are absent in HHS.
C) Incorrect: pH <7.30 suggests DKA, not HHS.
D) Incorrect: Kussmaul’s respirations are seen in DKA, not HHS.
A patient with Type 1 Diabetes is experiencing symptoms of hypoglycemia, including diaphoresis and tremors. The nurse checks the patient’s blood glucose, which is 3.4 mmol/L. What is the best intervention?
A) Administer 15g of fast-acting carbohydrates and recheck blood glucose in 15 minutes
B) Give 1 mg of IM glucagon immediately
C) Start an IV and administer D50W
D) Encourage the patient to rest until symptoms resolve
A) Administer 15g of fast-acting carbohydrates and recheck blood glucose in 15 minutes
Explanation: The 15/15 rule applies: Give 15g of carbohydrates, then recheck blood glucose in 15 minutes.
B) Incorrect: IM glucagon is used for severe hypoglycemia when the patient is unconscious or unable to eat.
C) Incorrect: IV dextrose (D50W) is only necessary if the patient is unresponsive or has no IV access for glucagon.
D) Incorrect: Rest does not correct hypoglycemia.
A patient with newly diagnosed Type 2 Diabetes asks why they need to monitor their blood glucose regularly. What is the best response?
A) “It helps determine if your insulin dose needs to be increased.”
B) “It allows you to adjust your carbohydrate intake throughout the day.”
C) “It helps detect patterns in your blood sugar and prevent complications.”
D) “It prevents the need for diabetes medication in the future.”
C) “It helps detect patterns in your blood sugar and prevent complications.”
Explanation: Regular monitoring helps patients recognize trends and prevent long-term complications like neuropathy and kidney disease.
A) Incorrect: Many Type 2 Diabetes patients do not require insulin initially.
B) Incorrect: Carbohydrate adjustments should be guided by healthcare professionals, not just self-monitoring.
D) Incorrect: Monitoring does not prevent medication use but supports better diabetes control.
The nurse is assessing a patient with HHS. Which assessment finding is most concerning?
A) Blood glucose of 42 mmol/L
B) Serum osmolality of 330 mOsm/kg
C) New-onset confusion and difficulty speaking
D) Dry mucous membranes and poor skin turgor
C) New-onset confusion and difficulty speaking
Explanation: Neurological symptoms (confusion, difficulty speaking, or coma) indicate worsening HHS and require immediate intervention.
A & B) Incorrect: High blood glucose and serum osmolality are expected findings in HHS.
D) Incorrect: Dehydration is common in HHS but not as urgent as neurological deterioration.
A nurse is reviewing an arterial blood gas (ABG) for a patient in DKA. Which result is expected?
A) pH 7.45, HCO3 26 mEq/L
B) pH 7.28, HCO3 15 mEq/L
C) pH 7.50, HCO3 28 mEq/L
D) pH 7.38, HCO3 22 mEq/L
B) pH 7.28, HCO3 15 mEq/L
Explanation: DKA causes metabolic acidosis (low pH and low bicarbonate).
A) Incorrect: Normal values (pH 7.35-7.45, HCO3 22-26) do not indicate acidosis.
C) Incorrect: pH 7.50 suggests alkalosis, not DKA.
D) Incorrect: pH and bicarbonate levels would be lower in DKA.
A patient in DKA is receiving IV insulin. Which finding suggests that treatment is effective?
A) Blood glucose decreases from 28 mmol/L to 14 mmol/L
B) Anion gap increases from 10 to 18
C) Serum bicarbonate decreases from 18 mEq/L to 10 mEq/L
D) Kussmaul respirations become more pronounced
A) Blood glucose decreases from 28 mmol/L to 14 mmol/L
Explanation: A gradual reduction in glucose indicates that insulin therapy is working.
B) Incorrect: An increasing anion gap suggests worsening acidosis.
C) Incorrect: Decreasing bicarbonate suggests worsening acidosis.
D) Incorrect: Kussmaul respirations should improve, not worsen.
A patient with HHS is receiving IV fluids. Which finding indicates the patient is improving?
A) Serum osmolality decreases from 340 mOsm/kg to 300 mOsm/kg
B) Blood glucose rises from 40 mmol/L to 45 mmol/L
C) Urine output decreases from 60 mL/hr to 10 mL/hr
D) The patient becomes more confused and lethargic
A) Serum osmolality decreases from 340 mOsm/kg to 300 mOsm/kg
Explanation: A decreasing serum osmolality means that fluid therapy is correcting dehydration.
