ENDOCRINE CASE STUDY
The nurse is preparing to speak with the healthcare provider about the client's plan of
care.
Choose the most likely options for the information missing from the state- ment(s)
by selecting from the lists of options provided.:
1. Concerned for client's increasing BNP.
Pioglitazone can cause fluid retension, worsening existing heart failure: Rationale for correct
answer: Pioglitazone can cause renal reabsorption of sodium, leading to excess fluid retention and heart failure exacerbation.
Increasing BNP levels are suggestive of worsening heart failure. Rationale for incorrect answers: Pioglitazone can increase ALT
levels, prompting discontinuation or dose titration of the drug. Pioglitazone is frequently prescribed with metformin; both agents
work synergistically to improve insulin receptor sensitivity without increasing insulin production and secretion. A decreased
HbA1c is the goal of pioglitazone therapy. A decreased LDL cholesterol would be a desirable goal when on pioglitazone therapy.
Pioglitazone can decrease gluconeogenesis in the liver and does not attect insulin production or secretion. Pioglitazone generally
causes hypoglycemia only when administered with insulin or a sulfonylurea.
2. 1415:
The client is a 34-year-old man presenting to the emergency department with reports
of heart palpitations during the previous hour. The client denies chest pain, relevant
cardiac history, and smoking or drug use. The client reports increasing fatigue and
weight gain over the past several weeks. The client has a history of diabetes mellitus
type 2 and anxiety. The client states he
only had water after his noon insulin dose, hoping it would help him "wake up."
Review of systems remarkable for rapid pulse and sinus tachycardia on
electrocardiogram (ECG). All other systems within normal limits.:
3. Concerned for blood glucose level because regular insulin can cause rapid
onset of hypOglycemia: The client is experiencing hypoglycemia, as evidenced by a blood glucose level of less than
74 mg/dL (4.1 mmol/L). The client did not eat within 15-30 minutes of his noon insulin dose, causing a rapid
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The nurse is preparing to speak with the healthcare provider about the client's plan of
care.
Choose the most likely options for the information missing from the state- ment(s)
by selecting from the lists of options provided.:
1. Concerned for client's increasing BNP.
Pioglitazone can cause fluid retension, worsening existing heart failure: Rationale for correct
answer: Pioglitazone can cause renal reabsorption of sodium, leading to excess fluid retention and heart failure exacerbation.
Increasing BNP levels are suggestive of worsening heart failure. Rationale for incorrect answers: Pioglitazone can increase ALT
levels, prompting discontinuation or dose titration of the drug. Pioglitazone is frequently prescribed with metformin; both agents
work synergistically to improve insulin receptor sensitivity without increasing insulin production and secretion. A decreased
HbA1c is the goal of pioglitazone therapy. A decreased LDL cholesterol would be a desirable goal when on pioglitazone therapy.
Pioglitazone can decrease gluconeogenesis in the liver and does not attect insulin production or secretion. Pioglitazone generally
causes hypoglycemia only when administered with insulin or a sulfonylurea.
2. 1415:
The client is a 34-year-old man presenting to the emergency department with reports
of heart palpitations during the previous hour. The client denies chest pain, relevant
cardiac history, and smoking or drug use. The client reports increasing fatigue and
weight gain over the past several weeks. The client has a history of diabetes mellitus
type 2 and anxiety. The client states he
only had water after his noon insulin dose, hoping it would help him "wake up."
Review of systems remarkable for rapid pulse and sinus tachycardia on
electrocardiogram (ECG). All other systems within normal limits.:
3. Concerned for blood glucose level because regular insulin can cause rapid
onset of hypOglycemia: The client is experiencing hypoglycemia, as evidenced by a blood glucose level of less than
74 mg/dL (4.1 mmol/L). The client did not eat within 15-30 minutes of his noon insulin dose, causing a rapid
1/3
