Deck 29: Endocrine and Metabolic Disorders

Question 1

Which statement concerning the complication of maternal diabetes is the most accurate?

A) Diabetic ketoacidosis (DKA)can lead to fetal death at any time during pregnancy.
B) Hydramnios occurs approximately twice as often in diabetic pregnancies than in nondiabetic pregnancies.
C) Infections occur about as often and are considered about as serious in both diabetic and nondiabetic pregnancies.
D) Even mild-to-moderate hypoglycemic episodes can have significant effects on fetal well-being.

Answer 1

Diabetic ketoacidosis (DKA)can lead to fetal death at any time during pregnancy.

Question 2

Preconception counseling is critical in the safe management of diabetic pregnancies.Which complication is commonly associated with poor glycemic control before and during early pregnancy?

A) Frequent episodes of maternal hypoglycemia
B) Miscarriage
C) Hydramnios
D) Hyperemesis gravidarum

Answer 2

Miscarriage

Question 3

A serious but uncommon complication of undiagnosed or partially treated hyperthyroidism is a thyroid storm,which may occur in response to stress such as infection,birth,or surgery.What are the signs and symptoms of this emergency disorder? (Select all that apply. )

A) Fever
B) Hypothermia
C) Restlessness
D) Bradycardia
E) Hypertension

Answer 3

Fever
Restlessness

Question 4

To manage her diabetes appropriately and to ensure a good fetal outcome,how would the pregnant woman with diabetes alter her diet?

A) Eat six small equal meals per day.
B) Reduce the carbohydrates in her diet.
C) Eat her meals and snacks on a fixed schedule.
D) Increase her consumption of protein.

Question 5

During a prenatal visit,the nurse is explaining dietary management to a woman diagnosed with pre-gestational diabetes.Which statement by the client reassures the nurse that teaching has been effective?

A) "I will need to eat 600 more calories per day because I am pregnant."
B) "I can continue with the same diet as before pregnancy as long as it is well balanced."
C) "Diet and insulin needs change during pregnancy."
D) "I will plan my diet based on the results of urine glucose testing."

Question 6

The nurse who is caring for a woman hospitalized for hyperemesis gravidarum would expect the initial treatment to involve what?

A) Corticosteroids to reduce inflammation
B) Intravenous (IV)therapy to correct fluid and electrolyte imbalances
C) Antiemetic medication,such as pyridoxine,to control nausea and vomiting
D) Enteral nutrition to correct nutritional deficits

Question 7

Hypothyroidism occurs in 2 to 3 pregnancies per 1000.Because severe hypothyroidism is associated with infertility and miscarriage,it is not often seen in pregnancy.Regardless of this fact,the nurse should be aware of the characteristic symptoms of hypothyroidism.Which do they include? (Select all that apply. )

A) Hot flashes
B) Weight loss
C) Lethargy
D) Decrease in exercise capacity
E) Cold intolerance

Question 8

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

A) Hypoglycemia
B) Hypercalcemia
C) Hypobilirubinemia
D) Hypoinsulinemia

Question 9

A woman diagnosed with gestational diabetes has had little or no experience reading and interpreting glucose levels.The client shows the nurse her readings for the past few days.Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates?

A) 75 mg/dl before lunch.This is low;better eat now.
B) 115 mg/dl 1 hour after lunch.This is a little high;maybe eat a little less next time.
C) 115 mg/dl 2 hours after lunch.This is too high;it is time for insulin.
D) 50 mg/dl just after waking up from a nap.This is too low;maybe eat a snack before going to sleep.

Question 10

The nurse is preparing to teach an antepartum client with GDM the correct method of administering an intermediate-acting insulin,such as neutral protamine Hagedorn (NPH),with a short-acting insulin (regular).In the correct order from 1 through 6,match the step number with the action needed to teach the client self-administration of this combination of insulin.

Step 1

A)Without adding air,withdraw the correct dose of NPH insulin.
B)Gently rotate the insulin to mix it and wipe the stopper.
C)Inject air equal to the dose of NPH insulin into the vial and remove the syringe.
D)Inject air equal to the dose of regular insulin into the vial and withdraw the medication.
E)Check the insulin bottles for the expiration date.
F)Wash hands.

Question 11

In terms of the incidence and classification of diabetes,which information should the nurse keep in mind when evaluating clients during their ongoing prenatal appointments?

A) Type 1 diabetes is most common.
B) Type 2 diabetes often goes undiagnosed.
C) Gestational diabetes mellitus (GDM)means that the woman will receive insulin treatment until 6 weeks after birth.
D) Type 1 diabetes may become type 2 during pregnancy.

Question 12

Which preexisting factor is known to increase the risk of gestational diabetes mellitus (GDM)?

A) Underweight before pregnancy
B) Maternal age younger than 25 years
C) Previous birth of large infant
D) Previous diagnosis of type 2 diabetes mellitus

Question 13

A client with maternal phenylketonuria (PKU)has come to the obstetrical clinic to begin prenatal care.Why would this preexisting condition result in the need for closer monitoring during pregnancy?

A) PKU is a recognized cause of preterm labor.
B) The fetus may develop cognitive problems.
C) A pregnant woman is more likely to die without strict dietary control.
D) Women with PKU are usually mentally handicapped and should not reproduce.

Question 14

Several metabolic changes occur throughout pregnancy.Which physiologic adaptation of pregnancy will influence the nurse's plan of care?

A) Insulin crosses the placenta to the fetus only in the first trimester,after which the fetus secretes its own.
B) Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar.
C) During the second and third trimesters,pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.
D) Maternal insulin requirements steadily decline during pregnancy.

