PBSC-RN Sem 2 Unit 6

which organ produces glucose?

liver

long-acting insulin (glargine/Lantus): onset/peak/duration

onset: 1-2 hours peak: no peak duration: 24+ hours

rapid-acting insulin (lispro/Humalog): onset/peak/duration

onset: 15 min peak: 60-90 min duration: 3-4 hours

counter-regulatory hormones (glucagon, epinephrine, growth hormone, and cortisol) increase blood glucose levels by:

(1) stimulating glucose production and release by the liver and (2) decreasing the movement of glucose into the cells. The counter-regulatory hormones and insulin usually maintain blood glucose levels within the normal range by regulating the release of glucose for energy during food intake and periods of fasting.

A nurse is working with a married woman who has come to the emergency department several times with injuries that appear to be related to domestic violence. While talking with the nurse manager, the nurse expresses disgust that the woman keeps returning to the situation. What is the best response by the nurse manager? 1. "She must not have the financial resources to leave her husband." 2. "Most women try to leave about six times before they are successful." 3. "There's nothing the staff can do; people are free to choose their own lives." 4. "These women should be told how stupid they are to stay in that kind of situation."

2. "Most women try to leave about six times before they are successful." RATIONALE: Nurses who work with victims of partner abuse need to be supportive and patient. It takes time and several attempts for most victims to leave abusive relationships. It may or may not be true that the client does not have the financial resources to leave her husband; there is not enough information to support this conclusion. The staff can encourage the woman to make plans for addressing various potential events and provide information about social services and telephone help lines. Shaming women in this position will simply make them less likely to seek help.

What behavioral findings correspond to intimate partner violence in young adolescents? Select all that apply. 1. Sexually acting out 2. Attempting suicide 3. Pattern of substance abuse 4. Fear of certain people or places 5. Preoccupation with others or one's own genitals

2. Attempting suicide 3. Pattern of substance abuse RATIONALE: Adolescent undergoing intimate partner violence may attempt suicide or have patterns of substance abuse. The behavioral findings in children undergoing sexual abuse include sexually acting out, fear of certain people or places, and a preoccupation with genitalia.

Which hormones are secreted by the client's hypothalamus? Select all that apply. 1. Growth hormone 2. Follicle-stimulating hormone 3. Prolactin-inhibiting hormone 4. Corticotropin-releasing hormone 5. Melanocyte-stimulating hormone

3. Prolactin-inhibiting hormone 4. Corticotropin-releasing hormone RATIONALE: The hormones that are secreted by the hypothalamus include prolactin-inhibiting hormone and corticotropin-releasing hormone. Growth hormone, follicle-stimulating hormone, and melanocyte-stimulating hormone are hormones secreted by the anterior pituitary gland.

which organ produces insulin?

pancrease

Which statement by the patient with type 2 diabetes is accurate? a. "I will limit my alcohol intake to one drink." b. "I am not allowed to eat any sweets because of my diabetes." c. "I cannot exercise because I take a blood glucose-lowering medication." d. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."

A. "I will limit my alcohol intake to one drink."

Polydipsia and polyuria related to diabetes mellitus are primarily due to: a. the release of ketones from cells during fat metabolism. b. fluid shifts resulting from the osmotic effect of hyperglycemia. c. damage to the kidneys from exposure to high levels of glucose. d. changes in RBCs resulting from attachment of excessive glucose to hemoglobin.

B. Fluid shifts resulting from the osmotic effect of hyperglycemia

pathophysiology for Type 1 diabetes

• Absence of insulin production • Acute onset

A patient has a serum sodium level of 152 mEq/L (152 mmol/L). The normal hormonal response to this situation is a. release of ADH. b. release of ACTH. c. secretion of aldosterone. d. secretion of corticotropin-releasing hormone.

A. release of ADH

Risk factors for impaired glucose regulation

Age Racial and ethnic groups Family history Lifestyle Medical risk factors Selected medications

All cells in the body are believed to have intracellular receptors for a. insulin. b. glucagon. c. growth hormone. d. thyroid hormone.

D. thyroid hormone

short-acting insulin (regular/Humulin R): onset/peak/duration

onset: 1/2-1 hour peak: 2-3 hours duration: 3-6 hours

intermediate-acting insulin (NPH/Humulin N): onset/peak/duration

onset: 2-4 hours peak: 4-10 hours duration: 10-16 hours

microvascular complications of diabetes

retinopathy; nephropathy; neuropathy

pathophysiology for Gestational diabetes

• Hormones to sustain pregnancy inhibit insulin production

Alterations in glucose regulation causing hypoglycemia

• Inadequate nutritional intake • Excessive exercise

A client is receiving dexamethasone to treat acute exacerbation of asthma. For what side effect should the nurse monitor the client? 1. Hyperkalemia 2. Liver dysfunction 3. Orthostatic hypotension 4. Increased blood glucose

4. Increased blood glucose RATIONALE: Dexamethasone increases gluconeogenesis, which may cause hyperglycemia. Hypokalemia, not hyperkalemia, is a side effect. Liver dysfunction is not a side effect. Hypertension, not hypotension, is a side effect.

