The nurse is caring for a patient with diabetes who presents with a hyperglycemic emergency. The patient's lab values are in the chart below. Which healthcare provider's (HCP) order will the nurse implement?

Administer intravenous normal saline 300 mL/hour

Administer regular insulin 20 units subcutaneously

Start bicarbonate infusion intravenously

Administer potassium chloride 40 mEq orally

Answer and Explanation

The Correct Answer is A

Choice A reason: Administering intravenous normal saline at 300 mL/hour is the appropriate initial intervention for a patient presenting with a hyperglycemic emergency. Fluid replacement is crucial to correct dehydration and improve circulatory volume, which will help improve renal perfusion and facilitate the excretion of excess glucose and ketones.

Choice B reason: Administering regular insulin 20 units subcutaneously is not the immediate priority. Intravenous insulin is preferred in a hyperglycemic emergency to ensure rapid and effective lowering of blood glucose levels.

Choice C reason: Starting a bicarbonate infusion intravenously is not indicated unless there is severe acidosis (pH < 7.0) or the patient is in shock. The pH of 7.20, while low, can typically be corrected with fluid and insulin therapy.

Choice D reason: Administering potassium chloride 40 mEq orally is not necessary at this point. The potassium level of 3.6 mEq/L is within the normal range, and potassium should be monitored and replaced as needed during ongoing treatment, especially when insulin therapy is initiated.

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Correct Answer is K

Explanation

Choice A reason: Atenolol 25 mg oral tablet with breakfast is a common beta-blocker used to manage heart conditions, but it does not indicate an immediate priority.

Choice B reason: Captopril 25 mg three times a day is an ACE inhibitor used to manage blood pressure and heart failure but is not an immediate priority unless there are contraindications.

Choice C reason: Hydrochlorothiazide 25 mg twice a day is a diuretic used to manage fluid retention and blood pressure. While important, it is not the immediate priority unless there are contraindications.

Choice D reason: Aspirin 81 mg tablet every day is a common medication for preventing blood clots but is not an immediate priority unless there are contraindications or interactions.

Choice E reason: Digoxin 0.125 mg every other day is used to manage heart conditions but is not the immediate priority unless there are contraindications or interactions.

Choice F reason: Furosemide 20 mg at bedtime is a diuretic used to manage fluid retention and blood pressure. While important, it is not the immediate priority unless there are contraindications.

Choice G reason: Multivitamin one tablet daily is a common supplement and is not the immediate priority.

Choice H reason: Some doses of medication are missing, which needs to be addressed, but it is not the immediate priority.

Choice I reason: Some routes of medications are missing, which needs to be addressed, but it is not the immediate priority.

Choice J reason: Some medications are duplicated, which is important but not the immediate priority unless it poses a risk to the patient.

Choice K reason: The medications have drug-drug interactions is the priority for the nurse to address. Drug-drug interactions can lead to adverse effects and complications, especially in a patient with multiple conditions such as heart failure, asthma, and kidney disease. Ensuring that medications are safe and do not interact negatively is crucial for patient safety.

A. Advise the patient to consume protein and carbohydrates immediately. B. Notify the provider of the result and recommend that the patient's insulin dose be increased. C. Instruct the patient to withhold the next scheduled dose of insulin. D. Suggest that the patient asks their provider to start them on metformin therapy.

Correct Answer is B

Explanation

Choice A reason: Advising the patient to consume protein and carbohydrates immediately is not appropriate in this context. The presence of ketones in the urine indicates that the body is using fat for energy due to a lack of insulin. Increasing carbohydrate intake without addressing the underlying insulin deficiency can worsen hyperglycemia and ketoacidosis.

Choice B reason: Notifying the provider of the result and recommending that the patient's insulin dose be increased is the appropriate intervention. The presence of ketones in the urine indicates inadequate insulin levels, and adjusting the insulin dose can help correct the metabolic imbalance and prevent further complications such as diabetic ketoacidosis.

Choice C reason: Instructing the patient to withhold the next scheduled dose of insulin is incorrect. Insulin is essential for managing blood glucose levels and preventing ketosis in patients with type 1 diabetes. Withholding insulin can lead to severe hyperglycemia and ketoacidosis.

Choice D reason: Suggesting that the patient ask their provider to start them on metformin therapy is not appropriate for type 1 diabetes. Metformin is used primarily for type 2 diabetes and is not effective in type 1 diabetes, where insulin is required for glucose management.

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The nurse is caring for a patient with diabetes who presents with a hyperglycemic emergency. The patient's lab values are in the chart below. Which healthcare provider's (HCP) order will the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is K

Explanation

The nurse is admitting a patient with type 1 diabetes. While reviewing the patient's laboratory results, the nurse notes the presence of ketones in the urine. What intervention will the nurse implement for this patient?

Correct Answer is B

Explanation

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