Chapter 40 Worksheet Mod 1 NIH III PDF

Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pan- creas Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The nurse is providing information to a patient recently diagnosed with type 1 diabetes mellitus (DM). The...

Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pan- creas Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The nurse is providing information to a patient recently diagnosed with type 1 diabetes mellitus (DM). The patient expresses a desire to understand the disease. Which informa- tion provided by the nurse is accurate? 1. Insulin is released into the gastrointestinal tract to aid in the digestion process. 2. Glucose is carried into cells when glucose transporters are activated in the mem- brane. 3. Diabetes is most frequently caused by the inability of the pancreas to release insulin. 4. Type 1 and type 2 DM are reversible with dietary, weight loss, and exercise programs. ____ 2. The nurse is evaluating the knowledge of a patient recently diagnosed with type 1 DM. Which statement by the patient indicates a need for additional information? 1. “My pancreas may have started to attack itself after a childhood viral infection” 2. “I may be genetically prone since diabetes goes back for several generations.” 3. “I will learn to carefully check my BG since I am prone to ketoacidosis.” 4. “I know that I am obese and can reduce my need for insulin with weight loss.” ____ 3. The nurse is assisting with nutrition teaching for a patient who voices concern over coping with a diabetic diet. Which response by the nurse about medical nutrition therapy is correct? 1. “Your diet will be a well-balanced, individualized meal plan that is healthy for your whole family.” 2. “Sugars and fats need to be avoided, but the dietitian will help you find acceptable alternatives.” 3. “You will require special foods, but stores now stock a variety of choices for people with diabetes.” 4. “The diet stresses high-protein and low-carbohydrate intake, but people adapt to the restrictions.” ____ 4. The nurse is providing care for a marathon runner who is recently diagnosed with DM. Which explanation regarding exercise is best for the nurse to provide? 1. “You will need to avoid regular exercise since it will lower your blood sugar.” 2. “You can still exercise, but running is too strenuous for someone with diabetes.” 3. “You always need to take some emergency glucose with you when you are running.” 4. “Exercise needs to be coordinated with the time your insulin is peaking.” ____ 5. The nurse is reinforcing teaching for a patient who is on four injections of regular insulin daily. About how many hours after each injection of insulin does the nurse teach the patient to be alert for symptoms of hypoglycemia? 1. 1/2 hour 2. 3 hours 3. 8 hours 4. 12 hours ____ 6. The nurse is providing information to a patient recently diagnosed with type 2 DM. The health care provider (HCP) prescribes an oral hypoglycemic medication for BG control. Which information is the best comparison the nurse can give the patient between insulin and an oral hypoglycemic? 1. Oral hypoglycemic agents act as an insulin replacement. 2. Oral hypoglycemic agents stimulate a partially working pancreas. 3. Insulin is used for a type 2 diabetic with a history of ketoacidosis. 4. Insulin is used by a type 2 diabetic to control BG levels. ____ 7. The nurse is providing care for a patient with type 2 DM who has been treated with an oral hypoglycemic agent. The HCP prescribes for the addition of insulin. Which situation does the nurse recognize as being the least valid reason for giving this patient insulin? 1. The patient is unable to effectively follow a diabetic diet. 2. The patient’s pancreas is unable to produce adequate insulin. 3. The amount of insulin is high, but the body cells are resistant. 4. The pancreas has worn out leading to little or no insulin production. ____ 8. A patient is admitted to the hospital with hyperosmolar hyperglycemia. The patient is 40 percent overweight and has a BG value of 987 mg/dL. Which is the priority focus while planning nursing care for this patient? 1. BG level 2. Hydration status 3. Presence of an illness 4. Age-related changes ____ 9. The nurse is collecting data on a new patient in a HCP’s office. Data includes the following: 65-year-old male, abdominal obesity with waist circumference of 42 inches, blood pressure 140/88 mm Hg, and fasting glucose of 120 mg/dL. Which health concerns by the HCP is least expected? 1. Probability of type 2 diabetes 2. Risk of cardiovascular issues 3. Damage to weight bearing joints 4. History of family health issues ____ 10. The nurse is monitoring laboratory BG levels for a patient diagnosed with type 2 DM. Which test result does the nurse use to evaluate the patient’s compliance with treatment?  1. Fasting BG test 2. Random BG testing 3. Oral glucose tolerance test 4. Glycohemoglobin testing ____ 11. A female patient is prescribed glyburide for control of BG. What precaution does the nurse teach the patient about this medication? 