Pathophysiology Ch. 20 Integrated Pathophysiologic Concepts

A client is diagnosed with diabetic ketoacidosis (DKA) in the emergency department. Which clinical manifestations will the client likely exhibit?

Polyuria, polydipsia, vomiting, and fatigue

A nurse educator is conducting a course for newly diagnosed diabetes clients. Which statement by a participant should the nurse follow up first?

"I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal."

A client being treated for diabetes type 2 with insulin presents to a clinic for routine visit. Blood work reveals a HbA1C of 11.0% (high). Which response by the client may account for this abnormal laboratory result?

"My meter broke so I have not been checking my blood glucose levels for a while."

A 3-year-old girl has just been diagnosed with type 1A diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain to the parents the etiology (cause) of their daughter's diabetes?

"The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin."

A young child develops type 1A diabetes. The parents ask, "They tell us this is genetic. Does that mean our other children will get diabetes?" The best response by the health care provider would be:

"This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes."

Impaired and delayed healing in a person with diabetes is caused by long-term complications that include:

Chronic neuropathies

Which metabolic abnormality can lead to the development of type 2 diabetes?

Insulin Resistance

The nurse cares for a client with type 2 diabetes. The nurse determines the client is at highest risk for foot ulcer formation based on which assessment findings?

report of decreased sensation and cool, pale feet

A client's primary care provider has prescribed an oral glucose tolerance test (GTT) as a screening measure for diabetes. Which instruction should the client be given?

"You will drink a sugar solution and then your blood sugar will be measured at specified intervals."

Following an oral glucose tolerance, a 36-year-old mother of 4 has been diagnosed with gestational diabetes mellitus (GDM), a problem that was not present in any of her previous pregnancies. What should her primary care provider tell her about this new health problem?

"Your baby could become too large or have low blood sugars if we're not vigilant about controlling your sugars."

The diabetes nurse educator is teaching a community education class for new diabetics. Which of these does the nurse include in the discussion of signs and symptoms of hyperglycemia? Select all that apply. -Fine moist skin -Anorexia -Weight loss -Thirst -Blurred vision

-Blurred vision -Weight loss -Thirst

A diabetic client presents to the clinic. He is concerned his lower legs are "feeling funny." Which assessment findings lead the health care provider to suspect the client may have developed somatic neuropathy? Select all that apply. -Both legs appear to be the same as far as numbness is involved. -With eyes closed, the client cannot identify where the health care provider is touching his feet. -Right foot has a diminished perception of vibration; left foot is normal. -Bilateral cool ankles and feet. -One leg has a reddened area in the calf and has a positive Homan sign.

-Both legs appear to be the same as far as numbness is involved. -Bilateral cool ankles and feet. -With eyes closed, the client cannot identify where the health care provider is touching his feet.

While shopping for groceries, a nurse notices a female adult exhibiting clammy skin, dizziness, and a lack of coordination. What intervention(s) could the nurse provide to prevent further progression? Select all that apply. -Get some hard candies and place one in the person's mouth. -Open a box of honey-flavored cereal and give the person a serving to eat. -Add some syrup to a container of juice and give the person a cup to drink. -Open a package of peanuts and put a handful of nuts in the person's mouth. -Get some fruit juice and assist the person in drinking it.

-Get some hard candies and place one in the person's mouth. -Add some syrup to a container of juice and give the person a cup to drink. -Get some fruit juice and assist the person in drinking it.

The nurse is educating a family about their parent who experienced a myocardial infarction (MI). Which concept(s) will the nurse include in the education? Select all that apply. -Inflammation may be used as an indicator for the diagnosis of myocardial infarction. -There could be a blockage in the artery resulting in a perfusion problem. -Your parent's genetics play a role in the development of heart disease. -Drinking too much water and soda can overload the vascular system and stress the heart. -Nutrition plays a limited role in the development of heart disease -Cortisol, released in times of stress, may play a role in the development of myocardial infarction.

-Inflammation may be used as an indicator for the diagnosis of myocardial infarction. -Cortisol, released in times of stress, may play a role in the development of myocardial infarction. -There could be a blockage in the artery resulting in a perfusion problem. -Your parent's genetics play a role in the development of heart disease.

The nurse is explaining hormonal feedback systems to a group of clients. Which information is accurate with regard to the pancreas? Select all that apply. -During a strenuous cardiovascular workout, blood glucose levels decrease and insulin levels increase accordingly. -Insulin secretion is increased during times of elevated serum potassium. -Following a high carbohydrate meal when blood glucose levels are high, insulin secretion increases. -Stimulation of the alpha cells of the pancreas automatically increases insulin secretion. -When glucagon levels are elevated, cells do not store sugar so the blood glucose levels are also high.

