Porth's Patho: Endocrine Ch. 41
A client's low serum T4 level has led to a diagnosis of hypothyroidism. When planning this client's care, the nurse should: -teach the client about the signs and symptoms of Graves disease. -ensure the client knows that the physician may propose surgery. -teach the client about the safe and effective use of synthetic thyroid hormones. -educate the client about the need to report any weight changes promptly.
teach the client about the safe and effective use of synthetic thyroid hormones. Hypothyroidism is treated by replacement therapy with synthetic preparations of T3 or T4. Graves disease is associated with hyperthyroidism, not hypothyroidism. Surgery is not a usual treatment modality.
A client is diagnosed with Addison disease. What statement by the client indicates an understanding of the discharge instructions by the nurse? -"I will have to take my medication for the rest of my life." -"Once the symptoms go away, I will be able to stop taking my medication." -"I should be able to control my condition with diet and exercise." -"If I have surgery, it will cure me."
"I will have to take my medication for the rest of my life." Addison disease, like type I diabetes, is a chronic metabolic disorder that requires lifetime hormone replacement therapy. The daily regulation of the chronic phase of Addison disease is usually accomplished with oral replacement therapy, with higher doses being given during periods of stress.
The mother of a 2-year-old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. The best response by the nurse is: -"When your child gets old enough, you will not have to administer injections." -"Insulin is destroyed by the stomach contents and has to be administered by injection." -"Insulin needs to go directly into the vein to work best." -"Your child is not old enough to swallow the pills needed to treat her diabetes."
"Insulin is destroyed by the stomach contents and has to be administered by injection." Insulin is destroyed by the gastrointestinal tract and needs to be administered via injection or inhalation. Type 1 diabetes is not treated with oral medications at this time. Insulin is administered subcutaneously rather than in the vein. The statement about the mother not having to give injections once the child is older does not address the mother's concerns.
Diabetic ketoacidosis (DKA) in a client with type 1 diabetes occurs when the lack of insulin leads to the release of which physiologic product? -Cortisol -Fatty acids -Potassium -Bicarbonate
Fatty acids DKA most commonly occurs in type 1 diabetes, when the lack of insulin leads to unsuppressed adipose cell lipase activity that breaks down triglycerides into fatty acids and glycerol. The subsequent increase in fatty acid levels leads to ketone production by the liver. Serum potassium levels may be normal or elevated, despite total potassium depletion resulting from protracted polyuria and vomiting. Metabolic acidosis is caused by the excess ketoacids that require buffering by bicarbonate ions; this leads to a marked decrease in serum bicarbonate levels. Stress increases the release of cortisol and other gluconeogenic hormones and predisposes the person to the development of ketoacidosis.
A client with Graves disease has ophthalmopathy and asks the nurse if the eyes will stay like this forever. What is the best response by the nurse? -"Your eyes will be like this but there are things we can do to reduce visual loss." -"The protrusion of the eyes will get worse before they get better." -"With treatment of the hyperthyroid state, the ophthalmopathy usually tends to stabilize." -"Once we treat your Graves disease, your eyes will go back to their normal state."
"With treatment of the hyperthyroid state, the ophthalmopathy usually tends to stabilize." The ophthalmopathy of Graves disease can cause severe eye problems, including tethering of the extraocular muscles resulting in diplopia; involvement of the optic nerve, with some visual loss; and corneal ulceration because the lids do not close over the protruding eyeball. The ophthalmopathy usually tends to stabilize after treatment of the hyperthyroidism.
After receiving change-of-shift report about the following four clients, which client should the nurse assess first? -53-year-old who has Addison disease and is due for a scheduled dose of hydrocortisone -22-year-old admitted with SIADH who has a serum sodium level of -130 mEq/L (130 mmol/L) -70-year-old returning from PACU following partial thyroidectomy who is extremely agitated, has an irregular pulse rate of 134, and an elevated temperature of 103.2°F (39.6°C) -31-year-old who has iatrogenic Cushing syndrome with a capillary blood glucose level of 204 mg/dL (11.32 mmol/L)
70-year-old returning from PACU following partial thyroidectomy who is extremely agitated, has an irregular pulse rate of 134, and an elevated temperature of 103.2°F (39.6°C) Manipulation of a hyperactive thyroid gland during thyroidectomy can cause thyroid storm. It is manifested by very high fever, extreme cardiovascular effects (tachycardia, HF, angina), and severe CNS effects (agitation, restlessness, and delirium). The 22-year-old has normal sodium levels. The 31-year old has a high blood glucose level but not at a critical level. The medication schedule for the 53-year-old is lower priority. It is always preferred to give medications in timely manner; however, thyroid storms are the priority for this group of clients.
Which pediatric assessment finding would the nurse recognize as an example of precocious puberty? -A 12-year-old male with advanced growth -A 16-year-old male with genital enlargement and pubic hair growth -A 13-year-old female with menarche and a recent growth spurt -A 7-year-old female with early menarche
A 7-year-old female with early menarche The 7-year-old needs to be evaluated. Precocious puberty is defined as the appearance of secondary sexual development before the age of 8 years in girls. There is a shift toward a "new normal" of earlier ages of puberty, with black girls entering puberty earlier than white girls and children who are obese entering puberty at earlier ages than children of normal body weight for age. In boys of both races, the lower age limit remains 9 years; however, it is recognized that puberty can develop earlier in boys with obesity. The assessment findings of the 12-, 13-, and 16-year-olds are not of concern because they are normal findings.
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). -An older adult client who got "light-headed" when he skipped his lunch. Blood glucose level was 60 mg/dL (3.33 mmol/L) at this time. -A school-aged child who had a blood glucose level of 115 following lunch. -A retired female registered nurse with a fasting plasma glucose level of 92 mg/dL (5.11 mmol/L).
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) Persons with IFG (impaired fasting plasma glucose [IFG] defined by an elevated FPG of 100 to 125 mg/dL [5.55 to 6.94 mmol/L]) and/or IGT (impaired glucose tolerance [IGT] plasma glucose levels of 140 to 199 mg/dL [7.77 to 11.04 mmol/L] with an OGTT) are often referred to as having prediabetes, meaning they are at relatively high risk for the future development of diabetes as well as cardiovascular disease.
A client with small cell carcinoma lung cancer may secrete an excess of which hormone, causing an ectopic form of Cushing syndrome due to a nonpituitary tumor? -GH -TSH -ACTH -DHEA
ACTH The third form (of Cushing syndrome) is ectopic Cushing syndrome, caused by a nonpituitary ACTH-secreting tumor. Certain extra pituitary malignant tumors such as small cell carcinoma of the lung may secrete ACTH or, rarely, CRH that can produce Cushing syndrome. The adrenal sex hormone dehydroepiandrosterone (DHEA) contributes to the pubertal growth of body hair, particularly pubic and axillary hair in women. Thyroid-stimulating hormone (TSH) levels are used to differentiate between primary and secondary thyroid disorders. Although secretion of growth hormone (GH) has diurnal variations over a 24-hour period, with nocturnal sleep bursts occurring 1 to 4 hours after onset of sleep, it is unrelated to ACTH and/or CRH secretion.
