Quiz4|Edocrine CC
Long-term complications of DM
all types subject to same complications; microangiopathy (e.g., retinopathy, nephropathy), macroangiopathy (e.g., peripheral vascular diseases, arteriosclerosis, coronary heart disease, cerebral vascular disease), neuropathy, skin problems (e.g., cellulitis, fungal infections, boils), periodontal disease
When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description? A sulfisoxazole (Gantrisin) B mexiletine (Mexitil) C prednisone (Orasone) D
A Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn't cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.
When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: A vasopressin (Pitressin Synthetic). B furosemide (Lasix). C regular insulin. D 10% dextrose.
A- Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.
Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? A antidiuretic hormone (ADH). B thyroid-stimulating hormone (TSH). C follicle-stimulating hormone (FSH). D luteinizing hormone (LH).
A. ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.
Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? A Fluid intake is less than 2,500 ml/day. B Urine output measures more than 200 ml/hour. C Blood pressure is 90/50 mm Hg. D The heart rate is 126 beats/minute.
A. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.
patho for DKA &HHNS
(1) DKA is associated with type 1; with inadequate insulin to support basal needs, proteins and fatsare used for energy; ketones are excreted via urine and breathing; dehydration and electrolyte imbalances occur; serum glucose level 300 to 600 mg/dL (2) HHNS is associated with type 2; hyperglycemia increases intravascular osmotic pressure, leading to polyuria and cellular dehydration; serum glucose level 500 to 900 mg/dL
During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise? A At least once a week B At least three times a week C At least five times a week D Every day
B Diabetic clients must exercise at least three times a week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once a week wouldn't achieve these goals. Exercising more than three times a week, although beneficial, would exceed the minimum requirement.
A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client: A prefers to take insulin orally. B has type 2 diabetes. C has type 1 diabetes. D is pregnant and has type 2 diabetes.
B Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't prescribed oral antidiabetic agents because the effect on the fetus is uncertain.
An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: A. 2 to 5 g of a simple carbohydrate. B.10 to 15 g of a simple carbohydrate. C.18 to 20 g of a simple carbohydrate. D.25 to 30 g of a simple carbohydrate.
B. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.
A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide? A "Administer desmopressin while the suspension is cold." B "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." C "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." D "You won't need to monitor your fluid intake and output after you start taking desmopressin."
C Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement.
A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating: A "The test needs to be repeated following a 12-hour fast." B "It looks like you aren't following the prescribed diabetic diet." C "It tells us about your sugar control for the last 3 months." D "Your insulin regimen needs to be altered significantly."
C The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.
For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? A Cool, clammy skin B Distended neck veins C Increased urine osmolarity D Decreased serum sodium level
C. In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glycosuria and polyuria, losing body fluids and experiencing fluid volume deficit. Cool, clammy skin; distended neck veins; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.
A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? A Infusing I.V. fluids rapidly as ordered B Encouraging increased oral intake C Restricting fluids D Administering glucose-containing I.V. fluids as ordered
C. To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.
diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar Non ketotic syndrome (HHNS) constitute medical emergencies
Causes: insufficient insulin, major stresses (e.g.,infection, surgery, trauma, pregnancy, emotional turmoil, nausea and vomiting); drugs (steroids); glucose load
Nurse Joey is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to: A Encourage the client to ask questions about personal sexuality. B Provide time for privacy. C Provide support for the spouse or significant other. D Suggest referral to a sex counselor or other appropriate professional.
D. The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.
Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: A Increasing saturated fat intake and fasting in the afternoon. B Increasing intake of vitamins B and D and taking iron supplements. C Eating a candy bar if lightheadedness occurs. D Consuming a low-carbohydrate, high protein diet and avoiding fasting.
D. To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn't help control hypoglycemia.
Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide? A "Be sure to take glipizide 30 minutes before meals." B "Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly." C "You won't need to check your blood glucose level after you start taking glipizide." D "Take glipizide after a meal to prevent heartburn."
a The client should take glipizide twice a day, 30 minutes before a meal, because food decreases its absorption. The drug doesn't cause hyponatremia and therefore doesn't necessitate monthly serum sodium measurement. The client must continue to monitor the blood glucose level during glipizide therapy.
