Urden Questions CBA 3
A nurse is teaching a patient with diabetes mellitus. The patient asks the nurse what is an acceptable HbA1c level for him. What should the nurse tell the patient? a. An acceptable level is less than 5.4%. b. An acceptable level is less than 6.5%. c. An acceptable level is determined by your practitioner. d. It is dependent on your age.
A A normal HbA1C value is less than 5.4%, with an acceptable target level for patients with diabetes below 6.5%.
A patient has been admitted with hyperosmolar hyperglycemic state (HHS). The nurse knows that intravenous insulin is usually administered at what dosage? a. 0.1 U/kg/h b. 1.0 U/kg/h c. 2.0 U/kg/h d. 5.0 U/kg/h
A Regular insulin infusing at an initial rate calculated as 0.1 unit per kg hourly (7 U/h for a person weighing 70 kg) should lower the plasma glucose by 50 to 70 mg/dL in the first hour of treatment. If the measured glucose does not decrease by this amount, the insulin infusion rate may be doubled until the blood glucose is declining at a rate of 50 to 70 mg/dL/h.
Which anatomic structure has influence over all areas of body functioning? a. Hypothalamus b. Pancreas c. Thyroid d. Pituitary
A The hypothalamus gland is known as the "master gland" because of the influence it has over all areas of body functioning. The hypothalamus controls pituitary gland action and response by secreting substances called release-inhibiting factors.
A patient is admitted after surgery with a history of hyperthyroidism. The nurse suspects the patient may be developing thyroid storm. Which finding would confirm this suspicion? a. Tachycardia b. Hypotension c. Decreased appetite d. Hypothermia
A Thyroid storm, also called thyroid crisis, is a rare and life-threatening exacerbation of hyperthyroidism. The pathophysiology underlying the transition from hyperthyroidism to thyroid storm is not fully understood because thyroid hormone levels are not necessarily different from patients with hyperthyroidism. Atrial fibrillation is the most common dysrhythmia in patients with hyperthyroidism, and tachydysrhythmias should be anticipated in thyroid storm, especially in patients with underlying heart disease.
A patient is brought to the hospital with a major stab wound. After excessive blood loss, the nurse should anticipate what change in the patient's serum osmolality? a. Increase b. Decrease c. Rapid decrease than increase d. Equal to his or her sodium level
A With hemorrhage the serum osmolality increases, which stimulates the release of antidiuretic hormone.
A patient is admitted with Cushing syndrome. Which findings would the nurse expect to note as confirming this diagnosis? (Select all that apply.) a. Hirsutism b. Rounded face c. Hypotension d. Decreased libido e. Scleroderma f. Fatigue and weakness
A, B, D, F Signs and symptoms of Cushing syndrome include hypertension, thin skin that bruises easily, and poor wound healing.
The nurse is managing a patient with hyperglycemia. Which findings would the nurse expect to note to support this diagnosis? (Select all that apply.) a. Anorexia b. Abdominal pain c. Bradycardia d. Fluid overload e. Change in level of consciousness f. Kussmaul respirations
A, B, E, F More than likely the patient with hyperglycemia will be fluid volume depleted and tachycardic.
A patient with thyrotoxicosis is admitted. Which laboratory tests would the nurse expect to be ordered for this patient? (Select all that apply.) a. Total serum triiodothyronine (TT3) b. Total serum thyroxine (TT4) c. Free urine thyroid stimulating hormone d. Total urine thyroxine e. Thyroglobulin (Tg) f. Free thyroxine (T4)
A, B, E, F Thyroid tests include total serum thyroxine, free thyroxine, total serum triiodothyronine, free triiodothyronine, thyroid-stimulating hormone (thyrotropin), and thyroglobulin.
A patient is admitted with a traumatic head injury. The patient starts to exhibit signs of a decrease in antidiuretic hormone (ADH). Which symptom would alert the nurse to this problem? a. Rapidly escalating hypertension b. Massive diuresis c. Pulmonary edema d. Hyperkalemia
B A low sodium level is associated with a low serum osmolality (hypoosmolar state). When sodium levels rise, plasma osmolality increases (hyperosmolar state). Antidiuretic hormone is then released to stimulate water resorption at the nephron to maintain sodium balance. This process decreases water loss from the body and subsequently concentrates and reduces urine volume. Fluid conserved in this manner is returned to the circulating plasma, where it dilutes the concentration (osmolality) of plasma.
A patient has been admitted with abdominal pain. The nurse notes that the patient's fasting blood glucose is 120 mg/dL. Which statement regarding this finding is accurate? a. This is a normal finding in critically ill patients. b. This finding is indicative of prediabetes, but another test should be done to confirm. c. This finding is lower than what the nurse would expect in a patient receiving intravenous fluids. d. This finding is indicative of diabetic ketoacidosis.
B A normal fasting plasma glucose (FPG) level is between 70 and 110 mg/dL. An FPG level between 110 and 126 mg/dL identifies a person who is prediabetic. An FPG level of greater than 126 mg/dL (7 mmol/L) is diagnostic of diabetes. In nonurgent settings, the test is repeated on another day to make sure the result is accurate.
A patient has been admitted with diabetic ketoacidosis (DKA). The nurse knows that the top priority in the initial treatment of DKA is which intervention? a. Lowering the blood sugar as quickly as possible b. Administering intravenous fluids c. Administering sodium bicarbonate d. Determining the precipitating cause
B A patient with diabetic ketoacidosis (DKA) is dehydrated and may have lost 5% to 10% of his or her body weight in fluids. A fluid deficit up to 6 L can exist in severe dehydration. Aggressive fluid replacement is provided to rehydrate both the intracellular and the extracellular compartments and prevent circulatory collapse.
A patient is admitted with a traumatic head injury. The patient starts to exhibit signs of a decrease in antidiuretic hormone (ADH). What is the function of ADH? a. Control blood pressure b. Regulate fluid balance c. Normalize potassium levels d. Maintain homeostasis
B Antidiuretic hormone has been identified as the single most important hormone responsible for regulating fluid balance within the body.
A patient has been admitted with a brain mass. The practitioner suspects it might be a pituitary tumor and orders a computed tomography (CT) scan. What area of brain should be scanned to confirm this diagnosis? a. Frontal lobe b. Base of the skull c. Temporal lobe d. Anterior fossa
B Computed tomography (CT) of the base of the skull identifies pituitary tumors, blood clots, cysts, nodules, or other soft tissue masses.