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? -Monitoring for fever -Education related to prevention of DKA -Orienting the client to the events surrounding his admission -Administration of intravenous fluids
Administration of intravenous fluids 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.
Which individual displays the precursors to acromegaly? -A client who has recently developed primary adrenal carcinoma -An adult who has a diagnosis of Cushing syndrome -A girl who has been diagnosed with precocious puberty -An adult with an excess of growth hormone due to an adenoma
An adult with an excess of growth hormone due to an adenoma When growth hormone (GH) excess occurs in adulthood or after the epiphyses of the long bones have fused, it causes a condition called acromegaly, which represents an exaggerated growth of the ends of the extremities.
A client is to have a serum thyroxine and thyroid stimulating laboratory test performed to assess the baseline status of the hypothalamic-pituitary target cell hormones. When educating the client about the laboratory tests, when would the nurse inform him the test should be obtained? -After 0900 -Before 0800 -Prior to midnight -At noon
Before 0800 The assessment of hypothalamic-pituitary function has been made possible by many newly developed imaging and radioimmunoassay methods. Assessment of the baseline status of the hypothalamic-pituitary target cell hormones involves measuring the following laboratory specimens (ideally obtained before 0800): serum cortisol, serum prolactin, serum thyroxine and TSH, serum testosterone and estrogen and serum LH/FSH, serum GH, and plasma and urine osmolality.
The results of a 44-year-old obese man's recent diagnostic workup have culminated in a new diagnosis of type 2 diabetes. Which pathophysiologic process underlies the client's new diagnosis? -Beta cell exhaustion due to long-standing insulin resistance -Actions of insulin autoantibodies (IAAs) and islet cell autoantibodies (ICAs) -Destruction of beta cells that is not attributable to autoimmunity -T-lymphocyte-mediated hypersensitivity reactions
Beta cell exhaustion due to long-standing insulin resistance Exhaustion of the beta cells arising from insulin resistance is characteristic of type 2 diabetes. Beta cell destruction in the absence of an autoimmune reaction is associated with type 1b diabetes, while autoimmune processes contribute to type 1a diabetes.
The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. The nurse teaches the student that epinephrine will cause which effect on blood glucose levels? -Blood glucose will elevate. -Hypoglycemia will occur. -Gluconeogenesis will occur. -An unusable form of glucose will be released.
Blood glucose will elevate. Epinephrine, a catecholamine, helps to maintain blood glucose levels during periods of stress. Epinephrine causes glycogenolysis in the liver, thus causing large quantities of glucose to be released into the blood.
The health care provider is teaching a client about the metabolic effect of cortisol. The most appropriate information to provide would be: -Regulation of behavior and emotion -Breakdown of proteins and fats -Regulation of anti-inflammatory reactions -Suppression of the immune response to invasive pathogens
Breakdown of proteins and fats The best-known metabolic effect of cortisol and other glucocorticoids is their ability to stimulate gluconeogenesis (glucose production) by the liver. Metabolic effects of cortisol involve the metabolism of proteins, carbohydrates, and fats. Behavior and emotion regulation is a psychological effect of cortisol. The other two options are immunologic and inflammatory effects of cortisol.
The nurse is caring for an adult client with growth hormone deficiency. When performing an assessment of this client, which system should the nurse be sure to assess for complications related to this disorder? -Respiratory system -Cardiovascular system -Renal system -Neurologic system
Cardiovascular system Evidence shows that cardiovascular mortality increases in GH-deficient adults. A higher prevalence of atherosclerotic plaques and endothelial dysfunction has been reported in both childhood and adult GH deficiency. The GH deficiency syndrome is associated with a cluster of cardiovascular risk factors, including central adiposity, insulin resistance, and dyslipidemia.
A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first? -Check blood glucose -Notify the physician -Administer glucose -Provide cheese and crackers
Check blood glucose Hypoglycemia is a medical emergency. Because other conditions can also cause these symptoms, the blood glucose level should be checked first. Then glucose should be given. The client should follow this with a protein and complex carbohydrate to avoid a recurrence of hypoglycemia. Blood glucose should be tested about 15 minutes after the glucose is given to monitor progress
Which criterion about insulin would prompt a diagnosis of type 1 diabetes? -Small amounts of insulin secreted -Insulin not efficiently used -Complete failure of insulin secretion -Large amounts of insulin secreted
Complete failure of insulin secretion In type 1 diabetes there is an absolute lack of insulin due to complete failure of the pancreas. In type 2 diabetes some insulin is produced but may not be properly used.
The newborn nursery nurse is obtaining a blood sample to determine if a newborn has congenital hypothyroidism. What long-term complication is the nurse aware can occur if this test is not performed and the infant has congenital hypothyroidism? -Dehydration from diarrhea -Accelerated growth -Irritability and restlessness -Cretinism
Cretinism Congenital hypothyroidism is a common cause of preventable intellectual disability. It affects approximately 1 in 4000 infants. The manifestations of untreated congenital hypothyroidism are referred to as cretinism. The term does not apply to the normally developing infant in whom replacement thyroid hormones therapy was instituted shortly after birth.
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 -Diabetic ketoacidosis -Inadequate bedtime insulin -Autonomic neuropathy
Dawn phenomenon The dawn phenomenon involves increased levels of fasting blood glucose or insulin requirement during the early morning hours. It is not preceded by hypoglycemia. Circadian release of growth hormone and cortisol may be contributing factors. The other answer selections are not characterized by increased early morning levels of blood glucose.
Parents of a 7-year-old girl are concerned about their daughter because she has begun to develop secondary sexual characteristics. What etiologic factor is most likely to underlie the child's condition? -Genetic predisposition -Physiologic effects of sexual abuse -Premature pituitary development resulting from a thyroid disorder -Early activation of the hypothalamic-pituitary-gonadal axis
Early activation of the hypothalamic-pituitary-gonadal axis Isosexual or central precocious puberty involves early activation of the hypothalamic-pituitary-gonadal axis, resulting in the development of appropriate sexual characteristics and fertility. It is not caused by trauma such as sexual abuse and it does not involve thyroid function. Precocious puberty is not noted to be a genetic trait.
Which pathophysiologic phenomenon may result in a diagnosis of Cushing disease? -Malfunction of the HPA system -Autoimmune destruction of the adrenal cortex -Excess ACTH production by a pituitary tumor -Hypopituitarism
Excess ACTH production by a pituitary tumor Three important forms of Cushing syndrome result from excess glucocorticoid production by the body. One is a pituitary form, which results from excessive production of ACTH by a tumor of the pituitary gland. Hypopituitarism and destruction of the adrenal cortex are associated with Addison disease. Disruption of the HPA system is not implicated in the etiology of Cushing disease.
