PCCN - Endocrine and Renal Issues Questions and Answers — Questions and Answers
Question 1: A 68-year-old male with a history of type 2 diabetes is admitted to the progressive care unit with altered mental status. His laboratory results show a blood glucose of 850 mg/dL, serum osmolality of 340 mOsm/kg, and a negative urine ketone test. Which of the following interventions is the highest priority?
- Administering an intravenous insulin bolus.
- Initiating fluid resuscitation with an isotonic solution. (Correct answer)
- Placing the patient on a cardiac monitor.
- Obtaining a STAT head CT scan.
Correct answer: Initiating fluid resuscitation with an isotonic solution.
The patient's presentation is consistent with Hyperosmolar Hyperglycemic State (HHS). The most critical initial intervention is aggressive fluid resuscitation to correct the profound dehydration and hyperosmolality, which are the primary causes of the altered mental status. While insulin will be administered, correcting the fluid deficit is the first priority to restore tissue perfusion.
Question 2: A patient is admitted with a diagnosis of Syndrome of Inappropriate Antidiuretic Hormone (SIADH). The nurse would expect which of the following laboratory findings?
- Hypernatremia and increased serum osmolality
- Hyponatremia and increased serum osmolality
- Hypernatremia and decreased serum osmolality
- Hyponatremia and decreased serum osmolality (Correct answer)
Correct answer: Hyponatremia and decreased serum osmolality
In SIADH, there is an excessive release of antidiuretic hormone (ADH), leading to water retention by the kidneys. This results in a dilutional hyponatremia (low serum sodium) and a decreased serum osmolality because the excess water dilutes the blood solutes.
Question 3: A patient in the progressive care unit develops an acute kidney injury (AKI) following a severe hypotensive episode. Their urine output is 20 mL/hr, BUN is 45 mg/dL, and creatinine is 2.8 mg/dL. Which classification of AKI is most likely?
- Intrarenal
- Postrenal
- Prerenal (Correct answer)
- Chronic
Correct answer: Prerenal
Prerenal AKI is caused by decreased blood flow to the kidneys. A severe hypotensive episode leads to renal hypoperfusion. This is characterized by a high BUN to creatinine ratio (in this case >20:1 is suggested but not explicitly calculated without a baseline) and oliguria, as the kidneys attempt to conserve volume.
Question 4: The nurse is caring for a patient admitted with Diabetic Ketoacidosis (DKA). The initial potassium level was 5.8 mEq/L. After several hours of treatment with intravenous fluids and an insulin infusion, the patient's potassium level is now 3.2 mEq/L. What is the nurse's priority action?
- Continue to monitor the patient without intervention.
- Administer intravenous potassium as ordered. (Correct answer)
- Decrease the rate of the insulin infusion.
- Administer a dose of sodium polystyrene sulfonate (Kayexalate).
Correct answer: Administer intravenous potassium as ordered.
Insulin therapy in DKA drives potassium from the extracellular fluid into the cells, which can lead to a rapid drop in serum potassium levels and cause hypokalemia. A potassium level of 3.2 mEq/L is low and requires replacement to prevent cardiac dysrhythmias and other complications. Administering potassium is the priority.
Question 5: A patient is brought to the unit with suspected adrenal crisis (Addisonian crisis). Which of the following assessment findings would be most consistent with this diagnosis?
- Hypertension, hyperglycemia, and hypernatremia
- Hypotension, hypoglycemia, and hyperkalemia (Correct answer)
- Bradycardia, fluid overload, and hypokalemia
- Tachycardia, hypertension, and hypercalcemia
Correct answer: Hypotension, hypoglycemia, and hyperkalemia
Adrenal crisis is a life-threatening condition caused by an acute deficiency of cortisol. The classic presentation includes severe hypotension (due to loss of vascular tone and volume), hypoglycemia (due to decreased gluconeogenesis), and hyperkalemia (due to aldosterone deficiency).
Question 6: Which of the following is a key differentiating feature between Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS)?
- The presence of severe dehydration
- The degree of hyperglycemia
- The presence of significant ketosis and metabolic acidosis (Correct answer)
- The level of consciousness
Correct answer: The presence of significant ketosis and metabolic acidosis
While both DKA and HHS involve hyperglycemia and dehydration, the hallmark of DKA is the presence of significant ketosis (leading to ketone bodies in the blood and urine) and a subsequent metabolic acidosis. In HHS, there is enough insulin to prevent ketosis, but not enough to prevent severe hyperglycemia.
PCCN - Endocrine and Renal Issues Questions and Answers
A 68-year-old male with a history of type 2 diabetes is admitted to the progressive care unit with altered mental status.
His laboratory results show a blood glucose of 850 mg/dL, serum osmolality of 340 mOsm/kg, and a negative urine ketone test.
Which of the following interventions is the highest priority?