CCRN (Adult) Critical Care Nursing Exam

A patient with diabetic ketoacidosis has an admission potassium of 3.2 mmol/L. The insulin infusion is ready to hang. According to the 2024 ADA/EASD hyperglycemic crises consensus, what should the nurse do?

1. AStart insulin now at half the usual infusion rate
2. BReplace potassium; hold insulin until K is above 3.5 mmol/LCorrect
3. CStart insulin now and recheck the potassium in 4 hours
4. DGive sodium bicarbonate before starting the insulin

Why: The 2024 consensus report states that when potassium is below 3.5 mmol/L, replacement should begin (about 10 mmol/h) and insulin should be delayed until potassium rises above 3.5 mmol/L, because insulin drives potassium into cells and can cause life-threatening arrhythmias and respiratory muscle weakness. A reduced insulin rate still lowers potassium. Routine bicarbonate is not recommended and also shifts potassium into cells.

A nurse notices that a patient's family and the medical team disagree about continuing dialysis, and the patient's own earlier wishes are not being heard. The nurse arranges a meeting and presents the patient's documented values. Which Synergy Model nurse characteristic does this best show?

1. AFacilitation of learning
2. BClinical inquiry
3. CAdvocacy/moral agencyCorrect
4. DSystems thinking

Why: The AACN Synergy Model defines advocacy/moral agency as working on another's behalf, representing the concerns of the patient and family, and helping resolve ethical and clinical concerns. Systems thinking is about managing environmental and system resources, clinical inquiry is questioning and evaluating practice, and facilitation of learning is teaching patients, families and staff.