PCCN - Endocrine and Renal Issues 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?

Accepted Answer

Initiating fluid resuscitation with an isotonic solution.

Answer

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?

Accepted Answer

Hyponatremia and decreased serum osmolality

Answer

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?

Accepted Answer

Prerenal

Answer

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?

Accepted Answer

Administer intravenous potassium as ordered.

Answer

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?

Accepted Answer

Hypotension, hypoglycemia, and hyperkalemia

Answer

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).

PCCN Exam Practice Test

PCCN Exam Practice Test

PCCN - Endocrine and Renal Issues Questions and Answers