CCRN 42 Practice Questions - Endocrine |Exam Questions With Answers|36 Pages
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CCRN
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CCRN
Weakness, fatigue, muscle pain, and abdominal discomfort in a patient receiving metformin would likely be associated with which of the following?
a. Hypoglycemia
b. Hyperglycemia
c. Heart failure
d. Lactic acidosis - ️️Correct answer: d
Rationale: These are symptoms that may indicate the s...
Weakness, fatigue, muscle pain, and abdominal discomfort in a
patient receiving metformin would likely be associated with
which of the following?
a. Hypoglycemia
b. Hyperglycemia
c. Heart failure
d. Lactic acidosis - ✔ ✔ Correct answer: d
Rationale: These are symptoms that may indicate the serious
adverse effect of metformin of lactic acidosis and
rhabdomyolysis.
Test-Taking Strategy: Hypoglycemia can cause weakness.
Abdominal pain is associated with metabolic acidosis which can
occur with hyperglycemia (DKA) and severe heart failure.
Weakness and fatigue do occur with heart failure. The symptom
that is inconsistent with both hyperglycemia and heart failure is
muscle pain. This would lead you to rhabdomyolysis and the
resultant lactic acidosis.
Which laboratory values would differentiate diabetic
ketoacidosis (DKA) from a hyperosmolar hyperglycemic state
(HHS)?
,a. Serum glucose of 600 mg/dL
b. Serum potassium of 4 mEq/L
c. Positive serum ketones
d. Serum osmolality of 320 mOsm/L - ✔ ✔ Correct answer:
c
Rationale: In DKA there is an absolute insulin deficiency that
causes glycogenolysis and gluconeogenesis. The
gluconeogenesis causes the incomplete breakdown of free fatty
acids, which results in ketones in the blood and urine. In HHS,
there is a relative insulin deficiency that causes glycogenolysis
but does not cause gluconeogenesis. Therefore tests for ketones
are positive in DKA but typically negative in HHS.
Test-Taking Strategy: A serum glucose of 600 mg/dL is
abnormal but could be due to DKA or HHS. A serum potassium
of 4 mEq/L could be seen in DKA or HHS. Elevated serum
osmolality of 320 mOsm/L could be seen in DKA or HHS and is
due to dehydration. Only the serum ketones distinguish between
the two hyperglycemic crises.
Which of the following accurately describes a difference
between diabetic ketoacidosis (DKA) and hyperglycemic
hyperosmolar state (HHS)?
a. Patients with DKA have higher serum glucose levels than
patients with HHS.
,b. Patients with DKA have a greater fluid deficit than patients
with HHS.
c. Patients with HHS require more insulin than patients with
DKA.
d. Patients with HHS have a greater potassium deficit than
patients with DKA. - ✔ ✔ Correct answer: d
Rationale: Patients with HHS generally have higher serum
glucose levels but require less insulin than patients with DKA.
The insulin deficit is considered relative in HHS and absolute in
DKA. The fluid deficit generally is greater in HHS (higher
serum glucose,
therefore, more osmotic diuresis), and potassium is excreted in
the osmotic diuresis. The potassium deficit, therefore, is greater
in HHS.
Test-Taking Strategy: None
A 16-year-old girl with a history of type 1 diabetes mellitus
(DM) is admitted to the critical care unit. Her friend states that
she has had a cold for the last few days. She is now lethargic.
The most likely cause of diabetic ketoacidosis in this patient is:
a. puberty.
b. insulin omission.
c. infection.
, d. dehydration. - ✔ ✔ Correct answer: c
Rationale: Infection is a common cause of ketoacidosis in the
patient with type 1 DM because it increases the need for insulin.
Test-Taking Strategy: Focus on the history. Included
information is usually (but not always) important. The fact that
the case study says that she has had a cold over the last few
days, and your knowledge that infection increases the need for
insulin, make option c the most logical choice.
A 16-year-old girl with a history of type 1 diabetes mellitus
(DM) is admitted to the critical care unit. Her friend states that
she has had a cold for the last few days. She is now lethargic.
Which of the following lab results would the nurse expect?
a. Hyperglycemia, hypokalemia, acidosis, elevated serum
osmolality
b. Hyperglycemia, hyperkalemia, acidosis, elevated serum
osmolality
c. Hyperglycemia, hypernatremia, alkalosis, decreased serum
osmolality
d. Hypoglycemia, hyponatremia, acidosis, decreased serum
osmolality - ✔ ✔ Correct answer: b
Rationale: The hyperglycemia is caused by insulin deficiency
and therefore the inability of insulin to move into the cell. This
hyperglycemia causes a hypertonic diuresis, dehydration, and
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