Glucose Regulation Mastery Assessment

The nurse is explaining insulin needs to a client with gestational diabetes who is in her second trimester of pregnancy. Which information would the nurse give to this client?

ANS: Insulin needs will increase during the second trimester.

A health care provider prescribes losartan for a client. Which is an important nursing action?

ANS: Monitor the client's blood pressure. *******Losartan is an aldosterone receptor blocking antihypertensive. A lowering of the client's blood pressure reflects a therapeutic response and should be monitored regularly. The client may be at risk for hyperkalemia, may be taken without regard to meals. It does not affect serum glucose levels.

An infant of a diabetic mother is admitted to the neonatal intensive care unit. Which is the priority nursing intervention for this infant?

ANS: Obtaining heel blood to test the glucose level ****Testing glucose level to determine hypoglycemia is the priority nursing intervention. Hypoglycemia may be present because of the sudden withdrawal of maternal glucose and increased fetal insulin production, which continues after birth.

When planning care for a client with type 1 diabetes, which change in insulin requirements would the nurse anticipate on the first postpartum day?

ANS: Sudden decrease *****During the first 24 hours postpartum, insulin requirements decrease substantially because the major source of insulin resistance, the placenta, has been removed. Women with type 1 diabetes usually only require 50% to 60% of their pregnancy insulin dose on the first postpartum day, provided they are eating a full diet. The decrease in insulin requirements after delivery is sudden not slow. Insulin requirements do not increase on the first postpartum day.

Which metabolic manifestations are likely to be observed in a client with hypothyroidism?

ANS: Intolerance to cold Decreased body temperature

When teaching a client with type 2 diabetes, which statement by the nurse reflects accurate information about preparing for a serum glucose test?

ANS: "Do not ingest anything before the test."- FASTING

Which statement by a client with type 2 diabetes indicates to the nurse that additional dietary teaching is needed?

ANS: "I can eat as much dietetic fruit as I want." *******The client needs further teaching; dietetic fruit is not sugar free and must be calculated in a diabetic individual's diet.

A client experiences ineffective control of type 1 diabetes. The client's study results indicate that a sudden decrease in blood glucose level is followed by rebound hyperglycemia. When this event occurs, which action would the nurse take?

ANS: Collaborate with the primary healthcare provider to alter the insulin prescription.

A client with type 1 diabetes self-administers neutral protamine Hagedorn (NPH) insulin every morning at 8:00 AM. The nurse evaluates that the client understands the action of the insulin when the client identifies which time range as the highest risk for hypoglycemia?

ANS: Noon to 8:00 PM *****The time of greatest risk for hypoglycemia occurs when the insulin is at its peak. The action of intermediate-acting insulin peaks in 4 to 12 hours. >Nine to 10:00 AM and 10:00 AM to 11:00 AM are too soon for NPH to produce a hypoglycemic response. >NPH insulin will have produced a hypoglycemic response before 8:00 PM and after noon. >A hypoglycemic response that occurs in 45 to 60 minutes after administration is associated with rapid-acting insulins.

Which condition results in elevated serum adrenocorticotropic hormone (ACTH) and urine cortisol levels?

ANS: Pituitary Cushing syndrome

Which clinical manifestation would be expected in a client with hyposecretion of growth hormone?

ANS: Reduced bone density

Which mechanism of action explains how glyburide decreases serum glucose levels

Stimulates the pancreas to produce insulin Stimulates the pancreas to produce insulin glyburide: sulfonylurea

The nurse is caring for a client with type 1 diabetes. Which signs or symptoms may indicate that the client has insulin-induced hypoglycemia?

Excessive hunger Weakness Diaphoresis Hypoglycemia affects the CNS, causing weakness. Hypoglycemia affects the SNS, causing diaphoresis. Excessive hunger is associated with hypoglycemia because the body needs glucose for cellular metabolism.

A lactating mother is administered oxytocin. The nurse understands which to be the function of oxytocin in this client?