A client is seeking treatment for infertility. What decrease in hormone secretion from the anterior lobe of the pituitary gland that regulates fertility would the nurse recognize may cause this issue? -Thyroid-stimulating hormone (TSH) -Follicle stimulating hormone (FSH) -Adrenocorticotropic hormone (ACTH) -Luteinizing hormone (LH)
Follicle stimulating hormone (FSH) ACTH controls the release of cortisol from the adrenal gland. TSH controls the secretion of thyroid hormone from the thyroid gland. LH regulates sex hormones. FSH regulates fertility.
Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of: -Graves disease -Addison disease -Cushing syndrome -Cushing disease
Graves disease Graves disease is an autoimmune disorder characterized by abnormal stimulation of the thyroid gland by thyroid-stimulating antibodies (TSH-receptor antibodies) that act through the normal TSH receptors.
When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis? -Goiter -Thyroid tumor -Congenital hypothyroidism -Hashimoto thyroiditis
Hashimoto thyroiditis The assessment of thyroid autoantibodies (e.g., antithyroid peroxidase antibodies in Hashimoto thyroiditis) is important in the diagnostic workup and consequent follow-up of clients with thyroid problems.
When the nurse is performing a health history for a client who is being admitted for hyperthyroidism, what symptom does the client report that the nurse would find associated with this disorder? -Weight gain -Increase in appetite -Fatigue -Constipation
Increase in appetite Thyroid hormone enhances gastrointestinal function, causing an increase in motility and production of GI secretions that often results in diarrhea. An increase in appetite and food intake accompanies the higher metabolic rate that occurs with increased thyroid hormone levels. At the same time, weight loss occurs because of the increased use of calories.
A client comes to the clinic with fatigue and muscle weakness. The client also states she has been having diarrhea. The nurse observes the skin of the client has a bronze tone and when asked, the client says she has not had any sun exposure. The mucous membranes of the gums are bluish-black. When reviewing laboratory results from this client, what does the nurse anticipate seeing? -Increased levels of ACTH -Positive C-reactive protein -Elevated WBC count -Increase in sedimentation rate
Increased levels of ACTH Hyperpigmentation results from elevated levels of ACTH. The skin looks bronzed or suntanned in exposed and unexposed areas, and the normal creases and pressure points tend to become especially dark. The gums and oral mucous membranes may become bluish-black. The amino acid sequence of ACTH is strikingly similar to that of melanocyte stimulating hormone; hyperpigmentation occurs in more than 90 percent of persons with Addison disease and is helpful in distinguishing the primary and secondary forms of adrenal insufficiency.
A client with hypothyroidism has not taken medication for several months, informing the nurse that she lost her insurance and is unable to afford the medication. When assessing the client's temperature tolerance and skin, what does the nurse anticipate finding? Select all that apply. -Increased perspiration -Intolerance to cold -Coarse and dry skin and hair -Thin and silky skin and hair -Decreased sweating
Intolerance to cold Coarse and dry skin and hair Decreased sweating The client with hypothyroidism experiences an intolerance to cold, decreased sweating, and coarse and dry skin and hair, related to the decrease in metabolic rate from the deficient thyroid secretion.
A client with severe hypothyroidism is presently experiencing hypothermia. What nursing intervention is a priority in the care of this client? -Placing the client on a hyperthermia blanket and using heated saline in order to induce vasodilation -Active rewarming of the client to increase body temperature rapidly -Slow rewarming of the client to prevent vasodilation and vascular collapse -Keeping the client in a hypothermic state in order to prevent renal failure
Slow rewarming of the client to prevent vasodilation and vascular collapse If hypothermia is present, active rewarming of the body is contraindicated because it may induce vasodilation and vascular collapse. Prevention is preferable to treatment and entails special attention to high risk populations, such as women with a history of Hashimoto thyroiditis.
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 needs to modify the diet related to the low readings. -The client is achieving normal glycemic control. -The client is at risk for an insulin reaction. -The client is at risk for developing hyperglycemia.
The client is achieving normal glycemic control The reading for the fasting blood glucose is appropriate, and the hemoglobin A1C level estimates good control of glucose levels over a 6- to 12-week period. This client should continue the exercise and diet routine as planned.
The nurse is providing discharge instructions for a client with Graves disease who has ophthalmopathy. What should the nurse be sure to include in the instructions to decrease exacerbation of this clinical manifestation? -The client should be strongly encouraged not to drink any alcohol. -The client should be informed that if he begins to feel symptoms getting worse, he should take an extra dose of medication. -The client should be informed that he should not be in contact with other people during the acute phase. -The client should be strongly urged not to smoke.
The client should be strongly urged not to smoke. Ophthalmopathy can also be aggravated by smoking, which should be strongly discouraged. It is not necessary for the client to avoid contact with others. Alcohol is not contraindicated but should be limited when taking any medication regimen. The client should not adjust the doses of medications without first consulting the physician.
The nurse is providing education for a client diagnosed with hypothyroidism. What information about diet should the nurse be sure to include in this information? -Due to increased metabolism, the client will need to increase the caloric intake. -The client should increase the sodium content in her diet. -The client should maintain a high protein diet. -The client should maintain a low cholesterol diet.
The client should maintain a low cholesterol diet. Blood levels of cholesterol are decreased in hyperthyroidism and increased in hypothyroidism. The client may be placed on an antihyperlipidemic medication in addition to decreasing the cholesterol heavy foods in the diet.
A newborn is screened for congenital hypothyroidism and is found to have the disorder. When educating the mother about the importance of the infant taking thyroid hormone supplement, what should be included in the education? -The infant will have to take the medication only until he reaches puberty. -Once the dosage levels are adjusted, the infant will remain on the same amount throughout life. -The medication dosage will increase every 6 months after laboratory testing. -The infant will have dosage levels adjusted as he grows.
The infant will have dosage levels adjusted as he grows. Congenital hypothyroidism is treated by hormone replacement. Evidence indicates that it is important to normalize T4 levels as rapidly as possible because a delay is accompanied by poorer psychomotor and mental development. Dosage levels are adjusted as the child grows. When early and adequate treatment regimens are followed, the risk of intellectual disability in infants detected by screening programs is essentially nonexistent.
The nurse is caring for an older adult client who is being treated for primary hypothyroidism. The medication therapy includes a "go low and go slow" regimen. What is the importance of this medication regimen for this client? -There is a risk of renal failure in the older adult client if a more rapid correction of thyroid levels is used. -There is a risk of inducing acute coronary syndromes in the older adult client if a more rapid correction of thyroid levels is used. -There is a risk to the older client of developing hyperthyroidism. -The older adult client is at increased risk for thyroid storm.
There is a risk of inducing acute coronary syndromes in the older adult client if a more rapid correction of thyroid levels is used. A "go low and go slow" approach to normalize thyroid levels should be considered in the treatment of older adult clients with hypothyroidism because of the risk of inducing acute coronary syndromes in the susceptible individual.