Hypoglycemia
a. Causes: excess insulin or oral antidiabetic medications; too little food or too much exercise when receiving antidiabetic medications b. Pathophysiology: excessive insulin lowers serum glucose level as glucose is carried into cells; decreased food intake in relation to prescribed anti-diabetic medications results in hypoglycemia; excessive exercise uses glucose for metabolism, decreasing serum glucose level
Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? a. Fluid intake is less than 2,500 ml/day. b. Urine output measures more than 200 ml/hour. c. Blood pressure is 90/50 mm Hg. d. The heart rate is 126 beats/minute.
a. Fluid intake is less than 2,500 ml/day Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.
DKA & HHNS
a. Hyperglycemia, glycosuria, polyuria b. Dehydration (e.g., flushed, hot, dry skin; decreased skin turgor [tenting]); hyperosmolar blood; hypotension; tachycardia; thirst; headache; confusion; drowsiness c. Metabolic acidosis (DKA only): Kussmaul respirations as body attempts to blow off carbon dioxide; ketonuria, sweet breath odor, anorexia, nausea, vomiting, decreased serum pH, decreased PCO2, decreased HCO3
Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? a. antidiuretic hormone (ADH). b. thyroid-stimulating hormone (TSH). c. follicle-stimulating hormone (FSH). d. luteinizing hormone (LH).
a. antidiuretic hormone (ADH). ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.
When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: a. vasopressin (Pitressin Synthetic) b. furosemide (Lasix). c. regular insulin. d. 10% dextrose.
a. vasopressin (Pitressin Synthetic) Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.
A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline? A "You'll need more insulin when you exercise or increase your food intake." B "You'll need less insulin when you exercise or reduce your food intake." C "You'll need less insulin when you increase your food intake." D "You'll need more insulin when you exercise or decrease your food intake."
b Exercise, reduced food intake, hypothyroidism, and certain medications decrease the insulin requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin antibodies, and certain medications increase the insulin requirements.
Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? A Tetanic contractions B Neck vein distention C Weight loss D Polyuria
b SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn't associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria).
Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? a. Tetanic contractions b. Neck vein distention c. Weight loss d. Polyuria
b. Neck vein distention SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn't associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria).
A patient with SIADH is treated with water restriction and administration of IV fluids. The nurses evaluates that treatment has been effective when the patient experiences a. increased urine output, decreased serum sodium, and increased urine specific gravity b. increased urine output, increased serum sodium, and decreased urine specific gravity c. decreased urine output, increased serum sodium, and decreased urine specific gravity d. decreased urine output, decreased serum sodium, and increased urine specific gravity
b. increased urine output, increased serum sodium, and decreased urine specific gravity (rationale- the patient with SIADH has water retention with hyponatremia, decreased urine output and concentrated urine with high specific gravity. improvement in the patient's condition reflected by increased urine output, normalization of serum sodium, and more water in the urine, decreasing the specific gravity.)
Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which she receives 8 U of regular insulin. Nurse Vince should expect the dose's: A Onset to be at 2 p.m. and its peak to be at 3 p.m. B Onset to be at 2:15 p.m. and its peak to be at 3 p.m. C Onset to be at 2:30 p.m. and its peak to be at 4 p.m. D Onset to be at 4 p.m. and its peak to be at 6 p.m.
c Regular insulin, which is a short-acting insulin, has an onset of 15 to 30 minutes and a peak of 2 to 4 hours. Because the nurse gave the insulin at 2 p.m., the expected onset would be from 2:15 p.m. to 2:30 p.m. and the peak from 4 p.m. to 6 p.m.
Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer: A I.M. or subcutaneous glucagon. B I.V. bolus of dextrose 50%. C 15 to 20 g of a fast-acting carbohydrate such as orange juice. D 10 U of fast-acting insulin.
c This client is having a hypoglycemic episode. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer either I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.
A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? a. Infusing I.V. fluids rapidly as ordered b. Encouraging increased oral intake c. Restricting fluids d. Administering glucose-containing I.V. fluids as ordered
c. Restricting fluids To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.
A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder? A Serum potassium level B Serum sodium level C Arterial blood gas (ABG) values D
d Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.