EAQ Concept of Metabolism

The nurse evaluates the statements of a client after teaching about hydrocortisone therapy. Which statement made by the client indicates effective learning?

"I should report if there is swelling in the hands or legs". Excessive concentration of hydrocortisone causes fluid retention and edema. Therefore the client's statement regarding the development of swelling in the hands or legs indicates effective learning. Vomiting, fevers, and diarrhea are associated with prednisone therapy.

A nurse is caring for a client with Cushing syndrome. Which cardiovascular complication should the nurse assess for in this client?

Hypertension Hypertension is a cardiovascular complication found in clients with Cushing syndrome due to increased metabolic demands and catecholamines. Chest pain is seen in clients with hyperthyroidism and hypothyroidism. Tachycardia and atrial fibrillation are manifestations of dysrhythmias, which are associated with hypothyroidism or hyperthyroidism, parathyroidism, and pheochromocytoma.

A nurse provides post-operative care to a client who has undergone a hypophysectomy. Which action should the nurse take if there is a yellowish discharge at the dressing site?

Diarrhea Weight loss Diarrhea and weight loss are the characteristic manifestations of a hyperfunctional thyroid gland. Anemia is seen in a client with a hypofunctional thyroid and decreased levels of thyroid hormone. Decreased appetite and distant heart sounds are symptoms of a hypofunctional thyroid gland.

A nurse is teaching a client with diabetes about the treatment of hypoglycemia. The nurse knows that teaching was effective if the client picks which foods to treat a hypoglycemic attack?

Sugar and slice of bread The suggested treatment of hypoglycemia in a conscious client is a simple sugar (such as two packets of sugar), followed by a complex carbohydrate (such as a slice of bread), and finally a protein (such as milk); the simple sugar elevates the blood glucose level rapidly; the complex carbohydrates and protein produce a more sustained response. Fruit juice and a lollipop are fast-acting sugars, and neither of them will provide a sustained response. The fat content of chocolate candy decreases the rate of absorption of glucose. Neither peanut butter crackers nor a glass of milk is a fast-acting sugar; peanut butter crackers and milk can be used to maintain the glucose level after it is raised.

A client is scheduled to have a thyroidectomy for thyroid cancer. What specific instruction about postoperative care should the nurse provide the client during preoperative teaching?

Support the head with the hands when changing positions Supporting the head with the hands when changing position relieves tension on the incision and limits the risk of dehiscence. Coughing should be avoided during the early postoperative period to prevent trauma to the operative site. Performing range-of-motion exercises of the head and neck should be avoided until advised by the primary healthcare provider, usually after sutures or skin clips have been removed. Pressure against the operative area is not necessary to promote integrity of the incision, and it may inhibit swallowing.

A nurse is teaching a client with type 1 diabetes about assessing for signs and symptoms of hypoglycemia as a result of excessive insulin. What response should the nurse instruct the client to monitor in addition to nervousness and hunger?

Sweating When serum glucose decreases, the sympathetic nervous system is stimulated, resulting in a surge of epinephrine and norepinephrine; this response causes sweating, tremors, tachycardia, palpitations, nervousness, and hunger. Increased thirst (polydipsia) occurs in response to the osmotic diuresis associated with hyperglycemia. The ketosis and acidosis of diabetic ketoacidosis lead to gastrointestinal problems such as nausea, anorexia, vomiting, and abdominal cramping.

A nurse is caring for a client who had a thyroidectomy. Which client response should the nurse assess when concerned about an accidental removal of the parathyroid glands during surgery?

Tetany Parathyroid removal eliminates the body's source of parathyroid hormone (parathormone), which increases the blood calcium level. The resulting low body fluid calcium affects muscles, including the diaphragm, resulting in dyspnea, asphyxia, and death. Loss of the thyroid gland will upset thyroid hormone balance and may cause myxedema. The parathyroids are not involved in regulating plasma volume; the pituitary and adrenal glands are responsible. The parathyroids do not regulate the adrenal glands.

A nurse is caring for a client with hyperthyroidism. Which laboratory test will be most beneficial in monitoring the effectiveness of drug therapy?

