Endocrine Adaptive Quiz

A 9-year-old child who has had type 1 diabetes for several years is brought to the emergency department of a community hospital. The child is exhibiting deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. What blood pH and glucose level does the nurse expect the laboratory tests to reveal? 1. 7.20 and 60 mg/dL (3.3 mmol/L) 2. 7.50 and 60 mg/dL (3.3 mmol/L) 3. 7.50 and 460 mg/dL (25.5 mmol/L) 4. 7.20 and 460 mg/dL (25.5 mmol/L)

4. 7.20 and 460 mg/dL (25.5 mmol/L) A pH of 7.20 and blood glucose level of 460 mg/dL (25.5 mmol/L) are expected values in ketoacidosis; the pH of 7.20 indicates acidosis (metabolic), and the blood glucose level of 460 mg/dL (25.5 mmol/L) is higher than the expected range of 90 to 110 mg/dL (5.0 to 6.1 mmol/L).

The clinical findings of a client with diabetes mellitus show decreased glucose tolerance. Which complication is anticipated in the client? 1. Cystitis 2. Thin and dry skin 3. Decreased bone density 4. Frequent yeast infections

4. Frequent yeast infections Decreased glucose tolerance may cause frequent yeast infections, but it is not associated with the risk of cystitis, thin and dry skin, and decreased bone density. The risk of cystitis, thin and dry skin, and decreased bone density are due to decreased ovarian production of estrogen.

A nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. What interventions should the nurse include to decrease the risk of complications? Select all that apply. 1. Examine the feet daily 2. Wear well-fitting shoes 3. Perform regular exercise 4. Powder the feet after showering 5. Visit the primary healthcare providers weekly 6. Test bathwater with the toes before bathing

1. Examine the feet daily 2. Wear well-fitting shoes 3. Perform regular exercise Clients with diabetes often have peripheral neuropathies and are unaware of discomfort or pain in the feet; the feet should be examined every night for signs of trauma. Well-fitting shoes prevent pressure and rubbing that can cause tissue damage and the development of ulcers. Daily exercise increases the uptake of glucose by the muscles and improves insulin use. Powdering the feet after showering may cause a pastelike residue between the toes that may macerate the skin and promote bacterial and fungal growth. Generally, visiting the primary healthcare provider weekly is unnecessary. Clients with diabetes often have peripheral neuropathy and are unable to accurately evaluate the temperature of bathwater, which can result in burns if the water is too hot.

The nurse provides a list of appropriate food choices to a client with newly diagnosed diabetes. The client reviews the list and says, "I do not like and refuse to eat asparagus, broccoli, and mushrooms." In response, the nurse teaches the client about the food exchange list. The nurse evaluates that teaching was effective when the client states, "Instead of asparagus, broccoli, and mushrooms, I will eat which foods?" 1. String beans, beets, or carrots." 2. Corn, lima beans, or dried peas." 3. Baked beans, potatoes, or parsnips." 4. Corn muffins, corn chips, or pretzels."

1. String beans, beets, or carrots." String beans, beets, and carrots are in the vegetable exchange, as are asparagus, broccoli, and mushrooms. Corn, lima beans, dried peas, baked beans, potatoes, or parsnips are starchy vegetables and are listed as bread exchanges. Corn muffins, corn chips, or pretzels are from the bread exchange list.

A nurse is discussing insulin needs with an adolescent with recently diagnosed type 1 diabetes. What information is important for the nurse to include concerning insulin administration? 1. Insulin will be required throughout life. 2. Insulin may be taken orally until adulthood. 3. Insulin needs increase with strenuous exercise. 4. Insulin needs decrease in the presence of an infection.

1. Insulin will be required throughout life. All those involved must understand that the child does not have an endogenous source of insulin and will require insulin administration throughout life. At this time there is no oral insulin with which to treat type 1 diabetes.

An insulin pump is instituted for a client with type 1 diabetes. The nurse plans discharge instructions. Which short-term goal is the priority for this client? 1. "Adhere to the medical regimen." 2. "Remain normoglycemic for 3 weeks." 3. "Demonstrate correct use of the insulin pump." 4. "List three self-care activities that help control the diabetes."

