Chapter 29: Endocrine and Metabolic Disorders
MULTIPLE CHOICE
1. 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
ANS: B
Preconception counseling is particularly important since strict metabolic control before
conception and in the early weeks of gestation is instrumental in decreasing the risk of
miscarriages. Frequent episodes of maternal hypoglycemia may occur during the first
trimester (not before conception) as a result of hormonal changes and the effects on insulin
production and use. Hydramnios occurs approximately 10 times more often in diabetic
pregnancies than in nondiabetic pregnancies. Typically, it is observed in the third trimester
of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events because the
decreased food intake by the mother and glucose transfer to the fetus contribute to
hypoglycemia.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: PlN
anUnR g INGTB.MCSOCM
inS : Client Needs: Physiologic Integrity
2. 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.”
ANS: C
Diet and insulin needs change during the pregnancy in direct correlation to hormonal
changes and energy needs. In the third trimester, insulin needs may double or even
quadruple. The diet is individualized to allow for increased fetal and metabolic
requirements, with consideration of such factors as prepregnancy weight and dietary habits,
overall health, ethnic background, lifestyle, stage of pregnancy, knowledge of nutrition, and
insulin therapy. Energy needs are usually calculated on the basis of 30 to 35 calories per
kilogram of ideal body weight. Dietary management during a diabetic pregnancy must be
based on blood, not urine, glucose changes.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity
,3. 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
ANS: A
Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor
glycemic control during the preconception time frame and into the early weeks of the
pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to
occur with severe diabetes and is the greatest risk in women with pregestational diabetes.
Increased weight, or macrosomia, is the greatest risk factor for this fetus.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning | Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
4. 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 balanceNURSINGTB.COM
b. Inadequate nutrition
c. Excessive nutrition
d. Disrupted sleep
ANS: B
This client’s clinical cues include weight loss, which supports a nursing diagnosis of
“Inadequate nutrition.” No clinical signs or symptoms support a nursing diagnosis of
disrupted fluid balance. This client reports weight loss not weight gain. Although the client
reports nervousness, the most appropriate nursing diagnosis, based on the client’s other
clinical symptoms, is “Inadequate nutrition.”
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity
5. 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.
ANS: B
, Children born to women with untreated PKU are more likely to be born with mental
retardation, microcephaly, congenital heart disease, and low birth weight. Maternal PKU has
no effect on labor. Women without dietary control of PKU are more likely to miscarry or
bear a child with congenital anomalies. Screening for undiagnosed maternal PKU at the first
prenatal visit may be warranted, especially in individuals with a family history of the
disorder, with low intelligence of an uncertain cause, or who have given birth to
microcephalic infants.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
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
ANS: B
Initially, the woman who is unable to down clear liquids by mouth requires IV therapy to
correct fluid and electrolyte imbalances. Corticosteroids have been successfully used to treat
refractory hyperemesis gravidarum, but they are not the expected initial treatment for this
disorder. Pyridoxine is vitamin B6, not an antiemetic medication. Promethazine, a common
antiemetic, may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition
via a feeding tube may be necessary to correct maternal nutritional deprivation but is not the
initial treatment for this client.
NURSINGTB.COM
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
7. 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.
ANS: B
Type 2 diabetes often goes undiagnosed because hyperglycemia gradually develops and is
often not severe. Type 2, sometimes called adult-onset diabetes, is the most common type of
diabetes. GDM refers to any degree of glucose intolerance first recognized during
pregnancy; insulin may or may not be needed. People do not go back and forth between type
1 and type 2 diabetes.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
8. Several metabolic changes occur throughout pregnancy. Which physiologic adaptation of
pregnancy will influence the nurse’s plan of care?
MULTIPLE CHOICE
1. 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
ANS: B
Preconception counseling is particularly important since strict metabolic control before
conception and in the early weeks of gestation is instrumental in decreasing the risk of
miscarriages. Frequent episodes of maternal hypoglycemia may occur during the first
trimester (not before conception) as a result of hormonal changes and the effects on insulin
production and use. Hydramnios occurs approximately 10 times more often in diabetic
pregnancies than in nondiabetic pregnancies. Typically, it is observed in the third trimester
of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events because the
decreased food intake by the mother and glucose transfer to the fetus contribute to
hypoglycemia.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: PlN
anUnR g INGTB.MCSOCM
inS : Client Needs: Physiologic Integrity
2. 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.”
ANS: C
Diet and insulin needs change during the pregnancy in direct correlation to hormonal
changes and energy needs. In the third trimester, insulin needs may double or even
quadruple. The diet is individualized to allow for increased fetal and metabolic
requirements, with consideration of such factors as prepregnancy weight and dietary habits,
overall health, ethnic background, lifestyle, stage of pregnancy, knowledge of nutrition, and
insulin therapy. Energy needs are usually calculated on the basis of 30 to 35 calories per
kilogram of ideal body weight. Dietary management during a diabetic pregnancy must be
based on blood, not urine, glucose changes.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity
,3. 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
ANS: A
Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor
glycemic control during the preconception time frame and into the early weeks of the
pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to
occur with severe diabetes and is the greatest risk in women with pregestational diabetes.
Increased weight, or macrosomia, is the greatest risk factor for this fetus.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning | Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
4. 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 balanceNURSINGTB.COM
b. Inadequate nutrition
c. Excessive nutrition
d. Disrupted sleep
ANS: B
This client’s clinical cues include weight loss, which supports a nursing diagnosis of
“Inadequate nutrition.” No clinical signs or symptoms support a nursing diagnosis of
disrupted fluid balance. This client reports weight loss not weight gain. Although the client
reports nervousness, the most appropriate nursing diagnosis, based on the client’s other
clinical symptoms, is “Inadequate nutrition.”
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity
5. 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.
ANS: B
, Children born to women with untreated PKU are more likely to be born with mental
retardation, microcephaly, congenital heart disease, and low birth weight. Maternal PKU has
no effect on labor. Women without dietary control of PKU are more likely to miscarry or
bear a child with congenital anomalies. Screening for undiagnosed maternal PKU at the first
prenatal visit may be warranted, especially in individuals with a family history of the
disorder, with low intelligence of an uncertain cause, or who have given birth to
microcephalic infants.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
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
ANS: B
Initially, the woman who is unable to down clear liquids by mouth requires IV therapy to
correct fluid and electrolyte imbalances. Corticosteroids have been successfully used to treat
refractory hyperemesis gravidarum, but they are not the expected initial treatment for this
disorder. Pyridoxine is vitamin B6, not an antiemetic medication. Promethazine, a common
antiemetic, may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition
via a feeding tube may be necessary to correct maternal nutritional deprivation but is not the
initial treatment for this client.
NURSINGTB.COM
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
7. 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.
ANS: B
Type 2 diabetes often goes undiagnosed because hyperglycemia gradually develops and is
often not severe. Type 2, sometimes called adult-onset diabetes, is the most common type of
diabetes. GDM refers to any degree of glucose intolerance first recognized during
pregnancy; insulin may or may not be needed. People do not go back and forth between type
1 and type 2 diabetes.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
8. Several metabolic changes occur throughout pregnancy. Which physiologic adaptation of
pregnancy will influence the nurse’s plan of care?
