9

Answer Key to Chapter 9 

You can review additional information regarding these answers in the corresponding section in which the Critical Thinking activities appear.

Critical Thinking Activity Section 9.3

1. The patient is at risk for a fracture due to a previous history of osteoporosis that weakens the bones and increases the risk for a fracture when injury occurs. Corticosteroids can cause muscle weakness that can lead to falls and fractures.

2. Alendronate, a bisphosphonates class of medication, is often used to treat osteoporosis and reduce the patient’s risk of fractures. Other preventative measures can be implemented such as weight-bearing exercise and calcium/vitamin D supplementation.

3. The patient should be instructed to avoid getting up without assistance. The room should be well-lit without loose rugs that can cause tripping. If the patient uses assistive devices like a cane or walker, these devices should be readily available.

4. The use of glucocorticoids can increase glucose levels. Although the patient has no history of diabetes, the increased blood glucose levels may require the temporary use of insulin.

5. Signs of adrenal suppression include severe fatigue, gastrointestinal upset, and a suppressed immune response that places the patient at risk for developing infections.

Critical Thinking Activity Section 9.4

1. Type 1 diabetes is an autoimmune disease affecting the beta cells of the pancreas so they do not produce insulin; synthetic insulin must be administered by injection or infusion.

Type 2 diabetes is acquired, and lifestyle factors such as poor diet and inactivity greatly increase a person’s risk for developing this disease. In type 2 diabetes, the body’s cells become resistant to the effects of insulin. In response, the pancreas increases its insulin secretion, but over time, the beta cells become exhausted. In many cases, type 2 diabetes can be reversed by moderate weight loss, regular physical activity, and consumption of a healthy diet. However, if blood glucose levels cannot be controlled with these measures, oral diabetic medication is implemented and eventually insulin may be required.

2. Surgery and hospitalization often stimulate a patient’s stress response, which includes the release of cortisol. Cortisol increases blood glucose levels, so the patient may require insulin to control blood sugar levels while hospitalized.

3. The nurse should administer 12 units of Humalog insulin, along with the scheduled 20 units of Humulin-N insulin at breakfast.

4. Metformin may be discontinued because it is contraindicated in patients with kidney disease (e.g., serum creatinine levels ≥1.5 mg/dL [males] or ≥1.4 mg/dL [females]).

5. The patient is displaying signs of hypoglycemia. A supplementary carbohydrate, such as four ounces of orange juice, should be administered as soon as possible. However, if the patient seems confused or unable to swallow, glucagon should be administered.

6. The patient has hypoglycemia because the peak effect of Humulin-N is about six hours. Because the medication is peaking between mealtimes, the patient’s blood sugar continues to decrease. On the other hand, the onset of Humalog insulin is 15-30 minutes, with the peak effect in 1-3 hours, so the food eaten during mealtime maintains a normal blood sugar as long as the meals and the insulin administration are matched.

7. The hemoglobin A1C test indicates the patient’s average level of blood sugar over the past 2 to 3 months. It is also referred to as HbA1c, glycated hemoglobin test, or glycohemoglobin. Normal hemoglobin A1C is less than 5.7%. In patients with diabetes, the goal is to maintain hemoglobin A1C levels less than 7%. The patient’s recent lab result of 10% indicates the need for additional diabetes medication, as well as patient education regarding diabetes management, to avoid the development of long-term complications of diabetes.

8. Lantus is a long-acting insulin that has a duration over 24 hours. It does not have a peak and should be administered once daily at the same time each day. Lantus should only be administered subcutaneously and should not be mixed with other insulin.

Critical Thinking Activity Section 9.5

The patient should be advised to take levothyroxine at the same time every morning, before eating or drinking. It should not be taken with other medications that may interfere with its absorption and should be taken at least 30 minutes before eating or two hours after eating. The patient should monitor for signs of hypothyroidism from too low of a dose of levothyroxine, such as constipation, weight gain, and fatigue. It is also important to watch for signs of too high of a dose of levothyroxine such as rapid or irregular heart rate.

Section 9.7 Case Study 2

1. Prednisone is a synthetic corticosteroid medication that is commonly used to treat a variety of inflammatory conditions, including asthma exacerbations. Prednisone works by suppressing the immune system and reducing inflammation in the body.

2. Common side effects of prednisone therapy include increased appetite, weight gain, fluid retention, mood changes, and difficulty sleeping. Other possible side effects include increased blood sugar levels, high blood pressure, decreased bone density, increased risk of infection, and increased risk of stomach ulcers.

3. Prednisone therapy is typically administered orally in the form of tablets or capsules. The dosage and duration of treatment depend on the condition being treated and the patient’s response to the medication. In the case of asthma exacerbation, a typical course of prednisone therapy may involve a high-dose regimen for several days, followed by a gradual tapering of the dose.

4. During prednisone therapy, patients should be monitored for potential side effects, including changes in blood sugar levels, blood pressure, and bone density. Regular blood tests may also be done to monitor for any signs of infection. Patients should also be monitored for any signs of adrenal suppression, which can occur if the medication is stopped abruptly.

5. Patients should be educated on the potential side effects of prednisone therapy and instructed to report any new or worsening symptoms to their health care provider. Patients should also be advised to take the medication with food to reduce the risk of stomach upset and to avoid abruptly stopping the medication. Patients should also be instructed to avoid exposure to individuals with infectious illnesses while on prednisone therapy.

Section 9.7 Case Study 2

1. Metformin is a medication commonly used in the management of type 2 diabetes. It works by reducing the amount of glucose produced by the liver and increasing the body’s sensitivity to insulin. It is typically used in combination with other diabetes medications, such as insulin.

2. Insulin is a hormone that is essential for the regulation of blood sugar levels. In individuals with type 2 diabetes, insulin therapy may be necessary to help manage blood sugar levels. Insulin can be administered via injection or through an insulin pump.

3. Common side effects of metformin include gastrointestinal symptoms such as diarrhea, nausea, and abdominal discomfort. More serious side effects can include lactic acidosis, a rare but potentially life-threatening condition. Common side effects of insulin therapy include hypoglycemia, weight gain, and injection site reactions.

4. Mr. D.K. should be monitored regularly to assess his blood sugar levels and ensure that they are within the target range. He should also be monitored for any signs of hypoglycemia, including confusion, sweating, and tremors. Regular kidney function tests should also be performed to monitor for any adverse effects of metformin on kidney function.

5. Mr. D.K. should be educated on the importance of adhering to his medication regimen and monitoring his blood sugar levels regularly. He should also be instructed on how to recognize and manage episodes of hypoglycemia. Mr. D.K. should also be advised to report any new or worsening symptoms to his health care provider. Finally, he should be encouraged to follow a healthy diet and exercise regularly to help manage his diabetes.