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Chapter 8: Special Nutritional Considerations for Endocrine Health

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Chapter 8: Special Nutritional Considerations for Endocrine Health

16 problems · 0 figures

Case Study 8.1.1 §8.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Sarah goes to the laboratory before her 24–28-week check for her oral glucose tolerance test (OGTT). Her results show an elevated level, indicating a need for further testing, so a second OGTT is ordered for confirmation. Following the second OGTT, Sarah is diagnosed with GD. Sarah is referred to a registered dietitian who specializes in GD. Sarah and the dietitian develop a personalized meal plan:

• Morning: 30 g of carbohydrates—2 slices of toast with poached eggs

• Snack: a serving of vegetables and hummus

• Lunch: 60 g of carbohydrates—sandwich on whole grain bread with lean shredded chicken and vegetables such as lettuce; she eats a serving of fruit such as an apple, and drinks mainly water

• Snack: ¼ cup of almonds

• Dinner: Lean protein with vegetables and 60 g of brown rice

Sarah is taught to monitor her blood glucose levels and to engage in some physical activity. Her health care provider started her on a low dose of 500 mg metformin twice daily. Her subsequent examination will occur at 32 weeks’ gestation. The nurse encourages Sarah to call the office if she has any questions or concerns before her next appointment and to adhere to the treatment plan. The nurse also encourages her to communicate openly with her health care team throughout the pregnancy.

The consumption of which nutrient should Sarah most closely monitor to manage her blood glucose levels?
  1. a.
    Water
  2. b.
    Fats
  3. c.
    Proteins
  4. d.
    Carbohydrates

Answer

D. Carbohydrates
Blood glucose levels are heavily influenced by carbohydrate intake.

Case Study 8.1.2 §8.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Sarah goes to the laboratory before her 24–28-week check for her oral glucose tolerance test (OGTT). Her results show an elevated level, indicating a need for further testing, so a second OGTT is ordered for confirmation. Following the second OGTT, Sarah is diagnosed with GD. Sarah is referred to a registered dietitian who specializes in GD. Sarah and the dietitian develop a personalized meal plan:

• Morning: 30 g of carbohydrates—2 slices of toast with poached eggs

• Snack: a serving of vegetables and hummus

• Lunch: 60 g of carbohydrates—sandwich on whole grain bread with lean shredded chicken and vegetables such as lettuce; she eats a serving of fruit such as an apple, and drinks mainly water

• Snack: ¼ cup of almonds

• Dinner: Lean protein with vegetables and 60 g of brown rice

Sarah is taught to monitor her blood glucose levels and to engage in some physical activity. Her health care provider started her on a low dose of 500 mg metformin twice daily. Her subsequent examination will occur at 32 weeks’ gestation. The nurse encourages Sarah to call the office if she has any questions or concerns before her next appointment and to adhere to the treatment plan. The nurse also encourages her to communicate openly with her health care team throughout the pregnancy.

The nurse asks Sarah about her protein intake. Sarah reports that she has been regularly craving and eating cheeseburgers. Why should the nurse be concerned about this finding?
  1. a.
    Sarah is not choosing lean protein sources.
  2. b.
    Sarah is eating too much cheese.
  3. c.
    Eating a lot of red meat can indicate anemia.
  4. d.
    This is not a concerning finding as long as Sarah is consuming adequate amounts of food.

Answer

A. Sarah is not choosing lean protein sources.
A healthy diet includes protein from lean sources such as chicken or seafood. Cheeseburgers are high in saturated fat, which can worsen insulin resistance.

Case Study 8.1.3 §8.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Sarah delivers a baby girl at 38 weeks’ gestation weighing 9 lb 1 oz. Sarah followed the recommendations of her nurse, dietitian, and health care provider, and her blood glucose levels are now at baseline pre-pregnancy levels. Because Sarah is at increased risk for developing type 2 diabetes, her nurse needs to incorporate this information into Sarah’s postpartum education.

