EAQ Metabolic Regulation

A nurse identifies that the client is experiencing a hypoglycemic reaction. Which intervention should the nurse implement to relieve the symptoms associated with this reaction? A.)Giving 4 oz (120 mL) of fruit juice B.)Administering 5% dextrose solution intravenously (IV) C.)Withholding a subsequent dose of insulin D.)Providing a snack of cheese and dry crackers

A

The nurse develops a teaching plan for a client with diabetes who has been diagnosed with lower extremity arterial disease (LEAD). What measures should the nurse include to increase arterial blood flow to the extremities? A.)Exercises that promote muscular activity B.)Meticulous care of minor skin breakdown C.)Elevation of the legs above the level of the heart D.)Soaking the feet in hot water each day

A Arterial blood flow is improved with exercise by fostering the development of collateral circulation. Meticulous care of minor skin breakdown is important for the person with diabetes, but it does not improve arterial blood flow. Elevating the legs above the heart reduces arterial blood flow; the legs should be kept dependent to facilitate tissue perfusion. Soaking the feet in hot water is contraindicated because it can burn the skin or cause drying; also, individuals with diabetes may have nephropathy, which alter the perception of temperature.

A small-for-gestational-age (SGA) newborn has just been admitted to the nursery. Nursing assessment reveals a high-pitched cry, jitteriness, and irregular respirations. With which condition are these signs associated? A.)Hypervolemia B.)Hypoglycemia C.)Hypercalcemia D.)Hypothyroidism

B SGA infants may exhibit hypoglycemia, especially during the first 2 days of life, because of depleted glycogen stores and inhibited gluconeogenesis. These are not signs of hypervolemia. Hypervolemia is usually the result of excessive intravenous infusion. It is unlikely that a full-term SGA infant will need intravenous supplementation. Hypercalcemia is uncommon in newborns. These signs are unrelated to hypothyroidism; signs of hypothyroidism are difficult to identify in the newborn.

The nurse identifies a 5-cm indurated region on the upper arm of a client with type 1 diabetes. The client says to the nurse, "That is where I give myself insulin shots." The nurse concludes that the nodule, which is neither warm nor painful, is a result of what condition? A.)Callus B.)An allergy C.)An infection D.)Lipodystrophy

D Lipodystrophy is a noninflammatory reaction causing localized atrophy or hypertrophy and a localized increase in collagen deposits. Injections of insulin will not cause a horny growth such as a wart or callus. An allergic response will precipitate a localized or systemic inflammatory response. Hyperthermia and localized heat, erythema, and pain are associated with an infection.

A client with a diagnosis of gastric cancer has a gastric resection with a vagotomy. Which clinical response should alert the nurse that the client is experiencing dumping syndrome? A.)Constipation B.)Clay-colored stools C.)Sensations of hunger D.)Reactive hypoglycemia

D 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.

When a client is receiving dexamethasone for adrenocortical insufficiency, what action does the nurse take to monitor for an adverse effect of the medication? A.)Auscultate for bowel sounds. B.)Assess deep tendon reflexes. C.)Culture respiratory secretions. D.)Measure blood glucose levels.

D Corticosteroids, such as dexamethasone, have a hyperglycemic effect, and blood glucose levels should be monitored routinely. Assessing bowel sounds is unnecessary; corticosteroids are not known to precipitate cessation of gastrointestinal activity. Although corticosteroids may increase the risk of developing an infection, routine culturing of respiratory secretions is unnecessary. Culturing respiratory secretions becomes necessary when the client exhibits adaptations of a respiratory infection. Monitoring deep tendon reflexes is required when administering magnesium sulfate, not dexamethasone.

A nurse plans to teach a client with type 1 diabetes about the use of an insulin pump. What information will the nurse include in client teaching? A.)Insulin pumps mimic the way a healthy pancreas works. B.)The insulin pump's needle should be changed every day. C.)Pumps are implanted in a subcutaneous pocket near the abdomen. D.)The insulin pump's advantage is that it only requires glucose monitoring once a day.

A The basal infusion rate mimics the low rate of insulin secretion during fasting, and the bolus before meals mimics the high output after meals. The subcutaneous needle may be left in place for as long as 3 days. Most insulin pumps are external to the body and access the body via a subcutaneous needle. Blood glucose monitoring is done a minimum of 4 times a day.