Question 15

A new mother with a thyroid disorder has come for a lactation follow-up appointment.Which thyroid disorder is a contraindication for breastfeeding?

A) Hyperthyroidism
B) Phenylketonuria (PKU)
C) Hypothyroidism
D) Thyroid storm

Question 16

A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks.She appears thin and somewhat nervous.She reports that she eats a well-balanced diet,although her weight is 5 pounds less than it was at her last visit.The results of laboratory studies confirm that she has a hyperthyroid condition.Based on the available data,the nurse formulates a plan of care.Which nursing diagnosis is most appropriate for the client currently?

A) Disrupted fluid balance
B) Inadequate nutrition
C) Excessive nutrition
D) Disrupted sleep

Question 17

An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pre-gestational diabetes.She attends her centering appointment accompanied by one of her girlfriends.This young woman appears more concerned about how her pregnancy will affect her social life than her recent diagnosis of diabetes.Several nursing diagnoses are applicable to assist in planning adequate care.What is the most appropriate diagnosis at this time?

A) Potential for injury to the fetus related to birth trauma
B) Lack of understanding related to diabetic pregnancy management
C) Lack of understanding related to insulin administration
D) Potential for injury to the mother related to hypoglycemia or hyperglycemia

Question 18

Which physiologic alteration of pregnancy most significantly affects glucose metabolism?

A) Pancreatic function in the islets of Langerhans is affected by pregnancy.
B) Pregnant women use glucose at a more rapid rate than nonpregnant women.
C) Pregnant women significantly increase their dietary intake.
D) Placental hormones are antagonistic to insulin,thus resulting in insulin resistance.

Question 19

Screening at 24 weeks of gestation reveals that a pregnant woman is experiencing gestational diabetes mellitus (GDM).In planning her care,the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus because of GDM.This fetus is at the greatest risk for which condition?

A) Macrosomia
B) Congenital anomalies of the central nervous system
C) Preterm birth
D) Low birth weight

Question 20

Which statement regarding the laboratory test for glycosylated hemoglobin A_lc is correct?

A) The laboratory test for glycosylated hemoglobin A_lc is performed for all pregnant women,not only those with or likely to have diabetes.
B) This laboratory test is a snapshot of glucose control at the moment.
C) This laboratory test measures the levels of hemoglobin A_lc,which should remain at less than 7%.
D) This laboratory test is performed on the woman's urine,not her blood.

Question 21

The nurse is preparing to teach an antepartum client with GDM the correct method of administering an intermediate-acting insulin,such as neutral protamine Hagedorn (NPH),with a short-acting insulin (regular).In the correct order from 1 through 6,match the step number with the action needed to teach the client self-administration of this combination of insulin.

Step 6

A)Without adding air,withdraw the correct dose of NPH insulin.
B)Gently rotate the insulin to mix it and wipe the stopper.
C)Inject air equal to the dose of NPH insulin into the vial and remove the syringe.
D)Inject air equal to the dose of regular insulin into the vial and withdraw the medication.
E)Check the insulin bottles for the expiration date.
F)Wash hands.

Question 22

The nurse is preparing to teach an antepartum client with GDM the correct method of administering an intermediate-acting insulin,such as neutral protamine Hagedorn (NPH),with a short-acting insulin (regular).In the correct order from 1 through 6,match the step number with the action needed to teach the client self-administration of this combination of insulin.

Step 4

A)Without adding air,withdraw the correct dose of NPH insulin.
B)Gently rotate the insulin to mix it and wipe the stopper.
C)Inject air equal to the dose of NPH insulin into the vial and remove the syringe.
D)Inject air equal to the dose of regular insulin into the vial and withdraw the medication.
E)Check the insulin bottles for the expiration date.
F)Wash hands.

Question 23

The nurse is preparing to teach an antepartum client with GDM the correct method of administering an intermediate-acting insulin,such as neutral protamine Hagedorn (NPH),with a short-acting insulin (regular).In the correct order from 1 through 6,match the step number with the action needed to teach the client self-administration of this combination of insulin.

Step 5

A)Without adding air,withdraw the correct dose of NPH insulin.
B)Gently rotate the insulin to mix it and wipe the stopper.
C)Inject air equal to the dose of NPH insulin into the vial and remove the syringe.
D)Inject air equal to the dose of regular insulin into the vial and withdraw the medication.
E)Check the insulin bottles for the expiration date.
F)Wash hands.

Question 24

The nurse is preparing to teach an antepartum client with GDM the correct method of administering an intermediate-acting insulin,such as neutral protamine Hagedorn (NPH),with a short-acting insulin (regular).In the correct order from 1 through 6,match the step number with the action needed to teach the client self-administration of this combination of insulin.

Step 3

A)Without adding air,withdraw the correct dose of NPH insulin.
B)Gently rotate the insulin to mix it and wipe the stopper.
C)Inject air equal to the dose of NPH insulin into the vial and remove the syringe.
D)Inject air equal to the dose of regular insulin into the vial and withdraw the medication.
E)Check the insulin bottles for the expiration date.
F)Wash hands.

Question 25

The nurse is preparing to teach an antepartum client with GDM the correct method of administering an intermediate-acting insulin,such as neutral protamine Hagedorn (NPH),with a short-acting insulin (regular).In the correct order from 1 through 6,match the step number with the action needed to teach the client self-administration of this combination of insulin.

Step 2

A)Without adding air,withdraw the correct dose of NPH insulin.
B)Gently rotate the insulin to mix it and wipe the stopper.
C)Inject air equal to the dose of NPH insulin into the vial and remove the syringe.
D)Inject air equal to the dose of regular insulin into the vial and withdraw the medication.
E)Check the insulin bottles for the expiration date.
F)Wash hands.