NURS 618 Saunders Med Surg Endocrine Revised

2020

Saunders Med Surg Endocrine

1. A client is brought to the emergency department in an unresponsive state, and a

diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would

immediately prepare to initiate which anticipated health care provider's prescription?

1. Endotracheal intubation

2. 100 units of NPH insulin

3. Intravenous infusion of normal saline

4. Intravenous infusion of sodium bicarbonate

Answer:

3. Intravenous infusion of normal saline

Rationale:

The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to

rehydrate the client to restore fluid volume and to correct electrolyte deficiency.

Intravenous (IV) 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 HHS.

2. An external insulin pump is prescribed for a client with diabetes mellitus. When the

client asks the nurse about the functioning of the pump, the nurse bases the response on

which information about the pump?

1. It is timed to release programmed doses of either short-duration or NPH insulin into

the bloodstream at specific intervals.

2. It continuously infuses small amounts of NPH insulin into the bloodstream while

regularly monitoring blood glucose levels.

3. It is surgically attached to the pancreas and infuses regular insulin into the pancreas.

This releases insulin into the bloodstream.

4. It administers a small continuous dose of short-duration insulin subcutaneously. The

client can self-administer an additional bolus dose from the pump before each meal.

Answer:

4. It administers a small continuous dose of short-duration insulin

subcutaneously. The client can self-administer an additional bolus dose

from the pump before each meal.

Rationale:

An insulin pump provides a small continuous dose of short-duration (rapid- or shortacting) insulin subcutaneously throughout the day and night. The client can self-

administer an additional bolus dose from the pump before each meal as needed. Shortduration insulin

3. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the

emergency department. Which findings support this diagnosis? Select all that apply.

1. Increase in pH

2. Comatose state

3. Deep, rapid breathing

4. Decreased urine output

5. Elevated blood glucose level

Answers:

2. Comatose state

3. Deep, rapid breathing

5. Elevated blood glucose level

Rationale:

Because of the profound deficiency of insulin associated with DKA, glucose cannot be

used for energy and the body breaks down fat as a secondary source of energy. Ketones,

which are acid byproducts of fat metabolism, build up and the client experiences a

metabolic ketoacidosis. High serum glucose contributes to an osmotic diuresis and the

client becomes severely dehydrated. If untreated, the client will become comatose due to

severe dehydration, acidosis, and electrolyte imbalance. Kussmaul's respirations, the

deep rapid breathing associated with DKA, is a compensatory mechanism by the body. 

The body attempts to correct the acidotic state by blowing off carbon dioxide (CO2),

which is an acid. In the absence of insulin, the client will experience severe

hyperglycemia. Option 1 is incorrect because in acidosis the pH would be low. Option 4

is incorrect because a high serum glucose will result in an osmotic diuresis and the client

will experience polyuria