Symptoms related to degree of HYPOglycemia:

-Weakness, dizziness, headache, hunger, blurred vision, difficulty concentrating, feeling shaky, palpitations -Mental status anxious, irritability, confusion, seizures, unconsciousness, coma -Skin diaphoretic, cool, clammy -Tachycardia; no change in respirations -Muscle tremors, normal hydration, no ketones

A client is hospitalized with a brain injury and a skull fracture. The registered nurse is delegating tasks to the healthcare team. Which member of the healthcare team is suitable to provide client care? Select all that apply. 1. Charge nurse 2. Chief nursing officer 3. Licensed practical nurse 4. Newly hired registered nurse 5. Unlicensed nursing professional

1. Charge nurse 4. Newly hired registered nurse RATIONALE: The charge nurse and newly hired registered nurses can be delegated the task of client care. They have the knowledge of client care in critical conditions. The chief nursing officer cannot take on the task due to other responsibilities. Neither the licensed practical nurse nor the unlicensed nursing personnel can take care of the client due to limited knowledge and skills.

Which glands secrete hormones that regulate metabolism of carbohydrates, proteins, and fats? Select all that apply. 1. Pancreas 2. Thyroid gland 3. Adrenal cortex 4. Adrenal medulla 5. Parathyroid gland

1. Pancreas 2. Thyroid gland 3. Adrenal cortex RATIONALE: The pancreas secretes insulin and glucagon, which affects the body's metabolism of carbohydrates, proteins, and fats. The thyroid gland secretes thyroid hormones T 3 and T 4 that regulate carbohydrates, proteins, and fat metabolism. Cortisol is a glucocorticoid secreted by the adrenal cortex that affects carbohydrates, proteins, and fat metabolism. Adrenal medulla secretes catecholamines, which do not affect metabolism of carbohydrates, proteins, and fats. Hormones secreted by the parathyroid gland mainly regulate calcium and phosphorus metabolism.

A client is concerned about taking hormones for birth control. Which contraceptives should the nurse tell the client have a hormonal component? Select all that apply. 1. Oral drugs 2. Diaphragm 3. Cervical cap 4. Female condoms 5. Foam spermicide 6. Transdermal agents

1. oral drugs 6. transdermal agents RATIONALE: Oral agents have a hormonal component. Transdermal agents have a hormonal component. The diaphragm, cervical cap, and female condom act as barriers. Foam spermicides kill the sperm; there is no hormonal effect.

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? 1. Urine output 2. Glucose level 3. Serum potassium 4. Immune response

2. Glucose level RATIONALE: As a result of increased cortisol levels, glucose metabolism is altered, which may contribute to an increase in blood glucose levels. Increased mineralocorticoids will decrease urine output. Sodium is retained by the kidneys, but potassium is excreted. The immune response is suppressed.

A nurse is caring for a client who had surgery for cancer of the pancreas. Which nutrients will the nurse most closely observe after surgery? 1. Beef and chicken 2. Proteins and grains 3. Vitamins and minerals 4. Fats and carbohydrates

4. Fats and carbohydrates RATIONALE: Fats and carbohydrates should be limited because the exocrine function of the pancreas is the formation of lipase for fat digestion, and the endocrine function of the pancreas is the secretion of insulin, a hormone that is essential for carbohydrate metabolism. Proteins and grains as well as vitamins and minerals are not as severely affected as fats and carbohydrates, especially glucose. Deficiencies of protein may occur because of inadequate intake but are not related specifically to pancreatic functioning. Beef and chicken are protein, which is not as affected as fats and carbohydrates.

What does the nurse expect the size of a newborn to be if the mother had inadequately controlled type 1 diabetes during her pregnancy? 1. Average for gestational age, term 2. Small for gestational age, preterm 3. Large for gestational age, postterm 4. Large for gestational age, near term

4. Large for gestational age, near term RATIONALE: Newborns of diabetic mothers may be large for gestational age because hyperglycemia in the mother precipitates hyperinsulinism in the fetus, resulting in excess deposits of fetal fat; these infants are usually born at or before term and are large, not average or small, for gestational age. Diabetic mothers with advanced vascular and renal disease may give birth to infants who are small for gestational age. Because of the risk for fetal death, women with diabetes should give birth before the 40th week of gestation, either by way of induction of labor or, if necessary, by cesarean birth.

