Nursing Clinical Skills questions

Questions 28

ATI RN

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Nursing Clinical Skills questions Questions

Question 1 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 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

A patient presents to the emergency department with suspected thyroid storm. The nurse should be alert to which of the following cardiac rhythms while providing care to this patient?

Correct Answer: A

Rationale: The correct answer is A: Atrial fibrillation. In thyroid storm, excess thyroid hormone levels can lead to increased sympathetic activity, causing tachycardia and arrhythmias like atrial fibrillation. Atrial fibrillation is common in thyroid storm due to the hypermetabolic state and increased risk of atrial arrhythmias. Other choices are incorrect: B (Idioventricular rhythm) is not typically associated with thyroid storm, C (Junctional rhythm) is less likely since atrial arrhythmias are more common, and D (Sinus bradycardia) is unlikely due to the hypermetabolic state causing tachycardia.

Question 4 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 (DKA) 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.

Question 5 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.

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