A nurse administers a tube of glucose gel to a client who is hypoglycemic. What explanation does the nurse share regarding the reversal of hypoglycemia? A.)It liberates glucose from hepatic stores of glycogen. B.)It provides a glucose source that is rapidly absorbed. C.)Insulin action is blocked as it competes for tissue sites. D.)Glycogen is supplied to the brain as well as other vital organs

B The glucose gel provides a simple sugar for rapid use by the body. Liberating glucose from hepatic stores of glycogen is related to the action of glucagon. It is a drug that mobilizes glycogen storage in the liver, leading to an increased blood glucose level. Glucose does not compete with insulin. Glucose gel does not supply glycogen to the brain and other vital organs.

A nurse plans an evening snack of milk, crackers, and cheese for a client who is receiving NPH insulin. What is the purpose of this snack? A.)Encouragement to stay on the diet B.)Food to counteract late insulin activity C.)Added calories to promote weight gain D.)High carbohydrates to provide nourishment for immediate use

B The protein in milk and cheese is converted slowly to glucose (gluconeogenesis), providing the body with some glucose during sleep while the insulin still is acting. The purpose of an evening snack is to cover for insulin activity during sleep, not to encourage the client to stay on the diet. There are no data that indicate a need to gain weight. The foods chosen are rich in protein and are used slowly.

Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes? A.)Ketones in the blood but not in the urine B.)Glucose in the urine but not hyperglycemia C.)Hyperglycemia and urine negative for ketones D.)Blood and urine positive for both glucose and ketones

C In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia. Ketones in the blood but not in the urine does not occur with either type. In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia and diabetes mellitus. Glucose in the urine but not hyperglycemia is impossible; if glycosuria is present, the level of glucose in blood first must exceed the renal threshold of 160 to 180 mg/dL (8.9 to 10 mmol/L). Blood and urine positive for both glucose and ketones is expected in uncontrolled type 1 diabetes.

A client at 40 weeks' gestation is admitted to the birthing unit in early labor. She tells the nurse that she awakened at 8:00 am and started having regular contractions that were 6 minutes apart. Her last full meal was eaten at about 6:00 pm the preceding day. She did not eat breakfast. Which assessment finding indicates a potential problem? A.)Blood pressure of 120/70 mm Hg B.)Decreased blood glucose level C.)Contractions lasting 35 to 40 seconds .D.)Vaginal fluid that tests olive-yellow on a Nitrazine strip

D Labor is hard work and can cause depletion of the pregnant woman's glucose stores, especially if she had not eaten for more than 14 hours. A blood pressure of 120/70 mm Hg is within expected limits and does not indicate a potential problem. Contractions lasting 35 to 40 seconds are typical of early labor. Nitrazine paper that turns a shade of yellow demonstrates that the membranes have not ruptured. This finding does not indicate a potential problem.

A client with type 1 diabetes is placed on an insulin pump. What is the priority short-term goal when teaching this client to control the diabetes? A.)"The client will adhere to the medical regimen." B.)"The client will remain normoglycemic for 3 weeks." C.)"The client will demonstrate correct use of the insulin pump." D.)"The client will list three self-care activities that are necessary to control the diabetes."

C Demonstrating the correct use of the administration equipment is a short-term goal, client oriented, necessary for the client to control the diabetes and measurable when the client performs a return demonstration for the nurse. Adhering to the medical regimen is not a short-term goal. Remaining normoglycemic for 3 weeks is measurable, but it is a long-term goal. Although listing three self-care activities that are necessary to control the diabetes is measurable and a short-term goal, it is not the one with the greatest priority when a client has an insulin pump that must be mastered before discharge.

While the nurse is at the bedside of a client in acute renal failure, the client states, "My healthcare provider said that I will be getting some insulin. Do I also have diabetes?" What is the best nursing response? A.)"No, the insulin will help your body handle the increased potassium level." B.)"I suggest that you ask your healthcare provider that question." C.)"You probably had an elevated blood glucose level, so your healthcare provider is being cautious." D.)"No, but insulin will reduce the toxins in your blood by lowering your metabolic rate."

A Insulin promotes the transfer of potassium into cells, which reduces the circulating blood level of potassium. The response "I suggest that you ask your healthcare provider that question" halts communication and is not supportive. Blood glucose levels usually are not elevated in acute renal failure. Insulin will not lower the metabolic rate.

