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WorksheetsTopic 1: Dypsnea - DKA
Total questions: 37
Worksheet time: 19mins
Which nonpharmacologic measure can help dyspnea by improving airflow and comfort?
Paced activity with rest breaks
Continuous warm room air
Strict bedrest for two days
High-protein diet daily
For acute dyspnea in hypoxic patients, which intervention is appropriate?
Supplemental oxygen therapy
Immediate benzodiazepines
Routine BiPAP for all
Nebulized saline only
Opioids are preferred over benzodiazepines as first-line therapy for dyspnea. Fill in the blank: (a) are first line, NOT benzos.
Which initial morphine regimen aligns with first-line dosing for dyspnea?
MS Contin 60 mg PO daily
MSIR 10 mg PO twice daily
Morphine 0.5 mg IV once
MSIR 2–4 mg PO Q4H prn
Match each antiemetic class to an example agent.
5-HT3 antagonist
Ondansetron
Phenothiazine
Promethazine
Dopamine antagonist/prokinetic
Metoclopramide
Corticosteroid
Dexamethasone
Which statement about ondansetron dosing and safety is accurate?
Max 32 mg/day; may increase QTc
Use only IM; QTc unchanged
No daily max; QTc decreases
Max 16 mg/day; QTc stable
Phenothiazines for nausea carry which Beers list precaution?
Required for vestibular triggers first-line
Preferred in elderly with insomnia
Avoid in elderly, especially men, cognitive impairment
Safe with Parkinson’s disease long term
Which risk is associated with IV promethazine administration?
Bradycardia in all patients
Anaphylaxis is universal
Severe hyperkalemia risk
Tissue injury including gangrene
Metoclopramide safety considerations include which statement?
No EPS risk with prolonged use
First-line in Parkinson’s disease
Avoid in complete bowel obstruction
Contraindicated for GI infections only
Which nonpharmacologic strategies can reduce nausea symptoms?
Intense exercise immediately
High-fat meals frequently
Cool cloth and room-temp foods
Strong odors to stimulate appetite
Which nonpharmacologic intervention should be prioritized first for hospitalized patients with delirium?
Clock and calendar, reassurance, reorientation
Immediate benzodiazepine for agitation control
Physical restraints with minimal interaction
High-dose haloperidol for rapid sedation
In delirium management, which statement about antipsychotics is most appropriate?
Start early at high scheduled doses
Use only as last resort at low initial dose
Prefer benzodiazepines before antipsychotics
Always safe in frail elderly patients
Which patient group should NOT receive haloperidol for delirium due to heightened risk?
Stable Parkinson’s disease patients
Young adults with alcohol withdrawal
Postoperative opioid-treated patients
Lewy Body Dementia patients
For typical VTE prophylaxis, what is the standard enoxaparin dosing when creatinine clearance is greater than 30 mL/min and body weight is not extreme?
60 mg subcutaneous daily
40 mg subcutaneous daily
1 mg/kg subcutaneous daily
30 mg subcutaneous twice daily
Which VTE prophylaxis option is preferred in renal failure because it is metabolized primarily in the liver?
Unfractionated heparin 5000 units SQ
Fondaparinux 2.5 mg SQ daily
Rivaroxaban 10 mg oral daily
Enoxaparin 40 mg SQ daily
All hospitalized patients with Type 1 diabetes require which baseline therapy to prevent ketosis?
Metformin continuation
Basal insulin administration
Sliding-scale insulin only
Prandial insulin only when eating
During extended NPO status in Type 1 diabetes, which management is recommended?
Stop insulin once glucose is under 180
Continue usual SQ basal-bolus regimen
Avoid SQ insulin; use D5 plus insulin infusion
Give prandial insulin every four hours
For hospitalized patients with Type 2 diabetes, which practice around metformin is advisable for planned contrast CT?
Hold metformin one day prior and 48 hours after
Continue metformin throughout the procedure
Hold only during the scan then resume same day
Stop permanently and switch to insulin drip
Which population most commonly develops diabetic ketoacidosis (DKA)?
Elderly with type 2 diabetes
Adults with type 1 diabetes
Middle-aged without diabetes
Children with type 2 diabetes
Which onset pattern best characterizes hyperosmolar hyperglycemic state (HHS)?
Sudden within minutes
Rapid over hours to one day
Intermittent over weeks
Gradual over days to weeks
Which precipitating factor is shared by both DKA and HHS?
Illness and infection
Only steroid use
Only missed insulin doses
Trauma exclusively in DKA
Which clinical sign is more specific for DKA than HHS?
Seizures and coma
Kussmaul respirations
Profound weakness
Altered mental status
In HHS, typical serum osmolality is best described as:
Always exactly 300 mOsm/kg
Often above 320 mOsm/kg
Within 275–295 mOsm/kg
Below 275 mOsm/kg
What arterial pH finding supports a diagnosis of DKA?
Less than 7.3 acidotic
Exactly 7.4 neutral
Between 7.35 and 7.45
Greater than 7.45 alkalosis
Which bicarbonate level pattern is typical of DKA versus HHS?
DKA above 22 mEq/L; HHS below 18 mEq/L
DKA below 18 mEq/L; HHS above 18 mEq/L
DKA exactly 22 mEq/L; HHS exactly 26 mEq/L
DKA variable high; HHS variable low
How does the anion gap typically differ between DKA and HHS?
Elevated in DKA, normal or slightly high in HHS
Equally elevated in both
Normal in both conditions
Low in DKA, high in HHS
Which ketone pattern distinguishes DKA from HHS?
Absent in both blood and urine
Present only in HHS consistently
Present in DKA, minimal or absent in HHS
Present in urine only for HHS
Which electrolyte pattern is typical at presentation in DKA?
Severe hypernatremia with low total body K+
Hyperkalemia due to total body K+ depletion
True hyperkalemia with total body K+ excess
Hyponatremia with total body K+ excess
What is the initial fluid management strategy for DKA?
No fluids until insulin starts
Immediate D5W at high rate
Begin 0.9% NaCl, adjust based on corrected Na+
Start 0.45% NaCl and restrict fluids
When initiating insulin in DKA, which potassium threshold requires correction before infusion?
Greater than 5.5 mEq/L
Between 4.0 and 4.5 mEq/L
Exactly 3.3 mEq/L
Less than 3.3 mEq/L
Which management detail is more characteristic of HHS than DKA?
Avoid fluid therapy in elderly patients
Routine bicarbonate infusion early
Immediate high-dose insulin bolus always
Slower insulin initiation if glucose not falling
Match each condition with its typical glucose range at presentation.
DKA
250–600 mg/dL
HHS
Often >600 mg/dL
Normal individuals
75–100 mg/dL
Which statement about dehydration is correct regarding DKA versus HHS?
Both conditions have minimal fluid loss
DKA shows severe 8–12 L loss
HHS shows moderate 3–6 L loss
DKA moderate 3–6 L; HHS severe 8–12 L
Which vital sign pattern is more severe in HHS compared to DKA?
Hypotension more severe
Respirations deeply rapid
Hypertension common
Bradycardia predominates
Which mortality estimate best aligns with HHS?
Always above 50%
About 10–20% in elderly
Approximately 0% consistently
Around 1–5% in adults
Which monitoring priority is emphasized for HHS management in elderly patients?
Strict fluid restriction first
Routine steroid tapering
Careful cardiac and renal status monitoring
Aggressive bicarbonate therapy
Which insulin administration approach is standard in both DKA and HHS?
IV regular insulin continuous infusion
Intermittent subcutaneous boluses
Long-acting insulin only initially
Insulin held until ketones clear
