A patient with diabetes mellitus (DM) developed a serum glucose of 900 and an elevated serum osmolality. The patient then became unconscious. What pathological process most likely caused the altered neurologic status?
The brain cells became edematous because of a blood to tissue shift of fluid.
Hyperinsulinemia caused hypoglycemia and a tonic clonic seizure.
The brain cells became dehydrated because of fluid shirting out of the cells.
Fluid volume overload caused higher pressure in the brain tissue
The Correct Answer is C
A. The brain cells became edematous because of a blood to tissue shift of fluid: This describes cerebral edema, which is not typically caused by hyperglycemia.
B. Hyperinsulinemia caused hypoglycemia and a tonic-clonic seizure: The scenario describes hyperglycemia, not hypoglycemia.
C. The brain cells became dehydrated because of fluid shifting out of the cells:. In hyperglycemic hyperosmolar syndrome (HHS), extremely high blood glucose leads to increased serum osmolality, causing water to move out of brain cells, leading to dehydration and altered consciousness.
D. Fluid volume overload caused higher pressure in the brain tissue: Fluid volume overload is not the primary issue in this scenario; rather, dehydration is the concern due to hyperglycemia.
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Related Questions
Correct Answer is B
Explanation
A. Elevating the head of the bed promotes venous return and helps increase the ICP: This is incorrect. Elevation of the head of the bed helps to decrease intracranial pressure (ICP) by promoting venous drainage rather than increasing it.
B. Elevation of the head of the bed aids in maintaining cerebral perfusion: Elevating the head of the bed helps to decrease ICP, which in turn aids in maintaining adequate cerebral perfusion pressure.
C. Elevation of the head of the bed will increase intracranial pressure (ICP): This is incorrect. Elevation of the head of the bed is intended to reduce ICP, not increase it.
D. The nurse should keep the head of the bed flat to ensure adequate arterial circulation: This is incorrect. Keeping the head of the bed flat can increase ICP, which is counterproductive in managing intracranial pressure.
Correct Answer is A
Explanation
A. Adherence to a low-fat diet: The patient likely experienced a transient ischemic attack (TIA), which is a warning sign for future strokes. A low-fat diet is recommended to help manage cholesterol and reduce the risk of atherosclerosis and stroke.
B. The administration of clot-busting drugs: Clot-busting drugs (thrombolytics) are used in the acute management of a stroke, but this patient’s symptoms resolved spontaneously, and the focus is on prevention.
C. Reporting any signs of heat or cold intolerance: This is unrelated to the prevention of stroke or management after a TIA.
D. Avoiding red wine and chocolate: While moderation in alcohol and certain foods is generally advised for overall health, this specific recommendation does not address the primary concern of preventing future cerebrovascular events.
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