A client with a history of violence is becoming increasingly agitated. Which nursing intervention will most likely increase the risk of acting-out behavior? 1. Being assertive 2. Responding early 3. Providing choices 4. Teaching relaxation

4. Teaching relaxation RATIONALE: Once the client is agitated, teaching will not be effective and may increase the client's anxiety. Teaching relaxation techniques can be done once the client calms down. Being assertive (not aggressive) shows the client that the nurse is confident in handling the situation. This may help reduce the client's anxiety. Responding before agitation escalates makes interventions more likely to be successful. Providing choices may help the client feel less threatened and avoids a power struggle.

The registered nurse coordinates with a dietician and a certified diabetes educator (CDE) while caring for a client recently diagnosed with diabetes. Which Quality and Safety Education for Nurses (QSEN) competency is involved in this intervention? 1. Safety 2. Patient-centered care 3. Evidence-based practice 4. Teamwork and collaboration

4. Teamwork and collaboration RATIONALE: The nurse recognizes the contributions of other health team members and coordinates effectively with them to ensure quality care for the client. This intervention involves the QSEN competency of teamwork and collaboration. The nurse values his of her own role in providing safety by minimizing the risk of harm to clients and health care providers through system effectiveness. The nurse provides patient-centered care by recognizing the client as the source of control and full partner in health care. The nurse applies evidence-based practice by integrating best current evidence with clinical expertise and client preferences and values to deliver optimum health care.

You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital (select all that apply)? a. Insulin administration b. Elimination of sugar from diet c. Need to reduce physical activity d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment

A. Insulin administration D. Use of a portable blood glucose monitor E. Hypoglycemia prevention, symptoms, and treatment

When obtaining subjective data from a patient during assessment of the endocrine system, the nurse asks specifically about a. energy level. b. intake of vitamin C. c. employment history. d. frequency of sexual intercourse.

A. energy level

A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of a. polyuria. b. severe dehydration. c. rapid, deep respirations. d. decreased serum potassium.

C. rapid, deep respirations (Kussmaul respirations)

A client with diabetes asks how exercise will affect insulin and dietary needs. What information does the nurse share about insulin and exercise? 1. "Exercise increases the need for carbohydrates and decreases the need for insulin." 2. "Exercise increases the need for insulin and increases the need for carbohydrates." 3. "Regular physical activity decreases the need for insulin and decreases the need for carbohydrates." 4. "Intensive physical activity decreases the need for carbohydrates but does not affect the need for insulin."

1. "Exercise increases the need for carbohydrates and decreases the need for insulin." RATIONALE: Exercise increases the uptake of glucose by active muscle cells without the need for insulin; carbohydrates are needed to supply energy for the increased metabolic rate associated with exercise. The need for insulin is decreased.

The nurse is assessing the client admitted with diabetic ketoacidosis. Which statement made by the client indicates a need for further education on sick day management? 1. "I need to stop taking my insulin when I am ill because I am not eating." 2. "I will check my urine for ketones when my blood sugar is over 250." 3. "I will try and take in Gatorade and water when I am sick." 4. "I will continue all my insulin including my glargine when I am sick."

1. "I need to stop taking my insulin when I am ill because I am not eating." RATIONALE: 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 over 250, drinking water and Gatorade, and continuing insulin indicate that the client has an understanding of the basic sick day rules.

What are the most common hormones produced in excess with hyperpituitarism? Select all that apply. 1. Prolactin 2. Growth hormone 3. Luteinizing hormone 4. Antidiuretic hormone 5. Melanocyte-stimulating hormone

1. Prolactin 2. Growth hormone RATIONALE: The most common hormones produced in excess with hyperpituitarism are prolactin and growth hormone. Excessive stimulation of luteinizing hormone and antidiuretic hormone is also associated with hyperpituitarism, but less commonly than prolactin and growth hormone. Secretion of melanocyte-stimulating hormone stimulates adrenocorticotropic hormone, which indirectly stimulates the pituitary gland, thus leading to hyperpituitarism.

A patient has a total serum calcium level of 3 mg/dL (1.5 mEq/L). If this finding reflects hypoparathyroidism, the nurse would expect further diagnostic testing to reveal a. decreased serum PTH. b. increased serum ACTH. c. increased serum glucose. d. decreased serum cortisol levels.

A. decreased serum PTH

An abnormal 2-hour plasma glucose level is greater than or equal to _____ during an oral glucose tolerance test (OGTT).

200 mg/dL (11.1 mmol/L)

The nurse is caring for a client who is recovering from a stroke. The primary health care provider has referred the client for rehabilitative care. Which interventions by the nurse help to make a successful referral process? Select all that apply. 1. Make the referral after the client is discharged. 2. Select a suitable rehabilitation center for the client. 3. Explain the need for referral to the client and family. 4. Provide the referral with adequate client information. 5. Determine what the referral recommends for client care.