-Insulin secretion is increased during times of elevated serum potassium. -Following a high carbohydrate meal when blood glucose levels are high, insulin secretion increases. -When glucagon levels are elevated, cells do not store sugar so the blood glucose levels are also high.

The nurse knows that a client with diabetes admitted for a lower limb infection likely is experiencing which pathophysiologic principle listed below? Select all that apply. -Hyperglycemia may provide an environment that enhances the growth of microorganisms. -Many clients with diabetes have sensory deficits and ignore minor trauma just because they can't feel it in their feet. -Infections happen to all age-groups and people and the client with diabetes has the same risk for developing an infection as other clients without diabetes. -Any exercise that creates diaphoresis in their feet can cause a fungal infection in clients with diabetes. -Clients with chronic diabetes may have vascular problems that impair circulation and therefore cells needed for adequate inflammatory response can't reach the site.

-Many clients with diabetes have sensory deficits and ignore minor trauma just because they can't feel it in their feet. -Clients with chronic diabetes may have vascular problems that impair circulation and therefore cells needed for adequate inflammatory response can't reach the site. -Hyperglycemia may provide an environment that enhances the growth of microorganisms.

The nurse is caring for a client with suspected type 1 diabetes mellitus. For which finding(s) should the nurse monitor? Select all that apply. -Polyphagia -Weight gain -Polydipsia -Hyperactivity -Polyuria

-Polyuria -Polyphagia -Polydipsia

A client presents to the emergency room with fatigue, weakness, dehydration, and thirst. What additional symptoms would correlate with a diagnosis of type 1 diabetes mellitus? Select all that apply. -Insomnia -Polyuria -Joint pain -Blurred vision -Recent weight loss

-Recent weight loss -Polyuria -Blurred vision

Which statement about glycosylated hemoglobin (HgbA1C) is appropriate for the nurse to share with a client newly diagnosed with diabetes? -HgbA1c reflects red blood cell exposure to glucose over the past 3 to 4 months. -The higher the HgbA1c level, the better controlled the blood glucose level has been. -The goal for the client with diabetes is for the HgbA1c to be 7% or lower. -Cardiovascular disease is associated with clients with diabetes who have elevated HgbA1c levels. -Once the HgbA1c level is elevated, it will always remain elevated.

-The goal for the client with diabetes is for the HgbA1c to be 7% or lower. -Cardiovascular disease is associated with clients with diabetes who have elevated HgbA1c levels. -HgbA1c reflects red blood cell exposure to glucose over the past 3 to 4 months.

An adolescent client asks the nurse about an insulin pump. Which information will the nurse include in this education? Select all that apply. -You will wear the pump on your belt, in your pocket, or on your arm or leg. -The pump will simulate your pancreas' delivery of insulin. -A small catheter will be placed into your subcutaneous tissue. -The pump will deliver a continuous basal rate but not a bolus amount of insulin. -You will get continuous rates of insulin, so you will not need to check daily blood glucose levels.

-You will wear the pump on your belt, in your pocket, or on your arm or leg. -The pump will simulate your pancreas' delivery of insulin. -A small catheter will be placed into your subcutaneous tissue.

Which presenting factor(s) leads the nurse to suspect an adolescent client has developed type 1 diabetes? Select all that apply. -sudden weight gain -blurred vision -always hungry -excessive thirst -frequent urination -sleepiness even after a full night's rest

-excessive thirst -frequent urination -always hungry -sleepiness even after a full night's rest -blurred vision

Which assessment data/laboratory result(s) would the nurse determine is sufficient for a diagnosis of type 1 diabetes in the client? Select all that apply. -fasting blood glucose level of 160 mg/dl (8.88 mmol/l) -total cholesterol level of 170 mg/dl (4.40 mmol/l) -20/30 vision via Snellen eye chart -weight loss of 5 lb (2.3 kg) in a 1 week period -random blood glucose level of 150 mg/dl (8.32 mmol/l)

-fasting blood glucose level of 160 mg/dl (8.88 mmol/l) -weight loss of 5 lb (2.3 kg) in a 1 week period

The nurse is educating a client with diabetes mellitus about the importance of adhering to the treatment regimen to maintain tight blood glucose control and help prevent large blood vessel complications. Which large blood vessel disease(s) is this client at risk for developing? Select all that apply. -peripheral vascular disease -stroke -eye problems -pulmonary embolism -heart attack

