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The nurse is caring for a 22-year-old female patient who is brought to the emergency department with a new onset of blurred vision and headache. Use the chart to answer the questions.

Exhibits

The nurse recognizes the patient is demonstrating signs of diabetic ketoacidosis (DKA). Which findings support this recognition? Select all that apply.

(Select All that Apply.)

Acetone breath and respiratory pattern

Blurred vision and headache

Nausea and vomiting

History of type 1 DM Appendix removal at age 7

Weekend alcohol ingestion

Tachycardia and hypotension

Insulin pump turned off

Answer and Explanation

Correct Answer : A,C,F,G

A. Acetone breath, characterized by a fruity or acetone-like odor on the patient's breath, is a classic sign of DKA. In addition, Kussmaul respirations, which are deep and labored breathing patterns, can occur as the body attempts to compensate for metabolic acidosis in DKA.
C. Nausea and vomiting are common symptoms of DKA and can occur due to metabolic acidosis, electrolyte imbalances, and gastrointestinal disturbances associated with the condition.
F. Tachycardia and hypotension are signs of hemodynamic instability, which can occur in severe cases of DKA due to dehydration, electrolyte imbalances, and the systemic effects of metabolic acidosis.
G. Turning off an insulin pump can lead to insulin deficiency, which is a precipitating factor for DKA, particularly in patients with type 1 diabetes who rely on continuous insulin therapy. This finding is consistent with the development of DKA.
B. Blurred vision and headache can be symptoms of DKA, although they are not specific to this condition. Elevated blood glucose levels and dehydration associated with DKA can lead to osmotic diuresis and subsequent fluid shifts, which may manifest as headache and visual disturbances.

D. A history of type 1 diabetes mellitus (DM) predisposes the patient to DKA but the history of appendix removal at age 7 is not directly relevant to the current presentation of DKA.
E. Alcohol ingestion can contribute to the development of DKA by inhibiting gluconeogenesis and promoting ketoacidosis, particularly if the patient is not consuming adequate carbohydrates and insulin. However, it is not a direct sign of DKA.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Sucralfate works by forming a protective barrier over the ulcer site. It adheres to the ulcer, shielding it from the harmful effects of gastric acid, pepsin, and bile salts. This protection allows the ulcer to heal by preventing further irritation and damage.
B. Medications that prevent gastric acid secretion are typically proton pump inhibitors (PPIs) or H2 receptor antagonists. Sucralfate does not reduce or inhibit the production of gastric acid; instead, it protects the ulcer from the acid already present.
C. Antacids are the type of medication that neutralize gastric acid. Sucralfate does not neutralize acid; it acts locally at the ulcer site to create a protective coating.
D. Antibiotics are used to kill Helicobacter pylori, the bacteria often responsible for causing peptic ulcers. Sucralfate does not have antibacterial properties and does not target or eliminate bacteria.

A. "I can have 6 ounces of alcohol before bed, to help me sleep." B. "I will sleep on my stomach with my head flat." C. "I should elevate the head of the bed." D. "I will have a snack 1 hour before going to bed."

Correct Answer is C

Explanation

C. Elevating the head of the bed can help reduce nighttime GERD symptoms. By elevating the head of the bed by about 6 to 8 inches (15 to 20 centimeters), gravity helps prevent stomach acid from refluxing into the esophagus while the individual is lying down. This position can alleviate symptoms such as heartburn, regurgitation, and coughing during sleep.
A. Alcohol consumption, especially before bedtime, can exacerbate GERD symptoms. Alcohol relaxes the lower esophageal sphincter (LES), allowing stomach acid to reflux into the esophagus more easily.
B. Sleeping on the stomach with the head flat can worsen GERD symptoms. This position can increase pressure on the stomach and promote reflux of stomach acid into the esophagus. Sleeping on the stomach is generally not recommended for individuals with GERD.
D. Eating a large meal or having a snack shortly before bedtime can increase the likelihood of GERD symptoms during sleep. It's generally recommended to avoid eating large meals or heavy snacks close to bedtime. Instead, individuals with GERD should aim to finish eating at least 2 to 3 hours before lying down to sleep.

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Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching for a client who has a duodenal ulcer and a new prescription for sucralfate. The client asks the nurse how sucralfate works. Which of the following statements should the nurse make?

Correct Answer is A

Explanation

A nurse is reinforcing teaching with a client who has gastroesophageal reflux disease (GERD) about minimizing the effects of reflux during sleep. Which of the following client statements indicates an understanding of the teaching?

Correct Answer is C

Explanation

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