3. Explain the need for referral to the client and family. 4. Provide the referral with adequate client information. 5. Determine what the referral recommends for client care. RATIONALE: Clients are discharged from health care facilities as soon as their conditions allow. Therefore they often need referrals for continuing care from another provider. It is important for the nurse to explain the need for the referral to the client and family. The nurse must coordinate with the referral and provide all necessary client information to prevent duplication of effort or exclusion of important information. The nurse must determine the referral recommendations for client care and include it in the treatment plan. Discharge planning starts as soon as the client is admitted to the health care facility. Therefore the nurse must plan for the referral as soon as possible, not after the client is discharged. The nurse should involve the client and family in the referral process. The client and family should be allowed to select a suitable rehabilitation center.

Which are appropriate therapies for patients with diabetes mellitus (select all that apply)? a. Use of statins to reduce CVD risk b. Use of diuretics to treat nephropathy c. Use of ACE inhibitors to treat nephropathy d. Use of serotonin agonists to decrease appetite e. Use of laser photocoagulation to treat retinopathy

A. Use of statins to reduce CVD risk C. Use of ACE inhibitors to treat nephropathy E. Use of laser photocoagulation to treat retinopathy

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? a. The patient must receive insulin therapy to prevent ketoacidosis. b. The patient has islet cell antibodies that have destroyed the pancreas's ability to produce insulin. c. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections. d. The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome.

D. The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome.

A client is admitted with posttraumatic brain injury and multiple fractures. The client's eyes remain closed, and there is no evidence of verbalization or movement when the nurse changes the client's position. What score on the Glasgow Coma Scale (GCS) should the nurse document? Record your answer using a whole number. _______ Total GCS score

The score is 3. The score on the GCS ranges from 3 to 15. The client's lack of response earns the minimum of one point in each of the categories: eye opening response, best verbal response, and best motor response.

oral hypoglycemics

Thiazolidinediones: pioglitazone (Actos) Biguanides: metformin (Glucophage) Sulfonylureas: chlorpropamide (Diabinese); glyburide (Micronase); glipizide (Glucotrol)

When intimate partner violence (IPV) is suspected, the nurse plays an important role as an advocate for the victim. The advocate role includes what important components? Select all that apply. a. Planning for future safety b. Normalizing victimization c. Validating the experiences d. Promoting access to community services e. Providing housing for the victim

a. Planning for future safety c. Validating the experiences d. Promoting access to community services RATIONALE: Planning for the client's future safety needs, validating the client's experiences by letting the victim know that he or she is not alone, and promoting access to community services are all important roles of the nurse advocate. An advocate would not normalize the victimization by seeing the abuse as normal in the victim's relationship and failing to respond to the disclosure of the abuse. The advocate role would include information and resources for housing if needed, but not necessarily provide it.

pathophysiology for Type 2 diabetes

• Insulin resistance & decreased insulin production • Insidious onset

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? a. A1C 9% b. BP 126/80 mm Hg c. FBG 130 mg/dL (7.2 mmol/L) d. LDL cholesterol 100 mg/dL (2.6 mmol/L)

A. A1C 9% - should be lower than 6.5%

Endocrine disorders often go unrecognized in the older adult because a. symptoms are often attributed to aging. b. older adults rarely have identifiable symptoms. c. endocrine disorders are relatively rare in the older adult. d. older adults usually have subclinical endocrine disorders that minimize symptoms.

A. symptoms are often attributed to aging.

An abnormal finding by the nurse during an endocrine assessment would be (select all that apply) a. blood pressure of 100/70 mm Hg. b. excessive facial hair on a woman. c. soft, formed stool every other day. d. 3-lb weight gain over last 6 months. e. hyperpigmented coloration in lower legs.

B. excessive facial hair on a woman E. hyperpigmented coloration in lower legs.

A characteristic common to all hormones is that they a. circulate in the blood bound to plasma proteins. b. influence cellular activity of specific target tissues. c. accelerate the metabolic processes of all body cells. d. enter a cell to alter the cell's metabolism or gene expression.

B. influence cellular activity of specific target tissues.

What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability? a. Call the physician. b. Administer insulin as ordered. c. Check the patient's blood glucose level. d. Assess for other neurologic symptoms.

C. Check the patient's blood glucose level. (BG may be low)

A patient is receiving radiation therapy for cancer of the kidney. The nurse monitors the patient for signs and symptoms of damage to the a. pancreas. b. thyroid gland. c. adrenal glands. d. posterior pituitary gland.

