ATI RN
Nursing Clinical Skills questions Questions
Question 1 of 5
Which of the following laboratory values would be more common in patients with diabetic ketoacidosis?
Correct Answer: A
Rationale: The correct answer is A (Blood glucose >1000 mg/dL) because diabetic ketoacidosis is characterized by severe hyperglycemia. High blood glucose levels (>1000 mg/dL) are common due to insulin deficiency leading to increased glucose production.
B: Negative ketones in the urine would be incorrect as DKA results in ketone production, leading to ketonuria.
C: Normal anion gap would be incorrect as DKA typically presents with an elevated anion gap metabolic acidosis due to ketone accumulation.
D: pH 7.24 would be incorrect as DKA would present with a lower pH due to metabolic acidosis.
Question 2 of 5
A patient has been on daily, high-dose glucocorticoid therapy for the treatment of rheumatoid arthritis. His prescription runs out before his next appointment with his physician. Because he is asymptomatic, he thinks it is all right to withhold the medication for 3 days. What is likely to happen to this patient?
Correct Answer: A
Rationale: The correct answer is A: He will go into adrenal crisis.
Rationale:
1. Glucocorticoids suppress the body's natural production of cortisol.
2. Abruptly stopping high-dose glucocorticoid therapy can lead to adrenal insufficiency.
3. Adrenal crisis can result in symptoms like weakness, fatigue, hypotension, and potentially life-threatening consequences.
4. This patient, being on high-dose glucocorticoid therapy, is at risk for adrenal crisis if he abruptly stops the medication.
Summary:
B: Thyroid storm is not related to abruptly stopping glucocorticoid therapy.
C: Autoimmune disease remission is unlikely to occur within 3 days of stopping medication.
D: It is not appropriate to stop high-dose glucocorticoid therapy abruptly, as it can lead to adverse effects like adrenal crisis.
Question 3 of 5
In the management of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome, when is an intravenous (IV) solution that contains dextrose started?
Correct Answer: D
Rationale:
Correct
Answer: D
Rationale: In diabetic emergencies, starting IV dextrose at 250 mg/dL prevents hypoglycemia while resolving ketoacidosis. Below 250 mg/dL, the body can use endogenous glucose, so IV dextrose is not necessary.
Summary:
A: Incorrect. Normal saline may be used for initial fluid resuscitation but does not address the need for glucose.
B: Incorrect. Starting dextrose at 70 mg/dL may lead to unnecessary hyperglycemia and complications.
C: Incorrect. Waiting until 150 mg/dL delays the provision of necessary glucose for metabolic functions.
Question 4 of 5
In hyperosmolar hyperglycemic syndrome, the laboratory results are similar to those of diabetic ketoacidosis, with three major exceptions. What differences would you expect to see in patients with hyperosmolar hyperglycemic syndrome?
Correct Answer: D
Rationale: In hyperosmolar hyperglycemic syndrome, patients have high blood glucose levels, leading to dehydration and increased serum osmolality. Unlike diabetic ketoacidosis, there is no significant ketosis in hyperosmolar hyperglycemic syndrome.
Therefore, the correct answer is D: Higher serum glucose, higher osmolality, and no ketosis.
A: Lower serum glucose, lower osmolality, and greater ketosis - This is incorrect because hyperosmolar hyperglycemic syndrome is characterized by high blood glucose levels and no significant ketosis.
B: Lower serum glucose, lower osmolality, and milder ketosis - This is incorrect because hyperosmolar hyperglycemic syndrome presents with higher glucose levels and no ketosis.
C: Higher serum glucose, higher osmolality, and greater ketosis - This is incorrect because hyperosmolar hyperglycemic syndrome does not typically involve significant ketosis.
Question 5 of 5
A patient with a history of type 1 diabetes and an eating disorder is found unconscious. In the emergency department, the following lab values are obtained: Glucose: 648 mg/dL pH: 88 P CO : 20 mm Hg a 2 P O : 95 mm Hg a 2 HCO ¯: undetectable Anion gap: >31 Na+: 127 mEq/L K+: 5 mEq/L Creatinine: 8 mg/dL After the patient’s airway and ventilation have been established, the next priority for this patient is:
Correct Answer: A
Rationale: The correct answer is A: administration of a 1-L normal saline fluid bolus. In this scenario, the patient is likely experiencing diabetic ketoacidosis (DK
A) due to the extremely high glucose levels, low bicarbonate, and anion gap metabolic acidosis. The priority is to correct the dehydration and electrolyte imbalances through fluid resuscitation with normal saline to improve perfusion and reverse the metabolic derangements. Options B, C, and D do not address the immediate need for volume resuscitation and correction of dehydration. Administering insulin or potassium without first addressing the fluid deficit could lead to further complications. Sodium bicarbonate is not recommended in DKA as it can worsen acidosis and has not been shown to improve outcomes.