1. “Avoid drinking alcohol.” 2. “Do not take it if you skip a meal.” 3. “You will need to use two forms of birth control.” 4. “Be sure it is discontinued before any tests involving contrast dye.” ____ 12. A patient with type 1 diabetes has frequent episodes of hypoglycemia, even with multiple daily BG self-monitoring throughout the day. Which method of self-monitoring does the nurse recognize as being more effective for this patient? 1. The patient needs a pocket-sized glucose monitor. 2. The patient will benefit from continuous monitoring. 3. The patient needs to check for urine ketones regularly. 4. The patient is a good candidate for a therapy pet. ____ 13. The nurse is providing care for a patient with diabetes who experiences frequent periods of hyperglycemia. Which comment by the patient is indicative to the nurse of a major cause of this BG imbalance? 1. “My job is really busy in tax season.” 2. “My diet never seems to fill me up.” 3. “I have increased my daily exercise.” 4. “I frequently substitute cookies for bread.” ____ 14. A patient being treated with rosiglitazone for type 2 DM is receiving a routine follow-up assessment. In addition to HbA1c and a fasting plasma glucose test, which other laboratory test should the nurse expect to be monitored in this patient? 1. Blood lipids 2. Liver function tests 3. Urine for microalbumin 4. Complete blood count (CBC) ____ 15. The nurse is discussing the management of an older adult client recently diagnosed with type 2 DM. Which information is least helpful? 1. An emergency call system should be placed in the home. 2. The family can promote healthy eating by supplying meals. 3. If hyperglycemia is controlled, BG levels can be relaxed. 4. A week’s supply of insulin can be drawn up and refrigerated. ____ 16. The nurse is researching the current information available regarding the long-term complications for patients diagnosed with diabetes. Which finding is accurate?  1. Chronic hypoglycemia causes a variety of serious complications. 2. Most complications involve either the large or tiny vessels of the body. 3. Type 1 diabetics are at greatest risk for complications even with tight control. 4. Patients with HbA1c levels below 6 percent are less likely to experience complica- tions. ____ 17. The nurse is preparing a patient with type 2 DM for surgery. The patient expresses concern about the use of insulin at this time. Which reason does the nurse understand that insulin therapy is appropriate in regard to surgery? 1. Surgery is a stressor causing counter-regulatory hormones to increase BG. 2. Insulin promotes healing and eliminates the common causes of infection. 3. Critically ill patients with diabetes require a lower BG from insulin therapy. 4. Ongoing insulin therapy is required for the type 2 diabetic after having surgery. ____ 18. A patient with diabetes has peripheral neuropathy. What should the nurse do to prevent related complications? 1. Wash, dry, and inspect feet daily. 2. Use a lubricating lotion on feet daily. 3. Wear loose comfortable shoes in the house. 4. Soak feet in soap and water for 20 minutes daily. ____ 19. The nurse is planning to review information with a patient diagnosed with diabetes. Which information does the nurse include regarding an increased risk for and treatment of infection? 1. IV antibiotics are the preferable for effective treatment of infection. 2. White blood cells (WBCs) become sluggish and ineffective against infection with hypoglycemia. 3. Circulation may not be adequate to heal a wound or fight infection. 4. Routine vaccinations to prevent infection are not effective with diabetes. ____ 20. A patient with type 1 DM expresses concern about developing retinopathy due to a chronic disease. Which information does the nurse provide to give the patient the best reassurance? 1. Newer laser surgery can improve sight after retinal hemorrhage. 2. The high incidence of cataracts can be surgically corrected. 3. Diabetes is low as a cause for blindness in the United States. 4. Good control of BG and blood pressure can reduce the risk. ____ 21. The nurse is employed at a clinic for patients diagnosed with diabetes. Which patient does the nurse identify as being at greatest risk for needing dialysis? 1. The non-Hispanic adult with type 1 DM since early childhood 2. The older adult with type 2 DM, unstable BG, and hypertension 3. The patient who is African American with type 2 DM and hypertension 4. The patient who is Asian with type 1 DM and well-controlled BG ____ 22. The nurse is contributing to a dietary presentation for patients in a multicultural community with diabetes. Which intervention will be least likely to meet the needs of the attendees? 