metabolism
The nurse is reviewing assessment data and determines which client is at highest risk for developing type 2 diabetes? A 45-year-old obese female with a sedentary lifestyle A 10-year-old male whose grandmother has type 2 diabetes A 40-year-old male who has liver disease due to hepatitis A 60-year-old female with a history of gestational diabetes
A 45-year-old obese female with a sedentary lifestyle Explanation: The person most at risk for developing type 2 diabetes is the 45-year-old obese female with a sedentary lifestyle. Other risk factors include family history, over age 40, and history of gestational diabetes. The 60-year-old would have developed it before age 60, if there were additional risk factors. Diabetes and metabolic syndrome are due to pancreatic problems, not liver problems. Reference: Chapter 41: Disorders of Endocrine Control of Growth and Metabolism - Page 1076
A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible? To decrease the possibility of nausea and vomiting To stimulate her appetite To restore liver glycogen and prevent secondary hypoglycemia To decrease the amount of glycogen in her system
To restore liver glycogen and prevent secondary hypoglycemia Explanation: A client with type 1 diabetes who requires glucagon should be given a complex carbohydrate snack as soon as possible to restore the liver glycogen and prevent secondary hypoglycemia. A complex carbohydrate snack doesn't decrease the possibility of nausea and vomiting or stimulate the appetite, and it increases the amount of glycogen in the system. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 51: Assessment and Management of Patients With Diabetes, Exercise Precautions, p. 1465. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1465
A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate? Increasing daily aerobic activity Using an insulin infusion pump Taking metformin Taking the herb chromium picolinate
Using an insulin infusion pump Explanation: Clients with type 1 diabetes mellitus require exogenous insulin because they have absolute lack of their own secretion. Insulin is a protein that would be digested if taken orally. To avoid injections, clients could use an insulin pump, which provides continuous infusion through a catheter placed under the skin that is changed every few days. While some herbal preparations may help lower blood glucose, they do not replace insulin. While aerobic activity helps mobilize glucose, it does not replace insulin. Metformin is an insulin sensitizer that enhances insulin utilization, but does not replace insulin. Reference: Chapter 41: Disorders of Endocrine Control of Growth and Metabolism - Page 1075
The nurse is caring for a hospitalized client who has class II obesity and who has limited mobility. The nurse should address the client's risk for skin breakdown by: making a referral to physical therapy. ensuring the client receives a high-calorie, high-protein diet. avoiding the use of pillows to position the client. cleaning and drying regularly within the client's skin folds.
cleaning and drying regularly within the client's skin folds. Explanation: The presence of more folds in the skin is associated with more skin moisture and increased skin friction, which are pressure ulcer risks. Consultation with a wound-ostomy-continence (WOC) nurse, not a physical therapist, may be advisable. There is no obvious need to avoid using pillows. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 48: Assessment and Management of Patients with Obesity, Nursing Management, p. 1368. Chapter 48: Assessment and Management of Patients with Obesity - Page 1368
Lifestyle risk factors for osteoporosis include lack of aerobic exercise. an estrogen deficiency or menopause. a low-protein, high-fat diet. lack of exposure to sunshine.
lack of exposure to sunshine. Explanation: Lifestyle risk factors for osteoporosis include lack of exposure to sunshine, a diet low in calcium and vitamin D, cigarette smoking, consumption of alcohol and/or caffeine, and lack of weight-bearing exercise. Lack of weight-bearing exercise, not aerobic exercise, is a lifestyle risk factor for osteoporosis. A diet low in calcium and vitamin D, not a low-protein, high-fat diet, is a lifestyle risk factor for osteoporosis. An estrogen deficiency or menopause is an individual risk factor for osteoporosis. Other individual risk factors include female gender, non-Hispanic white or Asian race, increased age, low weight and body mass index, family history of osteoporosis, low initial bone mass, and contributing coexisting medical conditions and medications. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 41: Management of Patients With Musculoskeletal Disorders, p. 1174. Chapter 41: Management of Patients With Musculoskeletal Disorders - Page 1174
A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest? Swimming Yoga Bicycling Walking
Walking Explanation: Weight-bearing exercises should be incorporated into the client's lifestyle activities. Walking is a low-impact method of weight-bearing exercise and would be the most universal or most likely form of exercise for the nurse to recommend. Bicycling, and swimming are not weight-bearing exercise and will not increase bone density. Yoga may or may not be weight-bearing exercise depending on the yoga poses being performed; it is not as likely as walking to be recommended by the nurse. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 41: Management of Patients With Musculoskeletal Disorders, Prevention, p. 1169. Chapter 41: Management of Patients With Musculoskeletal Disorders - Page 1169
A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan? Weight reduction through diet and exercise An eye examination every 2 years until age 50 Smoking reduction but not complete cessation Maintenance of blood glucose levels between 180 and 200 mg/dl
Weight reduction through diet and exercise Explanation: Type 2 diabetes is commonly obesity-related; therefore, weight reduction may enhance the normalization of the blood glucose level. Weight reduction should be achieved by a healthy diet and exercise to increase carbohydrate metabolism. Blood glucose levels should be maintained within normal limits to prevent the development of diabetic complications. Clients with type 1 or 2 diabetes shouldn't smoke at all because of the increased risk of cardiovascular disease. A funduscopic examination should be done yearly to identify early signs of diabetic retinopathy. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1364
