ENDO pt 1: Diabetes - Endocrine Clinical Assessment and Diagnostic Procedures

14. The nurse knows that an abnormal response to the ADH test would be a. a slight increase in urine osmolality. b. a decrease in urine output. c. a decrease in serum osmolality. d. no change in urine osmolality.

ANS: D If the urine osmolality remains unchanged after administering vasopressin, the target cells are no longer receptive to antidiuretic hormone.

15. When evaluating the patient for a pituitary tumor, attention on the computed tomography scan should be focused on the a. frontal lobe. b. sella turcica. c. temporal lobe. d. anterior fossa.

ANS: B The sella turcica at the base of the skull is the area to focus on to visualize the pituitary gland.

11. When preparing the patient for a serum ADH level, the nurse must withhold a. insulin and furosemide. b. morphine and carbamazepine. c. Lanoxin and potassium. d. heparin and beta-blockers.

ANS: B To prepare the patient for the test, all drugs that may alter the release of antidiuretic hormone (ADH) are withheld for a minimum of 8 hours. Common medications that affect ADH levels include morphine sulfate, lithium carbonate, chlorothiazide, carbamazepine, oxytocin, nicotine, alcohol, and selective serotonin reuptake inhibitors.

2. A hydration assessment consists of checking a variety of parameters, including a. skin turgor. b. serum potassium level. c. capillary refill. d. serum protein level.

ANS: A A hydration assessment includes observations of skin integrity, skin turgor, and buccal membrane moisture. Moist, shiny buccal membranes indicate satisfactory fluid balance. Skin turgor that is resilient and returns to its original position in less than 3 seconds after being pinched or lifted indicates adequate skin elasticity. Skin over the forehead, clavicle, and sternum is the most reliable for testing tissue turgor because it is less affected by aging and thus more easily assessed for changes related to fluid balance.

9. A normal HbA1c level for a normal person is a. less than 5.4%. b. less than 6.5%. c. between 5.4% and 6.5%. d. between 3% and 5.4%.

ANS: A A normal HbA1C value is less than 5.4%, with an acceptable target level for patients with diabetes below 6.5%.

3. Glycosylated hemoglobin levels provide information about a. the average blood glucose level over the previous 3 to 4 months. b. blood glucose levels in comparison with serum hemoglobin. c. serial glucose readings after ingestion of a concentrated glucose solution. d. the difference between serum and urine glucose levels.

ANS: A The glycated hemoglobin test (also known as the glycosylated hemoglobin, or HbA1C or A1C), provides information about the average amount of glucose that has been present in the patient's bloodstream over the previous 3 to 4 months. During the 120-day life span of red blood cells (erythrocytes), the hemoglobin within each cell binds to the available blood glucose through a process known as glycosylation.

1. Which of the following findings would you expect to see in the patient with hyperglycemia? (Select all that apply.) a. Anorexia b. Abdominal pain c. Bradycardia d. Fluid overload e. Change in level of consciousness f. Kussmaul respirations

ANS: A, B, E, F More than likely the patient with hyperglycemia will be fluid volume depleted and tachycardic.

8. The patient has a fasting glucose level of 150 mg/dL. The nurse knows this value is a. normal. b. diagnostic of diabetes, but it should be re-evaluated for accuracy. c. lower than what the nurse would expect in a patient receiving intravenous fluids. d. elevated, indicating diabetic ketoacidosis.

ANS: B A normal fasting glucose (FPG) level is between 70 and 110 mg/dL. An FPG level between 110 and 126 mg/dL identifies a person who is prediabetic. An FPG level of greater than 126 mg/dL (7 mmol/L) is diagnostic of diabetes. In nonurgent settings, the test is repeated on another day to make sure the result is accurate.

10. The patient weighed 62 kg on admission yesterday. Today the patient weighs 60 kg. The nurse knows this reflects a fluid loss of a. 1 L. b. 2 L. c. 4 L. d. 10 L.

ANS: B Daily weight changes coincide with fluid retention and fluid loss. Sudden changes in weight could result from a change in fluid balance; 1 L of fluid lost or retained is equal to approximately 2.2 lb, or 1 kg, of weight gained or lost.