1. Suggestions for culture sensitive substitutes 2. Presentation of the standard diabetic diet 3. Opportunity for patients to ask questions privately 4. Advance preparation regarding culturally preferred foods Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 23. The nurse is providing teaching to a patient with reactive hypoglycemia. Which instructions related to glucose monitoring should the nurse provide? (Select all that apply.) 1. “It is important to check your BG at bedtime.” 2. “It is important to check your BG 1 hour before meals.” 3. “You will need to check your BG 2 hours after meals.” 4. “You should check your BG when you get up in the morning.” 5. “Checking your BG once a day, at the same time each day, is sufficient.” ____ 24. A patient is diagnosed with diabetic ketoacidosis. Which manifestations should the nurse expect to observe in this patient? (Select all that apply.) 1. Dehydration 2. Hypertension 3. Flulike symptoms 4. Kussmaul’s respirations 5. Edema associated with fluid overload Completion Complete each statement. 25. A patient is upset to learn that a recent HbA1c level is 10.3 percent. Which average BG level does the nurse provide based upon this percentage if the equation 28.7 × HbA1c − 46.7 is used? (Round to the nearest whole number.) Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pan- creas Answer Section MULTIPLE CHOICE 1. ANS: 2 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Describe causes, signs and symptoms, and treatment of high and low blood glucose levels. Page: 817 Heading: Pathophysiology and Etiology Integrated Process: Teaching/Learning Client Need: Physiological Integrity/Physiological Adaptation Cognitive Level: Application (Applying) Concept: Metabolism Difficulty: Moderate Feedback Insulin is destroyed by gastric juices, which is the reason why insulin is not taken 1 orally. The pancreas does release other hormones such as lipase and amylase to aid in digestion. When blood glucose (BG) touches a cell membrane, glucose transporters are 2 activated and move the glucose into the cell for energy. The inability of the pancreas to produce insulin is type 1 DM; type 2 DM is the 3 most common. In type 2 DM, the pancreas is able to produce insulin. Type 2 DM can be reversed with dietary, weight loss, and exercise programs. Type 4 1 DM is irreversible. PTS: 1 CON: Metabolism 2. ANS: 4 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Explain the pathophysiologies of type 1 and type 2 diabetes mellitus. Page: 817 Heading: Type 1 Diabetes Integrated Process: Teaching/Learning Client Need: Pathological Integrity—Reduction of Risk Potential Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Moderate Feedback When the patient understands that type 1 DM may have been caused by a viral 1 infection, additional teaching is not necessary. It is a true statement that patients with type 1 DM may be genetically prone to the 2 disease; no additional teaching is necessary. Patients with type 1 DM are prone to developing ketoacidosis; the patient’s 3 statement is correct and does not require additional teaching. Type 2 DM can be caused by obesity and may respond positively to weight loss. 4 However, the pancreas of a patient with type 1 DM cannot trigger insulin produc- tion with weight loss. PTS: 1 CON: Metabolism 3. ANS: 1 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Identify therapeutic measures to help patients with diabetes mellitus control blood glucose levels. Page: 821 Heading: Nutrition Therapy Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Reduction of Risk Potential Cognitive Level: Application (Applying) Concept: Metabolism Difficulty: Moderate Feedback Because all diabetic nutrition recommendations emphasize low-fat intake and 1 balanced intake of other food groups, it is healthy for the whole family. Patients with diabetes do not have to avoid all sugars and fats. 2 Special foods are not necessary. 3 High protein is not recommended; low protein may be necessary if nephropathy 4 occurs. PTS: 1 CON: Metabolism 4. ANS: 3 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Identify therapeutic measures to help patients with diabetes mellitus control blood glucose levels. Page: 820 Heading: Exercise Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Reduction of Risk Potential Cognitive Level: Application (Applying) Concept: Metabolism Difficulty: Moderate Feedback Exercising at similar times each day also helps prevent BG fluctuations. 1 Running is not too strenuous for someone who is used to doing it, but patients with 2 neuropathy or foot problems should consult with a physician first. Persons with diabetes should always carry a quick source of sugar when exercising 3 in case the BG drops too low.  Individuals on intermediate-acting insulin are taught to avoid exercising at the 4 time of day when their BG is at its lowest point (i.e., when insulin or medication is peaking) and to have a carbohydrate snack before exercising if BG is less than 100 mg/dL. PTS: 1 CON: Metabolism 5. ANS: 2 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Identify therapeutic measures to help patients with diabetes mellitus control blood glucose levels. Page: 823 Heading: Medication: Onset, Peak, Duration Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Reduction of Risk Potential Cognitive Level: Application (Applying) Concept: Metabolism Difficulty: Moderate Feedback Onset is a half hour, and duration is 5 to 8 hours. 