C. adrenal glands

An appropriate technique to use during physical assessment of the thyroid gland is a. asking the patient to hyperextend the neck during palpation. b. percussing the neck for dullness to define the size of the thyroid. c. having the patient swallow water during inspection and palpation of the gland. d. using deep palpation to determine the extent of a visibly enlarged thyroid gland.

C. having the patient swallow water during inspection and palpation of the gland.

Symptoms related to degree of HYPERglycemia:

-No specific symptoms for elevated blood glucose, but symptoms may be associated with dehydration or acidosis and may include nausea, vomiting, abdominal cramps, fatigue, excessive hunger (polyphagia), excessive thirst (polydipsia) -Mental status can range from alert to confused and coma, particularly if in untreated ketoacidosis -Skin warm, moist -Deep, rapid respirations; acetone odor to breath; tachycardia if dehydrated -Dehydration, polyuria, ketones

A client with type 1 diabetes has an above-the-knee amputation because of severe lower extremity arterial disease. What is the nurse's primary responsibility two days after surgery when preparing the client to eat dinner? 1. Checking the client's serum glucose level 2. Assisting the client out of bed into a chair 3. Placing the client in the high-Fowler position 4. Ensuring the client's residual limb is elevated

1. Checking the client's serum glucose level RATIONALE: Because the client has type 1 diabetes, it is essential that the blood glucose level be determined before meals to evaluate the level of control of diabetes and the possible need for insulin coverage. To prevent flexion contractures of the hip, the client should not sit for a prolonged time; this is not the priority. Raising the head of the bed flexes the hips, which may result in hip flexion contractures; this is not the priority. Ensuring the client's residual limb is elevated may result in a hip flexion contracture and should be avoided.

The nurse knows that the newborns of mothers with diabetes often exhibit tremors, periods of apnea, cyanosis, and poor suckling ability. With which complication are these signs associated? 1. Hypoglycemia 2. Hypercalcemia 3. Central nervous system edema 4. Congenital depression of the islets of Langerhans

1. Hypoglycemia RATIONALE: The pancreas of a fetus of a diabetic mother responds to the mother's hyperglycemia by secreting large amounts of insulin; this leads to hypoglycemia after birth. Hypocalcemia, not hypercalcemia, occurs. Edema may be generalized, not specific to the central nervous system. In response to the increased glucose received from the mother, the islets of Langerhans in the fetus may become hypertrophied; these cells are not congenitally depressed.

The registered nurse (RN) finds that a student nurse is unwilling to participate in a community health literacy program conducted for clients with diabetes mellitus . Which action of the RN portrays his or her leadership ability? 1. Inspiring the student nurse to take active participation 2. Leaving the student nurse to make his or her own decision 3. Demanding that the student nurse takes active participation 4. Reporting the student nurse to the other higher level healthcare professionals

1. Inspiring the student nurse to take active participation RATIONALE: The leader should inspire and motivate his or her followers to complete the task successfully. Therefore inspiring the student nurse to participate actively in the program explores the leadership ability of the registered nurse (RN). Leaving the student nurse on his or her own to make a decision does not help the student nurse to grow in his or her profession. The leader should not demand his or her followers to do things as this does not indicate effective leadership ability. Reporting the student nurse to other higher level healthcare professionals does not indicate leadership ability.

The nurse is explaining insulin needs to a client with gestational diabetes who is in her second trimester of pregnancy. Which information should the nurse give to this client? 1. Insulin needs will increase during the second trimester. 2. Insulin needs will decrease during the second trimester. 3. Insulin needs will not change during the second trimester. 4. Insulin will be switched to an oral antidiabetic medication during the second trimester

1. Insulin needs will increase during the second trimester RATIONALE: The second trimester of pregnancy exerts a diabetogenic effect on the maternal metabolic status. Major hormonal changes result in decreased tolerance of glucose, increased insulin resistance, decreased hepatic glycogen stores, and increased hepatic production of glucose. Increasing levels of human chorionic somatomammotropin, estrogen, progesterone, prolactin, cortisol, and insulinase increase insulin resistance through their actions as insulin antagonists. Insulin resistance is a glucose-sparing mechanism that ensures an abundant supply of glucose for the fetus. Maternal insulin requirements gradually increase from about 18 to 24 weeks of gestation to about 36 weeks' gestation. The use of oral antidiabetes agents is currently not recommended by the American Diabetes Association for use during pregnancy.

The nurse provides education about signs and symptoms of hypoglycemia to a client with newly diagnosed type 1 diabetes. The nurse concludes that the teaching was effective when the client acknowledges the need to drink orange juice when experiencing which symptoms? 1. Nervous and weak 2. Thirsty with a headache 3. Flushed and short of breath 4. Nausea and abdominal cramps

1. Nervous and weak RATIONALE: Nervousness and weakness are the most commonly reported symptoms of hypoglycemia and are related to increased sympathetic nervous system activity. Feeling flushed and short of breath are adaptations of hyperglycemia. Being thirsty, having a headache, being nauseated, or having abdominal cramps are symptoms of hyperglycemia.

