Perrin: Understanding the Essentials of Critical Care Nursing Chapter 13: Care of the Patient with Endocrine Disorders MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the questions 1) The patient has an admitting diagnosis of diabetic ketoacidosis. Which of the following problems causes the cascade to diabetic ketoacidosis (DKA)? A) Ketosis B) Insulin deficiency C) Hypoglycemia D) Dehydration Answer: B Explanation: A) If inadequate insulin is present the cells starve (lack glucose) and use fats as an energy source. Ketoacids are released as a waste product. Lactic acids are produced as a result of anaerobic cellular metabolism. #1, #3, and #4 are incorrect responses. Although keto and dehydration are present, they are not the cause of DKA, but rather a result of it. Hyperglycemia, rather than hypoglycemia, is present. Nursing Process: Assessment Cognitive Level: Knowledge Category of Need: Physiological Integrity: Physiological Adaptation B) If inadequate insulin is present the cells starve (lack glucose) and use fats as an energy source. Ketoacids are released as a waste product. Lactic acids are produced as a result of anaerobic cellular metabolism. #1, #3, and #4 are incorrect responses. Although keto and dehydration are present, they are not the cause of DKA, but rather a result of it. Hyperglycemia, rather than hypoglycemia, is present. Nursing Process: Assessment Cognitive Level: Knowledge Category of Need: Physiological Integrity: Physiological Adaptation C) If inadequate insulin is present the cells starve (lack glucose) and use fats as an energy source. Ketoacids are released as a waste product. Lactic acids are produced as a result of anaerobic cellular metabolism. #1, #3, and #4 are incorrect responses. Although keto and dehydration are present, they are not the cause of DKA, but rather a result of it. Hyperglycemia, rather than hypoglycemia, is present. Nursing Process: Assessment Cognitive Level: Knowledge Category of Need: Physiological Integrity: Physiological Adaptation D) If inadequate insulin is present the cells starve (lack glucose) and use fats as an energy source. Ketoacids are released as a waste product. Lactic acids are produced as a result of anaerobic cellular metabolism. #1, #3, and #4 are incorrect responses. Although keto and dehydration are present, they are not the cause of DKA, but rather a result of it. Hyperglycemia, rather than hypoglycemia, is present. Nursing Process: Assessment Cognitive Level: Knowledge Category of Need: Physiological Integrity: Physiological Adaptation 2) The nurse is explaining the pathophysiology of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which statement is most accurate? HHNS: A) Is accompanied by severe metabolic acidosis. B) Results in cellular overhydration and interstitial space dehydration. C) Causes severe dehydration from very high osmolarity. D) Causes a severe decline in glucose production, resulting in increased metabolic rates to burn fat for energy. Answer: C Explanation: A) HHNS is a hyperglycemic state. The body removes glucose with water through the kidneys (osmotic diuresis). This causes severe vascular, interstitial, and cellular water losses, resulting in severe dehydration. #1, #2, and #4 are incorrect responses. If prese at all, metabolic acidosis is minimal in HHNS because there is some insulin present to allow glucose into the cells for cellular metabolism. Cells are not overhydrated but instead are dehydrated. Glucose production is increased rather than decreased. Nursing Process: Assessment Cognitive Level: Knowledge Category of Need: Physiological Integrity: Physiological Adaptation B) HHNS is a hyperglycemic state. The body removes glucose with water through the kidneys (osmotic diuresis). This causes severe vascular, interstitial, and cellular water losses, resulting in severe dehydration. #1, #2, and #4 are incorrect responses. If prese at all, metabolic acidosis is minimal in HHNS because there is some insulin present to allow glucose into the cells for cellular metabolism. Cells are not overhydrated but instead are dehydrated. Glucose production is increased rather than decreased. Nursing Process: Assessment Cognitive Level: Knowledge Category of Need: Physiological Integrity: Physiological Adaptation C) HHNS is a hyperglycemic state. The body removes glucose with water through the kidneys (osmotic diuresis). This causes severe vascular, interstitial, and cellular water losses, resulting in severe dehydration. #1, #2, and #4 are incorrect responses. If prese at all, metabolic acidosis is minimal in HHNS because there is some insulin present to allow glucose into the cells for cellular metabolism. Cells are not overhydrated but instead are dehydrated. Glucose production is increased rather than decreased. Nursing Process: Assessment Cognitive Level: Knowledge Category of Need: Physiological Integrity: Physiological Adaptation D) HHNS is a hyperglycemic state. The body removes glucose with water through the kidneys (osmotic diuresis). This causes severe vascular, interstitial, and cellular water losses, resulting in severe dehydration. #1, #2, and #4 are incorrect responses. If prese at all, metabolic acidosis is minimal in HHNS because there is some insulin present to allow glucose into the cells for cellular metabolism. Cells are not overhydrated but instead are dehydrated. Glucose production is increased rather than decreased. Nursing Process: Assessment Cognitive Level: Knowledge Category of Need: Physiological Integrity: Physiological Adaptation