Sarah asks if her diabetes will recur now that she is no longer pregnant. How should the nurse respond?
  1. a.
    “You need to be monitored 6 weeks after delivery for the signs of diabetes.”
  2. b.
    “Now that you are no longer pregnant, your diabetes has resolved and is no longer an issue.”
  3. c.
    “Having gestational diabetes increases your risk for developing type 1 diabetes later.”
  4. d.
    “Having gestational diabetes increases your risk for developing type 2 diabetes later.”

Answer

D. “Having gestational diabetes increases your risk for developing type 2 diabetes later.”
Having gestational diabetes increases a person’s risk for developing type 2 diabetes later in life.

Case Study 8.1.4 §8.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Sarah delivers a baby girl at 38 weeks’ gestation weighing 9 lb 1 oz. Sarah followed the recommendations of her nurse, dietitian, and health care provider, and her blood glucose levels are now at baseline pre-pregnancy levels. Because Sarah is at increased risk for developing type 2 diabetes, her nurse needs to incorporate this information into Sarah’s postpartum education.

The nurse reviews diet strategies with Sarah to decrease her risk for developing type 2 diabetes. Which of the following statements indicates additional instruction is needed?
  1. a.
    “I will limit my intake of concentrated sweets.”
  2. b.
    “I will avoid eating nuts.”
  3. c.
    “I will try to eat different fruits and vegetables.”
  4. d.
    “I will incorporate protein into my meals and snacks.”

Answer

B. “I will avoid eating nuts.”
Nuts include both healthy dietary fiber and healthy fats.

Case Study 8.2.5 §8.2 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Sarah delivered her baby 4 years ago. She has returned to the clinic for an annual exam. Before the examination, her primary health care provider ordered blood work to check Sarah’s metabolic processes and endocrine function. Sarah’s HbA1c result is 7.7%. Sarah weighs 167 lb and is 5 feet tall.

The nurse recognizes that the test result indicates which condition?
  1. a.
    Hyperthyroidism
  2. b.
    Type 1 diabetes
  3. c.
    Type 2 diabetes
  4. d.
    Hypoparathyroidism

Answer

C. Type 2 diabetes
Sarah’s hemoglobin A1C result indicates that she may have developed diabetes.

Case Study 8.2.6 §8.2 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Sarah delivered her baby 4 years ago. She has returned to the clinic for an annual exam. Before the examination, her primary health care provider ordered blood work to check Sarah’s metabolic processes and endocrine function. Sarah’s HbA1c result is 7.7%. Sarah weighs 167 lb and is 5 feet tall.

Which of the following dietary recommendations should the nurse reinforce during this visit?
  1. a.
    Lean proteins, fruits, vegetables, and plenty of starchy potatoes
  2. b.
    Lean proteins, fruits, vegetables, and low glycemic index foods
  3. c.
    High glycemic index foods with limited proteins, fruits, and vegetables
  4. d.
    No dietary recommendations, just medications

Answer

B. Lean proteins, fruits, vegetables, and low glycemic index foods
Sarah will need to continue to eat lean proteins, fruits, vegetables, and high-fiber foods to manage her blood glucose levels.

8-1 §8.RQ source ↗

How does protein intake contribute to growth and development during childhood?
  1. a.
    Maintains digestive function
  2. b.
    Influences nutrient absorption
  3. c.
    Plays an anabolic role similar to that of growth hormone
  4. d.
    Mediates levels of growth hormone

Answer

C. Plays an anabolic role similar to that of growth hormone
Protein, in the form of lean meat and dairy products, is essential for growth and development. It plays an anabolic role similar to that of growth hormone and insulin-like growth factor.