It helps with the ejection of milk " Induction of labor and abortion are other functions performed by oxytocin but not in a lactating mother. Oxytocin also controls uterine bleeding after the delivery."

A client with type 1 diabetes mellitus has a finger-stick glucose level of 258 mg/dL (14.3 mmol/L) at bedtime. A prescription for sliding-scale regular insulin exists. Which would the nurse do?

ANS: Administer the insulin as prescribed.

What is hyperglycemia?

ANS: Excessive thirst is associated with hyperglycemia because fluid shifts, along with the excess glucose being excreted by the kidneys, result in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis. -Thirst occurs with hyperglycemia in response to dehydration associated with osmotic diuresis. Hyperventilation occurs with diabetic ketoacidosis; Kussmaul respirations are an effort to counteract the effects of a buildup of ketones as the body seeks acid-base balance.

The nurse is assessing a client admitted with diabetic ketoacidosis. Which statement made by the client indicates a need for further education on sick day management?

ANS: "I will stop taking my insulin when I am ill because I am not eating." ******The diabetic client's metabolic needs will require the same amount of insulin and sometimes more when in a stressed state, including illness. -The client checking the urine for ketones when blood sugar is more than 250, alternating water and Gatorade intake, and continuing insulin indicate that the client has an understanding of the basic sick day rules.

Which fasting plasma (FPG) level would indicate a client has prediabetes?

ANS: 100 mg/dL (5.6 mmol/L) ****FPG of 100 to 125 mg/dL = prediabetes. A 70 mg/dL (3.9 mmol/L) FPG =hypoglycemic. An FPG of 126 mg/dL (7.0 mmol/L) or greater = diabetes.

Which outcome is the best indication that a client with type 1 diabetes is successfully managing the disease?

ANS: Stabilization of the serum glucose

An obese client with type 2 diabetes asks about the intake of alcohol or special "dietetic" food in the diet. Which instruction would be included in the teaching plan?

ANS: Alcohol can be consumed, with its calories counted in the diet. ****In the overweight individual with type 2 diabetes, occasional alcohol can be ingested with caloric substitution for equivalent fat exchanges in the diet because it is metabolized like fat. Alcohol can be used as long as it is accounted for in the diet.

Which hormonal deficiency causes diabetes insipidus in a client?

ANS: Antidiuretic hormone (ADH) *****"Decreased levels of prolactin may cause decreased amounts of milk secretion after birth. Decreased levels of thyrotropin cause hypothyroidism, weight gain, and lethargy. Luteinizing hormone deficiency causes menstrual abnormalities, decreased libido, and breast atrophy."

The client with which laboratory values should be treated first during a diabetes mellitus campaign?

ANS: B Rationale: The client with an HbA1c percentage level of less than 7%, fasting plasma glucose above 126 mg/dL, and 2-hour plasma glucose greater than 200 mg/dL indicates diabetes mellitus. Client B has increased values for A1c percentage, fasting plasma glucose, and 2-hour plasma glucose. Client B should be treated first. Clients A, C, and D have normal values for diabetes mellitus and therefore can be treated after client B.

Which action would the home health nurse take when caring for a client with a pink and moist left leg venous stasis ulcer?

ANS: Clean the wound with normal saline and apply prescribed hydrocolloid dressings weekly. *******For noninfected venous stasis ulcers, typical care includes cleaning with normal saline/ applying hydrocolloid dressing, which is left in place for at least 3 to 5 days to promote a moist environment for wound healing. Because venous stasis ulcers are associated with edema, not with poor arterial blood flow to the wound, clients are taught to keep the leg elevated for 20 minutes at least 4 to 5 times daily to reduce swelling.

Which information regarding hormonal influences would the nurse fully understand when teaching a client about breast-feeding?

ANS: Suckling stimulates the pituitary gland to release oxytocin, which initiates the let-down reflex

When determining the main difference between type 1 and type 2 diabetes, the nurse recognizes which clinical presentation about type 1?

ANS: Complications are not present at the time of diagnosis.

