A 20-year-old woman with poorly controlled diabetes mellitus is scheduled for urgent drainage of an abdominal abscess. She received an initial dose of regular insulin 10 units followed by regular insulin 5 units/hr for the past five hours. Laboratory studies show serum sodium concentration 128 mEq/L, potassium 5.4 mEq/L, chloride 80 mEq/L, and glucose 750 mg/dl. The most appropriate perioperative management is
(A) addition of subcutaneous NPH insulin
(B) administration of sodium bicarbonate to correct metabolic acidosis
(C) administration of normal saline solution to correct the presumed hypovolemia
(D) administration of furosemide to correct hyponatremia
(E) infusion of 5% dextrose in 0.2% saline solution to prevent hypoglycemia
In a patient with adult respiratory distress syndrome who is being mechanically ventilated, which of the following findings indicates the most severe disease?
(A) Decreased functional residual capacity
(B) Decreased lung compliance
(C) Hypercarbia
(D) Hypoxemia
(E) Increased dead space
C
Mepivacaine 40 ml of a 1% solution with epinephrine 1:200,000 is injected into the brachial plexus sheath at the axilla after eliciting a paresthesia in the ulnar nerve distribution. Which of the following is most likely to remain intact?
(A) Adduction of the thumb
(B) Flexion at the wrist
(C) Sensation of the lateral forearm
(D) Sensation on the palmar surface of the lateral three and one half fingers
(E) Sensation on the palmar surface of the medial one and one half fingers
Five minutes after intrathecal administration of tetracaine 12 mg in hyperbaric solution, a 60-year-old man has a weak hand grasp. Respirations are normal, heart rate has decreased from 80 to 45 bpm, and blood pressure has decreased from 150/80 to 90/50 mmHg. The most appropriate management at this time is
(A) administration of atropine
(B) administration of ephedrine
(C) administration of phenylephrine
(D) placement of the patient in the head-down position