8-2 §8.RQ source ↗

Which of the following foods supplies micronutrients that decrease inflammation?
  1. a.
    Kale
  2. b.
    Sourdough bread
  3. c.
    Beef
  4. d.
    White rice

Answer

A. Kale
Kale is a leafy green vegetable that is a key source of anti-inflammatory micronutrients.

8-3 §8.RQ source ↗

Medications given to older adults to stimulate appetite target which hormone?
  1. a.
    Ghrelin
  2. b.
    Thyroid-stimulating hormone
  3. c.
    Insulin
  4. d.
    Cholecystokinin

Answer

D. Cholecystokinin
Clients can take antagonist medications to lower cholecystokinin levels to stimulate appetite.

8-4 §8.RQ source ↗

Which of the following is a good food choice for a client with Hashimoto’s thyroiditis who needs to consume iodine-rich foods?
  1. a.
    Leafy green vegetables
  2. b.
    Fish
  3. c.
    Citrus fruits
  4. d.
    Whole grains

Answer

B. Fish
Fish is an iodine-rich food and a good choice for a client with Hashimoto’s thyroiditis.

8-5 §8.RQ source ↗

The nurse is providing dietary education for a client with diabetes. The client asks why their sodium intake should be limited. What is the best response from the nurse?
  1. a.
    “Lowering your sodium intake can decrease your blood glucose level.”
  2. b.
    “A low-sodium diet can decrease inflammation in the body.”
  3. c.
    “Sodium-controlled diets can lower your elevated risk for developing cardiovascular disease and hypertension.”
  4. d.
    “Adding less salt to your food can decrease the food’s glycemic index.”

Answer

C. “Sodium-controlled diets can lower your elevated risk for developing cardiovascular disease and hypertension.”
Sodium should be limited to 2300 mg/day to decrease the risk for cardiovascular disease and hypertension associated with diabetes.

8-6 §8.RQ source ↗

What is the recommended daily intake of saturated fats for individuals with diabetes?
  1. a.
    Less than 5%
  2. b.
    Less than 10%
  3. c.
    Less than 15%
  4. d.
    Less than 20%

Answer

B. Less than 10%
Clients with diabetes should restrict saturated fats to less than 10% of daily intake.

8-7 §8.RQ source ↗

What should the nurse include in dietary instructions for a client with diabetes regarding alcohol consumption?
  1. a.
    Alcohol consumption can either raise or lower blood glucose levels.
  2. b.
    Alcohol consumption does not affect blood glucose levels.
  3. c.
    Drinking alcohol is acceptable if low-sugar or sugar-free ingredients are used in mixed drinks.
  4. d.
    Drinking alcohol may worsen signs of hypoglycemia when it occurs.

Answer

A. Alcohol consumption can either raise or lower blood glucose levels.
Alcohol consumption causes variability in blood glucose levels.

8-8 §8.RQ source ↗

Which of the following practices will help clients with diabetes decrease the risk for hypoglycemia after insulin administration?
  1. a.
    Administering less than the prescribed dose of insulin
  2. b.
    Coordinating insulin administration with their meal schedule
  3. c.
    Eating less than the prescribed amount of carbohydrates
  4. d.
    Administering insulin between meals

Answer

B. Coordinating insulin administration with their meal schedule
Insulin and other medications used to manage diabetes require coordination with meals to maintain proper blood glucose levels.

8-9 §8.RQ source ↗

Which of the following instructions should the nurse include when teaching a client about levothyroxine?
  1. a.
    “You can take this medication at any time during the day.”
  2. b.
    “You can take this medication at the same time you take vitamins and other supplements.”
  3. c.
    “Take this medication at the same time every day with meals.”
  4. d.
    “Take this medication on an empty stomach.”

Answer

D. “Take this medication on an empty stomach.”
Levothyroxine should be taken on an empty stomach and timed to avoid interaction with certain foods and supplements that can inhibit absorption.

8-10 §8.RQ source ↗

The nurse is documenting a client’s medications during an admission assessment. Which of the following medications can decrease parathyroid levels, thereby increasing the risk for bone fractures?
  1. a.
    Levothyroxine
  2. b.
    Metformin
  3. c.
    Furosemide
  4. d.
    Insulin

Answer

C. Furosemide
Loop diuretics, such as furosemide, cause the parathyroid gland to decrease the production of parathyroid hormone, which is important in maintaining bone stability.

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Problems and answers are adapted from Nutrition for Nurses by Emerald Charity Bilbrew, Jody Vogelzang and Kelli Whittington, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/nutrition/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.