Glucose Regulation

Which medication is responsible for neonatal hypoglycemia? 1 Warfarin 2 Simvastatin 3 Tolbutamide 4 Methimazole

Tolbutamide is an oral hypoglycemic agent used in the treatment of type 2 diabetes mellitus. It is known to have effects such as neonatal hypoglycemia. Warfarin, a common blood thinner, may cause teratogenic effects such as skeletal and central nervous system defects. Simvastatin, an HMG-CoA reductase inhibitor used for the treatment of high cholesterol, may cause teratogenic effects such as facial malformations and severe central nervous system anomalies. Methimazole, an antithyroid medication administered for the treatment of maternal hyperthyroidism, may cause teratogenic effects such as neonatal goiter, cretinism, and hypothyroidism.

A client with type 1 diabetes asks what causes several brown spots on the skin. What would be the best response by the nurse? 1 "The brown spots reflect the accumulation of blood fats in the skin; they should disappear." 2 "Those spots indicate a high glucose content in the skin that may get infected if left untreated." 3 "They are the result of diseased small vessels in the shins and may spread if not treated soon." 4 "Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot."

"Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot" is an accurate explanation for the client's concern; brown spots are caused by the deposit of hemosiderin in the tissue. Brown spots reflecting the accumulation of blood fats in the skin and disappearing is the definition of a xanthoma. A high glucose content in the skin that has become infected is not the cause of brown spots on the skin; increased glucose in the skin is not observable by inspection. Brown spots result from the deposition of hemosiderin. Blood vessels may become diseased with diabetes, but this does not cause brown spots.

Which hormone would the nurse identify as inhibiting insulin and glucagon secretion? 1 Amylin 2 Somatostatin 3 Triiodothyronine (T 3) 4 Pancreatic polypeptide

Somatostatin is a hormone that inhibits insulin and glucagon secretion, as well as growth hormone, thyroid stimulating hormone, and cholecystokinin. Amylin decreases glucagon secretion, but not insulin; it also decreases gastric motility and endogenous glucose release from the liver. Triiodothyronine (T 3) regulates the metabolic rate of all cells and processes of cell growth and tissue differentiation; it does not influence insulin and glucagon secretion. Pancreatic polypeptide affects the regulation of pancreatic exocrine function and metabolism of absorbed nutrients

Which complication is the result of type 1 diabetes in a pregnant client? 1 Increased risk of hypertensive states 2 Abnormal placental implantation 3 Excessive weight gain because of increased appetite 4 Decreased amount of amniotic fluid as the pregnancy progresses

1 Increased risk of hypertensive states The likelihood of gestational hypertension increases fourfold in the client with diabetes mellitus, probably because of a preexisting vascular disorder. Abnormal implantation occurs because of scarring or uterine abnormalities, not because of diabetes. Most pregnant women have an increased appetite; excessive weight gain may be caused by a macrosomic fetus and hydramnios. More than 2000 mL of amniotic fluid (hydramnios, polyhydramnios) is associated with diabetes; its exact cause is unknown. It also occurs with major congenital fetal anomalies, Rh sensitization, and infections (e.g., syphilis, toxoplasmosis, cytomegalovirus, herpes, and rubella).

Why is blood glucose self-monitoring preferred over urine glucose testing? 1 Blood glucose monitoring is more accurate. 2 Blood glucose monitoring is easier to perform. 3 Blood glucose monitoring is done by the client. 4 Blood glucose monitoring is not influenced by medications

Blood glucose testing is a more direct and accurate measure; urine testing provides an indirect measure that can be influenced by kidney function and the amount of time the urine is retained in the bladder.

An unconscious adolescent with type 1 diabetes is brought to the emergency department. The blood glucose level is 742 mg/dL (41.2 mmol/L). Which finding would the nurse expect during the initial assessment? 1 Pyrexia 2 Hyperpnea 3 Bradycardia 4 Hypertension

Rapid breathing (hyperpnea) is an attempt by the respiratory system to eliminate excess carbon dioxide; it is a characteristic compensatory mechanism for correcting metabolic acidosis. An increase in temperature (pyrexia) will occur if an infection is present; it is not a response to hyperglycemia. Tachycardia, not bradycardia, results from the hypovolemia of dehydration. Hypotension, not hypertension, may result from the decreased vascular volume associated with hyperglycemia.