B) Incorrect: Blood glucose should decrease, not increase.
C) Incorrect: Decreasing urine output may indicate worsening kidney function.
D) Incorrect: Worsening confusion suggests inadequate treatment.
A nurse is preparing to administer IV insulin to a patient with DKA. What must be done first?
A) Check the patient’s potassium level
B) Administer 50% dextrose IV
C) Hold all IV fluids
D) Give subcutaneous insulin before starting IV insulin
A) Check the patient’s potassium level
Explanation: Insulin causes potassium to shift into cells, which can lead to life-threatening hypokalemia.
B) Incorrect: Dextrose is given only if glucose drops too low.
C) Incorrect: IV fluids are critical in DKA and should not be held.
D) Incorrect: IV insulin is the priority treatment.
A patient with Type 1 Diabetes reports frequent episodes of hypoglycemia during exercise. What is the best nursing recommendation?
A) “Avoid all physical activity to prevent hypoglycemia.”
B) “Check blood glucose before, during, and after exercise.”
C) “Take an extra dose of insulin before exercising.”
D) “Consume a high-protein meal right before exercise.”
B) “Check blood glucose before, during, and after exercise.”
Explanation: Exercise can cause glucose levels to drop, so frequent monitoring is key to preventing hypoglycemia.
A) Incorrect: Exercise is beneficial for diabetes management.
C) Incorrect: Extra insulin can cause severe hypoglycemia.
D) Incorrect: Carbohydrates, not protein, are the primary energy source during exercise.
A nurse is educating a patient on the effects of alcohol on blood sugar. Which statement indicates correct understanding?
A) “Drinking alcohol can cause delayed hypoglycemia.”
B) “Alcohol increases blood sugar and prevents low glucose levels.”
C) “I should always take extra insulin before drinking alcohol.”
D) “As long as I drink on an empty stomach, my blood sugar will remain stable.”
A) “Drinking alcohol can cause delayed hypoglycemia.”
Explanation: Alcohol inhibits gluconeogenesis in the liver, which can lead to delayed hypoglycemia.
B) Incorrect: Alcohol does not increase blood sugar in a predictable way.
C) Incorrect: Extra insulin is not required and may increase hypoglycemia risk.
D) Incorrect: Drinking on an empty stomach worsens hypoglycemia.
A patient with a history of recurrent hypoglycemia has an HbA1c of 5.8%. What should the nurse suspect?
A) The patient has well-controlled diabetes
B) The patient is at risk for hypoglycemia unawareness
C) The patient needs a higher insulin dose
D) The patient has been noncompliant with treatment
B) The patient is at risk for hypoglycemia unawareness
Explanation: A very low HbA1c in a diabetic patient may indicate frequent hypoglycemia episodes, leading to hypoglycemia unawareness.
A) Incorrect: The target HbA1c is usually ~7% for diabetics.
C) Incorrect: Increasing insulin may worsen hypoglycemia.
D) Incorrect: Noncompliance would result in higher glucose levels.
A patient with Type 1 Diabetes is admitted for DKA. The nurse understands that which of the following laboratory findings confirms this diagnosis?
A) Blood glucose of 11 mmol/L, pH of 7.38, bicarbonate 22 mEq/L
B) Blood glucose of 16 mmol/L, presence of ketones, pH of 7.28
C) Blood glucose of 8 mmol/L, normal anion gap, bicarbonate 24 mEq/L
D) Blood glucose of 40 mmol/L, serum osmolality of 320 mOsm/kg, no ketones
B) Blood glucose of 16 mmol/L, presence of ketones, pH of 7.28
Explanation: DKA is diagnosed by hyperglycemia, metabolic acidosis (pH <7.30), and the presence of ketones.
A) Incorrect: A normal pH and bicarbonate do not indicate DKA.
C) Incorrect: DKA is associated with metabolic acidosis, not normal bicarbonate and anion gap.
D) Incorrect: These findings are more consistent with HHS, which lacks ketones.
A patient with Type 2 Diabetes presents with severe dehydration, blood glucose of 50 mmol/L, and serum osmolality of 340 mOsm/kg. The nurse suspects Hyperosmolar Hyperglycemic State (HHS). What is the priority nursing action?
