DIABETIC EMERGENCIES
A conscious diabetic patient has BG 58 mg/dL, is shaky and diaphoretic, and says they feel “weird.” They have a meal tray arriving in 30 minutes. What is the best immediate action?
What is administer 15g of fast-acting carbohydrates?
Rationale:
Meal is too far away. Hypoglycemia (<70) requires immediate correction using 15/15 rule—not waiting.
A heart failure patient reports sudden weight gain of 3 lbs in 24 hours. What is the priority interpretation?
Answer: What is fluid retention and worsening heart failure?
Rationale:
1 kg ≈ 1 L fluid → early sign of decompensation.
A patient with Type 2 DM on metformin is scheduled for a CT scan with IV contrast. What is the priority nursing action?
Answer: What is hold metformin 24–48 hours before and after contrast?
Rationale:
Risk of lactic acidosis, especially with renal impairment.
A patient with HF is prescribed furosemide. What finding indicates effectiveness?
Answer: What is decreased edema and increased urine output?
A patient presents with bilateral crackles, pink frothy sputum, and SpO₂ 88%. BP is 150/90. What is the priority condition AND first intervention?
Answer: What is acute left-sided heart failure and position in high Fowler’s with oxygen?
Rationale:
Pulmonary edema = HF, not primary respiratory issue.
Positioning + O₂ comes before meds.
A patient with DKA has potassium 3.2 mEq/L and glucose 450 mg/dL. The provider orders an insulin drip. What should the nurse do FIRST?
Answer: What is hold insulin and replace potassium?
Rationale:
Insulin shifts K⁺ into cells → can cause fatal hypokalemia. Must correct K⁺ to ≥3.5 before insulin.
A patient with chest pain unrelieved by nitroglycerin for 20 minutes arrives at the ED. What is the priority concern?
Answer: What is myocardial infarction?
Rationale:
Pain not relieved by nitro = MI until proven otherwise.
A patient taking glipizide skips lunch and later becomes confused and diaphoretic. What caused this?
Answer: What is sulfonylurea-induced hypoglycemia?
Rationale:
Glipizide increases insulin regardless of food → high hypoglycemia risk.
A patient on furosemide develops muscle cramps and weakness. What is the likely cause?
Answer: What is hypokalemia?
A patient reports unilateral leg swelling, warmth, and pain after surgery. What is the priority nursing action?
What is avoid massaging the leg and notify the provider?
Rationale:
Suspected DVT → massaging can dislodge clot → PE.
A patient with Type 1 DM presents with deep, rapid respirations, confusion, and fruity breath. ABG shows pH 7.28. What is the priority physiological problem?
Answer: What is metabolic acidosis due to DKA?
Rationale:
Kussmaul respirations = compensation for metabolic acidosis, not a primary respiratory issue.
A patient in hypertensive emergency has BP 210/120. What is the priority principle of treatment?
Answer: What is gradual blood pressure reduction (no more than 25% in first hour)?
Rationale:
Dropping BP too fast → stroke or MI.
A patient is prescribed insulin glargine and lispro. When should each be administered?
What is glargine once daily (no peak) and lispro with meals?
Rationale:
A patient taking lisinopril develops swelling of the lips and tongue. What is the priority action?
Answer: What is stop the medication and treat for angioedema?
Rationale:
This is life-threatening airway emergency.
A HF patient gains 2.5 lbs overnight and has ankle edema. What is the priority medication adjustment expected?
Answer: What is increase diuretic therapy (furosemide)?
A patient recovering from hypoglycemia is alert. What is the next best step after glucose normalizes?
Answer: What is give a snack with protein and complex carbohydrates?
Rationale:
Prevents rebound hypoglycemia after initial glucose correction.
A patient on metoprolol has HR 52 bpm and BP 110/70. What is the nurse’s priority action?
Answer: What is hold the medication and notify the provider?
Rationale:
Beta blockers ↓ HR → hold if HR < 60.
A patient receives NPH insulin at 0800. When is hypoglycemia most likely?
What is between 1400–2200?
Rationale:
NPH peaks 6–14 hours later → highest risk window.
A patient on ACE inhibitors has potassium 5.8. What is the priority?
Answer: What is hold medication and notify provider?
Rationale:
ACE inhibitors → hyperkalemia risk.
A patient has chest pain relieved by rest and nitroglycerin. What is the diagnosis?
Answer: What is stable angina?
Rationale:
Predictable + relieved by nitro = NOT MI
A Type 2 diabetic patient has glucose 900 mg/dL, no ketones, and severe dehydration. What condition is most likely AND what is the priority?
Answer: What is HHNS and aggressive IV fluid replacement?
Rationale:
HHNS = extreme hyperglycemia without ketosis. Fluids come before insulin.
A post-op patient suddenly develops dyspnea, tachycardia, and chest pain. What is the first nursing action?
What is apply high-flow oxygen?
Rationale:
Suspected PE → ABC priority = oxygen first, then notify provider.
A patient with DKA is on an insulin drip. Glucose drops to 190 mg/dL. What is the priority change?
Answer: What is add dextrose to IV fluids?
Rationale:
Prevents hypoglycemia while continuing insulin to clear ketones.
A patient with HF is short of breath and has crackles. What is the FIRST nursing action?
Answer: What is position in high Fowler’s?
Rationale:
Always position before meds (ABC priority).
A hypertensive patient suddenly becomes confused. What is the priority concern?
Answer: What is hypertensive encephalopathy (end-organ damage)?