HESI case studies- Diabetes Type 1
1. What is the mechanism that results in Kussmaul respirations?
To compensate for metabolic acidosis, the respirations are deep and rapid.
2. To achieve the goal of restoring Lara’s fluid volume, the nurse would expect to implement which intervention?
Maintain an infusion of normal saline solution.
3. To restore Lara’s blood glucose to a normal level, what should the nurse prepare to administer?
An IV infusion containing regular insulin.
4. In addition to monitoring Lara’s blood glucose level, what additional lab values should the nurse monitor carefully?
-Blood Urea Nitrogen (BUN)
5. The nurse’s decision about what to tell these callers should be based on what primary consideration?
Lara’s right to privacy regarding her health information.
6. Which response is best for the charge nurse to provide?
“The lab values can be copied as long as there is no identifying client data.”
7. The nurse identifies that Lara has experienced classic symptoms of diabetes, which are:
Polyuria, polyphagia, and polydipsia.
8. How should the nurse respond?
“The symptoms have an abrupt onset that is often brought on by a viral illness, like the flu.”
9. What is the best initial response by the nurse?
“It must be quite a shock to learn that you have diabetes.”
10. What is the best response by the nurse?
“I’ll leave you alone for now, but I will stop back by in 30 minutes.”
11. Which statement made by Lara indicates that she correctly understands self-administration of insulin?
“The amount of short-acting insulin I take every day is based on my blood sugar readings.”
12. Which action should the nurse implement?
Encourage Lara to inject the insulin with the needle in place, as inserted.
13. What is the priority nursing action?
Check Lara’s blood glucose.
14. Which action should the nurse take first?
Administer IV dextrose to a diabetic client with a blood glucose level of 25 mg/dL.
15. What action should the nurse take first?
Ask the unit clerk to find out when the trays will be available.
16. What is the best response by the nurse?
“Alcohol does contain a lot of empty calories, but it is also likely to cause you blood glucose to decrease.”
17. What is the best response by the nurse?
Advise Lara that extra insulin should not generally be given before exercise.
18. What is the best nursing action?
Ask the roommate if Lara has emergency supplies such as glucagon or cake icing available.
19. Once Lara is more alert, what instructions should the nurse provide the roommate?
Give Lara some crackers and milk while waiting for the emergency transport.
20. What technique should the nurse use to assess for this occurrence?
Monitor blood glucose levels during the night and before breakfast.
21. Which statement by Lara reflects understanding of glycosylated Hgb?
“At least I won’t have this done again for 3 months. I will really work at following my diet between now and then.”
22. How should the nurse respond?
“She needs a second test performed before a diagnosis is made.”
23. How should the nurse respond?
“Being sick increases your blood sugar. Taking your usual insulin dose is important.”
24. How should the nurse respond?
“There is no direct correlation, but family history is important in diabetes.”
25. What is the best response?
“Women with gestational diabetes are at high risk for developing diabetes after pregnancy, but not all will get the disease.”
26. How should the nurse respond?
HHNS is caused by persistent hyperglycemia, but ketosis does not occur.
27. What intervention should the nurse implement?
Tell Lara that HHNS is less likely to occur in Type I diabetes than in Type II diabetes.
28. Which lab value indicates that Lara is working to reduce her risk for cardiovascular disease?
Low-density lipoprotein (LDL) cholesterol of 80 mg/dL.
29. Which finding(s) indicate that Lara is experiencing complication of diabetes?
-Burning sensation in her toes
-Protein in her urine
-A sore on her foot that is having trouble healing.
30. What response should the nurse make?
“You’re absolutely right, and your health care teak will be there to help you.”