A) Administer an IV bolus of 50% dextrose
B) Give subcutaneous insulin immediately
C) Start an IV line and administer normal saline
D) Encourage the patient to drink fluids
C) Start an IV line and administer normal saline
Explanation: Severe dehydration is the primary concern in HHS, requiring aggressive fluid resuscitation with normal saline.
A) Incorrect: Dextrose is not needed in hyperglycemia.
B) Incorrect: IV insulin is preferred over subcutaneous insulin in HHS.
D) Incorrect: Oral fluids are not sufficient for the degree of dehydration in HHS.
A nurse is caring for a patient in DKA receiving IV insulin. Which laboratory value requires immediate intervention?
A) Blood glucose of 14 mmol/L
B) Serum potassium of 2.8 mEq/L
C) Bicarbonate of 18 mEq/L
D) Serum sodium of 136 mEq/L
B) Serum potassium of 2.8 mEq/L
Explanation: Hypokalemia (<3.3 mEq/L) is a life-threatening complication of insulin therapy and must be corrected before continuing insulin infusion.
A) Incorrect: A blood glucose of 14 mmol/L is expected as DKA resolves.
C) Incorrect: A bicarbonate of 18 mEq/L suggests improving acidosis.
D) Incorrect: Serum sodium of 136 mEq/L is normal.
A patient with hypoglycemia is found unresponsive. The nurse should immediately:
A) Administer a high-protein snack
B) Administer intramuscular glucagon
C) Check blood glucose and wait for confirmation before acting
D) Encourage the patient to drink orange juice
B) Administer intramuscular glucagon
Explanation: For an unresponsive hypoglycemic patient, IM glucagon is the first-line treatment.
A) Incorrect: A high-protein snack is appropriate after glucose levels are corrected, but not as an initial intervention.
C) Incorrect: Immediate treatment is required, waiting for glucose confirmation can delay care.
D) Incorrect: Oral intake is unsafe due to the risk of aspiration.
A patient with HHS has received IV insulin and fluids. Which of the following indicates that the condition is improving?
A) Blood glucose decreases from 55 mmol/L to 22 mmol/L
B) Serum osmolality increases from 315 mOsm/kg to 350 mOsm/kg
C) The patient becomes more lethargic and confused
D) Urine output decreases significantly
A) Blood glucose decreases from 55 mmol/L to 22 mmol/L
Explanation: A gradual drop in blood glucose is a sign that treatment is effective.
B) Incorrect: Increasing osmolality suggests worsening dehydration.
C) Incorrect: Worsening confusion indicates inadequate treatment.
D) Incorrect: Decreased urine output suggests worsening kidney function.
A patient with DKA has received IV insulin and fluids. The nurse knows that which finding indicates resolution of DKA?
A) Blood glucose is 12 mmol/L
B) Anion gap has returned to normal
C) Bicarbonate level is 14 mEq/L
D) Urine ketones remain positive
B) Anion gap has returned to normal
Explanation: Resolution of DKA is confirmed when the anion gap normalizes, indicating that metabolic acidosis has resolved.
A) Incorrect: Blood glucose correction alone does not indicate DKA resolution.
C) Incorrect: Bicarbonate should be >18 mEq/L before DKA is resolved.
D) Incorrect: Ketones should clear from the urine as DKA resolves.
A nurse is educating a diabetic patient about the effects of exercise on blood glucose. Which statement by the patient indicates a need for further teaching?
A) “I should check my blood glucose before and after exercise.”
B) “If my blood glucose is low before exercise, I should eat a snack first.”
C) “Exercise can cause my blood sugar to rise, so I should take extra insulin beforehand.”
D) “If I feel shaky or weak during exercise, I should stop and check my blood sugar.”
C) “Exercise can cause my blood sugar to rise, so I should take extra insulin beforehand.”
Explanation: Exercise typically lowers blood glucose, not raises it. Taking extra insulin before exercise can lead to severe hypoglycemia.
A, B, & D) Correct: These statements demonstrate appropriate understanding of blood sugar management during exercise.
A patient in DKA has a potassium level of 5.9 mEq/L. What is the nurse’s priority action?