1 Regular insulin peaks in 2 to 5 hours, so blood sugar will be lowest at this time. 2 Onset is a half hour, and duration is 5 to 8 hours. 3 Onset is a half hour, and duration is 5 to 8 hours. 4 PTS: 1 CON: Metabolism 6. ANS: 2 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Differentiate the action of insulin and oral hypoglycemic agents in lowering blood glucose levels. Page: 817 Heading: Oral Hypoglycemic Medication Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Physiological Adaptation Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Moderate Feedback Oral hypoglycemic agents are not an insulin replacement; they work to stimulate 1 the pancreas to make more insulin or to make tissues more sensitive to insulin.  2 Oral hypoglycemic agents are prescribed for type 2 DM because there is a partially working pancreas. This is the best comparison the nurse can present about the difference between insulin and oral hypoglycemic agents. Type 2 diabetics do not experience ketoacidosis, which is a serious complication 3 for type 1 diabetics related to an inability for the body to produce insulin. With a type 2 diabetic, insulin is prescribed when the patient is having difficulty 4 controlling BG levels. In contrast, the type 1 diabetic uses insulin to sustain life. PTS: 1 CON: Metabolism 7. ANS: 1 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Explain the pathophysiologies for type 1 and type 2 diabetes mellitus. Page: 823 Heading: Type 2 Diabetes Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Physiological Adaptation Cognitive Level: Application (Applying) Concept: Metabolism Difficulty: Moderate Feedback The HCP may need to eventually prescribe insulin to a patient who cannot 1 effectively follow a diabetic diet to promote BG control. However, other interven- tions such as education and support would be considered before adding insulin to the therapy. When a patient’s pancreas is unable to produce adequate insulin, the HCP will 2 prescribe insulin in addition to an oral hypoglycemic agent. When a patient’s pancreas is producing a normal or high amount of insulin, but the 3 BG level remains elevated, the patient is likely to have body cells that are resistant. The HCP will prescribe insulin in addition to an oral hypoglycemic agent. If the patient’s pancreas wears out and little or deficient amounts of insulin are 4 produced, the HCP will prescribe insulin to be added to the oral hypoglycemic regimen. PTS: 1 CON: Metabolism 8. ANS: 2 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Describe causes, signs and symptoms, and treatment of high and low blood glucose levels. Page: 829 Heading: Hyperosmolar Hyperglycemic State Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Physiological Adaptation Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Moderate Feedback The BG level can be elevated as high as 1,500 mg/dL in a client with hyperosmo- 1 lar hyperglycemia. BG level is not the nurse’s priority focus. The nurse’s priority focus for a patient with hyperosmolar hyperglycemia is the 2 state of hydration. A reduced fluid intake is often a contributing factor; however, as BG levels rise, polyuria can cause profound dehydration. The presence of an illness can contribute to the patient’s condition, but the nurse’s 3 priority focus is on stabilizing the patient to avoid shock, coma, or death. Older clients with type 2 DM are more inclined to experience hyperosmolar 4 hyperglycemia, but patient’s age is not the nurse’s focus. PTS: 1 CON: Metabolism 9. ANS: 3 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Discuss how diabetes mellitus increases risk of complications such as heart disease, blindness, and kidney failure. Page: 830 Heading: Metabolic Syndrome Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Physiological Adaptation Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Moderate Feedback The patient is exhibiting risk factors related to metabolic syndrome; the patient is 1 at high risk for type 2 DM. The patient is exhibiting risk factors related to metabolic syndrome; the patient is 2 at high risk for cardiovascular issues. The patient may be at risk for damage to weight-bearing joints, due to age and 3 weight; however, this is not likely to be the HCP’s greatest concern. The HCP will be concerned about the patient’s family medical history; a genetic 4 predisposition for type 2 DM puts the patient at greater risk. PTS: 1 CON: Metabolism 10. ANS: 4 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Identify diagnostic tests used to diagnose and monitor diabetes mellitus and its complications. Page: 827 Heading: Diagnostic Tests Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Physiological Adaptation Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Moderate Feedback Fasting BG test is effective for diagnosing diabetes; however, this is not a test to 1 indicate compliance with treatment. 