A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis? A.)Decreased serum glucose levels B.)Decreased serum calcium levels C.)Increased blood urea nitrogen levels D.)Increased serum bicarbonate levels

C

The nurse is caring for a client newly diagnosed with diabetes. What symptom of hypoglycemia is most common and should be taught to the client? A.)Kussmaul respirations B.)Tachycardia C.)Confusion D.)Anorexia

C The most common symptoms of hypoglycemia are nervousness, weakness, perspiration, and confusion. Kussmaul respirations are associated with hyperglycemia or ketoacidosis. Bradycardia is associated with hypoglycemia; tachycardia is not. Anorexia is associated with hyperglycemia.

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

D 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 is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? A.)Urine output B.)Glucose level C.)Serum potassium D.)Immune response

B 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.

The health care provider prescribes one tube of glucose gel for the client with type 1 diabetes. The nurse recognizes that this is for treatment of which diabetes complication? A.)Diabetic acidosis B.)Hyperinsulin secretion C.)Insulin-induced hypoglycemia D.)Idiosyncratic reactions to insulin

C Glucose gel delivers a measured amount of simple sugars to provide glucose to the blood for rapid action. Acidosis occurs when there is an increased serum glucose level; therefore glucose gel is not indicated. Diabetes mellitus involves a decreased insulin production. Glucose gel is not indicated in idiosyncratic reactions to insulin.

A client with a history of type 1 diabetes is experiencing progressive problems with venous stasis. The client tells the nurse, "I bumped my leg a week ago, and now it has an open draining area just above the ankle." Which information is most important for the nurse to explore when collecting the client's health history? A.)The type of treatment and care the client is receiving B.)What dosage and type of insulin the client is taking and how often C.)The number of family members that are experiencing similar problems D.)How many times a day the client voids and the frequency of bowel movements

A Asking what type of treatment the client is receiving and how the client is managing care will elicit a variety of data such as medications, diet, and other aspects of care and even includes the care of the new wound. Although it is important to know about the client's insulin use, the information is too limited and does not include how the client is caring for the new wound or for the diabetes itself. Although information about a client's bowel and bladder habits is important, it is not the priority. Although information about the client's children is important, determining the number of family members the client has and whether they are having similar problems is not the priority.

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? A.)Hypoglycemia B.)Hypercalcemia C.)Central nervous system edema D.)Congenital depression of the islets of Langerhans

A 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.

What is the priority nursing intervention in the planning of nursing care for an adolescent client with anorexia nervosa? A.)Rewarding weight gain by increasing privileges B.)Discussing the importance of eating a balanced diet C.)Encouraging the client to include high-calorie foods in the diet D.)Focusing family therapy on the influence of the client's behavior on the family

A Behavior modification programs are helpful treatment modes for many clients with anorexia nervosa. Discussing the importance of eating a balanced diet is ineffective. The person with anorexia nervosa is more concerned with losing weight than with eating a balanced diet. A well-balanced diet should be encouraged, but actual weight gain is critical and must be reinforced. Although family therapy may be helpful, emphasis on the anorexia may reinforce the negative behavior. Also, family therapy will not be a priority until the client gains weight.

Why does the nurse teach the parents of a young child with type 1 diabetes how to test the child's urine at home during periods of stress or illness, even though blood glucose testing is being done four times a day? A.)Urine should be tested for acetone during illness and when the blood glucose level is increased. B.)Blood glucose testing before meals and at bedtime may be stopped once the child is stabilized on insulin. C.)Urine testing remains the most accurate way to check for a high glucose level if double-voided specimens are used. D.)The short-term glucose level is more accurately reflected in a urine specimen than in a blood specimen, especially in children.

A Urine testing is primarily helpful in detecting acetone (the simplest ketone), which are most likely to be present during illness and hyperglycemia.. Because of the complexity of the diabetic regimen and the variety of factors that influence the serum glucose level (e.g., food ingested, exercise, medications, and the stresses of growth and development), serum glucose levels in children can fluctuate; therefore the serum glucose level should be checked before meals and at bedtime. Blood, not urine, is the best specimen with which to determine the glucose level.

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? A.)Eat a snack before going to bed. B.)Measure the blood glucose level between 2 AM and 4 AM. C.)Identify whether morning symptoms are typical for hyperglycemia. D.)Administer the prescribed bedtime insulin immediately before going to bed.