A nurse caring for a pregnant client at 28 weeks' gestation and her partner suspects intimate partner violence. Which assessments support this suspicion? Select all that apply. 1. The woman has injuries to the breasts and abdomen. 2. The partner refuses to come into the examination room. 3. The partner answers questions that are asked of the woman. 4. The woman has visited the clinic several times in the last month. 5. The partner is excessively attentive while the health history is being taken.

1. The woman has injuries to the breasts and abdomen. 3. The partner answers questions that are asked of the woman. 4. The woman has visited the clinic several times in the last month. RATIONALE: During pregnancy, batterers may concentrate their anger at the pregnancy itself and focus their assaults on the breasts, buttocks, and abdomen. It is common for the abuser to control the conversation by answering for the client. Women who are battered are at risk for stress illnesses such as gastrointestinal distress and chest pain. They are also more likely to suffer from frequent headaches and depression. Control is a primary concern of the abuser, so it would be highly unlikely for him to leave the client alone with the care provider. Excessive attentiveness while the health history is being taken is not typical behavior of an abusive person.

An abnormal fasting plasma glucose (FPG) level is greater than or equal to _____. Fasting is defined as no caloric intake for at least 8 hours.

126 mg/dL (7.0 mmol/L)

A client with a traumatic brain injury is demonstrating signs of increasing intracranial pressure, which may exert pressure on the medulla. What should the nurse assess to determine involvement of the medulla? Select all that apply. 1. Taste 2. Breathing 3. Heart rate 4. Fluid balance 5. Voluntary movement

2. Breathing 3. Heart rate RATIONALE: The medulla, part of the brainstem just above the foramen magnum, is concerned with vital functions such as breathing. The medulla is concerned with vital functions [1] [2] such as heart rate. The opercular-insular area of the parietal cerebral lobe is concerned with taste sensations. The medulla is not concerned with fluid balance. Osmoreceptors of the hypothalamus cause increased or decreased antidiuretic hormone (ADH) secretion depending on serum osmolarity. Voluntary movements are mediated through the somatomotor area of the cerebral cortex.

A small-for-gestational-age (SGA) newborn who has just been admitted to the nursery has a high-pitched cry, appears jittery, and exhibits irregular respirations. What complication does the nurse suspect? 1. Hypovolemia 2. Hypoglycemia 3. Hypercalcemia 4. Hypothyroidism

2. Hypoglycemia RATIONALE: SGA infants may exhibit signs of hypoglycemia, especially during the first 2 days of life, because of depleted glycogen stores and inhibited gluconeogenesis. Decreased blood pressure, pallor with cyanosis, tachycardia, retractions, lethargy, and a weak cry are signs of hypovolemia. Hypercalcemia is uncommon in newborns. These signs are unrelated to hypothyroidism; signs of hypothyroidism are difficult to identify in the newborn.

A nurse administers the drug desmopressin acetate (DDAVP) to a client with diabetes insipidus. What should the nurse monitor to evaluate the effectiveness of the drug? 1. Arterial blood pH 2. Intake and output 3. Fasting serum glucose 4. Pulse and respiratory rates

2. Intake and output RATIONALE: DDAVP replaces antidiuretic hormone, facilitating reabsorption of water and consequent return of a balanced fluid intake and urinary output. The mechanisms that regulate pH are not affected. DDAVP does not alter serum glucose levels; diabetes mellitus, not diabetes insipidus, results in hyperglycemia. Although correction of tachycardia is consistent with correction of dehydration, the client is not dehydrated if the fluid intake is adequate; respirations are unaffected.

A client with type 1 diabetes consistently has high glucose levels on awakening in the morning. What should the nurse instruct the client to do to differentiate between the Somogyi effect and the dawn phenomenon? 1. Eat a snack before going to bed. 2. Measure the blood glucose level between 2 AM and 4 AM. 3. Identify whether morning symptoms are typical for hyperglycemia. 4. Administer the prescribed bedtime insulin immediately before going to bed.

2. Measure the blood glucose level between 2 AM and 4 AM RATIONALE: During the hours of sleep, the Somogyi effect may be caused by a decline in the blood glucose level in response to too much insulin. The resulting hypoglycemia stimulates counterregulatory hormones, which precipitate lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia and ketosis. Treatment involves decreasing the evening insulin. The client should check blood glucose between 2 AM and 4 AM and if the blood glucose is less than 70, the client is having a Somogyi effect. The dawn phenomenon is characterized by the release of counterregulatory hormones in the predawn hours, precipitating hyperglycemia on awakening. Treatment involves an increase in insulin. Eating a snack before going to bed should be done when insulin is taken before sleep, but it will not help to differentiate between the Somogyi effect and the dawn phenomenon. Administering the prescribed bedtime insulin immediately before going to bed depends on the insulin regimen prescribed by the health care provider and will not help to differentiate between the Somogyi effect and the dawn phenomenon. The manifestation (symptoms) of hyperglycemia has no role in differentiating the conditions.