2 Random BG testing is most effective in diagnosing diabetes; however, this is not a test to indicate compliance with treatment. An oral glucose tolerance test is effective in diagnosing diabetes; however, this is 3 not a test to indicate compliance with treatment. The glycohemoglobin test (HbA1c) measures the glucose attached to red blood 4 cells (RBCs), which have a lifespan of about 3 months. The test provides a good analysis of the average BG level for the previous 2 to 3 months, which indicates compliance with treatment regimen. PTS: 1 CON: Metabolism 11. ANS: 1 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Plan nursing care and education for the patient with diabetes mellitus. Page: 824 Heading: Oral Hypoglycemic Medication Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Pharmacological Therapies Cognitive Level: Application (Applying) Concept: Metabolism Difficulty: Moderate Feedback Sulfonylureas, such as glyburide, interact with alcohol and can make the patient 1 very ill. This action should be taken for meglitinides and alpha-glucosidase inhibitors. 2 Glitazones may interfere with birth control. 3 4 This action should be taken for metformin. PTS: 1 CON: Metabolism 12. ANS: 2 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Identify diagnostic tests used to diagnose and monitor diabetes mellitus and its complications. Page: 827 Heading: Self-Monitoring of Blood Glucose Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Reduction of Risk Potential Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Moderate Feedback The patient has two issues, multiple monitoring needs and frequent hypoglycemia; 1 this suggestion does not effectively or efficiently address either. 2 This patient will benefit from continuous monitoring. This newer type of device monitors BG via a small catheter inserted into the abdomen. The device monitors BG regularly and can be set to alarm if BG drops too low. Checking for urine ketones on a regular basis does not effectively address either 3 patient issue. Some patients with either hyper- or hypoglycemia can benefit from a therapy pet 4 trained to identify either condition. However, this would not address the issue of multiple BG checks throughout the day. PTS: 1 CON: Metabolism 13. ANS: 1 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Describe causes, signs and symptoms, and treatment of high and low blood glucose levels. Page: 827 Heading: Hyperglycemia Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Physiological Adaptation Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Moderate Feedback A major cause of hyperglycemia for a diabetic is stress; the patient is expressing a 1 cause of stress.  A common cause of hyperglycemia for a diabetic is eating more than the meal plan 2 prescribes. Without further assessment, stress is still the major cause. 3 Increasing a daily exercise plan is more likely to cause hypoglycemia. Mismanagement of the prescribed meal plan can cause hyperglycemia. Cookies 4 are not a good substitute for bread. PTS: 1 CON: Metabolism 14. ANS: 2 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Plan nursing care and education for the patient with diabetes mellitus. Page: 827 Heading: Oral Hypoglycemic Medication Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Pharmacological Therapies Cognitive Level: Application (Applying) Concept: Metabolism Difficulty: Moderate Feedback Lipids are important to monitor in any diabetic patient, but are not unique to 1 glitazones. Liver function must be monitored in patients taking glitazones. 2 Microalbumin is important to monitor in any diabetic patient but, is not unique to 3 glitazones. A CBC test would supply nonspecific information. 4 PTS: 1 CON: Metabolism 15. ANS: 2 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Identify therapeutic measures to help patients with diabetes mellitus control blood glucose levels. Page: 817 Heading: Gerontological Issues Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Reduction of Risk Potential Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Moderate Feedback  Especially if the older adult lives alone, an emergency call system should be 1 placed in the home. Food delivery services have become common and are a good source for the patient 2 living alone. The family cannot always be depended on to deliver the patient’s meals. This information is the least helpful. The BG parameters can be relaxed for the older adult patient, especially if hyper- 3 glycemia is controlled and incidents are rare. Having a week’s supply of insulin drawn up and stored in the refrigerator can be 4 helpful for the older adult who is diabetic. PTS: 1 CON: Metabolism 16. ANS: 2 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Identify