The hallmark manifestations of Cushing syndrome are a moon face, a "buffalo hump" between the shoulder blades, and a protruding abdomen. What other manifestations of Cushing syndrome occur? -Muscle wasting and thickened extremities -Muscle weakness and thickened extremities -Thin extremities and muscle weakness -Thin extremities and increased strength
Thin extremities and muscle weakness The major manifestations of Cushing syndrome represent an exaggeration of the many actions of cortisol. Altered fat metabolism causes a peculiar deposition of fat characterized by a protruding abdomen; subclavicular fat pads or "buffalo hump" on the back; and a round, plethoric "moon face." There is muscle weakness, and the extremities are thin because of protein breakdown and muscle wasting.
The nurse is caring for a client with diabetes who has developed gastroparesis. Which symptom does the nurse expect the client to report? -Diarrhea -Weight gain -Intolerance to fats -Vomiting after eating
Vomiting after eating Gastroparesis (delayed emptying of stomach) is characterized by reports of epigastric discomfort, nausea, postprandial vomiting, bloating, and early satiety.
An obese adult has recently been diagnosed with type 2 diabetes. The nurse knows that the most likely treatment plan for this client will include which topics? -Weight loss, glucose monitoring, and oral antihyperglycemic medications -Injectable insulin, nutrition management, and adequate hydration -Continuous subcutaneous insulin infusion (CSII) and nutrition management -Daily monitoring for urine ketones and weight loss measures.
Weight loss, glucose monitoring, and oral antihyperglycemic medications Persons with type 2 diabetes would be unlikely to require insulin initially and oral medications are likely to be of benefit as an addition to weight loss and glucose monitoring.
A diabetic client 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 lab result? -"My meter broke so I have not been checking my blood glucose levels for a while." -"To tell you the truth, my blood glucose levels have been pretty normal for me." -"I've had more periods of hypoglycemia than usual over the past few months." -"I've been doing great. I haven't needed much insulin coverage before meals."
"My meter broke so I have not been checking my blood glucose levels for a while." Glycosylated hemoglobin is hemoglobin into which glucose has been irreversibly incorporated. Because glucose entry into the red blood cell is not insulin dependent, the rate at which glucose becomes attached to the hemoglobin molecule depends on blood glucose; the level is an index of blood glucose levels over the previous 6 to 12 weeks. If the diabetic client is not monitoring his or her blood glucose, he or she could be having more periods of hyperglycemia and just is not aware of the need for insulin coverage.
A client is seeking treatment for infertility. What decrease in hormone secretion from the anterior lobe of the pituitary gland that regulates fertility would the nurse recognize may cause this issue? -Adrenocorticotropic hormone (ACTH) -Luteinizing hormone (LH) -Thyroid-stimulating hormone (TSH) -Follicle stimulating hormone (FSH)
Follicle stimulating hormone (FSH) ACTH controls the release of cortisol from the adrenal gland. TSH controls the secretion of thyroid hormone from the thyroid gland. LH regulates sex hormones. FSH regulates fertility.
A client is diagnosed with type 2 diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome? -High-density cholesterol 35 mg/dL (0.91 mmol/L) -Glycosylated hemoglobin 5.2% (0.52) -Fasting blood glucose 155 mg/dL (8.60 mmol/L) -Blood pressure 148/90 mm Hg
Glycosylated hemoglobin 5.2% (0.52) The goals of the nutritional plan for type 2 diabetes mellitus include normal glucose levels, normal lipid levels, weight loss to ideal body weight (or at least 5% to 10% of total body weight) and regulating blood pressure. High-density cholesterol should be above 60 mg/dL (1.55 mmol/L).
Which client would be considered to be exhibiting manifestations of "prediabetes"? -A school-aged child who had a blood glucose level of 115 following lunch. -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). -An older adult client who got "light-headed" when he skipped his lunch. Blood glucose level was 60 mg/dL (3.33 mmol/L) at this time. -A retired female registered nurse with a fasting plasma glucose level of 92 mg/dL (5.11 mmol/L).
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). Persons with IFG (impaired fasting plasma glucose [IFG] defined by an elevated FPG of 100 to 125 mg/dL [5.55 to 6.94 mmol/L]) and/or IGT (impaired glucose tolerance [IGT] plasma glucose levels of 140 to 199 mg/dL [7.77 to 11.04 mmol/L] with an OGTT) are often referred to as having prediabetes, meaning they are at relatively high risk for the future development of diabetes as well as cardiovascular disease.
The health care provider is reviewing diurnal variation pattern in adrenocorticotropic (ACTH) levels. Select the typical diurnal variation pattern in adrenocorticotropic (ACTH) levels. -ACTH maintains a consistent level regardless of the time of day. -ACTH peaks in the morning and declines throughout the day. -ACTH increases in the morning and peaks again in the evening hours. -ACTH peaks in correspondence with food intake.
ACTH peaks in the morning and declines throughout the day ACTH levels have diurnal variation in which they reach their peak in the early morning (around 6 to 8 AM) and decline as the day progresses related to rhythmic activity of the CNS. The diurnal pattern is reversed in people who work during the night and sleep during the day. The rhythm also may be changed by physical and psychological stresses, endogenous depression, and liver disease or other conditions that affect cortisol metabolism.
Diabetic ketoacidosis (DKA) is a condition that mostly occurs in type 1 diabetics. What are the definitive diagnostic criteria for DKA? -Blood glucose level greater than 350 mg/dL (19.43 mmol/L); bicarbonate less than 5 mEq/L (5 mmol/L) and pH less than 7.4 -Blood glucose level greater than 350 mg/dL (19.43 mmol/L); bicarbonate less than 5 mEq/L (5 mmol/L) and pH less than 7.4 -Blood glucose level greater than 250 mg/dL (13.88 mmol/L); bicarbonate less than 25 mEq/L (25 mmol/L) and pH less than 7.3 -Blood glucose level greater than 250 mg/dL (13.88 mmol/L); bicarbonate less than 15 mEq/L (15 mmol/L) and pH less than 7.3
Blood glucose level greater than 250 mg/dL (13.88 mmol/L); bicarbonate less than 15 mEq/L (15 mmol/L) and pH less than 7.3 The definitive diagnosis of DKA consists of hyperglycemia (blood glucose levels >250 mg/dL), low bicarbonate (<15 mEq/L), and low pH (<7.3), with ketonemia (positive at 1:2 dilution) and moderate ketonuria. The other answers are not diagnostic for DKA.
The parents of a child who is diagnosed with short stature ask what may have caused the abnormality. Which response by the nurse is most accurate? Select all that apply. -Acute kidney disease -Chromosomal abnormalities -Panhyperpituitarism -GH deficiency -Hyperthyroidism -Malabsorption syndromes -Protein-calorie malnutrition
Chromosomal abnormalities GH deficiency Malabsorption syndromes Protein-calorie malnutrition Short stature is a condition in which the attained height is well below the third percentile or linear growth is below normal for age and gender. Short stature, or growth retardation, has a variety of causes: chromosomal abnormalities, GH deficiency, hypothyroidism, and panhypopituitarism. Other conditions known to cause short stature include protein-calorie malnutrition, chronic diseases such as chronic kidney disease, poorly controlled diabetes mellitus, malabsorption syndromes like celiac disease, and certain therapies such as excessive glucocorticoid administration.