3. "Demonstrate correct use of the insulin pump." Demonstrating correct use of the insulin pump is the short-term, client-oriented goal necessary for the client to manage the pump and avoid hypo- and hyperglycemia; this outcome can be measured by observing a return demonstration by the client.

While obtaining the client's health history, which factor does the nurse identify that predisposes the client to type 2 diabetes? 1. Having diabetes insipidus 2. Eating low-cholesterol foods 3. Being 20 pounds (9 kilograms) overweight 4. Drinking a daily alcoholic beverage

3. Being 20 pounds (9 kilograms) overweight Excessive body weight is a known predisposing factor to type 2 diabetes; the exact relationship is unknown.

Four hours after surgery, the blood glucose level of a client who has type 1 diabetes is elevated. What intervention should the nurse implement? 1. Administer an oral hypoglycemic 2. Institute urine glucose monitoring 3. Give supplemental doses of regular insulin 4. Decrease the rate of the intravenous infusion

3. Give supplemental doses of regular insulin The blood glucose level needs to be reduced; regular insulin begins to act in 30 to 60 minutes. The client has type 1, not type 2, diabetes, and an oral hypoglycemic will not be effective. Blood glucose levels are far more accurate than urine glucose levels.

A male client who is receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. What is the nurse's best initial action? 1. Have the client assessed for an enlarged prostate. 2. Obtain a urine specimen from the client to test for ketonuria. 3. Perform a finger stick to test the client's blood glucose level. 4. Assess the client's lower extremities for the presence of pitting edema.

3. Perform a finger stick to test the client's blood glucose level. The client has signs of an increased serum glucose level, which may result from steroid therapy; testing the blood glucose level is a method of gathering more data.

The most appropriate method for a nurse to evaluate the effects of the maternal blood glucose level in the infant of a diabetic mother is by performing a heel stick blood test on the newborn. What specifically does this test determine? 1. Blood acidity 2. Glucose tolerance 3. Serum glucose level 4. Glycosylated hemoglobin level

3. Serum glucose level Obtaining a blood glucose level is a simple, cost-effective method of testing newborns for suspected hypoglycemia. Although the acidity of the blood will indicate whether the newborn has metabolic acidosis as a result of hypoglycemia, it is more important to determine whether the newborn has hypoglycemia so it can be corrected before acidosis develops. The glucose tolerance test and glycosylated hemoglobin level test are not used in newborns.

A client with type 2 diabetes is taking one glyburide tablet daily. The client asks whether an extra pill should be taken before exercise. What is the nurse's best reply? 1. "You will need to decrease how much you are exercising." 2. "An extra pill will help your body use glucose when exercising." 3. "The amount of medication you need to take is not related to exercising." 4. "Do not take an extra pill because you may become hypoglycemic when exercising."

4. "Do not take an extra pill because you may become hypoglycemic when exercising." Exercise improves glucose metabolism. Exercise is associated with a risk for hypoglycemia, not hyperglycemia; an additional antidiabetic agent is contraindicated. Exercise should not be decreased because it improves glucose metabolism. Also, this response does not answer the client's question. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through balanced diet, exercise, and pharmacologic therapy.

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops the flu and is concerned about the need for special care. What should the nurse instruct the client to do? 1. Skip the oral hypoglycemic pill, drink plenty of fluids, and stay in bed 2. Avoid food, drink clear liquids, take a daily temperature, and stay in bed. 3. Eat as much as possible, increase fluid intake, and call the office again the next day. 4. Take the oral hypoglycemic pill, drink warm fluids, and perform a serum glucose test before meals and at bedtime.

4. Take the oral hypoglycemic pill, drink warm fluids, and perform a serum glucose test before meals and at bedtime. Physiological stress increases gluconeogenesis, requiring continued pharmacological therapy despite an inability to eat; fluids prevent dehydration, and monitoring serum glucose levels permits early intervention if necessary. Skipping the oral hypoglycemic can precipitate hyperglycemia; serum glucose levels must be monitored. Food intake should be attempted to prevent acidosis; oral hypoglycemics should be taken, and serum glucose levels should be monitored. Telling the client to eat as much as possible, increase fluid intake, and call the office again the next day are incomplete instructions; oral hypoglycemics should be taken, and serum glucose levels should be monitored. Eating as much as possible can precipitate hyperglycemia.