CHAPTER 19 The Endocrine System

CHAPTER 19 The Endocrine System

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

19.1•The nurse is reviewing laboratory results for a healthy 68-year-old client who is a new client to a medical practice. The glycosylated hemoglobin (HbA1c) result is 6.0%. The nurse knows that

1. the client needs a workup to determine the cause of the anemia.
2. the client has undiagnosed type 2 diabetes mellitus.
3. the client has had an average blood glucose level of 120 over the past 3 months.
4. the client needs a referral to a dietician.

Answer: 3

Rationale: The glycosylated hemoglobin gives the practitioner an estimate of the client’s blood glucose over the past 3 months by measuring how much glucose is attached to the hemoglobin in red blood cells, which have an average life span of about 4 months. A HbA1c of 6 relates to an average glucose level of 120. Ideally, the glycosylated hemoglobin should be less than 7.0%. The glycosylated hemoglobin does not relate to anemia and is not used to diagnose diabetes. There is no need for a dietician referral based on this data.

Assessment

Physiological Integrity

Analysis

19.2•The priority goal for older clients diagnosed with diabetes mellitus is

1. maintenance of proper glycemic control.
2. yearly eye examinations.
3. keeping appointments with podiatrists for foot care.
4. recognizing the symptoms of myocardial infarction and knowing the correct action to take.

Answer: 1

Rationale: Maintenance of proper control over glucose levels is imperative to stop the damaging affects associated with abnormally high levels of blood glucose. Yearly eye examinations, proper foot care, and being aware of the manifestations of coronary heart disease are important, but proper blood glucose control will decrease the likelihood of these complications of diabetes from occurring.

Planning

Physiological Integrity

Application

19.3•Smoking cessation is especially important for clients with diabetes mellitus because smoking

1. promotes weight gain.
2. is a major factor in the development of diabetic neuropathy.
3. accelerates arteriosclerotic changes in blood vessels.
4. increases insulin resistance.

Answer: 3

Rationale: Smoking is especially unhealthy for diabetic clients because smoking accelerates the arteriosclerotic effects that occur in blood vessels from elevated levels of blood glucose. Smoking is not associated with weight gain; in fact, people use weight gain as an excuse not to quit smoking. Poor glycemic control in diabetics is associated with the development of complications including diabetic neuropathy. Smoking does not affect insulin resistance.

Diagnosis

Physiological Integrity

Analysis

19.4•A risk factor for the diabetic client associated with aggressive glycemic control is

1. the development of foot ulcers.
2. decreased vision acuity associated with diabetic retinopathy.
3. frequent skin yeast infections.
4. hypoglycemic episodes.

Answer: 4

Rationale: Aggressive glycemic control involves keeping the blood glucose level at levels low enough to decrease complications of diabetes mellitus. This increases the risk of hypoglycemia. Blood glucose levels that are too low put clients at risk for falls, disorientation, and dehydration. Foot ulcers, diabetic retinopathy, and frequent skin yeast infections are all associated with poor glucose control with elevated glucose blood levels.

Planning

Physiological Integrity

Analysis