A patient is receiving insulin due to the development of steroid-induced hyperglycemia. In addition to lowering blood glucose levels, what other physiologic effect may occur when insulin is administered? a. Breakdown of proteins b. Hypercalcemia c. Hypokalemia d. Cellular dehydration
C Insulin is a potent anabolic hormone that produces hypoglycemia and augments the transport of potassium into the cells. With potassium driven into the cells, serum potassium may decrease, resulting in hypokalemia.
A patient weighs 140 kg and is 60 inches tall. The patient's blood sugar is being controlled by glipizide. Which topic would be important for the nurse to include in the patient's discharge education plan? a. Signs of hyperglycemia b. Proper injection technique c. Weight loss d. Increased caloric intake
C This patient weighs 308 lb and is 5 feet tall. Diet management and exercise are interventions to facilitate weight loss in patients with type 2 diabetes.
The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which statement best describes the rationale for administrating potassium supplements with the patient's insulin therapy? a. Potassium replaces losses incurred with diuresis. b. The patient has been in a long-term malnourished state. c. Intravenous (IV) potassium renders the infused solution isotonic. d. Insu
D Low serum potassium (hypokalemia) occurs as insulin promotes the return of potassium into the cell and metabolic acidosis is reversed. Replacement of potassium by administration of potassium chloride (KCl) begins as soon as the serum potassium falls below normal. Frequent verification of the serum potassium concentration is required for patients with diabetic ketoacidosis (DKA) who are receiving fluid resuscitation and insulin therapy.
The nurse is caring for a patient with a traumatic brain injury. The nurse suspects the patient is developing diabetes insipidus. Which test or procedure would confirm this diagnosis? a. Skull radiographs b. Serum glucose level c. Water deprivation test d. Antidiuretic hormone (ADH) stimulation test
D Serum antidiuretic hormone (ADH) levels are compared with the blood and urine osmolality to differentiate syndrome of inappropriate antidiuretic hormone (SIADH) from central diabetes insipidus (DI). Increased ADH levels in the bloodstream compared with a low serum osmolality and elevated urine osmolality confirms the diagnosis of SIADH. Reduced levels of serum ADH in a patient with high serum osmolality, hypernatremia, and reduced urine concentration signal central DI.
The release of hormones by the pituitary gland is under the control which part of the brain? a. Cerebellum b. Occipital lobe c. Temporal lobe d. Hypothalamus
D The pituitary gland communicates with the hypothalamus by means of a vascular network.
The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes. The nurse notes that the patient is extremely dehydrated. To make this assessment, what did the nurse evaluate? a. Skin turgor b. Nail bed color c. Capillary refill d. Skin temperature
A A hydration assessment includes observations of skin integrity, skin turgor, and buccal membrane moisture. Moist, shiny buccal membranes indicate satisfactory fluid balance. Skin turgor that is resilient and returns to its original position in less than 3 seconds after being pinched or lifted indicates adequate skin elasticity. Skin over the forehead, clavicle, and sternum is the most reliable for testing tissue turgor because it is less affected by aging and thus more easily assessed for changes related to fluid balance.
What hormone do the alpha cells of the pancreas secrete? a. Glucagon b. Insulin c. Somatostatin d. Pancreatic polypeptide hormone
A Alpha cells secrete glucagon; beta cells secrete insulin; delta cells secrete somatostatin, and pancreatic polypeptide cells secrete pancreatic polypeptide hormone.
A patient with thyrotoxicosis has been admitted. What effect of increased T3 and T4 levels might the nurse expect to see in this patient? a. Increased oxygen consumption b. Decreased basal metabolic rate c. Decreased cardiac output d. Increased calcium levels
A Both thyroid hormones impact the rate at which oxygen is used in the body and thus affect all metabolic processes in the body.
Decreased insulin and increased glucagon result in what physiologic process? a. Increased glycogenolysis b. Decreased fat mobilization c. Decreased ketosis d. Increased glycogen storage
A Decreased insulin and increased glucagon result in increased glycogenolysis.
A patient is admitted with diabetic ketoacidosis (DKA). The nurse knows that the dehydration associated with DKA results from which pathophysiologic mechanism? a. Increased serum osmolality and urea b. Decreased serum osmolality and hyperglycemia c. Ketones and potassium shifts d. Acute renal failure
A Hyperglycemia increases the plasma osmolality, and the blood becomes hyperosmolar. Cellular dehydration occurs as the hyperosmolar extracellular fluid draws the more dilute intracellular and interstitial fluid into the vascular space in an attempt to return the plasma osmolality to normal.
A patient has been admitted who is suspected of having thyrotoxicosis. Which laboratory findings would confirm this diagnosis? a. Very low thyroid-stimulating hormone (TSH) b. Decreased T3 uptake ratio c. Increased serum osmolality d. Decreased urine osmolality
A Hyperthyroidism (thyrotoxicosis) is indicated by very low thyroid-stimulating hormone level, high serum T4, and an increased T3:T4 ratio.
A patient is presenting with signs of diabetes insipidus (DI). Which findings would confirm this diagnosis? a. Hyperosmolality and hypernatremia b. Hyperosmolality and hyponatremia c. Hypoosmolality and hypernatremia d. Hypoosmolality and hyponatremia
A In central diabetes insipidus (DI), there is an inability to secrete an adequate amount of antidiuretic hormone (arginine vasopressin) in response to an osmotic or nonosmotic stimuli, resulting in inappropriately dilute urine. Hypernatremia is usually associated with serum hyperosmolality.
A patient presents with ketoacidosis and a blood glucose level of 125 mg/dL. Diabetic ketoacidosis has been ruled out. The nurse knows that ketoacidosis can occur in which condition? a. Acute pancreatitis b. Drug overdose c. Hyperglycemic hyperosmolar state d. Hyperaldosteronism
A Ketoacidosis also occurs with acute pancreatitis, starvation, and alcoholic ketoacidosis.
The nurse is developing a discharge education plan for a patient with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Which topic should be included in the plan? a. Measuring intake and output b. Encouraging fluids c. A low-sodium diet d. Hypothermia management
A Patient and family education about syndrome of inappropriate secretion of antidiuretic hormone (SIADH), its effect on water balance, and the reasons for fluid restrictions using the teach back method should include how to measure intake and output.