A client is brought to the emergency department by the paramedics. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). The nurse should identify what components of HHS? Select all that apply. Hyperglycemia Hypernatremia Glycosuria Dehydration Leukocytosis
Glycosuria Dehydration Hypernatremia Hyperglycemia In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 51: Assessment and Management of Patients With Diabetes, Hyperglycemic Hyperosmolar Syndrome, p. 1486. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1486
In order to determine the body mass index (BMI) for a client, which of the following assessment data must the nurse obtain? Abdominal circumference 24-hour dietary recall Neck circumference Height and weight
Height and weight Explanation: Clinically, obesity and overweight have been defined in terms of BMI. BMI is based on height and weight measurements and has a correlation with body fat. Reference: Chapter 39: Alterations in Nutritional Status - Page 1023
What are the hallmark signs of diabetes mellitus? Polyuria, polydipsia, and polyphagia Polyuria, polydipsia, and pheochromocytoma Polycythemia, polydipsia, and pheochromocytoma Polyuria, polyphagia, and polycythemia
Polyuria, polydipsia, and polyphagia Explanation: The most commonly identified signs and symptoms of diabetes are referred to as the three polys: (1) polyuria (i.e., excessive urination), (2) polydipsia (i.e., excessive thirst), and (3) polyphagia (i.e., excessive hunger). Pheochromocytoma and polycythemia are not hallmark signs of diabetes mellitus. Reference: Chapter 41: Disorders of Endocrine Control of Growth and Metabolism - Page 1078
Which of the following is the first-line medication that would be used to treat and prevent osteoporosis? Selective estrogen receptor modulators Anabolic agents Bisphosphonates Calcitonin
Bisphosphonates Explanation: Bisphosphonates, along with calcium and vitamin D supplements, are the first-line medications given to prevent/treat osteoporosis. The other medications are prescribed after these drugs are used. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 41: Management of Patients With Musculoskeletal Disorders, Pharmacologic Therapy, p. 1172. Chapter 41: Management of Patients With Musculoskeletal Disorders - Page 1172
A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should:
wash and inspect the feet daily.
The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL (48.67 mmol/L). The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time? Orienting the client to the events surrounding his admission Education related to prevention of DKA Monitoring for fever Administration of intravenous fluids
Administration of intravenous fluids Explanation: Goals of care for clients with DKA include administration of insulin and intravenous fluid and electrolyte replacement solutions. A common reason for development of DKA is an infection; monitoring for a fever should not take priority over administration of insulin and fluid replacement. Reference: Chapter 41: Disorders of Endocrine Control of Growth and Metabolism - Page 1080
When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is: "The circulation in your feet can help us determine how severe your diabetes is." "It's easier to get foot infections if you have diabetes." "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." "The physician wants to be sure your shoes fit properly so you won't develop pressure sores."
"Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." Explanation: The nurse should make the client aware that diabetes affects sensation in the feet and that he might hurt his foot but not feel the wound. Although it's important that the client's shoes fit properly, this isn't the only reason the client's feet need to be checked. Telling the client that diabetes mellitus increases the risk of infection or stating that the circulation in the client's feet indicates the severity of his diabetes doesn't provide the client with complete information.
What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? Bone spurs Decreased height Diarrhea Increased heel pain
Decreased height Explanation: Clients with osteoporosis become shorter over time. Reference: Chapter 41: Management of Patients With Musculoskeletal Disorders, Pathophysiology, p. 1170.
The nurse is taking the history of a client with diabetes who is experiencing autonomic neuropathy. Which would the nurse expect the client to report? Paresthesias Soft tissue ulceration Skeletal deformities Erectile dysfunction
Erectile dysfunction Explanation: Autonomic neuropathy affects organ functioning. According the American Diabetes Association, up to 50% of men with diabetes develop erectile dysfunction when nerves that promote erection become impaired. Skeletal deformities and soft tissue ulcers may occur with motor neuropathy. Paresthesias are associated with sensory neuropathy. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 51: Assessment and Management of Patients With Diabetes, Sexual Dysfunction, p. 1494. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1494
An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as being suggestive of diabetes? "Lately, I drink and drink and can't seem to quench my thirst." "When I went to the washroom the last few days, my urine smelled odd." "No matter how much sleep I get, it seems to take me hours to wake up." "I've always been a fan of sweet foods, but lately I'm turned off by them.
"Lately, I drink and drink and can't seem to quench my thirst." Explanation: Classic clinical manifestations of diabetes include the "three Ps": polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 51: Assessment and Management of Patients With Diabetes, Clinical Manifestations, p. 1460. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1460
A client with diabetes calls the clinic reporting a "flu bug." What should the nurse tell the client to do? Select all that apply. "Try to eat small amounts of carbs, if possible." "For now, check your urine for ketones every 8 hours." "Take your usual dose of insulin." "Ensure that you check your blood glucose every hour." "Make sure to stick to your normal diet."
