Question

A 68-year-old woman with an 8-year history of diabetes mellitus presents to the clinic for worsening dyspnea and cough. She has had chronic obstructive pulmonary disease (COPD; see the Respiratory Function chapter) since age 55. She now has dyspnea from walking one-third of a block, as well as a persistent cough. She has managed her type 2 DM with diet and exercise. Her last glycosylated hemoglobin (HgbA1c), which was measured 1 month ago, was 6.8% (normal range is 4–6%). Physical examination reveals an anxious woman with blood pressure of 134/70 mm Hg, pulse of 116, respiratory rate of 24 breaths per minute, and weight of 190 pounds. Expiratory wheezing is present bilaterally. No accessory muscles are being used. No cyanosis is present. The lab evaluation results are as follows: arterial blood gas (ABG) 7.46; PaO2 60; PaCO2 40; O2 sat 88% (see the Fluid, Electrolyte, and Acid–Base Homeostasis chapter).

The patient is started on albuterol (bronchodilator) and a course of prednisone (glucocorticoid) at 40 mg/day for 3 days, then tapering over 2 weeks. On day 3, she calls back to the clinic to report that her blood glucose level is 358 mg/dL at 4:00 p.m.

1. Which of the following is the most likely cause of this patient’s acute loss of glucose control?
   1. An acid–base imbalance
   2. Prednisone therapy
   3. COPD exacerbation
   4. Albuterol
2. All of the following actions are important for this patient to learn regarding glucocorticoid therapy, but which is the most important?
   1. Monitor cuts for healing
   2. Take the medication with food
   3. Do not stop taking the medication abruptly
   4. Contact her healthcare provider if she has any manifestations of infection
3. Which of the following endocrine conditions is this patient at risk of developing?
   1. Hyperthyroidism
   2. Pheochromocytoma
   3. Addison’s disease
   4. Cushing’s syndrome
4. Given this patient’s acute loss of glucose control, which of the following interventions would the nurse expect to be ordered for this patient?
   1. Insulin as needed per routine sliding scale (dosing based on blood glucose levels)
   2. Increase exercise
   3. Decrease caloric intake
   4. Decrease prednisone dose

Answer 1

1. Which of the following is the most likely cause of this patient’s acute loss of glucose control?
   1. Prednisone therapy
2. All of the following actions are important for this patient to learn regarding glucocorticoid therapy, but which is the most important?
   1. Do not stop taking the medication abruptly
3. Which of the following endocrine conditions is this patient at risk of developing?
   1. Cushing’s syndrome
4. Given this patient’s acute loss of glucose control, which of the following interventions would the nurse expect to be ordered for this patient?
   1. Insulin as needed per routine sliding scale (dosing based on blood glucose levels)