The nurse is caring for a patient with a head injury who has developed diabetes insipidus (DI). What medication would the nurse expect to be prescribed for the patient? a. Vasopressin b. Insulin c. Glucagon d. Propylthiouracil
A Patients with central diabetes insipidus (DI) who are unable to synthesize antidiuretic hormone (ADH) require replacement ADH (vasopressin) or an ADH analog. The most commonly prescribed drug is the synthetic analog of ADH, desmopressin (DDAVP). DDAVP can be given intravenously, subcutaneously, or as a nasal spray. A typical DDAVP dose is 1 to 2 mcg intravenously or subcutaneously every 12 hours.
A patient is admitted with diabetic ketoacidosis (DKA). The patient presents with dry, cracked lips and is begging for something to drink. What reply would be the nurse's best response? a. "We can't give you anything to drink until we get your blood sugar under control." b. "You can have one cup of coffee without sugar." c. "You can drink anything you want as long as it's sugar free." d. "You can drink as much water has you can handle."
A Patients with diabetic ketoacidosis (DKA) are kept on NPO status (nothing by mouth) until the hyperglycemia is under control.
A patient has been admitted with diabetic ketoacidosis, and treatment has been initiated. Which findings would lead the nurse to suspect the patient is dehydrated? a. Poor skin turgor and flat neck veins b. Dyspnea and crackles c. Presence of Chvostek and Trousseau signs d. Extra heart sounds and 3+ edema
A Poor skin turgor and flat neck veins are indicative of dehydration. Dyspnea, crackles, extra heart sounds, and 3+ edema are signs of fluid overload. Chvostek and Trousseau signs are indicative of hypocalcemia.
The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which medical intervention would the nurse expect to be ordered for this patient? a. Extensive hydration b. Oral hypoglycemic agents c. Large doses of intravenous (IV) insulin d. Limiting food and fluids
A Rapid IV fluid replacement requires the use of a volumetric pump. Insulin is administered intravenously to patients who are severely dehydrated or have poor peripheral perfusion to ensure effective absorption. Patients with diabetic ketoacidosis (DKA) are kept on NPO (nothing by mouth) status until the hyperglycemia is under control. Critical care nurses are responsible for monitoring the rate of plasma glucose decline in response to insulin.
A patient has been diagnosed with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse would expect the first line treatment to include which intervention? a. Fluid restriction b. Hypotonic intravenous fluid administration c. Administration of D5W d. Administration of vasopressin
A Reduction in fluid intake is one component of the treatment plan for syndrome of inappropriate secretion of antidiuretic hormone (SIADH).
As a patient with diabetic ketoacidosis (DKA) receives insulin and fluids, the nurse knows careful assessment must be given to which electrolyte? a. Potassium b. Sodium c. Phosphorus d. Calcium
A Replacement of potassium by administration of potassium chloride (KCl) begins as soon as the serum potassium falls below normal. Frequent verification of the serum potassium concentration is required for the patient with diabetic ketoacidosis receiving fluid resuscitation and insulin therapy.
A patient is being evaluated for thyroid dysfunction. The patient's medications include aspirin, digoxin, chlorothiazide, and insulin. The nurse knows that the laboratory work may be affected by which of these medications? a. Aspirin b. Digoxin c. Insulin d. Chlorothiazide
A Several drugs increase the serum level of T4 by displacing protein-bound T4. Drugs that displace T4, including heparin (both unfractionated and low-molecular-weight heparins), cause an increase in serum T4 levels. Salicylates (aspirin) and furosemide (Lasix) also raise T4 serum levels by the same mechanism.
A patient is diagnosed with a pheochromocytoma. What signs or symptoms might the nurse expect to see in this patient? a. Hypertension and tachycardia b. Weight gain and acne c. Diarrhea and facial swelling d. Blurred vision and poor skin turgor
A Signs and symptoms of pheochromocytoma include hypertension and tachycardia. Weight gain and acne are signs of Cushing syndrome. Diarrhea and facial swelling are signs of hyperthyroidism. Blurred vision and poor skin turgor are signs of hyperglycemia.
A patient was admitted with asthma who has been on steroids for a long time. The nurse knows that this patient is at risk of developing secondary Cushing syndrome. What would be the cause of this condition? a. Pharmacologic glucocorticoids b. Pharmacologic mineralocorticoids c. Cortisol d. Aldosterone
A Symptoms identical to those of primary Cushing syndrome occur in patients with the secondary form who chronically take pharmacologic doses of glucocorticoids, for example, transplant recipients who take steroids to prevent solid organ rejection, patients with chronic obstructive pulmonary disease, or those with chronic inflammatory conditions. Cortisol and aldosterone are hormones released by the adrenal gland.
A patient is admitted with diabetic ketoacidosis. The nurse requests the practitioner order a glycosylated hemoglobin (HbA1C). What information does this test provide to the health care team? a. It is an indicator of the patient's average blood glucose level over the previous 3 to 4 months. b. It compares blood glucose levels with serum hemoglobin over the previous 3 to 4 weeks. c. It is an indicator of the patient's highest blood ketone level over the past month. d. It associates the serum and
A The glycated hemoglobin test (also known as the glycosylated hemoglobin, or HbA1C or A1C) provides information about the average amount of glucose that has been present in the patient's bloodstream over the previous 3 to 4 months. During the 120-day life span of red blood cells (erythrocytes), the hemoglobin within each cell binds to the available blood glucose through a process known as glycosylation.
The nurse has admitted a patient with hyperglycemic hyperosmolar state (HHS). Which medical intervention would the nurse expect to see ordered for this patient? a. Rapid rehydration with intravenous fluids b. Insertion of a pulmonary artery catheter c. Administration of high-dose intravenous insulin d. Hourly monitoring of urine glucose and ketone levels
A The goals of medical management are rapid rehydration, insulin replacement, and correction of electrolyte abnormalities, specifically potassium replacement. The underlying stimulus of the hyperglycemic hyperosmolar state (HHS) must be discovered and treated. The same basic principles used to treat patients with diabetic ketoacidosis are used for patients with HHS.