-heart attack -stroke -peripheral vascular disease

A client has developed gestational diabetes. Which information will the nurse include in client education to minimize complications? Select all that apply. -risks of giving birth to a large-for-gestational-age newborn, if gestational diabetes is not controlled -signs/symptoms of low blood glucose in a newborn -importance of taking oral glycemic medication as prescribed -appropriate diet and exercise while pregnant -importance of tight control of blood glucose by frequent blood testing throughout the day

-risks of giving birth to a large-for-gestational-age newborn, if gestational diabetes is not controlled -signs/symptoms of low blood glucose in a newborn -importance of tight control of blood glucose by frequent blood testing throughout the day -appropriate diet and exercise while pregnant

The nurse is caring for a female client, 5 ft 2 in (157 cm) in height and 186 lb (84.3 kg) in weight, who was recently diagnosed with metabolic syndrome. For which diagnostic finding(s) will the nurse monitor and assess? Select all that apply. -obesity -blood pressure 168/95 mm Hg (high) -pulse rate 90 beats/min, regular rhythm (normal) -low-density lipoprotein (LDL) level 45 mg/dl (1.17 mmol/l) (normal) -triglyceride level 256 mg/dl (2.89 mmol/l) (high)

-triglyceride level 256 mg/dl (2.89 mmol/l) (high) -obesity -blood pressure 168/95 mm Hg (high)

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

Which client would be considered to be exhibiting manifestations of "prediabetes"?

A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL (10.49 mmol/L).

A 60 year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration, and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which action should be the wife's first choice?

Administration of 15 to 20 g of glucose in a concentrated carbohydrate source.

Hypoglycemia has a sudden onset with a progression of symptoms. What are the signs and symptoms of hypoglycemia?

Altered cerebral function and headache

While reviewing the role of glucagon regarding the regulation of blood glucose, the nurse knows that which situation could lead to an inhibition of glucagon release?

An increase in glucose levels

When educating a client about type 1 diabetes, the nurse will mention that this type is caused by which mechanism?

Autoimmune destruction of pancreatic beta cells

A client with a history of diabetes presents to the emergency department following several days of polyuria and polydipsia with nausea/vomiting. On admission, the client labs show a blood glucose level of 480 mg/dL (26.64 mmol/L) and bicarbonate level of 7.8 mEq/L (7.8 mmol/L). The nurse suspects the client has diabetic ketoacidosis (DKA). The priority intervention should include:

Begin a loading dose of IV regular insulin followed by a continuous insulin infusion.

A nurse is assessing a client who is experiencing hypoglycemia caused by an insulin reaction. The client is conscious and can follow directions. Which intervention is most appropriate at this time?

Immediately administer a rapidly absorbed form of glucose (preferably via oral route if the client is alert enough to swallow).

A hospitalized client with diabetes mellitus has sudden onset of slurred speech; lack of coordination; and cool, clammy skin. What will the nurse do first?

Check blood glucose.

A client with type 2 diabetes experiences unexplained elevations of fasting blood glucose in the early morning hours. Which conditions can account for this effect?

Dawn phenomenon

The nurse is caring for a client with type 1 diabetes mellitus and metabolic acidosis. Which respiratory symptoms does the nurse expect?

Deep, rapid respirations

The nurse is caring for a client with type 1 diabetes mellitus and polyuria. For which complication should the nurse monitor?

Dehydration

The nurse is caring for a client exhibiting polyuria, polydipsia, polyphagia, nocturia, weight loss, and fatigue. Arterial blood gases show a pH of 7.22. For which condition does the nurse suspect?

Diabetic ketoacidosis

The nurse is caring for a client with type 2 diabetes mellitus. Which treatments should the nurse anticipate for the client?

Diet, exercise, oral glycemic agents, and possible insulin

A client with pancreatitis is admitted with weight loss, nausea, and vomiting. To maintain nutrition, the physician orders parenteral nutrition to be started. Knowing that a major side effect of parenteral nutrition is a hyperosmolar hyperglycemic state, the nurse should assess the client for which clinical manifestations?

Dry lips, excess urine output, and seizures.

Diabetic ketoacidosis (DKA) in a client with type 1 diabetes occurs when the lack of insulin leads to the release of which physiologic product?

Fatty acids

A 40-year-old man who is morbidly obese and leads a sedentary lifestyle has recently been diagnosed with type 2 diabetes. Which aspects of the man's obesity likely contributed to his new health problem?

Free fatty acids contribute to problems such as beta cell dysfunction and insulin resistance.

Which statement best describes an aspect of the normal process of glucose metabolism?

Glucose that exceeds metabolic needs is converted and stored by the liver.

A client with diabetes will be undergoing an evaluation of the fluctuation of blood glucose over the previous 120-day span. Which test will this client undergo?

