Solution to Porth essentials of pathophysiology, Exams of Nursing

Download Solution to Porth essentials of pathophysiology and more Exams Nursing in PDF only on Docsity! Solution to Porth essentials of pathophysiology A 15 year-old boy with type 1 diabetes is exasperated by his regimen of blood sugar monitoring and insulin administration, and has told his mother that he wants to scale both back. Which of the following responses by his mother is most accurate? - answer ✅✅"Even though it's hard to do, you need to continue so you don't go blind or need a kidney transplant down the road." A 15-year-old who has just been diagnosed with type 1 diabetes says she read on the Internet that diabetes is the leading cause of acquired blindness among Americans. She asks you if she will lose her sight. In addition to explaining that new treatment technologies are being worked on every day, which of the following would be the most appropriate response? - answer ✅✅Explain that almost all people with type 1 diabetes do experience some degree of vision loss. A 30 year-old man with a diagnosis of type 1 diabetes is aware of the multiple effects that insulin has on his metabolism. Which of the following physiological processes are actions of insulin? Select all that apply. - answer ✅✅• Facilitating triglyceride synthesis from glucose in fat cells • Inhibiting protein breakdown • Promoting glucose uptake by target cells. A 30-year-old male who manages his type 1 diabetes with glyburide presents at the emergency • He states that his bowel movements are almost always loose. • The client states that he has been unable to maintain an erection in recent years. A 60 year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice? - answer ✅✅Administration of 15 to 20 g of glucose in a concentrated carbohydrate source. A client admitted to the hospital with elevated blood glucose is diagnosed with type 1 diabetes mellitus. What characteristics commonly differentiate type 1 diabetes mellitus from type 2 diabetes mellitus? Select all that apply. - answer ✅✅• Onset before age 20 • Autoimmune beta cell damage • Abrupt onset of symptoms A client admitted to the hospital with elevated blood glucose is diagnosed with type 2 diabetes mellitus. What characteristics commonly differentiate type 2 diabetes mellitus from type 1 diabetes mellitus? Select all that apply. - answer ✅✅• Onset after age 35 • Overweight A client diagnosed with type 2 diabetes has been instructed about managing his condition with diet. The nurse determines further teaching is necessary when the client states: - answer ✅✅"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads." A client has been experiencing elevated blood glucose levels. The nurse anticipates that the client assessment data would include: - answer ✅✅Polydipsia A client is admitted to the emergency department and diagnosed with diabetic ketoacidosis (DKA). The client would most likely manifest: - answer ✅✅Ketosis A client is brought to the emergency department with a suspected diagnosis of DKA (diabetic ketoacidosis). Select the assessment/diagnostic data to confirm the diagnosis. Select all that apply. - answer ✅✅• Low serum bicarbonate • Positive urine ketones A client is diagnosed with type 2 diabetes mellitus and begins to follow a nutritional plan at home. ketoacidosis (DKA). The priority intervention should include: - answer ✅✅Begin a loading dose of IV regular insulin followed by a continuous insulin infusion. A client with diabetes mellitus arrives at the hospital with a blood glucose level of 639 mg/dl. What assessment data would indicate type 2 diabetes mellitus rather than type 1? - answer ✅✅Negative ketones in urine A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first? - answer ✅✅Check blood glucose A client with diabetes mellitus reports morning hyperglycemia for several days. What action should taken? - answer ✅✅Check blood glucose at 2 AM A client with diabetic retinopathy develops a retinal bleed and asks the nurse, "How can I prevent this from happening again?" What response provides the most effective information? - answer ✅✅Maintain healthy blood pressure and blood sugar levels. A client with severe hypoglycemia is unconscious. Which method of providing glucose should be avoided? - answer ✅✅Orange juice orally A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate? - answer ✅✅Using an insulin infusion pump A client with type 2 diabetes has routine lab work, which reveals elevated free fatty acids (FFA). The client asks, "Why is this significant?" The most accurate response would be: Select all that apply. - answer ✅✅• This may increase the amount of triglyceride (a form of fat) stored in your liver or around your heart. • Your pancreas is affected by increased fat (lipotoxicity), which