CCRN Endocrine and Metabolic Crises 3

Question 1

A patient with DKA has an arterial blood gas showing pH 7.18, HCO3 8 mEq/L. This represents which acid-base disturbance?

Accepted Answer

High anion gap metabolic acidosis

Answer

Respiratory alkalosis

Answer

Metabolic alkalosis

Answer

Respiratory acidosis

Question 2

Kussmaul respirations observed in a DKA patient represent what compensatory mechanism?

Accepted Answer

Respiratory compensation to blow off CO2 and reduce acidosis

Answer

Airway obstruction

Answer

Pulmonary edema

Answer

Hyperventilation from anxiety

Question 3

Which patient is at highest risk for hyperosmolar hyperglycemic state (HHS)?

Accepted Answer

An elderly patient with type 2 diabetes and an acute infection

Answer

A young athlete with type 1 diabetes

Answer

A child with new-onset diabetes

Answer

A patient with well-controlled type 1 diabetes

Question 4

A patient receiving an insulin infusion for HHS requires careful glucose lowering primarily to prevent which complication?

Accepted Answer

Cerebral edema from rapid osmotic shifts

Answer

Hyperkalemia

Answer

Liver failure

Answer

Pulmonary fibrosis

Question 5

A patient with syndrome of inappropriate antidiuretic hormone (SIADH) would be expected to have which sodium and fluid status?

Accepted Answer

Hyponatremia with fluid retention

Answer

Hypernatremia with dehydration

Answer

Hypernatremia with fluid overload

Answer

Normal sodium with dehydration

Question 6

Which treatment is appropriate for symptomatic SIADH with severe hyponatremia?

Accepted Answer

Fluid restriction and possibly hypertonic saline

Answer

Aggressive hypotonic IV fluids

Answer

Free water boluses

Answer

Desmopressin administration

Question 7

A patient with diabetes insipidus (DI) typically presents with which findings?

Accepted Answer

Polyuria with dilute urine and hypernatremia

Answer

Oliguria with concentrated urine

Answer

Hyponatremia with fluid overload

Answer

Anuria with low serum sodium