Glycosylated hemoglobin

A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes. The best diagnostic indicator that would support the client's response would be:

Glycosylated hemoglobin, hemoglobin A1C (HbA1C)

Which assessment finding of a client constitutes a criterion for a diagnosis of metabolic syndrome?

Has a high blood pressure that is consistently in the range of 140/90 mm Hg or greater

A client has been admitted with diabetic ketoacidosis. The emergency department starts an IV to improve circulatory volume. If there is a sudden change in extracellular fluid osmolality which results in a too rapid blood glucose lowering, the nurse will likely observe which clinical manifestations?

Headaches, dizziness, change in level of consciousness.

A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action?

Helping the client make meaningful changes to his diet and activity level

A 30-year-old client who manages type 2 diabetes with glyburide presents at the emergency room reporting headache, confusion, and tachycardia. The client has come from a party at which the client drank two beers to celebrate running a half-marathon. Which is likely to be the cause of this client's?

Hypoglycemia

While trying to explain the physiology behind type 2 diabetes to a group of nursing students, the instructor will mention which accurate information?

In skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance.

The nurse is caring for a client on repaglinide therapy for type 2 diabetes mellitus. Which mechanism of action does the nurse associate with this medication?

Increased insulin secretion from pancreas

The pediatric nurse is caring for a client with type 1 diabetes mellitus. Which treatments should the nurse anticipate for the client?

Insulin, exercise, and diet

Diabetics are at higher risk than are the majority of the population for injury to organ systems in the body. Which organs are most at risk?

Kidneys and eyes

The nurse is caring for a client with type 1 diabetes mellitus who has been unable to eat. Which finding requires immediate action?

Mental status changes

Which treatment regimen is most likely to result in stable blood glucose levels for a client with a diagnosis of type 1 diabetes?

Monitor blood glucose levels throughout the day and administer exogenous insulin replacement as needed

A client with diabetes mellitus arrives at the hospital with a blood glucose level of 639 mg/dL (35.46). What assessment data would indicate type 2 diabetes mellitus rather than type 1?

Negative ketones in urine

Secondary diabetes occurs because of disorders that produce hyperglycemia by stimulating the hepatic production of glucose or decrease the cellular use of glucose. Which disorders can be causes of secondary diabetes?

Pheochromocytoma and Cushing syndrome

A client has been experiencing elevated blood glucose levels. The nurse anticipates that which assessment data correlates with hyperglycemia?

Polydipsia

Infections are common in people with diabetes. Which infection is thought to be related to a neurogenic bladder?

Pyelonephritis

The nurse is assessing a client with diabetes mellitus who exhibits the Somogyi effect. Which finding does the nurse expect?

Rebound hyperglycemia

The nurse knows that the client with which complication of diabetes has the greatest risk for the development of foot ulcers?

Sensory neuropathy

A client with diabetes carries insulin with him at all times. At 11:35, he obtains a blood glucose reading of 218 mg/dL (12.1 mmol/L) and self-administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject?

Short acting

A client with diabetes mellitus is reporting burning pain of the feet and some numbness. These symptoms are likely due to which cause?

Somatic neuropathy

The nurse is teaching a client with diabetes about the signs and symptoms of hypoglycemia. The client asks, "Why will I get headache, disturbed behavior, coma, and seizures if it's my pancreas that's impaired?" Which response is the best explanation?

The brain relies on blood glucose as its main energy source.

A client is managing diabetes with exercise and diet. The health care provider reviews the client's most recent laboratory results: fasting blood glucose level at 80 mg/dL (4.44 mmol/L) and a hemoglobin A1C of 5% (0.05). Select the response that best identifies the client.

The client is achieving normal glycemic control.

A client newly diagnosed with type 1 diabetes asks the nurse, "Can you explain what caused me to develop an autoimmunity that destroyed my pancreatic beta cells?" Which answer is accurate?

You may have been exposed to a virus like group-B coxsackie.

Which type of cell is responsible for synthesis, storage, and secretion of digestive enzymes?

acini cells of exocrine pancreas

A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate?

Using an insulin infusion pump

The nurse educates a client with diabetes about glycemic agents. Which drug category works to prevent excessive glucose release from the liver?

biguanides

The nurse cares for a client with diabetes. Which evening meal is an appropriate choice for this client?

deli sandwich with whole wheat bread, turkey, lettuce, tomato and pickles and apple slices

A client with diabetes has laboratory results that indicate the presence of microalbuminuria. Which priority self-care measures should the client's care team prescribe for this client?

diet, exercise, and prescriptions to lower blood pressure below 140/80 mm Hg