The physical examination of a client reveals moon face, buffalo hump, and truncal obesity. The laboratory report reveals salivary cortisol level of 3.0 ng/mL (9.54 nmol/L). Which other manifestations would be present in the client?

ANS: Edema, Osteoporosis, Muscle atrophy ******"Moon face, buffalo hump, and truncal obesity are clinical manifestations of hypercortisolism. A normal salivary cortisol is 2.0 ng/mL (6.36 nmol/L); a higher level also indicates hypercortisolism. Hypercortisolism= sodium & water reabsorption and retention, leading to hypervolemia and edema. Hypercortisolism may cause mineral loss leads to osteoporosis. This condition may also cause musculoskeletal changes caused by nitrogen depletion/ mineral loss. This may lead to muscle atrophy. "

A client with a diagnosis of gastric cancer has a gastric resection with a vagotomy. Which clinical response would alert the nurse that the client is experiencing dumping syndrome?

ANS: Reactive Hypoglycemia ********Rapid gastric emptying that occurs after a gastric resection causes rapid elevation of blood glucose followed by increased insulin secretion, resulting in reactive hypoglycemia and dumping syndrome. Diarrhea, not constipation, occurs. Steatorrhea, not clay-colored stools, may occur. Anorexia, not sensations of hunger, occurs.

Which eye problem is the leading cause of blindness in clients with diabetes?

ANS: Retinopathy ******"Diabetic retinopathy is a leading cause of blindness in diabetics. Glaucoma and cataracts also are associated with diabetes, but retinopathy is the most common eye problem"

The nurse determines that an adolescent with newly diagnosed type 1 diabetes has sufficient knowledge of the disorder. Which is the next appropriate action?

ANS: Setting goals with the client

Which hormone would the nurse identify as inhibiting insulin and glucagon secretion?

ANS: Somatostatin is a hormone that inhibits insulin It also inhibits glucagon secretion, 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.

Which is an appropriate teaching goal for a client who is newly diagnosed as having type 2 diabetes?

ANS: To identify symptoms of hypoglycemia or hyperglycemia ****"Foot care should be done daily, should perform self-serum glucose monitoring to identify serum glucose levels"

Which statement is accurate when teaching the client with diabetes about foot care?

ANS: Wear synthetic fiber socks when exercising

Which factors can predispose a client with type 1 diabetes to a diabetic ketoacidotic coma?

ANSWERS: Excessive emotional stress Running a fever with the flu ******Emotional stress stimulates the sympathetic nervous system, which releases glucocorticoids, ultimately increasing the blood glucose level. The stress of an infection increases metabolism and the production of glucocorticoids, resulting in an elevated blood glucose level.

Which laboratory value supports the presence of diabetic ketoacidosis in a client with type 1 diabetes?

Increased blood urea nitrogen levels Bottom of Form With diabetic ketoacidosis, blood urea nitrogen level generally is increased because of dehydration. With diabetic ketoacidosis, the serum glucose levels are generally greater than 300 mg/dL (16.7 mmol/L).

The nurse observes that a client's urine has a sweet fruity odor. Which information is important to evaluate when performing a further client assessment?

Serum glucose level Bottom of Form Sweet fruity-smelling urine is an indicator of ketoacidosis, which can result from uncontrolled diabetes.

What is hypoglycemia?

ANS: Too much insulin will precipitate insulin coma (hypoglycemia). Exercise uses glucose for muscle contraction, decreasing the blood glucose level; this may precipitate insulin coma (hypoglycemia). Not eating enough calories in relation to the amount of insulin received may precipitate insulin coma (hypoglycemia)

Which rationale accurately explains why insulin is prescribed for clients in acute renal failure?

ANS: It promotes transfer of potassium into cells to lower serum potassium levels. *****Insulin promotes the transfer of potassium into cells, which reduces the circulating blood level of potassium.

11-year-old preadolescent has just been found to have type 1 diabetes. The child, who likes sweets, asks about sugar and sugar substitutes in the diet. Which information would the nurse and the dietitian give the child?