A patient is being treated for hypothyroidism. The nurse knows that this disorder can affect a variety of physiologic processes. What are the major functions of the thyroid hormones? (Select all that apply.) a. Increase the rate of glucose used by the cells b. Decrease fat metabolism c. Increase the body's demand for vitamins d. Decrease cardiac output e. Stimulate bone resorption f. Increase serum cholesterol levels
A, C, E Major functions of thyroid hormones include interacting with growth hormone, maturation of the skeletal system, development of the central nervous system, stimulating carbohydrate metabolism, increasing the rate of glucose absorption from the gastrointestinal tract, increasing the rate of glucose use by the cells, accelerating the rate of fat metabolism, increasing cholesterol degradation in the liver, decreasing serum cholesterol levels, increasing protein anabolism and catabolism, mobilizing protein and releasing amino acids into circulation, increasing energy from protein nutrients through gluconeogenesis, increasing the body's demand for vitamins, increasing oxygen consumption and use, increasing basal metabolic rate, marked chronotropic and inotropic effects on the heart, increasing cardiac output, stimulating the contractility and excitability of the myocardium, increasing blood volume, expanding respiratory rate and depth necessary for normal hypoxic and hypercapnic driv
A patient has been admitted with a brain tumor. The patient starts to exhibit signs of an increase in antidiuretic hormone (ADH). When large amounts of ADH are released, the nurse should anticipate what change in the patient's sodium levels? a. Increase b. Decrease c. Rapid increase than decrease d. Depends on potassium level
B Antidiuretic hormone (ADH) also contributes to control of the sodium level in the extracellular fluid by control of plasma osmolality. The sodium ion concentration in the plasma largely determines plasma osmolality. Osmoreceptors, located in the hypothalamus, are sensitive to changes in the circulating plasma osmolality. Because ADH causes the patient to retain free water, the patient will have a dilutional hyponatremia
A patient has been admitted with uncontrolled atrial fibrillation and muscle wasting. The practitioner suspects the patient may have a thyroid disorder. The nurse auscultates a bruit over the thyroid. What does this finding indicate? a. Normal function b. Enlargement of the thyroid c. Hypoplasia of the thyroid d. Tumor of the thyroid
B Auscultation of the thyroid is accomplished by use of the bell portion of the stethoscope to identify a bruit or blowing noise from the circulation through the thyroid gland. The presence of a bruit indicates enlargement of the thyroid as evidenced by increased blood flow through the glandular tissue.
The nurse is caring for a patient with a traumatic brain injury. Yesterday the patient weighed 62 kg and today the patient weighs 60 kg. How much fluid loss does this change in weight reflect? a. 1 L b. 2 L c. 4 L d. 10 L
B Daily weight changes coincide with fluid retention and fluid loss. 1 L of fluid lost or retained is equal to approximately 2.2 lb, or 1 kg, of weight gained or lost. This patient lost 2 kg of weight, which is equivalent to 2 L of fluid.
The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which symptom is most suggestive of DKA? a. Irritability b. Excessive thirst c. Rapid weight gain d. Peripheral edema
B Diabetic ketoacidosis (DKA) has a predictable clinical presentation. It is usually preceded by patient complaints of malaise, headache, polyuria (excessive urination), polydipsia (excessive thirst), and polyphagia (excessive hunger). Nausea, vomiting, extreme fatigue, dehydration, and weight loss follow. Central nervous system depression, with changes in the level of consciousness, can lead quickly to coma.
A patient has been admitted with uncontrolled atrial fibrillation and muscle wasting. The practitioner suspects the patient may have a thyroid disorder. The nurse anticipates the practitioner will initially order which diagnostic procedure to visualize the thyroid? a. Magnetic resonance imaging (MRI) b. Ultrasound c. Biopsy d. Computed tomography (CT)
B Diagnostic tests often begin with ultrasonography to visualize a thyroid nodule or tumor.
A patient is receiving total parenteral nutrition (TPN). During rounds the dietitian states that she believes the patient is getting too much glucose. Identify one area in which excess glucose is stored as glycogen. a. Pancreas b. Hepatic cells c. Gallbladder d. Stomach
B Excess glucose in the form of glycogen is stored in the hepatic and muscle cells for use as fuel at a later time.
The patient has been admitted from a skilled nursing facility with urinary sepsis. The patient has severe muscle wasting. What is the process by which fat and protein are converted to glucose for fuel? a. Glycogenolysis b. Gluconeogenesis c. Digestion d. Biotransformation
B For long-term energy needs, glucagon stimulates glucose release through the more complex process of gluconeogenesis. In gluconeogenesis, fat and protein nutrients are rapidly broken down into end products that are then changed into glucose.
When a patient with diabetic ketoacidosis (DKA) has insulin infusing intravenously, the nurse expects a drop in the serum levels of which electrolytes? a. Sodium and potassium b. Potassium and phosphate c. Bicarbonate and calcium d. Sodium and phosphate
B Frequent verification of the serum potassium concentration is required for patients with DKA receiving fluid resuscitation and insulin therapy. The serum phosphate level is sometimes low (hypophosphatemia) in DKA. Insulin treatment may make this more obvious as phosphate is returned to the interior of the cell. If the serum phosphate level is less than 1 mg/dL, phosphate replacement is recommended.
A patient has been admitted post thyroidectomy. The nurse knows that adequate thyroid function is dependent on which factor? a. Basal metabolic rate b. Dietary intake of iodine c. Colloid osmotic pressure d. Sodium levels in the blood
B Functioning of the thyroid gland depends on many factors that respond to a delicate hormonal interplay; the hypothalamus, anterior pituitary, dietary intake of iodine, and circulating protein bodies in the blood all affect thyroid gland function.
A patient with diabetic ketoacidosis (DKA) has an insulin drip infusing, and the nurse has just administered subcutaneous insulin. The nurse is alert for signs of hypoglycemia, which would include what findings? a. Kussmaul respirations and flushed skin b. Irritability and paresthesia c. Abdominal cramps and nausea d. Hypotension and itching
B Irritability and paresthesia are seen in hypoglycemia.
A patient is admitted with severe hyperglycemia due to new-onset type 1 diabetes mellitus. The nurse notes a sweet-smelling odor on the patient's exhaled breath. What causes this phenomenon? a. Metabolic alkalosis b. Ketoacidosis c. Glycosylation d. Dehydration
B Ketoacidosis results in the patient's breathing becoming deep and rapid (Kussmaul respirations) and the patient's breath having a fruity odor. Metabolic alkalosis and dehydration do not cause this phenomenon. Glycosylation is when the hemoglobin within each cell binds to the available blood glucose.