"Take your usual dose of insulin." "Try to eat small amounts of carbs, if possible." Explanation : For prevention of DKA related to illness, the client should attempt to consume frequent small portions of carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinking fluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours and the client should take the usual dose of insulin. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 51: Assessment and Management of Patients With Diabetes, Chart 51-9, p. 1484. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1484
A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? Observing the client for 1 hour, then rechecking the fingerstick glucose level Administering a 500-ml bolus of normal saline solution Administering 1 ampule of 50% dextrose solution, per physician's order Inserting a feeding tube and providing tube feedings
Administering 1 ampule of 50% dextrose solution, per physician's order Explanation: The nurse should administer 50% dextrose solution to restore the client's physiological integrity. Feeding through a feeding tube isn't appropriate for this client. A bolus of normal saline solution doesn't provide the client with the much-needed glucose. Observing the client for 1 hour delays treatment. The client's blood glucose level could drop further during this time, placing him at risk for irreversible brain damage. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 51: Assessment and Management of Patients With Diabetes, Initiating Emergency Measures, p. 1482. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1482
A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? Assess the client's breath odor Assess the client's ability to move all extremities Assess for excessive sweating Assess the client's ability to take a deep breath
Assess the client's breath odor Explanation: DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue, with eventual stupor and coma if not treated. The breath has a characteristic fruity odor due to the presence of ketoacids. Checking the client's breath will help the nurse confirm the diagnosis. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 51: Assessment and Management of Patients With Diabetes, p. 1459. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1459
The nurse is caring for a client who received regular insulin at 7 am. Four hours later the nurse finds the client diaphoretic, cool, and clammy. Which of these interventions is the priority? Bathe the client with tepid water. Place the client in the supine position. Repeat the dose of insulin. Give the client a concentrated carbohydrate.
Give the client a concentrated carbohydrate. Explanation: The client is displaying symptoms of hypoglycemia, which include headache, difficulty in problem solving, altered behavior, coma, and seizures. Hunger may occur. Activation of the sympathetic nervous system may cause anxiety, tachycardia, sweating, and cool and clammy skin. Reference: Chapter 41: Disorders of Endocrine Control of Growth and Metabolism - Page 1081
A client has been prescribed alendronate for the prevention of osteoporosis. Which is the highest priority nursing intervention associated with the administration of the medication? Ensure adequate intake of vitamin D in the diet Assess for the use of corticosteroids Encourage the client to get yearly dental exams Have the client sit upright for at least 30 minutes following administration
Have the client sit upright for at least 30 minutes following administration Explanation: While all interventions are appropriate, the highest priority is having the client sit upright for 60 minutes following administration of the medication. This will prevent irritation and potential ulceration of the esophagus. The client should have adequate intake of vitamin D and obtain yearly dental exams. The concurrent use of corticosteroids and alendronate is link to a complication of osteonecrosis. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 41: Management of Patients With Musculoskeletal Disorders, Table 41-1, p. 1173. Chapter 41: Management of Patients With Musculoskeletal Disorders - Page 1173
Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply. Hypertension Obesity Age greater of 45 years or older Family history History of gestational diabetes
Hypertension Obesity Family history Age greater of 45 years or older History of gestational diabetes Risk factors for the development of diabetes mellitus include hypertension, obesity, family history, age of 45 years or older, and a history of gestational diabetes. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 51: Assessment and Management of Patients With Diabetes, Chart 51-1, p. 1457. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1457
The school nurse identifies more children with type 2 diabetes each year and recognizes that this trend is mainly attributed to what issue? Obesity and inadequate exercise Economics Working parents Lack of after-school programs due to budget constraints
Obesity and inadequate exercise Explanation: Type 2 diabetes is being increasingly identified in children. This trend is attributed mainly to obesity and inadequate exercise, because most children with type 2 are seriously overweight and have poor eating habits Reference: Chapter 38: Agents to Control Blood Glucose Levels - Page 637
When educating a client about glargine, the nurse should explain that this medication: has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours. will have a peak effect within 30 minutes, and thus it can be taken after a meal. has a rapid onset and peaks in about 5 minutes after injection, so the client will need to eat food immediately after injection. is a combination with short acting and intermediate acting insulin so it is safe to take anytime throughout the day.
has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours. Explanation: Glargine is long-acting insulin that has a slow, prolonged absorption rate and provides a relatively constant concentration over 12-24 hours. Rapid acting insulin has a rapid onset and peaks in about 5 minutes after injection. Short acting insulin will have a peak effect within 30 minutes, and thus it can be taken after a meal. Intermediate-acting insulin is a combination with short acting insulin so it is safe to take anytime throughout the day. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 33: Diabetes Mellitus and the Metabolic Syndrome, p. 810. Chapter 41: Disorders of Endocrine Control of Growth and Metabolism - Page 810