A nurse is caring for a client who had a traumatic brain injury with increased intracranial pressure. Which healthcare provider prescription should the nurse question? 1. Continue anticonvulsants 2. Teach isometric exercises 3. Continue osmotic diuretics 4. Keep head of bed at 30 degrees

2. Teach isometric exercises RATIONALE: The prescription for isometric exercises should be questioned; isometric exercises increase the basal metabolic rate and intracranial pressure. Anticonvulsants may be administered prophylactically after traumatic brain injury to limit the risk for seizures, which will further increase intracranial pressure. Osmotic diuretics may be used to draw fluid from the cerebral tissue into the vascular space to decrease cerebral edema and intracranial pressure. Elevation of the head of the bed helps reduce cerebral edema as the result of gravitational force on the fluid.

most common symptoms of Type 1 diabetes

3 Ps: polydipsia, polyuria, polyphagia Unexplained weight loss

A nurse is teaching a 10-year-old child with type 1 diabetes about insulin requirements. When does the nurse explain that insulin needs will decrease? 1. When puberty is reached 2. When infection is present 3. When emotional stress occurs 4. When active exercise is performed

4. When active exercise is performed RATIONALE: Exercise reduces the body's need for insulin. Increased muscle activity accelerates transport of glucose into muscle cells, thus producing an insulinlike effect. With increased growth and associated dietary intake, the need for insulin increases during puberty. An infectious process may require increased insulin. Emotional stress increases the need for insulin.

The nurse is assessing a client who reports frequent urination. Which inquiry made by the nurse will help determine diabetes insipidus? 1. "Do you have history of cancer?" 2. "Are you on fluoroquinolone therapy?" 3. "Are you on lithium carbonate therapy?" 4. "Do you have a history of lymphoma?"

3. "Are you on lithium carbonate therapy?" RATIONALE: Lithium carbonate is known to interfere with normal kidney response to antidiuretic hormone. Therefore enquiring about lithium carbonate therapy can help assess for diabetes insipidus, which has a clinical manifestation of frequent urination. Inquiry about history of cancer helps in assessing syndrome of inappropriate antidiuretic hormone (SIADH) because some cancer therapy drugs result in SIADH. Treatment with fluoroquinolone antibiotics also can result in SIADH. Hodgkin's and Non-Hodgkin's lymphoma are causes of SIADH.

A client with adrenal insufficiency reports feeling weak and dizzy, especially in the morning. What should the nurse determine is the most probable cause of these symptoms? 1. A lack of potassium 2. Postural hypertension 3. A hypoglycemic reaction 4. Increased extracellular fluid volume

3. A hypoglycemic reaction RATIONALE: Deficiency of glucocorticoids causes hypoglycemia in the client with Addison disease. Clinical manifestations of hypoglycemia include nervousness; weakness; dizziness; cool, moist skin; hunger; and tremors. Hypokalemia is evidenced by nausea, vomiting, muscle weakness, and dysrhythmias. Weakness with dizziness on arising is postural hypotension, not hypertension. An increased extracellular fluid volume is evidenced by edema, increased blood pressure, and crackles.

Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? 1. Providing oxygen 2. Encouraging carbohydrates 3. Administering fluid replacement 4. Teaching facts about dietary principles

3. Administering fluid replacement RATIONALE: 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. Oxygen therapy is not necessarily indicated. Carbohydrates will increase the blood glucose level, which is already high. Although dietary instruction may be appropriate later, such instruction is inappropriate during the crisis.

One component of a hospital disaster plan would include a workplace violence protection plan. Which unit in the hospital would be the priority for implementation and evaluation of this plan? 1. Medical unit 2. Surgical unit 3. Emergency department 4. Maternity department

3. Emergency department RATIONALE: The Emergency Nursing Association (ENA) supports comprehensive workplace violence prevention plans to be included as a component of the organizational disaster plan. The ENA recommends that the comprehensive workplace violence prevention plan be implemented and evaluated in every emergency department. Medical units, surgical units, and maternity departments may also require such plans; however, these units have system barriers that decrease the risk for violence when compared to emergency departments.