Which pathophysiologic mechanism occurs in the syndrome of inappropriate antidiuretic hormone (SIADH)? a. Massive diuresis, leading to hemoconcentration b. Dilutional hyponatremia, reducing sodium concentration to critically low levels c. Hypokalemia from massive diuresis d. Serum osmolality greater than 350 mOsm/kg
B Patients with the syndrome of inappropriate antidiuretic hormone (SIADH) have an excess of antidiuretic hormone secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia.
A patient is admitted with diabetic ketoacidosis (DKA) and is experiencing polyuria. Which electrolyte disturbances would the nurse expect to see at this phase of DKA? a. Decreased calcium and increased phosphorus levels b. Decreased potassium and sodium levels. c. Increased sodium and decreased phosphorus levels d. Decreased calcium and potassium levels.
B Polyuria results in large volumes of water, along with sodium, potassium, and phosphorus, being excreted in the urine, causing a fluid volume deficit.
A patient has been diagnosed with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse is administering hypertonic saline. The nurse knows that the serum sodium should not be raised more than how many milliequivalents per day? a. 5 mEq/day b. 10 mEq/day c. 20 mEq/day d. 25 mEq/day
B Serum sodium levels must be evaluated at least every 4 hours during the acute phase of sodium replacement. The serum sodium should not be raised more than 10 mEq/L in 24 hours.
What hormone does the adrenal cortex secrete to maintain homeostasis? a. Androgens b. Aldosterone c. Adrenocorticotrophic hormone (ACTH) d. Corticosteroid
B The adrenal cortex secretes cortisol. It regulates fluid homeostasis by means of aldosterone, and it secretes androgens.
A patient is admitted post arrest from sudden cardiac death. According the code record the patient received a total of 6 mg of epinephrine. The nurse knows that epinephrine and norepinephrine are also secreted by which organ? a. Adrenal cortex b. Adrenal medulla c. Anterior pituitary d. Posterior pituitary
B The adrenal medulla (inner region) secretes two important catecholamines: epinephrine, also known as adrenaline, and norepinephrine, also known as noradrenaline.
The nurse has admitted a patient with hyperglycemic hyperosmolar state (HHS). Which findings would the nurse expect to observe in this patient? a. Hyperglycemia with low serum osmolality b. Severe hyperglycemia with minimal or absent ketosis c. Little or no ketosis in serum with rapidly escalating ketonuria d. Hyperglycemia and ketosis
B The hallmarks of HHS are extremely high levels of plasma glucose with resulting elevations in serum hyperosmolality and osmotic diuresis. The disorder occurs mainly in patients with type 2 diabetes.
A patient is admitted with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse understands that the hyponatremia associated with this disorder is the result of which mechanism? a. Increased cortisol release b. Excessive water reabsorption c. Excessive sodium excretion d. Decreased glucagon release
B The patient with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) has an excess of ADH secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia.
An older patient presents with a serum glucose level of 900 mg/dL, hematocrit of 55%, and no serum ketones. Immediate attention must be given to which intervention? a. Evaluating clotting factors b. Fluid administration c. Insulin administration d. Sodium replacement
B The physical examination may reveal a profound fluid deficit. Signs of severe dehydration include longitudinal wrinkles in the tongue, decreased salivation, and decreased central venous pressure, with increases in heart rate and rapid respirations (Kussmaul air hunger does not occur). In older patients, assessment of clinical signs of dehydration is challenging.
A patient is admitted with hyponatremia. The practitioner suspects the patient may have syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and orders a serum ADH level for the next morning. Which medications must be stopped or withheld at least 8 hours prior to the test? a. Insulin and furosemide b. Morphine and carbamazepine c. Digoxin and potassium d. Heparin and lopressor
B To prepare the patient for the test, all drugs that may alter the release of antidiuretic hormone (ADH) are withheld for a minimum of 8 hours. Common medications that affect ADH levels include morphine sulfate, lithium carbonate, chlorothiazide, carbamazepine, oxytocin, nicotine, alcohol, and selective serotonin reuptake inhibitors.
Which pathophysiologic mechanism occurs in the patient with type 2 diabetes? a. Lack of insulin production b. Imbalance between insulin production and use c. Overproduction of glucose d. Increased uptake of glucose in the cells
B Type 2 diabetes results from a progressive insulin secretory defect in addition to insulin resistance.
When the brain perceives a stressful or threatening situation, the hypothalamus releases ________________________, which causes the anterior pituitary to release______________. a. cortisol; androgens b. corticotropin-releasing hormone; adrenocorticotrophic hormone (ACTH) c. ACTH; glucocorticoid hormone d. ACTH; epinephrine
B When the brain perceives a stressful or threatening situation, the hypothalamus releases corticotropin-releasing hormone, which acts on the anterior pituitary to release adrenocorticotrophic hormone, which circulates in the bloodstream to reach the adrenal cortex and stimulate glucocorticoid hormone release.
A patient with bronchogenic oat cell carcinoma has a drop in urine output. The laboratory reports a serum sodium level of 120 mEq/L, a serum osmolality level of 220 mOsm/kg, and urine specific gravity of 1.035. The nurse suspects the patient may be developing what problem? a. Diabetes ketoacidosis (DKA) b. Diabetes insipidus (DI) c. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) d. Hyperaldosteronism
C A decreased urine output, hyponatremia, hypoosmolality, and high urine specific gravity are classic signs of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Oat cell carcinoma is a precipitating factor for SIADH.
A nurse is caring for a patient who is having difficulty maintaining a normal blood sugar level. In the healthy body, how is a normal blood glucose level is maintained? a. Insulin secretion b. Cellular metabolism c. Insulin-to-glucagon ratio d. Insulin-to-thyroxine ratio
C A normal blood glucose level is maintained by the insulin-to-glucagon ratio. When the blood glucose level is high, insulin is released and glucagon is inhibited. When blood glucose levels are low, glucagon rather than insulin is released.
