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

Accumulation of ketoacids in DKA produces a high anion gap metabolic acidosis with low pH and low bicarbonate.

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

Deep, rapid Kussmaul breathing is the lungs compensating for metabolic acidosis by eliminating CO2.

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

HHS classically occurs in older type 2 diabetics with a precipitating illness such as infection causing severe dehydration and hyperglycemia.

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

Lowering glucose and osmolality too quickly causes rapid fluid shifts into the brain, risking cerebral edema.

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

Excess ADH causes water retention and dilutional hyponatremia with concentrated urine.

CCRN Review Practice Test