causes beta cell dysfunction, leading to the need for insulin. A diabetic client presents to the clinic. He is concerned his lower legs are "feeling funny." Which of the following assessment findings lead the health care provider to suspect the client may have developed somatic neuropathy? Select all that apply. - answer ✅✅• Both legs appear to be the same as far as numbness is involved. • Bilateral cool ankles and feet. • With eyes closed, the client cannot identify where the HCP is touching his feet. A diabetic patient's most recent blood work indicated a decreased glomerular filtration rate, and sudden change in extracellular fluid osmolality which results in a too rapid blood glucose lowering, the nurse will likely observe which of the following clinical manifestations? - answer ✅✅Headaches, dizziness, change in level of consciousness. A patient hospitalized with type 1 diabetes has been administered a scheduled dose of regular insulin. Which of the following are processes of insulin? Select all that apply. - answer ✅✅• Fat storage • Glucose uptake by muscle and adipose tissue • Protein synthesis A patient is diagnosed with hyperglycemic hyperosmolar state (HHS). Which of the following factors contribute to the severe hyperglycemia that precipitates HHS? Select all that apply - answer ✅✅• Hyperglucagonemia • Glycosuria and dehydration • Hepatic glycogenolysis • Insulin deficiency A patient is diagnosed with metabolic syndrome. Frequent concomitants of this syndrome include which of the following? Select all that apply. - answer ✅✅• Body mass index (BMI) greater than 30 • Elevated fasting blood glucose (FBG) • Coronary artery disease • Hypertriglyceridemia A patient is evaluated for diabetes. Which of the following signs and symptoms would the nurse identify as indications of increased blood glucose levels? Select all that apply. - answer ✅✅• Blurred vision • Thirst • Fatigue • Skin infections A patient is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level (FBS) of 80 mg/dL and a hemoglobin A1C of 5%. Based on these findings, which of the following can the nurse assume? - answer ✅✅The patient is achieving normal glycemic control. A patient with diabetes asks the nurse for advice in controlling between-meal blood glucose levels. Which of the following might the nurse suggest as a long-acting insulin to provide a consistent basal level? - answer ✅✅Glargine (Lantus) A patient with diabetes has been injured. The nurse will tell the patient that healing of the injury may be delayed due to which of the following diabetic complications? Select all that apply. - answer ✅✅• Chronic neuropathies • Vascular impairment chronological order. Use all the options. - answer ✅✅• Decrease in pH • Breakdown of triglycerides • Low serum insulin levels • Ketone production by the liver • Production of fatty acids and glycerol A young adult has been experiencing some extreme fatigue, changes in vision and unexpected weight loss. At the health clinic, the healthcare provider is assessing for hyperglycemia. Which would be considered the most commonly identifiable signs/symptoms of diabetes? Select all that apply. - answer ✅✅• Frequent thirst • Excess urination • Ravaging hunger A young child develops type 1A diabetes. The parents ask, "They tell us this is genetic. Does that mean our other children will get diabetes?" The best response by the health care provider would be: - answer ✅✅"This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes." Diabetics are at higher risk than are the majority of the population for injury to organ systems in the body. Which organs are most at risk? - answer ✅✅Kidneys and eyes Diabetics are hospitalized for a number of reasons. What is the most common complication of diabetes requiring hospitalization? - answer ✅✅Foot problems During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur? - answer ✅✅Hyperglycemia Following an oral glucose tolerance, a 36 year-old mother of 4 has been diagnosed with gestational diabetes mellitus (GDM), a problem that was not present in any of her previous pregnancies. What should her primary care provider tell her about this new health problem? - answer ✅✅"Your baby could become too large or have low blood sugars if we're not vigilant about controlling your sugars." For which conditions is diabetes mellitus a risk factor? Select all that apply. - answer ✅✅• Coronary artery disease • Cerebrovascular accident • Chronic kidney disease Select the most appropriate intervention for the nurse to teach a client diagnosed with distal symmetric neuropathy related to diabetes. - answer ✅✅Inspect the feet for blisters daily Select the most common symptoms of diabetes. Select all that apply. - answer ✅✅• Polydipsia • Polyuria • Polyphagia