A client with long-term diabetes mellitus reports a "pins and needles" feeling in the feet. What interventions can help reduce this symptom? Select all that apply. -Control blood glucose -Lidocaine patch -Furosemide -Walk daily -Gabapentin
Control blood glucose Lidocaine patch Gabapentin People with peripheral neuropathies may develop altered perception of pain, vibration, and temperature in the distal extremities. The primary intervention for neuropathy is controlling the blood glucose levels. Additional interventions for diabetic neuropathic pain include antidepressants, anticonvulsants, and topical anesthetics. Alternative therapies include acupuncture and capsaicin (hot pepper) cream. If the client has reduced sensation in the feet, walking could lead to injuries due to lack of awareness. Better activity choices would be those that place less stress on the feet, such as swimming or cycling. A diuretic will not improve neuropathy.
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? -Inadequate bedtime insulin -Dawn phenomenon -Autonomic neuropathy -Diabetic ketoacidosis
Dawn phenomenon The dawn phenomenon involves increased levels of fasting blood glucose or insulin requirement during the early morning hours. It is not preceded by hypoglycemia. Circadian release of growth hormone and cortisol may be contributing factors. The other answer selections are not characterized by increased early morning levels of blood glucose.
The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding? -Temperature 96°F (35.5°C) -Blood pressure 180/110 mm Hg -Heart rate 110 and bounding -Respiratory rate 14
Heart rate 110 and bounding Cardiovascular and respiratory functions are strongly affected by thyroid function. With an increase in metabolism, there is a rise in oxygen consumption and production of metabolic end products, with an accompanying increase in vasodilation. Blood volume, cardiac output, and ventilation are all increased. Heart rate and cardiac contractility are enhanced as a means of maintaining the needed cardiac output. Blood pressure is likely to change little because the increase in vasodilation tends to offset the increase in cardiac output.
During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur? -Hyperglycemia -Hepatomegaly -Adrenal hyperplasia -Portal hypertension
Hyperglycemia In predisposed persons, the prolonged elevation of glucocorticoid hormones can lead to hyperglycemia and the development of diabetes mellitus and starvation. They stimulate gluconeogenesis by the liver, sometimes producing a 6- to 10-fold increase in hepatic glucose production. A prolonged increase in glucocorticoid hormones does not cause hepatomegaly, portal hypertension, or adrenal hyperplasia.
A client diagnosed with metabolic syndrome and growth hormone (GH) deficiency will likely display which physical assessment finding? -Enhanced insulin uptake -Increased visceral fat -Increased bone mineral density -Increase in lean body mass
Increased visceral fat GH deficiency is associated with a cluster of cardiovascular risk factors including central adiposity (associated with increased visceral fat), insulin resistance, and dyslipidemia. These features also are associated with the metabolic syndrome.
The most common cause of thyrotoxicosis is Graves disease. When assessing this client, the nurse should put priority on which sign/symptom? -Ophthalmopathy -Facial myxedema with puffy eyelids -Pulse rate of 64 beats/minute -Complaints of muscle fatigue
Ophthalmopathy Graves disease is characterized by a triad of hyperthyroidism, goiter, ophthalmopathy (exophthalmos), or less commonly, dermopathy (pretibial edema due to accumulation of fluid and glycosaminoglycans). Even in persons without exophthalmos (i.e., bulging of the eyeballs seen in ophthalmopathy), there is an abnormal retraction of the eyelids and infrequent blinking such that they appear to be staring. Although the myxedema of hypothyroidism is most obvious in the face and other superficial parts, it also affects many of the body organs. Common to all types of thyrotoxicosis, rather than unique to Graves disease, cholesterol blood levels are decreased; muscle proteins are broken down and used as fuel, which accounts for the muscle fatigue that occurs with all types of hyperthyroidism.
A 51-year-old woman has been diagnosed with Cushing syndrome after a diagnostic workup that reveals cortisol hypersecretion. The nurse knows which assessment finding would be inconsistent with her diagnosis? -A "moon face" and muscle weakness -Poor stress management and hyperpigmentation -Increased blood pressure and decreased potassium levels -A protruding abdomen and a "buffalo hump" on the back
Poor stress management and hyperpigmentation Hyperpigmentation and a low tolerance for stress are associated with Addison disease and its consequent elevated levels of ACTH. High blood pressure, hypokalemia, and "buffalo hump" and "moon face" are all characteristic of the elevated steroid levels that denote Cushing syndrome.
Primary adrenal insufficiency is manifested by: -Hypopigmentation over neck and BP greater than 150/90 -Truncal obesity and 3+ pitting edema in lower legs -Potassium level of 2.8 mEq/L (2.8 mmol/L) and weight gain of 3 pounds overnight -Serum sodium level of 120 mEq/L (120 mmol/L) (low) and blood glucose level of 48 mg/dL (2.66 mmol/L) (low)
Serum sodium level of 120 mEq/L (120 mmol/L) (low) and blood glucose level of 48 mg/dL (2.66 mmol/L) (low) Primary adrenal insufficiency is adrenal cortical hormone deficiency with elevated adrenocorticotropic hormone (ACTH) levels caused by a lack of feedback inhibition. Manifestations are related primarily to mineralocorticoid deficiency, causing increased urinary losses of sodium, chloride, and water, along with decreased excretion of potassium. The result is hyponatremia, loss of extracellular fluid, decreased cardiac output, and hyperkalemia. Because of a lack of glucocorticoid, the person with Addison disease has poor tolerance to stress. This deficiency causes hypoglycemia, lethargy, weakness, fever, and gastrointestinal symptoms such as anorexia, nausea, vomiting, and weight loss. Hypopigmentation results from elevated ACTH levels.
The nurse is educating a newly diagnosed client with Hashimoto thyroiditis who is to be discharged from the acute care facility. What should the nurse be sure to include in the education to prevent complications? -The client should be informed that if he observes an increase in fatigue, an extra dose of his thyroid medication should be taken. -The client should skip a dose of the thyroid supplement if he has symptoms of fever or restlessness. -The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention. -The client should not participate in any exercise activity that could utilize more thyroid hormone.
The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention. Prevention is preferable to treatment and entails special attention to high-risk populations, such as women with a history of Hashimoto thyroiditis. These persons should be informed about the signs and symptoms of severe hypothyroidism and the need for early medical treatment.
A child is born with dwarfism to normal-sized parents. The physician is explaining how growth hormone (GH) plays a central role in the increase in stature that characterizes childhood and adolescence. What is the first step in the growth hormone chain of events? -The hypothalamus secretes GHRH. -GH is released and circulates unbound in the plasma. -Epiphyseal growth plates of long bones are influenced. -The liver is stimulated.
The hypothalamus secretes GHRH. Like other pituitary functions, hypothalamic stimulation precedes hormone release. In the case of GH, stimulation is the result of GHRH by the hypothalamus. GH is then released by the pituitary gland, stimulating the liver to release IGFs, which ultimately causes the epiphyseal plates of long bones to grow.