therapeutic measures to help patients with diabetes mellitus control blood glucose levels. Pages: 830–832 Heading: Long-Term Complications Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Reduction in Risk Potential Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Moderate Feedback It is chronic hyperglycemia, not hypoglycemia, which causes a variety of serious 1 complications for the patient with diabetes. It is a factual statement that most complications for the patient with diabetes 2 involves either the large vessels (macrovascular complications) or the tiny vessels (microvascular complications) in the body. Tiny vessels found in the eyes and kidneys are commonly effected. In general, type 2 diabetics are at greater risk for complications. However, type 1 3 diabetics decrease the likelihood of having complications if tight control is maintained on BG levels. Patients with an HbA1c below 7 percent are less likely to develop complications 4 related to diabetes. PTS: 1 CON: Metabolism 17. ANS: 1 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: List measures to increase the safety of the patient with diabetes mellitus who is undergoing surgery. Page: 832 Heading: Special Consideration for the Patient Undergoing Surgery Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Reduction of Risk Potential Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Moderate Feedback Surgery is a stressor that causes an elevation in BG even if the patient is fasting. 1 Insulin is an effective and efficient method of controlling BG levels for the surgical patient. Insulin does not promote healing or eliminate the common causes of infection. 2 Insulin prevents high BG, which can interfere with these processes. Critically ill patients with diabetes require a higher level of BG; a range of 140 to 3 180 mg/dL is recommended. The type 2 diabetic will revert to presurgical management after the stress of 4 surgery has passed. PTS: 1 CON: Metabolism 18. ANS: 1 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Plan nursing care and education for the patient with diabetes mellitus. Page: 830 Heading: Foot Complications Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Reduction of Risk Potential Cognitive Level: Application (Applying) Concept: Metabolism Difficulty: Moderate Feedback The feet must be washed, dried, and inspected daily to recognize pressure points or 1 red areas before they turn into wounds that are difficult to treat. Lubricating lotion can be a medium for bacterial or fungal growth and should be 2 avoided, especially between the toes. Sturdy, well-fitting shoes should be worn all the time to protect the feet from 3 injury. Soaking the feet can cause maceration of the skin, increasing the risk for sores. 4 PTS: 1 CON: Metabolism 19. ANS: 3 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Plan nursing care and education for the patient with diabetes mellitus. Page: 830 Heading: Infection Integrated Process: Clinical Problem-Solving (Nursing Process) Client Need: Physiological Integrity—Reduction of Risk Potential Cognitive Level: Application (Applying) Concept: Metabolism Difficulty: Moderate Feedback A patient with diabetes is at risk for poor circulation, which decreases the effec- 1 tiveness of IV antibiotic treatment. Topical antibiotics may be more effective. WBCs become sluggish and ineffective against infections in the presence of 2 hyperglycemia, not hypoglycemia. Patients with diabetes are at risk for poor circulation, which slows down the ability 3 to heal a wound or fight an infection. Patients with diabetes are encouraged to receive routine vaccinations against flu, 4 pneumonia, and hepatitis; prevention of illness or infection is crucial. PTS: 1 CON: Metabolism 20. ANS: 4 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Plan nursing care and education for the patient with diabetes mellitus. Page: 831 Heading: Eyes Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Reduction of Risk Potential Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Moderate Feedback If the patient experiences retinal hemorrhage, information about newer laser 1 surgery that can improve sight may be reassuring; however, information about prevention is the most reassuring. Patients with diabetes are at greater risk for developing cataracts and it may be 2 reassuring to know that the condition can be surgically corrected. However, the patient is more likely interested in prevention. Diabetes is the leading cause of blindness in adults in the United States. The 3 presented information is untrue. Good control of BG and blood pressure can reduce the risk of vision complications 4 in the patient who is diabetic. Prevention is always preferred over treatment when possible. PTS: 1 CON: Metabolism 21. ANS: 2 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Discuss how diabetes mellitus increases risk of complications such as heart disease, blindness, and kidney failure. Page: 834 