The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL. The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time? - answer ✅✅Administration of intravenous fluids The diagnosis of type 1 diabetes would be confirmed by: - answer ✅✅Insulin is not available for use by the body. The family of a client in the hospital with diabetes mellitus out of control asks the nurse to explain the client's recent weight loss while eating more than usual. How will the nurse respond? - answer ✅✅Glucose is unused without insulin, so body fats are used for energy. The health care provider has prescribed Repaglinide 2 mg for a client diagnosed with type 2 diabetes. The most important information for the nurse to give the client would be: - answer ✅✅"Take the medication 15 to 30 minutes before each meal." The mother of a 2-year-old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. The best response by the nurse is: - answer ✅✅"Insulin is destroyed by the stomach contents and has to be administered by injection." The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. Which of these effects on blood glucose levels does the nurse teach the student epinephrine will cause? - answer ✅✅Blood glucose will elevate. The nurse and nursing student are performing medication reconciliation. Which of these medications taken by the client does the nurse teach the student are implicated in causing hyperglycemia? Select all that apply. - answer ✅✅• Loop diuretics • Glucocorticoids • Oral contraceptives • Antipsychotics The nurse is teaching a client with diabetes and the family about the signs and symptoms of hypoglycemia. The client asks what produces signs and symptoms of headache, disturbed behavior, coma, and seizures. The best response would be: - answer ✅✅The brain relies on blood glucose as its main energy source. The nurse knows that increased blood glucose levels will pull water out of cells and result in which of the following? Select all that apply. - answer ✅✅• Polydipsia • Polyuria The nurse screening for diabetes mellitus at a health fair does not have enough supplies for all of the clients attending. Which clients should be given screening priority? - answer ✅✅• Male age 45, BMI 32 • Female age 30, history GDM • Male age 65, hypertension The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary healthcare provider for further evaluation? - answer ✅✅Random blood glucose 195 mg/dl The obstetrical nurse is caring for a client who has been treated for gestational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which of these risk factors in the teaching? - answer ✅✅Woman with a family history of diabetes The pancreas is an endocrine organ that is composed of the acini and the islets of Langerhans. The islets of Langerhans have alpha, beta, and delta cells as well as the PP cell. Which cells secrete insulin? - answer ✅✅Beta cells Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur? - answer ✅✅Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen Type 2 diabetes is caused by metabolic abnormalities in the presence of insulin. What are these metabolic abnormalities? (Select all that apply.) - answer ✅✅• Deranged secretion of insulin • Insulin resistance • Increased glucose production by the liver What are the hallmark signs of diabetes mellitus? - answer ✅✅Polyuria, polydipsia, and polyphagia answer ✅✅A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL. Which of the following criteria about insulin would prompt a diagnosis of type 1 diabetes? - answer ✅✅Complete failure of insulin secretion Which of the following interventions is important for the nurse to teach a patient diagnosed with distal symmetric neuropathy related to diabetes? Select all that apply. - answer ✅✅• Inspect the feet daily for blisters. • Wear well-fitted shoes. Which of the following statements best describes an aspect of the normal process of glucose metabolism? - answer ✅✅Glucose that exceeds metabolic needs is converted and stored by the liver. While reviewing the role of glucagon in regards to regulation of blood glucose, the nurse knows which of the following situations could lead to an inhibition of glucagon release? - answer ✅✅An increase in glucose levels. While trying to explain the physiology behind type 2 diabetes to a group of nursing students, the instructor will mention which of the following accurate information? - answer ✅✅In skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance. While working on the med-surg floor, the nurse has a client who is experiencing an insulin reaction. The client is conscious and can follow directions. The most appropriate intervention would be: - answer ✅✅Immediately administer 15 g of glucose (preferably via oral route if the client is alert enough to swallow) and wait for 15 minutes. Then repeat this if necessary.