The nurse is taking a health history from a client with acromegaly. The client informs the nurse that he is waking up several times a night and has been told he has sleep apnea. What does the nurse inform the client is the rationale for this syndrome? -The client is drinking too much fluid prior to going to bed. -There is an increase in edema of the larynx. -There is an increase in pharyngeal soft tissue accumulation. -The trachea is narrowed.
There is an increase in pharyngeal soft tissue accumulation. The pathogenesis of sleep apnea syndrome is obstructive in the majority of people due to increased pharyngeal soft tissue accumulation.
A client with type 1 diabetes has started a new exercise routine. Knowing there may be some increased risks associated with exercise, the health care provider should encourage the client to: -watch for rapid weight loss. -be careful that he or she is not experiencing rebound hyperglycemia. -carry a snack with a rapidly absorbed form of glucose to prevent profound hypoglycemia. -monitor for respiratory disorders.
carry a snack with a rapidly absorbed form of glucose to prevent profound hypoglycemia. People with diabetes are usually aware that delayed hypoglycemia can occur after exercise. Although muscle uptake of glucose increases significantly, the ability to maintain blood glucose levels is hampered by failure to suppress the absorption of injected insulin and activate the counterregulatory mechanisms that maintain blood glucose (to cause a hyperglycemia response). Even after exercise ceases, insulin's lowering effect on blood glucose levels continues, resulting in profound symptomatic hypoglycemia. Treatment of hypoglycemia involves administration of a rapidly absorbed form of glucose. Rapid weight loss accompanies the polyuria and dehydration of hyperglycemia rather than hypoglycemia. Respiratory disorders are associated with preexisting pulmonary or vascular problems exacerbated by the period of exercise.
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: -"If you put all your children on a low-carbohydrate diet, maybe they won't get diabetes." -"This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes." -"We don't know what causes diabetes, so we will just have to wait and see." -"Probably not. Since genetically your other children have a different cellular makeup, they just might not become diabetic."
"This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes." Type 1 diabetes is subdivided into two types: type 1A, immune-mediated diabetes, and type 1B, idiopathic diabetes. Type 1A diabetes is characterized by autoimmune destruction of beta cells. The other choices are not absolutely correct. The fact that type 1 diabetes is thought to result from an interaction between genetic and environmental factors led to research into methods directed at prevention and early control of the disease. These methods include the identification of genetically susceptible persons and early intervention in newly diagnosed persons with type 1 diabetes.
A client with a new diagnosis of type 2 diabetes mellitus states, "I am really worried that I might need to take injections. Is there something I can do to avoid that?" What is the best response by the nurse? -"If you exercise weekly, you won't need injections." -"Diabetes management is complicated; you can't avoid injections." -"You could regulate your diet, exercise regularly, and lose weight." -"A support group could help you cope with stress and learn helpful tips."
"You could regulate your diet, exercise regularly, and lose weight." Diabetes management is based on dietary regulation, exercise, and medications. Many clients with type 2 diabetes mellitus can avoid injections if they exercise regularly, follow dietary guidelines, and manage their weight.
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? -"We'll monitor this closely and begin insulin therapy as soon as possible." -"This is likely a result of your liver releasing too much fat, rather than your pancreas not secreting insulin." -"This diabetes is unlikely to persist after you give birth, but the main risk is that your baby will likely be born with diabetes." -"Your baby could become too large or have low blood sugars if we're not vigilant about controlling your sugars."
"Your baby could become too large or have low blood sugars if we're not vigilant about controlling your sugars." Women with GDM are at higher risk for complications of pregnancy, mortality, and fetal abnormalities. Fetal abnormalities include macrosomia, hypoglycemia, hypocalcemia, polycythemia, and hyperbilirubinemia. GDM often persists as type 2 diabetes after delivery. The baby does not face a significantly higher risk of developing diabetes. Nutrition therapy would precede insulin therapy and GDM involves a pancreatic etiology.
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: -Limit fluid intake to only 250 mL/4 hours. -Give at least 50 units of regular insulin IV stat and recheck blood glucose in 2 hours. -Push a stat dose of bicarbonate followed by a double-dose (loading) of metformin. -Begin a loading dose of IV regular insulin followed by a continuous insulin infusion.
Begin a loading dose of IV regular insulin followed by a continuous insulin infusion. The goals in treating DKA are to improve circulatory volume and tissue perfusion, decrease blood glucose, and correct the acidosis and electrolyte imbalances. These objectives usually are accomplished through the administration of insulin and intravenous fluid and electrolyte replacement solutions. An initial loading dose of short-acting (i.e., regular) or rapid-acting insulin often is given intravenously, followed by continuous low-dose, short-acting insulin infusion. Frequent laboratory tests are used to monitor blood glucose. The fluids need to be replaced, not withheld. Too rapid a drop in blood glucose may cause hypoglycemia, which can occur with a large dose of regular insulin. The client may require bicarbonate, but glucose levels are lowered with insulin in this emergency situation, not by oral medication.
A client is diagnosed with adrenocorticotropic hormone deficiency (ACTH) and is to begin replacement therapy. Regarding which type of replacement will the nurse educate the client? -Replacement therapy with synthetic thyroid hormone -Growth hormone replacement therapy -Cortisol replacement therapy -Replacement therapy with prolactin
Cortisol replacement therapy Cortisol replacement is started when ACTH deficiency is present; thyroid replacement when TSH deficiency is detected; and sex hormone replacement when LH and FSH are deficient. GH replacement is indicated for pediatric GH deficiency, and is increasingly being used to treat GH deficiency in adults.
Which pathophysiologic phenomenon may result in a diagnosis of Cushing disease? -Excess ACTH production by a pituitary tumor -Hypopituitarism -Malfunction of the HPA system -Autoimmune destruction of the adrenal cortex
Excess ACTH production by a pituitary tumor Three important forms of Cushing syndrome result from excess glucocorticoid production by the body. One is a pituitary form, which results from excessive production of ACTH by a tumor of the pituitary gland. Hypopituitarism and destruction of the adrenal cortex are associated with Addison disease. Disruption of the HPA system is not implicated in the etiology of Cushing disease.
A 15-year-old child with type 1 diabetes asks nurse about the potential to "lose sight." Which response would be the most appropriate? -Reassure the client that only type 2 diabetes is a risk factor for blindness. -Tell the client there is about a 50% chance of suffering some diabetes-related sight loss by the age of 50. -Explain that many people with diabetes experience some complications like retinopathy, but these are best prevented with tight control of glucose levels. -Tell the client to expect that eyesight loss will likely begin gradually by the age of 25.
Explain that many people with diabetes experience some complications like retinopathy, but these are best prevented with tight control of glucose levels. The types of microvascular complications that occur in diabetes mellitus can include neuropathy, retinopathy, nephropathy, and disorders of gastrointestinal motility. In the United States, diabetes is a leading cause of vision loss and blindness as well as chronic kidney disease. Pregnancy, puberty, and cataract surgery can accelerate these changes.
Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur? -Diabetogenic gene from both parents, physiologic triggering event, and an allergic reaction to pancreatic delta cells -Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen -Diabetogenic gene from both parents, environmental triggering event, and a B-lymphocyte reaction to alpha cell antigens -Genetic predisposition, physiologic triggering event, allergic reaction to pancreatic alpha cells
Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen Type 1A diabetes is thought to be an autoimmune disorder resulting from a genetic predisposition (i.e., diabetogenic genes); an environmental triggering event, such as an infection; and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen.
The family of a client in the hospital with diabetes mellitus that is out of control asks the nurse to explain the client's recent weight loss while eating more than usual. How will the nurse respond? -Fatty acids enter the glycolytic pathway to release energy. -Lack of insulin raises circulating blood glucose levels. -Glucose is unused without insulin, so body fats are used for energy. -Surplus glucose is stored as glycogen in the liver.
Glucose is unused without insulin, so body fats are used for energy. Most of these options are true statements, but they do not answer the question asked by the family. Normally, nutrients are metabolized in a number of ways. Glucose is transported into cells by insulin and then is broken down to carbon dioxide and water. When there is surplus glucose present, it is metabolized and stored as glycogen in the liver and skeletal muscles. Further surplus is converted by the liver to fatty acids and stored as triglycerides. When triglycerides are metabolized, the glycerol molecule enters the glycolytic pathway to release energy. Excess proteins are also converted to fatty acids for storage. Insulin is needed to transport glucose into cells, prevent fat breakdown, and inhibit gluconeogenesis. When diabetes is out of control there is lack of insulin. Weight loss occurs as the cells break down fats to use fatty acids for energy
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. -Teaching the client about the action and safe administration of insulin. -Educating the client about the risks and management of hypoglycemia. -Assisting the client with the appropriate choice of oral antihyperglycemics.
Helping the client make meaningful changes to his diet and activity level. Weight loss and dietary management are the initial focus of treatment for type 2 diabetes. For many people with type 2 diabetes, the benefits of exercise include a decrease in body fat, better weight control, and improvement in insulin sensitivity. If good glycemic control cannot be achieved with exercise and diet, then antidiabetic agents and even insulin can be added to the treatment plan. Education is imperative, but there is no need to emphasize hypoglycemia, since the client will not be using insulin initially.
A 30-year-old man who manages his type 1 diabetes with glyburide presents at the emergency room reporting headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half marathon. Which phenomenon is likely to be the cause of his symptoms? -Hypoglycemia -Somogyi effect -Hyperosmolar hyperglycemic state -Diabetic ketoacidosis
Hypoglycemia In hypoglycemia, headache, difficulty in problem solving, disturbed or altered behavior, coma, and seizures may occur. At the onset, activation of the parasympathetic nervous system often causes hunger, and the initial parasympathetic response is followed by activation of the sympathetic nervous system; this causes anxiety, tachycardia, sweating, and constriction of the skin vessels (i.e., the skin is cool and clammy). In diabetic ketoacidosis, the client typically has a history of 1 or 2 days of polyuria, polydipsia, nausea, vomiting, and marked fatigue. Abdominal pain and tenderness may be experienced without abdominal disease, and the breath has a characteristic fruity smell. The most prominent manifestations of hyperosmolar hyperglycemic state are dehydration and neurologic signs, including grand mal seizures, hemiparesis, Babinski reflexes, aphasia, muscle fasciculations, hyperthermia, hemianopia, nystagmus, and visual hallucinations; the client will also experience excessive thirst. The Somogyi effect describes a cycle of insulin-induced posthypoglycemic hyperglycemic episodes.
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? -Somogyi effect -Hyperosmolar hyperglycemic state -Diabetic ketoacidosis -Hypoglycemia
Hypoglycemia In hypoglycemia, headache, difficulty in problem solving, disturbed or altered behavior, coma, and seizures may occur. At the onset, activation of the parasympathetic nervous system often causes hunger, and the initial parasympathetic response is followed by activation of the sympathetic nervous system; this causes anxiety, tachycardia, sweating, and constriction of the skin vessels (i.e., the skin is cool and clammy). In diabetic ketoacidosis, the client typically has a history of one or two days of polyuria, polydipsia, nausea, vomiting, and marked fatigue. Abdominal pain and tenderness may be experienced without abdominal disease, and the breath has a characteristic fruity smell. The most prominent manifestations of hyperosmolar hyperglycemic state are dehydration and neurologic signs including grand mal seizures, hemiparesis, Babinski reflexes, aphasia, muscle fasciculations, hyperthermia, hemianopia, nystagmus, and visual hallucinations; the client will also experience excessive thirst. The Somogyi effect describes a cycle of insulin-induced posthypoglycemic hyperglycemic episodes.
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? -Call the health care provider and wait for a prescription for this client. -Skip the oral glucose tablets and go directly to giving intramuscular glucagon. Repeat the glucagon in 15 minutes if the blood glucose level is not within a normal range. -Start pushing 50% glucose solution intravenously and do not stop pushing until the client's repeat blood glucose level is above 100 mg/dL (5.55 mmol/L). -Immediately administer a rapidly absorbed form of glucose (preferably via oral route if the client is alert enough to swallow).
Immediately administer a rapidly absorbed form of glucose (preferably via oral route if the client is alert enough to swallow). The most effective treatment of an insulin reaction is the immediate administration of 15 g of glucose in a concentrated carbohydrate source. Alternative methods for increasing blood glucose may be required when the person having the reaction is unconscious or unable to swallow. Glucagon may be given intramuscularly or subcutaneously. Glucagon acts by hepatic glycogenolysis to raise blood glucose. In situations of severe or life-threatening hypoglycemia, administer glucose (20 to 50 mL of a 50% solution) intravenously.
How does insulin participate in cellular metabolism? Select all that apply. -Promotes triglyceride synthesis in the liver -Increases use of fatty acids as fuel -Increases amino acid conversion to glucose -Promotes glycogen conversion to glucose -Transports glucose into skeletal muscle
Increases use of fatty acids as fuel Promotes glycogen conversion to glucose Transports glucose into skeletal muscle Insulin is needed to transport glucose into cells, prevent fat breakdown, and inhibit gluconeogenesis. Glucagon works to raise blood glucose levels by converting amino acids to glucose, activating lipase to release fatty acids for energy, and to promote glycogenolysis, breaking down glycogen to glucose.
A client with diabetes mellitus takes insulin, but still has unstable blood glucose levels. When the primary health care provider prescribes pramlintide the client asks the nurse how this second medication will help. What is an appropriate response by the nurse? -It blocks absorption of glucose from the intestine. -It makes it easier for insulin to enter receptors. -It stimulates the pancreas to secrete more insulin. -It slows gastric emptying and decreases appetite.
It slows gastric emptying and decreases appetite. Amylin is a hormone secreted by the pancreatic beta cells that works with insulin to lower blood glucose. Pramlintide is a synthetic amylin that acts to suppress glucagon release, slow gastric emptying, and decrease appetite.