A patient in diabetic ketoacidosis (DKA) is comatose with a temperature of 102.2° F. The nurse suspects the patient may have which secondary disorder? a. Head injury b. Hypothalamus infarction c. Infection d. Heat stroke
C A patient in diabetic ketoacidosis can experience a variety of complications, including fluid volume overload, hypoglycemia, hypokalemia or hyperkalemia, hyponatremia, cerebral edema, and infection.
Patients who have sustained head trauma or have undergone resection of a pituitary tumor have an increased risk of developing which disorder? a. Type 1 diabetes b. Thyrotoxicosis c. Diabetes insipidus d. Myxedema coma
C Any patient who has head trauma or resection of a pituitary tumor has an increased risk of developing diabetes insipidus.
A patient has been admitted with multiple trauma due to a motor vehicle accident several weeks ago. Given the prolonged critical illness, the nurse knows the patient may no longer secrete adequate amounts of what hormone? a. Aldosterone b. Adrenocorticotropic hormone (ACTH) c. Cortisol d. Antidiuretic hormone (ADH)
C Cortisol is secreted in response to physiologic stress as a result of infection, trauma, and hypoglycemia. Early in critical illness, a rise in cortisol levels can be documented. However, over time the adrenal gland may not be able to secrete adequate amounts of stress hormones, especially when critical illness is prolonged. Aldosterone is secreted in response to intravascular hypovolemia.
Glucagon release is stimulated by which physiologic factor? a. Increases in circulating insulin b. Decreases in blood amino acids c. Stimulation of the sympathetic nervous system d. High blood glucose levels
C Glucagon release from the pancreas is stimulated by low blood glucose levels, starvation, exercise, or stimulation of the sympathetic nervous system.
A patient with thyrotoxicosis has been admitted. The nurse knows that when levels of T3 and T4 are elevated, the pituitary gland inhibits what hormone? a. Thyroglobulin b. Thyroid-releasing hormone (TRH) c. Thyroid-stimulating hormone (TSH) d. Calcitonin
C In response to decreased circulating levels of T3 and T4, the hypothalamus releases thyroid-releasing hormone (TRH). TRH activates thyroid-stimulating hormone (TSH) in the anterior pituitary, and TSH stimulates the thyroid gland to manufacture and release the thyroid hormones T3 and T4 in the presence of iodine.
The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes. Which laboratory results would the nurse note confirming this diagnosis? a. Hemoglobin A1C of 3% b. Absence of ketones in the urine c. Presence of ketones in the blood d. Fasting glucose of 105 mg/dL
C Ketone bodies are a byproduct of rapid fat breakdown. Ketone blood levels rise in acute illness, fasting, and with sustained elevation of blood glucose in type 1 diabetes in the absence of insulin. The patient would also have ketones in the urine, a hemoglobin A1C greater than 6%, and a fasting glucose greater than 125 mg/dL.
The nurse is caring for a critically ill patient with type 1 diabetes. The nurse understands that the patient is at risk for developing diabetic ketoacidosis (DKA) secondary to what etiology? a. Excess insulin administration b. Inadequate food intake c. Physiologic and psychologic stress d. Increased release of antidiuretic hormone (ADH)
C Major neurologic and endocrine changes occur when an individual is confronted with physiologic stress caused by any critical illness, sepsis, trauma, major surgery, or underlying cardiovascular disease.
The nursing management plan for a patient with thyrotoxicosis would include which intervention? a. Providing diversional stimuli b. Restricting fluids c. Maintaining a quiet, restful environment d. Administering thyroid supplements at the same time each day
C Patients in thyroid storm are agitated, anxious, and unable to rest, and they benefit from an environment that is calm. Gradually, the effects of the antithyroid medications, iodides, and -adrenergic blocking drugs will decrease the neurologic symptoms related to the catecholamine sensitivity. Frequent reassurance and clear, simple explanations of the patient's condition help decrease the fear brought on by the onset thyroid storm
A patient is admitted with a long history of mental illness. The patient's spouse states the patient has been drinking up to 10 gallons of water each day for the past 2 days and refuses to eat. The patient is severely dehydrated and soaked with urine. The nurse suspects the patient has which problem? a. Central diabetes insipidus (DI) b. Nephrogenic DI c. Dipsogenic DI d. Iatrogenic DI
C Psychogenic diabetes insipidus (DI) is a rare form of the disease that occurs with compulsive drinking of more than 5 L of water a day. Long-standing psychogenic DI closely mimics nephrogenic DI because the kidney tubules become less responsive to antidiuretic hormone as a result of prolonged conditioning to hypotonic urine.
A patient is admitted with diabetic ketoacidosis (DKA). The patient's arterial blood gas indicates the patient has an uncompensated metabolic acidosis. The patient has rapid, regular respirations. Which medical intervention would the nurse expect to initiate to correct the acidosis? a. Initiate oxygen therapy via a face mask. b. Administer sodium bicarbonate. c. Administer insulin and fluids intravenously. d. Prepare for intubation.
C Replacement of fluid volume and insulin interrupts the ketotic cycle and reverses the metabolic acidosis. In the presence of insulin, glucose enters the cells, and the body ceases to convert fats into glucose.
A nurse is initiating a patient teaching plan for a patient with hypothyroidism. The patient is currently taking salicylates, lithium, and sulfonamides. It is important that the nurse tell the patient that these medications influence thyroid levels. How are thyroid levels affected by these medications? a. They increase T3 b. They increasing T4 c. They decrease T3 d. They decrease T4
C Salicylates, lithium, and sulfonamides can cause a decrease in T3 levels.
Which statement best describes the effects of somatostatin? a. It stimulates the release of antidiuretic hormone and oxytocin. b. It suppresses the release of pancreatic polypeptide. c. It inhibits the release of insulin and glucagon. d. It inhibits the release of thyroid-stimulating hormone and thyroid hormone.
C Somatostatin decreases glucagon secretion, and in high quantities, it decreases insulin release. Hyperglycemia stimulates the activity of the delta cells. It is theorized that the release of insulin enables somatostatin to control beta-cell activity. Somatostatin may be involved in the regulation of the postprandial influx of glucose into cells.
A patient has been admitted after surgery for removal of a brain tumor. The nurse suspects the patient may be developing diabetes insipidus (DI). Which findings would confirm the nurse's suspicion? a. Hyperglycemia and hyperosmolarity b. Hyperglycemia and peripheral edema c. Intense thirst and passage of excessively large quantities of dilute urine d. Peripheral edema and pulmonary crackles
C The clinical diagnosis is made by the dramatic increase in dilute urine output in the absence of diuretics, a fluid challenge, or hyperglycemia. Characteristics of DI are intense thirst and the passage of excessively large quantities of very dilute urine.