ANS: Sugar substitutes such as saccharin, aspartame, or sucralose can be used. ***Saccharin, aspartame, and sucralose are nonnutritive sweeteners recommended for individuals with diabetes. -Honey is not a sugar substitute. Honey, a fructose, provides 1.3 x as many calories as does table sugar and must be calculated into the diet.

Which statement made by a client recently diagnosed with type 1 diabetes indicates that further education is necessary regarding the teaching plan?

ANS: "Once I get my glucose levels under control, there is a good chance that I will be able to switch from insulin to an oral medication." *********Type 1 DM is an autoimmune disorder in which beta cells are destroyed. No insulin or very little insulin is produced. A person with type 1 DM will need lifelong insulin injections to control blood sugar.

The nurse teaches the parents of a 5-year-old boy with type 1 diabetes about blood glucose monitoring at home. Which statement by the parents indicates that the teaching has been effective?

ANS: "We'll notify the clinic if the blood sugar is higher than 200 (11.1 mmol/L)."

Which nursing intervention is appropriate when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

ANS: Administering fluid replacement *******As a result of osmotic pressures created by an increased serum glucose level, the cells become dehydrated; the client must receive fluid and then insulin. - dietary instruction may be appropriate later, such instruction is inappropriate during the crisis.

Which hormonal imbalance would the nurse suspect in a client who has low serum sodium levels?

ANS: Aldosterone *****"Aldosterone is mineralocorticoid secreted by the adrenal cortex that maintains sodium/ water balance. Reduced sodium lvls in the client indicate a cortisol imbalance. depleted sodium levels in a client indicate hyponatremia."

A student with type 1 diabetes asks the nurse which hormone causes the blood glucose level to rise. Which hormone would the nurse report?

ANS: Glucagon

While the nurse is teaching a client with diabetes about food choices, the client states, "I do not like broccoli." Which food would the nurse suggest to substitute for broccoli?

ANS: Green beans ****Peas, corn, and mashed potatoes are all starches

An adolescent with a body mass index (BMI) of 30 reports fatigue, frequent urination, and a tingling sensation on the feet. The adolescent is then diagnosed with type 2 diabetes mellitus. Which nursing interventions would be appropriate?

ANSWERS: Physical activities Dietary counseling Behavior modification *****An adolescent with type 2 DM should engage in regular physical activity to reduce his or her weight and glucose levels. Dietary counseling improve nutritional intake and decrease saturated fats/sugars. Behavior modification weight programs help adolescents identify & eliminate inappropriate eating behavior habits. >Bariatric surgery is recommended for clients with morbid obesity (BMI 40). Dietary restriction should not be recommended =loss of nutrients.

Which clinical manifestations would the nurse expect to assess in a client diagnosed with hypoglycemia?

ANSWERS: Palpitations Diaphoresis Slurred speech **********Palpitations, an adrenergic symptom, occur as the glucose level decreases; the SNS is activated, and epinephrine and norepinephrine are secreted, causing this response. Diaphoresis is a SNS response that occurs as epinephrine and norepinephrine are released. Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of the CNS becomes depressed.

Which signs and symptoms would the nurse include when teaching a client about ketoacidosis?

ANSWERS: Confusion Excessive thirst Fruity-scented breath ****DKA signs and symptoms often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. So the body begins to break down fat as an alternative fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, leading to diabetic ketoacidosis if untreated. S/sx include excessive thirst, frequent urination, N/V, abdominal pain, weakness or fatigue, SOB, fruity-scented breath, and confusion.

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops an infection with anorexia. Which advice will the nurse provide to the client?

ANSWERS: Continue to take the oral medication. Drink fluids throughout the day. Monitor capillary glucose levels. ******Physiological stress increases gluconeogenesis, requiring continued pharmacological therapy despite an inability to eat; fluids prevent dehydration; monitoring of glucose levels permits early intervention if necessary. Skipping the oral hypoglycemic agent may precipitate hyperglycemia. Food intake will be attempted to prevent acidosis. Delaying an oral hypoglycemic agent may precipitate hyperglycemia.