The nurse is caring for a client with diabetes mellitus who is scheduled to receive an intravenous (IV) administration of 25 units of insulin in 250 mL normal saline. What does the nurse recognize as the only type of insulin that is compatible with intravenous solutions? 1. NPH insulin 2. Insulin lispro 3. Regular insulin 4. Insulin glargine

3. Regular insulin RATIONALE: Regular insulin acts rapidly, is approved for IV administration, and is compatible with intravenous solutions. Insulin lispro is not compatible with intravenous solutions; it is a rapid-acting insulin. Insulin glargine is not compatible with intravenous solutions; it is a long-acting insulin. NPH insulin is not compatible with intravenous solutions; it is an intermediate-acting insulin.

Which statement is true regarding the functions of kidney hormones? 1. Prostaglandin increases blood flow and vascular permeability. 2. Bradykinin regulates intrarenal blood flow via vasodilation or vasoconstriction. 3. Renin raises blood pressure because of angiotensin and aldosterone secretion. 4. Erythropoietin promotes the absorption of calcium in the gastrointestinal tract (GI) tract.

3. Renin raises blood pressure because of angiotensin and aldosterone secretion. RATIONALE: Renin is a kidney hormone that raises blood pressure as a result of angiotensin and aldosterone secretion. Prostaglandin is a kidney hormone that regulates intrarenal blood flow via vasodilation or vasoconstriction. Bradykinin is a kidney hormone that increases blood flow and vascular permeability. Erythropoietin is a kidney hormone that stimulates the bone marrow to make red blood cells.

Two clients with polydipsia and polyuria arrived at the hospital. Both were having similar symptoms but were diagnosed with different types of diabetes insipidus. Which assessment finding helped to differentiate the diagnosis? 1. Urine output 2. Specific gravity 3. Urine osmolarity 4. Serum osmolarity

3. Urine osmolarity RATIONALE: Polydipsia and polyuria are signs of diabetes insipidus. When a water deprivation test is performed, urine osmolarity is increased dramatically from 100 to 600 mOsm (mmol)/kg in clients with central diabetes insipidus. But in nephrogenic diabetes insipidus, the urine osmolarity may not be greater than 300 mOsm (mmol)/kg. The urine output is 2 L to 20 L/day in all types of diabetes insipidus. The specific gravity is less than 1.005 in all types of diabetes insipidus and the serum osmolarity is also greater than 295 mOsm (mmol)/kg in all types of diabetes insipidus.

While assessing the airway patency of a client after a bomb blast, the nurse suspects severe brain injury and gives a score of 7 using the Glasgow Coma Scale (GCS). Which intervention is most appropriate for the client? 1. Performing the jaw-thrust maneuver 2. Maintaining vascular access using a large-bore catheter 3. Observing for chest wall trauma or other physical abnormalities 4. Preparing for endotracheal intubation and mechanical ventilation

4. Preparing for endotracheal intubation and mechanical ventilation RATIONALE: The most appropriate intervention for a client with a GCS score of 7 is preparing for endotracheal intubation and mechanical ventilation. The jaw-thrust maneuver is performed in a client if there is any risk of spinal injury. The use of large-bore catheters to maintain vascular access is done to perform resuscitation in traumatic conditions. Observing for chest wall trauma or other physical abnormalities may not be the appropriate intervention for a client with brain injury.

most common symptoms of Type 2 diabetes

Episodes of: blurred vision, fatigue, poor wound healing, infections

Which organ is responsible for producing sex steroid hormones?

Sex steroid hormones such as estrogen, progesterone, androgen, and relaxin are required for normal growth and development in females and for maintaining pregnancy. The ovaries are the organs that produce the sex steroid hormones. The cervix is the lower part of the uterus that helps to retain the developing fetus inside the uterus. The vagina produces various secretions and lubricants that enhance libido. Fallopian tubes provide space for fertilization of ova by sperm.

A client has increased intracranial pressure resulting from a traumatic brain injury. Assessment findings indicate that the client is unconscious with vital signs of pulse 60 beats/min, respirations 16 breaths/min, and blood pressure 142/64 mm Hg. The nurse reviews the treatment plan and questions which prescription? a. mannitol b. dexamethasone c. chlorpromazine d. morphine

d. morphine RATIONALE: Morphine injection is contraindicated for an unconscious, neurologically impaired client because it depresses respirations. Mannitol, an osmotic diuretic, is used to reduce increased intracranial pressure. Dexamethasone, a corticosteroid antiinflammatory agent, is used to help reduce increased intracranial pressure. Chlorpromazine, an antipsychotic/neuroleptic/antiemetic, can be given safely to a neurologically impaired client for restlessness.

the process of maintaining optimal blood glucose levels

glucose regulation

Alterations in glucose regulation causing hyperglycemia

• Insufficient insulin production • Deficient hormone signaling • Excessive Counter-regulatory Hormone • Adverse reaction to medication

macrovascular complications of diabetes

stroke; heart disease; peripheral vascular disease