Through what mechanism does the endocrine system help maintain equilibrium? a. Control of smooth muscle b. Control of skeletal muscle c. Hormones d. Neuronal control
C The endocrine system controls and communicates by distributing potent hormones throughout the body.
A patient with hyperglycemic hyperosmolar state (HHS) has a serum glucose level of 400 mg/dL and a serum sodium level of 138 mEq/L. What is the intravenous fluid of choice? a. D5W c. 0.9% NS b. 0.45% NS d. D5/NS
C The fluid deficit may be as much as 150 mL/kg of body weight. The average 150-lb adult can lose more than 7 to 10 L of fluid. Physiologic saline solution (0.9%) is infused at 1 L/h, especially for patients in hypovolemic shock if there is no cardiovascular contraindication. Several liters of volume replacement may be required to achieve a blood pressure and central venous pressure within normal range. Infusion volumes are adjusted according to the patient's hydration state and sodium level.
Which nursing intervention should be initiated on all patients with the syndrome of inappropriate antidiuretic hormone (SIADH)? a. Placing the patient on an air mattress b. Forcing fluids c. Initiating seizure precautions d. Applying soft restraints
C The patient with the syndrome of inappropriate antidiuretic hormone (SIADH) has an excess of ADH secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia. Symptoms of severe hyponatremia include an inability to concentrate, mental confusion, apprehension, seizures, a decreased level of consciousness, coma, and death.
The nurse understands that the onset of seizures in the patient with diabetes insipidus (DI) is indicative of which situation? a. Increased potassium levels b. Hyperosmolality c. Severe dehydration d. Toxic ammonia levels
C This excessive intake of water reduces the serum osmolality to a more normal level and prevents dehydration. In the person with a decreased level of consciousness, the polyuria leads to severe hypernatremia, dehydration, decreased cerebral perfusion, seizures, loss of consciousness, and death.
A patient is admitted with hypernatremia secondary to neurogenic diabetes insipidus. The nurse notes that the patient's serum osmolality is 350 mOsm/kg. What does this finding indicate? a. The patient is overhydrated. b. The patient's serum osmolality is normal. c. The patient is dehydrated. d. The patient is hypothyroid.
C Values for serum osmolality in the bloodstream range from 275 to 295 mOsm/kg H2O. Increased serum osmolality stimulates the release of antidiuretic hormone, which in turn reduces the amount of water lost through the kidney.
A patient reports losing weight even though she eats "everything in sight." She also reports tremors and diarrhea. The nurse suspects the patient may have what problem? a. Hypothyroidism b. Diabetes mellitus c. Hyperthyroidism d. Pituitary tumor
C Weight loss, increased appetite, tremors, insomnia, and diarrhea are symptoms of hyperthyroidism.
The nurse knows that during the resuscitation of a patient with diabetic ketoacidosis (DKA), the intravenous (IV) line should be changed to a Patient becomes more alert b. IV insulin has been infusing for 4 hours c. Blood glucose drops to 200 mg/dL d. Blood glucose drops to 100 mg/dL
C When the serum glucose level decreases to 200 mg/dL, the infusing solution is changed to a 50/50 mix of hypotonic saline and 5% dextrose. Dextrose is added to replenish depleted cellular glucose as the circulating serum glucose level falls.
A patient is admitted with critical hypotension, hyperkalemia, hyponatremia, and hypoglycemia. The nurse knows that these symptoms are highly suggestive of which disorder? a. Myxedema b. Diabetes insipidus c. Addisonian crisis d. Cushing syndrome
C disonian crisis is a life-threatening condition in which the adrenal gland is almost nonfunctional, usually because of destruction of adrenal tissue. The patient presents acutely with critical hypotension, an elevated serum potassium level (hyperkalemia), a low serum sodium level (hyponatremia), and hypoglycemia.
The nurse is caring for a patient with diabetes insipidus, which is the result of a decrease in antidiuretic hormone (ADH). Which statements regarding the stimulation or inhibition of ADH are accurate? (Select all that apply.) a. Infection stimulates the release of ADH. b. Cold stimulates the release of ADH. c. Emesis stimulates the release of ADH. d. Opioids inhibit the release of ADH. e. Hemorrhage inhibits the release of ADH. f. Pain inhibits the release of ADH.
C, D Emesis, hemorrhage, and pain stimulate the release of antidiuretic hormone (ADH). Cold and opioids inhibit the release of ADH. Infection does not directly affect the release of ADH.
Which medication can place a patient at risk for developing syndrome of inappropriate secretion of antidiuretic hormone (SIADH)? a. Adenosine b. Diltiazem c. Heparin sodium d. Acetaminophen
D Acetaminophen increases the release of antidiuretic hormone.
A patient is admitted with severe hyperglycemia. The patient is very lethargic and has a "fruity" odor to his breath. The nurse knows the odor on the patient's breath is indicative of which situation? a. Alcohol intoxication b. Lack of sodium bicarbonate c. Hypokalemia d. Presence of acetone
D Acid ketones dissociate and yield hydrogen ions (H+) that accumulate and precipitate a decrease in serum pH. The level of serum bicarbonate also decreases, consistent with a diagnosis of metabolic acidosis. Breathing becomes deep and rapid (Kussmaul respirations) to release carbonic acid in the form of carbon dioxide. Acetone is exhaled, giving the breath its characteristic "fruity" odor.
A patient with a history of type 2 diabetes was admitted after aneurysm repair. The patient's serum glucose levels have been elevated for the past 2 days, and the patient is concerned about becoming dependent on insulin. Which statement is the nurse's best response to the patient's concerns? a. "This surgery may have damaged your pancreas. We will have to do more evaluation." b. "Perhaps your diabetes was more serious from the beginning." c. "You will need to discuss this with your physician." d
D Adrenal hormones released during stress elevate blood sugar by increasing insulin resistance and increasing hepatic gluconeogenesis.
