A client with type 2 diabetes normally achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the client has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment?
Stress has likely caused an increase in the client's blood sugar levels.
The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars.
The client has likely overstimulated her ability to control her diabetes using non-pharmacologic measures.
Alterations in bile metabolism and release have likely caused hyperglycemia.
The Correct Answer is A
A. Stress has likely caused an increase in the client's blood sugar levels:
This statement is accurate. Stress, especially related to surgery, can lead to increased levels of stress hormones, such as cortisol and catecholamines, which can elevate blood sugar levels. Surgery is a physiological stressor that can impact glucose metabolism.
B. The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars:
This is the most appropriate choice. Surgery, anesthesia, and changes in fluid balance can affect blood glucose levels. The stress response to surgery can lead to fluctuations in blood sugar, and patients may need insulin during this period.
C. The client has likely overstimulated her ability to control her diabetes using non-pharmacologic measures:
This statement is not accurate. Overstimulation is not a common cause of the need for insulin in the context of surgery. The stress and physiological changes associated with surgery are more likely contributors.
D. Alterations in bile metabolism and release have likely caused hyperglycemia:
While alterations in metabolism can impact glucose regulation, in the context of surgery, the primary factors are the stress response, changes in fluid balance, and potential alterations in the ability to eat or drink normally rather than specific effects on bile metabolism.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. 15 to 20 g of a fast-acting carbohydrate such as orange juice:
This is a standard and initial treatment for hypoglycemia. Fast-acting carbohydrates, like orange juice or glucose tablets, can quickly raise blood sugar levels. However, in the scenario described, the client is still conscious, and glucagon may be a more appropriate choice.
B. I.V. bolus of dextrose 50%:
Intravenous (IV) dextrose is a more aggressive intervention and is typically reserved for severe cases of hypoglycemia or for unconscious patients. It is not the first-line treatment for conscious patients.
C. I.M. or subcutaneous glucagon:
Glucagon is a hormone that raises blood sugar levels by promoting the conversion of stored glycogen in the liver to glucose. It is administered either intramuscularly (I.M.) or subcutaneously. In a conscious patient with hypoglycemia who cannot take oral carbohydrates, glucagon can be an effective and rapid way to raise blood sugar levels.
D. 10 U of fast-acting insulin:
Administering more insulin in a situation of hypoglycemia would worsen the condition. The goal in hypoglycemia is to raise blood sugar, and giving more insulin would have the opposite effect.
Correct Answer is A
Explanation
A. Erythropoietin (Epogen):
Explanation: Erythropoietin is a hormone that stimulates the production of red blood cells. In chronic kidney disease, especially when associated with anemia, the production of erythropoietin by the kidneys may be reduced. Erythropoietin (Epogen) is commonly used to stimulate the production of red blood cells and manage anemia in patients with chronic kidney disease.
B. Eltrombopag (Promacta):
Explanation: Eltrombopag is a medication used to stimulate the production of platelets and is primarily indicated for conditions associated with thrombocytopenia (low platelet count). It is not used to treat anemia associated with chronic kidney disease.
C. GM-CSF (Leukine):
Explanation: Granulocyte-macrophage colony-stimulating factor (GM-CSF or Leukine) is a medication that stimulates the production of white blood cells and is used in certain conditions to address decreased white blood cell counts. It is not typically used for managing anemia.
D. Thrombopoietin (TPO):
Explanation: Thrombopoietin is a hormone that stimulates the production of platelets. Medications that mimic the action of thrombopoietin, such as romiplostim and eltrombopag, are used to treat thrombocytopenia. Thrombopoietin is not used for the treatment of anemia.
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