B 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 with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiologic responses? A.)Pituitary hypoplasia B.)Hyperplasia of the adrenal cortex C.)Deprivation of adrenocortical hormones D.)Insufficient adrenocorticotropic hormone (ACTH) production

B Hyperplasia of the adrenal cortex leads to increased secretion of cortical hormones, which causes signs of Cushing syndrome. Pituitary hypoplasia is a malfunction of the pituitary that will result in Simmonds disease (panhypopituitarism), which has clinical manifestations similar to those for Addison disease. Cushing syndrome results from excessive cortical hormones. ACTH stimulates production of adrenal hormones. Inadequate ACTH will result in Addisonian signs and symptoms.

A client with a history of type 1 diabetes is diagnosed with heart failure. Digoxin is prescribed. What is an important nursing action associated with this drug? A.)Administer the digoxin 1 hour after the client's morning insulin B.)Monitor the client for atrial fibrillation and first-degree heart block C.)Administer the medication with 8 ounces (240 mL) of orange juice D.)Withhold the medication if the apical pulse rate is greater than 60 beats/min

B The speed of conduction is decreased when digoxin is given, and this can result in premature beats, atrial fibrillation, and first-degree heart block. Digoxin does not deplete potassium and therefore orange juice does not need to be given; orange juice is high in calories and needs to be calculated in the diet. Insulin and digoxin can be given at the same time. The purpose of the drug is to reduce a rapid heart rate and therefore should be administered; it should be withheld when the client's heart rate decreases below a parameter set by the healthcare provider (e.g., 60 beats/min).

The laboratory findings of an obese hypertensive adolescent reveal hyperinsulinemia and dyslipidemia. Which condition is the adolescent likely to have? A.)Pulmonary disease B.)Musculoskeletal disease C.)Insulin resistance syndrome D.)Non-alcoholic fatty liver disease

C Insulin resistance syndrome, also known as metabolic syndrome or syndrome X is a condition seen mostly in obese clients that manifests as hyperinsulinemia and dyslipidemia. Asthma, exercise intolerance, and sleep apnea are associated with pulmonary disease. Musculoskeletal diseases such as slipped capital femoral epiphysis and Blount's disease are characterized by the inward angle of the lower leg due to an overgrowth of medial aspect of proximal tibial metaphysis. Non-alcoholic fatty liver disease (NAFLD) is characterized by increased levels of aminotransferase, inflammation, tissue death, and fibrosis of the liver.

A school nurse is teaching a 12-year-old child with recently diagnosed type 1 diabetes about the action of insulin injections. What statement indicates that the child understands how insulin works in the body? A.)"Glucose is released as fats break down." B.)"It keeps glucose from being stored in the liver." C.)"Glucose is carried into cells, where it is used for energy." D.)"It stops wasting of blood glucose by converting it to glycogen."

C Specialized insulin receptors on insulin-sensitive cells transport glucose through cell membranes, making it available for use. Insulin does not break down fats to release glucose, prevent glucose from being stored in the liver, or convert glucose into glycogen.

A 67-year-old man with type 2 diabetes sadly confides in the nurse that he has been unable to have an erection for several years. What is the best response by the nurse? A.)"At your age sex isn't that important." B.)"Sex isn't everything it's cracked up to be." C.)"You sound upset about not being able to have an erection." D.)"Maybe it's time for you to speak to your primary healthcare provider about this."

C When a client reveals something, it is important for the nurse to gather more information. The response "You sound upset about not being able to have an erection" promotes further communication. Assessment is the first step of the nursing process. "At your age sex isn't that important" is a subjective, judgmental response that reflects the nurse's view of sexuality in older adults. "Sex isn't everything it's cracked up to be" interjects the nurse's view and violates the concept of neutrality when counseling clients. Having the client speak to his primary healthcare provider may be indicated eventually, but first the nurse must obtain more information.

A 12-year-old child with type 2 diabetes is scheduled for abdominal surgery. Which factors are most important for the nurse to consider during the postoperative period? Select all that apply. A.)Infection will likely occur at the surgical site. B.)Ketoacidosis frequently occurs later in the postoperative period. C.)The blood glucose level will increase because of the stress of surgery. D.)Urine test results are the most useful gauge of diabetic control after surgery. E.)Diabetic control is usually maintained with insulin after surgery.

C,E The stress of surgery causes the release of epinephrine and glucocorticoids, which increase the blood glucose level. Most individuals with type 2 diabetes who control their diabetes through diet and exercise require insulin during the recovery period. Although the child with diabetes is at risk for infection, surgical aseptic technique should prevent infection. Ketoacidosis is associated with type 1, not type 2, diabetes. Urine test results are affected by many variables and therefore are not reliable indicators of the blood glucose level.