A patient has been admitted after a craniotomy. The patient starts to exhibit changes in the level of antidiuretic hormone (ADH). The nurse knows that ADH works primarily affects which organ? a. Liver b. Pancreas c. Stomach d. Kidneys
D Antidiuretic hormone has two functions: (1) By means of the V1 receptors, it constricts smooth muscles within the arterial wall, and (2) through V2 receptors, it regulates fluid balance by altering the permeability of the kidney tubule to water.
A patient is reporting a headache, fatigue, abdominal pain, and blurred vision. The nurse knows that these signs may indicate the patient has what problem? a. Hypothyroidism b. Pituitary tumor c. Cushing syndrome d. Hyperglycemia
D Because severe hyperglycemia affects a variety of body systems, all systems are assessed. The patient may complain of blurred vision, headache, weakness, fatigue, drowsiness, anorexia, nausea, and abdominal pain.
A patient is admitted with multiple trauma. Which hormone would the nurse expect to be increased in response to physiologic stress? a. Mineralocorticoid b. Corticosteroid c. Glucocorticoid d. Cortisol
D Cortisol is released in response to physiologic stress caused by infection, trauma, and the fasting state.
A patient was admitted with diabetic ketoacidosis (DKA) an hour ago and is on an insulin drip. Suddenly, the nurse notices frequent premature ventricular contractions (PVCs) on the electrocardiogram. The nurse notifies the practitioner. The nurse would anticipate an order for which intervention? a. A lidocaine bolus b. Stopping the insulin drip c. Synchronizing cardioversion d. Obtaining serum electrolytes
D Hypokalemia can occur within the first hours of rehydration and insulin treatment. Continuous cardiac monitoring is required, because low serum potassium (hypokalemia) can cause ventricular dysrhythmias.
A patient is being evaluated for thyroid dysfunction. The laboratory findings include a decreased serum free thyroxine (T4) level and an elevated thyroid-stimulating hormone (TSH) level. These findings confirm which diagnosis? a. Cushing syndrome b. Addison disease c. Thyrotoxicosis d. Hypothyroidism
D Hypothyroidism is indicated by a high thyroid-stimulating hormone (TSH) and low serum T4 levels. Thyrotoxicosis is hyperthyroidism and is indicated by very low TSH, high serum T4, and increased T3:T4 ratio. Addison disease is a rare disorder of the adrenal cortex that involves hyposecretion of glucocorticoids (cortisol), sometimes occurring with hyposecretion of mineralocorticoids (aldosterone). Cushing syndrome is caused by the excess release of the glucocorticoid hormone cortisol.
A patient is admitted with hypernatremia secondary to diabetes insipidus (DI). The practitioner suspects the patient has neurogenic DI. Which finding would confirm that diagnosis? a. A slight increase in urine osmolality b. A decrease in urine output c. A decrease in serum osmolality d. No change in urine osmolality
D In cases of severe central diabetes insipidus (DI)d the urine osmolality shows a significant increase (becomes more concentrated). Test results in which urine osmolality remains unchanged indicate nephrogenic DI.
A patient with type 2 diabetes is admitted. He is very lethargic and hypotensive. A diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is given. Which findings support this diagnosis? a. Decreased serum glucose and increased serum ketones b. Increased urine ketones and decreased serum osmolality c. Increased serum osmolality and increased serum potassium d. Increased serum osmolality and increased serum glucose
D Laboratory findings are used to establish the definitive diagnosis of hyperglycemic hyperosmolar syndrome (HHS). Plasma glucose levels are strikingly elevated (greater than 600 mg/dL). Serum osmolality is greater than 320 mOsm/kg.
A patient has been admitted who is suspected of having thyrotoxicosis. Which symptom would support this diagnosis? a. Lethargy despite adequate sleep b. Bradycardia not related to medications c. Constipation despite laxatives d. Weight loss despite increased appetite
D Signs and symptoms of thyrotoxicosis include tremors, insomnia, increased appetite, diarrhea, muscle weakness or wasting, and a change in menstruation.
A patient is admitted with extreme fatigue, vomiting, and headache. This patient has type 1 diabetes that has been well controlled with an insulin pump. The patient states, "I know it could not be my diabetes because my pump gives me 24-hour control." Which reply would be the nurse's best response? a. "You know a lot about your pump, and you are correct." b. "You're right. This is probably a virus." c. "We'll get an abdominal CT and see if your pancreas is inflamed." d. "We'll check your serum b
D Subcutaneous insulin pumps can malfunction. It is critical to assess glucose and ketone levels to evaluate for diabetic ketoacidosis.
A patient is admitted with hypernatremia secondary to diabetes insipidus (DI). Which test would help the practitioner differentiate between central and nephrogenic DI? a. Water deprivation test b. Serum osmolality c. Serum antidiuretic hormone level d. Antidiuretic hormone (ADH) test
D The antidiuretic hormone test is used to differentiate between neurogenic diabetes insipidus (DI) (central) and nephrogenic (kidney) DI. In severe central DI, in which the pituitary is affected, the urine osmolality shows a significant increase (becomes more concentrated), which indicates that the cell receptor sites on the kidney tubules are responsive to vasopressin. Test results in which urine osmolality remains unchanged indicate nephrogenic DI, suggesting kidney dysfunction because the kidneys are no longer responsive to antidiuretic hormone.
A patient is admitted with severe hyperglycemia due to new-onset type 1 diabetes mellitus. Which signs and symptoms obtained as part of the patient's history might indicate the presence of hyperglycemia? a. Recent episodes of tachycardia and missed heart beats b. Decreased urine output accompanied by peripheral edema c. Periods of hyperactivity with weight gain d. Increased thirst and increased urinary output
D The patient or family member may relay information about recent, unexplained changes in weight, thirst, hunger, and urination patterns.
A patient is admitted with diabetic ketoacidosis (DKA). The nurse knows that the lack of insulin results in which process? a. Decreased glucagon release b. Decreased glycogenolysis c. Decreased ketone production d. Increased gluconeogenesis
D The release of glucagon from the liver is stimulated when insulin is ineffective in providing the cells with glucose for energy. Glucagon increases the amount of glucose in the bloodstream by breaking down stored glucose (glycogenolysis). In insulin deficiency states, fat is rapidly converted into glucose (gluconeogenesis). Ketoacidosis occurs when free fatty acids are metabolized into ketones: Acetoacetate, â-hydroxybutyrate, and acetone are the three ketone bodies that are produced.