Heading: Kidneys Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Physiological Adaptation Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Difficult Feedback The non-Hispanic patient with type 1 DM since childhood does not exhibit any 1 risks other than longevity of the disease process. The older adult with type 2 DM, unstable BG, and hypertension is at greatest risk 2 for needing dialysis. Four risk factors exist: diabetes, age, uncontrolled BG, and hypertension. The patient with diabetes who is African American with type 2 DM and hyperten- 3 sion exhibits three risk factors for needing dialysis: ethnicity, diabetes, and hypertension. The patient who is Asian with type 1 DM and well-controlled BG does not exhibit 4 any risks other than the disease process. Duration of the disease is not included. PTS: 1 CON: Metabolism 22. ANS: 2 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Plan nursing care and education for patients with diabetes mellitus. Page: 829 Heading: Cultural Considerations Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Teaching/Learning Cognitive Level: Application (Applying) Concept: Metabolism Difficulty: Moderate Feedback Suggestions for culture-sensitive food substitutes will be likely to meet the needs 1 of patients with diabetes in a multicultural community. Due to the expected multicultural attendees, the presentation of the standard 2 diabetic diet is least likely to meet the needs of the attendees.  3 It is important for the nurse to provide the opportunity for patients to ask questions privately. The patients may not be comfortable asking group questions due to language, culture, and dietary differences. The nurse will be able to meet the needs of multicultural attendees if advance 4 preparation is made regarding culturally preferred foods. PTS: 1 CON: Metabolism MULTIPLE RESPONSE 23. ANS: 1, 3, 4 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Explain reactive hypoglycemia and its treatment. Page: 836 Heading: Reactive Hypoglycemia Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Reduction of Risk Potential Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Difficult Feedback 1. Low BG may occur as an overreaction of the pancreas to eating. The pancreas senses a rising BG and produces more insulin than is necessary for the use of that glucose. As a result, the BG drops to below normal. Readings should be taken in the morning on arising, 2 hours after each meal, at bedtime, and during symptoms of hypoglycemia. 2. Checking BG levels 1 hour before meals will not help the patient control reactive hypoglycemia. 3. Low BG may occur as an overreaction of the pancreas to eating. The pancreas senses a rising BG and produces more insulin than is necessary for the use of that glucose. As a result, the BG drops to below normal. Readings should be taken in the morning on arising, 2 hours after each meal, at bedtime, and during symptoms of hypoglycemia. 4. Low BG may occur as an overreaction of the pancreas to eating. The pancreas senses a rising BG and produces more insulin than is necessary for the use of that glucose. As a result, the BG drops to below normal. Readings should be taken in the morning on arising, 2 hours after each meal, at bedtime, and during symptoms of hypoglycemia. 5. Checking BG once daily at the same time will not help the patient control reactive hypoglycemia. PTS: 1 CON: Metabolism  24. ANS: 1, 3, 4 Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Describe causes, signs and symptoms, and treatment of high and low blood glucose levels. Page: 829 Heading: Diabetic Ketoacidosis Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Reduction of Risk Potential Cognitive Level: Analysis (Analyzing) Concept: Metabolism Difficulty: Difficult Feedback 1. With such high BG and the accompanying polyuria, the body becomes dehydrat- ed very quickly. 2. Tachycardia, hypotension, and shock can result. 3. The combination of dehydration, potassium imbalance, and acidosis causes the patient to develop flu-like symptoms, including abdominal pain and vomiting. 4. The body attempts to compensate for acidosis by deepening respirations, thereby blowing off excess carbon dioxide. The deep, sighing respiratory pattern is called Kussmaul’s respirations. 5. With such high BG and the accompanying polyuria, the body becomes dehydrat- ed quickly. PTS: 1 CON: Metabolism COMPLETION 25. ANS: 249 mg/dL Chapter: Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Objective: Identify therapeutic measures to help patients with diabetes mellitus control blood glucose levels. Page: 826 Heading: Estimated Average Glucose Integrated Process: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity—Reduction of Risk Potential Cognitive Level: Application (Applying) Concept: Metabolism Difficulty: Difficult Feedback: When using this equation, the patient’s average BG level is calculated as: 28.7 × 10.3 − 46.7 = 248.91. With rounding, it would be 249 mg/dL. PTS: 1 CON: Metabolism