A) Start IV insulin immediately
B) Restrict potassium-rich foods
C) Monitor for ECG changes
D) Administer IV potassium replacement
C) Monitor for ECG changes
Explanation: Hyperkalemia (>5.5 mEq/L) can cause life-threatening arrhythmias, so ECG monitoring is critical.
A) Incorrect: Insulin therapy should be started but must be done carefully due to the potassium shift.
B) Incorrect: Dietary potassium restriction is not an immediate intervention.
D) Incorrect: Potassium should not be replaced if levels are already high.
A nurse is caring for a patient receiving IV insulin for DKA. The patient’s blood glucose is 13 mmol/L, but the anion gap is still elevated. What is the appropriate intervention?
A) Discontinue IV insulin and switch to subcutaneous insulin
B) Add dextrose to IV fluids and continue insulin therapy
C) Increase the IV insulin infusion rate
D) Stop all IV fluids and monitor blood glucose
B) Add dextrose to IV fluids and continue insulin therapy
Explanation: Dextrose is added when glucose falls below 14 mmol/L to prevent hypoglycemia while continuing insulin to resolve acidosis.
A) Incorrect: Stopping IV insulin before the anion gap normalizes can cause DKA to persist.
C) Incorrect: Increasing the insulin rate is not necessary if acidosis is resolving.
D) Incorrect: Stopping IV fluids would worsen dehydration.
A patient with diabetes presents with confusion, diaphoresis, and tachycardia. What is the most likely cause?
A) Hyperglycemia
B) Hypoglycemia
C) Diabetic ketoacidosis
D) Hyperosmolar Hyperglycemic State
B) Hypoglycemia
Explanation: Confusion, diaphoresis, and tachycardia are hallmark symptoms of hypoglycemia.
A) Incorrect: Hyperglycemia typically causes polyuria, polydipsia, and weight loss, not diaphoresis.
C & D) Incorrect: Both DKA and HHS present with dehydration and altered mental status but not sweating.
A patient with Type 1 Diabetes is experiencing nausea, abdominal pain, and rapid breathing. The nurse suspects Diabetic Ketoacidosis (DKA). What is the most likely cause of this condition?
A) Excessive insulin administration
B) Missed insulin doses or infection
C) Increased carbohydrate intake
D) Low-fat diet
B) Missed insulin doses or infection
Explanation: DKA is often triggered by missed insulin doses, infection, illness, or increased stress on the body, leading to a lack of insulin and fat breakdown for energy.
A) Incorrect: Excessive insulin would cause hypoglycemia, not DKA.
C) Incorrect: Increased carbohydrate intake alone does not cause DKA if insulin is present.
D) Incorrect: Dietary fat intake does not directly lead to DKA.
A nurse is educating a patient with Type 2 Diabetes about preventing Hyperosmolar Hyperglycemic State (HHS). Which statement by the patient indicates a need for further teaching?
A) “I will drink plenty of fluids when I am sick.”
B) “I should check my blood sugar more often when I’m feeling unwell.”
C) “I don’t need to take my diabetes medication if I’m not eating much.”
D) “I will contact my healthcare provider if my blood sugar stays high.”
C) “I don’t need to take my diabetes medication if I’m not eating much.”
Explanation: Skipping diabetes medication, even when not eating, can lead to extreme hyperglycemia and dehydration, increasing the risk of HHS.
A, B, & D) Correct: Staying hydrated, monitoring blood sugar, and seeking medical help are appropriate actions to prevent HHS.
A patient with DKA is receiving IV insulin therapy. Which intervention should the nurse prioritize to prevent complications?
A) Encourage the patient to drink fluids
B) Monitor for signs of cerebral edema
C) Restrict carbohydrate intake
D) Administer a high-protein meal before insulin therapy
B) Monitor for signs of cerebral edema
Explanation: A rapid decrease in blood glucose can cause fluid shifts, leading to cerebral edema, which is a life-threatening complication of DKA treatment.
A) Incorrect: Oral fluids may be helpful but are not the priority during IV therapy.
C) Incorrect: Carbohydrate intake should be managed but is not the immediate concern.
D) Incorrect: Food should be introduced after DKA is resolved.
A patient with Type 2 Diabetes is started on an exercise plan. What is the best advice the nurse can give to prevent hypoglycemia during exercise?
A) “Exercise on an empty stomach to burn more glucose.”
B) “Take extra insulin before exercising to control blood sugar spikes.”
