A nurse is caring for a client in the emergency department who is actively dying from a catastrophic injury. Which of the following is the priority in planning care for this client?

Discussing organ donation with the family

Communicating sensitively with the client and family

Creating a plan for pain relief, nutrition, and hydration

Contacting the family's spiritual advisor

Answer and Explanation

The Correct Answer is B

A. "Discussing organ donation with the family": While organ donation is important, it is not the priority in the setting of an actively dying client. The primary concern at this stage should be addressing the immediate needs of the client and their family, focusing on emotional support and comfort.
B. "Communicating sensitively with the client and family.": When caring for a client who is actively dying, providing emotional support and clear communication with the family is critical. Sensitively addressing the family’s concerns and the client’s comfort is essential in this stage of care.
C. "Creating a plan for pain relief, nutrition, and hydration.": While ensuring pain relief is important, in the context of an actively dying patient, the focus should primarily be on comfort rather than ongoing interventions like nutrition and hydration, which may no longer be beneficial.
D. "Contacting the family's spiritual advisor.": While spiritual support is valuable, it should not be the first priority. Ensuring the client’s comfort and providing emotional support to the family should be prioritized initially, and the spiritual advisor can be contacted afterward if desired.

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Correct Answer is A

Explanation

A. Insulin resistance: HHS typically occurs in clients with type 2 diabetes who have some circulating insulin, but not enough to prevent severe hyperglycemia. Insulin resistance is a key feature, as it allows glucose levels to rise without triggering significant fat breakdown or ketone production.
B. Metabolic acidosis: Metabolic acidosis is more commonly seen in diabetic ketoacidosis (DKA) due to the accumulation of ketones. In HHS, acidosis is usually absent or only mild because fat breakdown is minimal.
C. Hypervolemia: HHS leads to profound dehydration due to osmotic diuresis caused by severe hyperglycemia. Clients are more likely to be hypovolemic rather than hypervolemic due to fluid losses.
D. Ketosis: Unlike DKA, HHS generally does not present with significant ketosis because the body retains enough insulin to prevent fat breakdown. The absence of ketosis is one of the key diagnostic differences between the two conditions.

A. Calcium level of 10.0 mg/dL (9.0 to 10.5 mg/dL) B. Serum sodium 138 mEq/L (136 to 145 mEq/L) C. Serum potassium 4.8 mEq/L (3.5 to 5.0 mEq/L) D. Serum glucose 58 mg/dL (74 to 106 mg/dL)

Correct Answer is D

Explanation

A. Calcium level of 10.0 mg/dL (9.0 to 10.5 mg/dL): The calcium level here is normal, and insulin therapy does not directly affect calcium levels. Therefore, this is not an adverse outcome related to insulin administration.

B. Serum sodium 138 mEq/L (136 to 145 mEq/L): The sodium level is within normal range. Insulin therapy does not typically cause major shifts in sodium, so this is not a concern.

C. Serum potassium 4.8 mEq/L (3.5 to 5.0 mEq/L): The potassium level here is also within normal range. Insulin therapy is often used to lower potassium levels, so this result does not suggest an adverse effect.

D. Serum glucose 58 mg/dL (74 to 106 mg/dL): This indicates hypoglycemia, which is a well-known adverse effect of insulin therapy. When insulin is administered, especially in the context of treating hyperkalemia, it can lower blood glucose levels to dangerously low levels, leading to hypoglycemia.

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A nurse is caring for a client in the emergency department who is actively dying from a catastrophic injury. Which of the following is the priority in planning care for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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