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 liver -Kidneys and eyes -Liver and eyes -Pancreas and eyes
Kidneys and eyes Diabetic nephropathy is the leading cause of chronic kidney disease, accounting for 40% of new cases. Also, diabetes is the leading cause of acquired blindness in the United States. The liver and pancreas are not organs that diabetes attacks.
A client with diabetic retinopathy develops a retinal bleed and asks the nurse, "How can I prevent this from happening again?" What response provides the most effective information? -Control stress and monitor vision changes. -Maintain healthy blood pressure and blood sugar levels. -Wear glasses when reading and limit computer time. -Visit your eye health professional for annual exams.
Maintain healthy blood pressure and blood sugar levels. Diabetic retinopathy occurs when blood vessels have increased permeability, develop microaneurysms, vascular proliferation, scarring, and retinal detachment. These conditions are worsened when the client has poor glycemic control, poorly controlled hypertension, and hyperlipidemia. Laser photocoagulation can be used to stop vessel proliferation and bleeding. An annual examination will evaluate the disease, but does not prevent recurrence. Eye use patterns do not change retinopathy.
Which maternal factor contributes to an infant having macrosomia, hypoglycemia, and hyperbilirubinemia? -Maternal diabetes -Fetal chromosome disorder -Maternal nutrition -Fetal gene disorder
Maternal diabetes A mother with diabetes is more likely to have a large body size (macrosomia), especially if the diabetes is uncontrolled. Other fetal abnormalities include hypoglycemia, hypocalcemia, polycythemia, and hyperbilirubinemia. The other factors contribute primarily to the infant being small for gestational age (SGA). The other disorders do not necessarily lead to a high birth weight.
An overweight, 14-year-old boy feels tired all the time. He sleeps 12 to 14 hours a day and has a voracious appetite but no energy to burn off the calories. He has been diagnosed with hypothyroidism brought about by the accumulation of a nonpitting mucosal edema. For which life-threatening condition should his care team be prepared? -Pheochromocytoma -Thyroid storm -Myxedema coma -The paraneoplastic secretion of endocrine hormones
Myxedema coma Myxedema implies the presence of a nonpitting mucous type of edema caused by an accumulation of a hydrophilic mucopolysaccharide substance in the connective tissues throughout the body. The hypothyroid state may be mild, with only a few signs and symptoms, or it may progress to a life-threatening condition called myxedema coma. Pheochromocytoma is a tumor of the adrenal gland. Thyroid storm is related to hyperthyroidism. Paraneoplastic syndrome is a separate condition.
The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary health care provider for further evaluation? -Random blood glucose 195 mg/dL (10.82 mmol/L) -Urine ketones 0 -Fasting blood glucose 89 mg/dL (4.94 mmol/L) -Hemoglobin A1C 6.0% (.06)
Random blood glucose 195 mg/dL (10.82 mmol/L) Laboratory values that are considered normal are hemoglobin A1C less than 6.5 percent, fasting plasma glucose of (FPG) less than 100 mg/dL or less than 140 mg/dL 2 hours after an oral glucose tolerance test (GTT). Urine should be free of ketones. A hemoglobin A1C value that is greater than or equal to 6.5 percent, a fasting blood glucose greater than 126mg/dL, or a blood glucose level greater than 200 mg/dL 2 hours after a glucose tolerance test (GTT) indicate diabetes mellitus. Values between these levels are considered to place clients at increased risk for diabetes mellitus and require further evaluation. A random blood glucose level is expected to correlate with the two-hour GTT results and should be below 200 mg/dL.
The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary health care provider for further evaluation? -Urine ketones 0 -Fasting blood glucose 89 mg/dL (4.94 mmol/L) -Hemoglobin A1C 6.0% (.06) -Random blood glucose 195 mg/dL (10.82 mmol/L)
Random blood glucose 195 mg/dL (10.82 mmol/L) Laboratory values that are considered normal are hemoglobin A1C less than 6.5 percent, fasting plasma glucose of (FPG) less than 100 mg/dL or less than 140 mg/dL 2 hours after an oral glucose tolerance test (GTT). Urine should be free of ketones. A hemoglobin A1C value that is greater than or equal to 6.5 percent, a fasting blood glucose greater than 126mg/dL, or a blood glucose level greater than 200 mg/dL 2 hours after a glucose tolerance test (GTT) indicate diabetes mellitus. Values between these levels are considered to place clients at increased risk for diabetes mellitus and require further evaluation. A random blood glucose level is expected to correlate with the two-hour GTT results and should be below 200 mg/dL.
A client with diabetes mellitus is reporting burning pain of the feet and some numbness. These symptoms are likely due to which cause? -Peripheral vascular disease -Intermittent claudication -Somatic neuropathy -Autonomic neuropathy
Somatic neuropathy Somatic neuropathy is usually bilateral and symmetric and associated with paresthesia, burning sensations, and numbness along with decreased senses of vibration, pain, temperature, and proprioception, particularly in the lower extremities. The autonomic neuropathies result in disorders of vasomotor function, decreased cardiac responses, inability to empty the bladder, gastrointestinal motility problems, and sexual dysfunction. Peripheral vascular disease is a general complication of diabetes, and intermittent claudication is pain associated with arterial insufficiency in the legs.
The nurse is providing education for a client diagnosed with hypothyroidism. What information about diet should the nurse be sure to include in this information? -The client should maintain a high protein diet. -Due to increased metabolism, the client will need to increase the caloric intake. -The client should increase the sodium content in her diet. -The client should maintain a low cholesterol diet.
The client should maintain a low cholesterol diet. Blood levels of cholesterol are decreased in hyperthyroidism and increased in hypothyroidism. The client may be placed on an antihyperlipidemic medication in addition to decreasing the cholesterol heavy foods in the diet.
When caring for the client with diabetes, the nurse emphasizes the risk of kidney disease. Which test does the nurse encourage the client to have performed annually for early detection of renal disease? -Lipid levels -Urine test for microalbuminuria -Hemoglobin A1C -Renal angiogram
Urine test for microalbuminuria One of the first manifestations of diabetic nephropathy is an increase in urinary albumin excretion (i.e., microalbuminuria), which is easily assessed by laboratory methods. A spot urine test to detect microalbumin should be done annually for all persons with diabetes. Hemoglobin A1C determines average blood glucose over 6-12 weeks.
The obstetrical nurse is caring for a client who has been treated for gestational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which risk factor in the teaching? -Woman with a family history of diabetes -First pregnancy -First birth occurring during the teenage years -Woman who has had a child under 5 lb (2.2 kg)
Woman with a family history of diabetes Gestational diabetes occurs most commonly in black, Hispanic/Latino and Native American/First Nation women. It most frequently affects women with a family history of diabetes; a history of stillbirth or spontaneous abortion; women who previously gave birth to a newborn with fetal anomaly or had a previous large-for-gestational-age infant; those who are obese; those of advanced maternal age; or those who have had five or more pregnancies.
