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Chapter 24: Endocrine Disorders and Therapeutic Management

Priorities in Critical Care Nursing 7th Edition Urden - Stacy - Lough

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Chapter 24: Endocrine Disorders and Therapeutic Management

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

  1. A patient with diabetes in the critical care unit is at risk for developing diabetic ketoacidosis (DKA) secondary to
a. excess insulin administration.
b. inadequate food intake.
c. physiologic and psychologic stress.
d. increased release of antidiuretic hormone (ADH).

 

 

ANS:  C

Major neurologic and endocrine changes occur when an individual is confronted with physiologic stress caused by any critical illness, sepsis, trauma, major surgery, or underlying cardiovascular disease.

 

  1. The hallmark of hyperglycemic hyperosmolar syndrome (HHS) is
a. hyperglycemia with low serum osmolality.
b. severe hyperglycemia with minimal or absent ketosis.
c. little or no ketosis in serum with rapidly escalating ketonuria.
d. hyperglycemia and ketosis.

 

 

ANS:  B

The hallmarks of HHS are extremely high levels of plasma glucose with resulting elevations in serum hyperosmolality and osmotic diuresis. The disorder occurs mainly in patients with type II diabetes.

 

  1. The primary intervention for hyperglycemic hyperosmolar syndrome (HHS) is
a. rapid rehydration.
b. monitoring vital signs.
c. high-dose intravenous (IV) insulin.
d. hourly urine sugar and acetone testing.

 

 

ANS:  A

The goals of medical management are rapid rehydration, insulin replacement, and correction of electrolyte abnormalities, specifically potassium replacement. The underlying stimulus of HHS must be discovered and treated. The same basic principles used to treat patients with diabetic ketoacidosis are used for patients with HHS.

 

  1. Characteristics of diabetes insipidus (DI) are
a. hyperglycemia and hyperosmolarity.
b. hyperglycemia and peripheral edema.
c. intense thirst and passage of excessively large quantities of dilute urine.
d. peripheral edema and pulmonary crackles.

 

 

ANS:  C

The clinical diagnosis is made by the dramatic increase in dilute urine output in the absence of diuretics, a fluid challenge, or hyperglycemia. Characteristics of DI are intense thirst and the passage of excessively large quantities of very dilute urine.

 

  1. Patients with central DI are treated with
a. vasopressin.
b. insulin.
c. glucagon.
d. propylthiouracil.

 

 

ANS:  A

Patients with central DI who are unable to synthesize antidiuretic hormone (ADH) require replacement ADH (vasopressin) or an ADH analog. The most commonly prescribed drug is the synthetic analog of ADH, desmopressin (DDAVP). DDAVP can be given intravenously, subcutaneously, or as a nasal spray. A typical DDAVP dose is 1 to 2 mcg intravenously or subcutaneously every 12 hours.

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