C) “Carry a source of fast-acting glucose, like juice or glucose tablets.”
D) “Avoid all physical activity to prevent fluctuations in blood sugar levels.
C) “Carry a source of fast-acting glucose, like juice or glucose tablets.”
Explanation: Exercise increases insulin sensitivity, which can lower blood glucose. Carrying a fast-acting glucose source helps prevent hypoglycemia.
A) Incorrect: Exercising on an empty stomach can worsen hypoglycemia.
B) Incorrect: Taking extra insulin before exercise can cause severe hypoglycemia.
D) Incorrect: Exercise is beneficial for diabetes management.
The nurse is teaching a patient with diabetes about alcohol consumption. Which statement by the patient requires further teaching?
A) “Drinking alcohol on an empty stomach can cause my blood sugar to drop.”
B) “I should always eat a meal when I drink alcohol to prevent low blood sugar.”
C) “If I drink alcohol, I don’t need to take my insulin.”
D) “Alcohol can cause delayed hypoglycemia hours after drinking.”
C) “If I drink alcohol, I don’t need to take my insulin.”
Explanation: Patients with diabetes should never skip insulin due to alcohol consumption. Instead, they should monitor their blood sugar closely and eat food to prevent hypoglycemia.
A, B, & D) Correct: Alcohol can lower blood sugar, especially when consumed on an empty stomach.
A patient with diabetes is learning about foot care. Which statement indicates the need for further teaching?
A) “I should check my feet daily for cuts or sores.”
B) “I should always wear shoes, even in my house.”
C) “I can use a heating pad to warm my feet if they feel cold.”
D) “I should avoid cutting my toenails too short to prevent injury.”
C) “I can use a heating pad to warm my feet if they feel cold.”
Explanation: Diabetic neuropathy reduces sensation, increasing the risk of burns from heating pads. Instead, warm socks or blankets should be used.
A, B, & D) Correct: Checking feet daily, wearing shoes, and proper nail care prevent diabetic foot complications.
The nurse is caring for a patient with HHS who is experiencing confusion and disorientation. What is the best nursing intervention?
A) Encourage oral fluids to rehydrate
B) Provide a high-protein meal to stabilize blood sugar
C) Administer IV fluids and continue monitoring neurological status
D) Apply restraints to prevent injury from confusion
C) Administer IV fluids and continue monitoring neurological status
Explanation: HHS leads to severe dehydration and neurological changes. IV fluids are the priority intervention to restore hydration and improve mental status.
A) Incorrect: Oral fluids are insufficient for severe dehydration.
B) Incorrect: High-protein meals do not correct HHS.
D) Incorrect: Restraints are unnecessary and do not address the underlying cause of confusion.
A nurse is teaching a newly diagnosed diabetic patient about self-monitoring blood glucose (SMBG). Which statement indicates proper understanding?
A) “I should check my blood sugar only if I feel dizzy or weak.”
B) “I will check my blood sugar before meals and at bedtime.”
C) “If my blood sugar is high, I will immediately take extra insulin.”
D) “I don’t need to check my blood sugar if I’m taking my medication as prescribed.”
B) “I will check my blood sugar before meals and at bedtime.”
Explanation: Routine blood glucose checks help identify trends and prevent complications.
A) Incorrect: Waiting until symptoms appear may result in delayed intervention.
C) Incorrect: Insulin adjustments should be based on provider recommendations, not self-dosing.
D) Incorrect: Monitoring is essential even with prescribed medication.
A patient with diabetes reports waking up with high blood sugar levels every morning. What is the nurse’s best response?
A) “This is likely due to the Dawn Phenomenon, which occurs from natural hormone release overnight.”
B) “You must be eating too many carbohydrates before bed.”
C) “Skipping dinner may help lower your morning blood sugar.”
D) “This is normal and nothing to worry about.”
A) “This is likely due to the Dawn Phenomenon, which occurs from natural hormone release overnight.”
Explanation: The Dawn Phenomenon occurs due to early morning hormone release (e.g., cortisol, growth hormone) leading to high fasting blood sugar. Adjusting nighttime insulin may help.
B) Incorrect: Although eating before bed can affect glucose levels, it is not always the cause.
C) Incorrect: Skipping dinner can increase the risk of nighttime hypoglycemia.
D) Incorrect: Persistent high morning blood sugar should be addressed.