6. A 16-year-old young woman is admitted to the critical care unit with severe hyperglycemia caused by new-onset type 1 diabetes mellitus. The nurse notes a sweet-smelling odor on the patient's exhaled breath. This is a result of a. compensation for metabolic alkalosis. b. ketoacidosis. c. prior ingestion of high-calorie foods. d. decreased serum osmolality.

ANS: B If ketoacidosis occurs, the patient's breathing becomes deep and rapid (Kussmaul respirations), and the breath may have a fruity odor.

1. Which of the following laboratory results is found in a patient with hyperglycemia? a. Insulin level of 25 /mL b. Absence of ketones in the urine c. Presence of ketones in the blood d. Serum osmolality of 270 mOsm/kg H2O

ANS: C In diabetic ketoacidosis, fat breakdown (lipolysis) occurs so rapidly that fat metabolism is incomplete, and the ketone bodies (acetone, -hydroxybutyric acid, and acetoacetic acid) accumulate in the blood (ketonemia) and are excreted in the urine (ketonuria). It is recommended that all patients with diabetes perform self-test or have their blood or urine tested for the presence of ketones during any alteration in level of consciousness or acute illness with elevated blood glucose.

12. The nurse knows that a serum osmolality of 378 mOsm/kg indicates a patient who is a. overhydrated. b. normal. c. dehydrated. d. hypokalemic.

ANS: C Values for serum osmolality in the bloodstream range from 275 to 295 mOsm/kg H2O. Increased serum osmolality stimulates the release of antidiuretic hormone, which in turn reduces the amount of water lost through the kidney.

7. A 16-year-old young woman is admitted to the critical care unit with severe hyperglycemia caused by new-onset type 1 diabetes mellitus. The patient is complaining of headache and blurred vision. The nurse knows that these are signs that may indicate a. kidney stones. b. diabetes insipidus. c. hypoglycemia. d. hyperglycemia.

ANS: D Because severe hyperglycemia affects a variety of body systems, all systems are assessed. The patient may complain of blurred vision, headache, weakness, fatigue, drowsiness, anorexia, nausea, and abdominal pain.

4. Which of the following laboratory studies or diagnostic procedures is most useful in identifying central diabetes insipidus (DI)? a. Skull radiographs b. Serum glucose level c. Water deprivation test d. Antidiuretic hormone (ADH) stimulation test

ANS: D Serum antidiuretic hormone ADH levels are compared with the blood and urine osmolality to differentiate syndrome of inappropriate antidiuretic hormone (SIADH) from central diabetes insipidus (DI). Increased ADH levels in the bloodstream compared with a low serum osmolality and elevated urine osmolality confirms the diagnosis of SIADH. Reduced levels of serum ADH in a patient with high serum osmolality, hypernatremia, and reduced urine concentration signal central DI.

13. The nurse knows that the best test to differentiate between central and nephrogenic DI is a. the water deprivation test. b. serum osmolality. c. computed tomography scan. d. the ADH test.

ANS: D The antidiuretic hormone test is used to differentiate between neurogenic diabetes insipidus (DI) (central) and nephrogenic (kidney) DI. In severe central DI, in which the pituitary is affected, the urine osmolality shows a significant increase (becomes more concentrated), which indicates that the cell receptor sites on the kidney tubules are responsive to vasopressin. Test results in which urine osmolality remains unchanged indicate nephrogenic DI, suggesting kidney dysfunction because the kidneys are no longer responsive to ADH.

5. A 16-year-old young woman is admitted to the critical care unit with severe hyperglycemia caused by new-onset type 1 diabetes mellitus. Which of the following signs and symptoms obtained as part of the patient's history might indicate the presence of hyperglycemia? a. Recent episodes of tachycardia and missed heart beats b. Decreased urine output accompanied by peripheral edema c. Periods of hyperactivity with weight gain d. Increased thirst and increased urinary output

ANS: D The patient or family member may relay information about recent, unexplained changes in weight, thirst, hunger, and urination patterns.