Thyroxine (T4), total The thyroxine (T4) total study is the best method of monitoring thyroid therapy. A free thyroxine (FT4) study measures the active component of total T4; this test is an indicator of thyroid function. Free triiodothyronine (FT3) measures the active component of triiodothyronine (T3) total. Total T3 helps to diagnose hyperthyroidism when T4 levels are normal.

A client is diagnosed as having type 2 diabetes. What is a priority teaching goal for the client?

To identify pending hypoglycemia or hyperglycemia Knowledge of the signs and treatment for hypoglycemia or hyperglycemia is critical to the client's health and well-being and essential for survival. Although performing foot care daily is important, it is not the priority. The client has type 2 diabetes, which is usually controlled by oral hypoglycemics. Self-serum glucose monitoring is more accurate than sugar and acetone urine measurements to identify serum glucose levels.

A client with type 1 diabetes who has been adhering to a prescribed insulin regimen is admitted to the hospital in ketoacidosis. Which factor may have precipitated the ketoacidosis?

Upper respiratory infection Infection is a stress that increases adrenocortical secretion of glucocorticoids, which will increase the blood glucose level. Exercise requires glucose for muscle contraction, which decreases the blood glucose level. Decreased food intake will decrease the blood glucose level. Working the night shift will have no impact on the blood glucose level.

The nurse is teaching a diabetic client about the advantages of using an insulin pump. What information should the nurse include? Select all that apply.

It can improve A1C levels Clients may be able to exercise without eating more carbohydrates Maintaining a consistent acceptable blood glucose level will improve A1C results. Because insulin is administered only as needed, the client will be able to exercise without having to increase the carbohydrate intake. Ketoacidosis may occur if the catheter becomes dislodged and the client does not receive insulin for hours. Insulin pumps can cause weight gain, not loss. An insulin pump is more expensive than subcutaneous insulin injections.

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis. Which arterial blood gas results are associated with this diagnosis?

pH: 7.28; PCO2: 28; HCO3: 18 A low pH and bicarbonate reflect metabolic acidosis; a low PCO2 indicates compensatory hyperventilation. A low pH and elevated PCO2 reflect hypoventilation and respiratory acidosis. An elevated pH and bicarbonate reflect metabolic alkalosis; an elevated PCO2 indicates compensatory hypoventilation. An elevated pH and low PCO2 reflect hyperventilation and respiratory alkalosis.

The nurse is caring for a client who reports sweating, tachycardia, and tremors. The laboratory report of the client reveals serum cortisol below normal and a blood glucose level of 60 mg/dL. What is the primary care to be provided to the client?

Administer glucagon A decrease in cortisol levels impairs the glucose metabolism. The client's blood glucose level is 60 mg/dL, which is indicative of hypoglycemia. Therefore the nurse should administer glucagon as per the prescription to manage the low glucose levels. Kayexalate is a potassium-binding resin that facilitates potassium excretion and is used to manage hyperkalemia. Intramuscular hydrocortisone is given concomitantly every 12 hours as part of hormone replacement in adrenal insufficiency. Insulin with dextrose in normal saline is given to manage hyperkalemia by causing an intracellular shift of potassium.

The physical examination of a client reveals moon face, buffalo hump, and truncal obesity. The laboratory report reveals salivary cortisol level of 3.0 ng/mL (9.54 nmol/L). Which other manifestations would be present in the client? Select all that apply.

Edema Osteoporosis Muscle atrophy Hypercortisolism may result in sodium and water reabsorption and retention, leading to hypervolemia and edema. Hypercortisolism may also cause mineral loss, which leads to osteoporosis. This condition may also cause musculoskeletal changes caused by nitrogen depletion and mineral loss. This may lead to muscle atrophy. Moon face, buffalo hump, and truncal obesity are clinical manifestations of hypercortisolism. A normal salivary cortisol is 2.0 ng/mL (6.36 nmol/L); a higher level also indicates hypercortisolism. Hypogonadism is a loss of secondary sexual characteristics, which may occur due to increased prolactin secretion. A barrel-shaped chest is seen in clients with acromegaly (due to increased growth hormone secretion) and chronic obstructive pulmonary disease.

A nurse is preparing to assess the client's thyroid gland. Arrange the procedure for posterior palpation of the thyroid gland in sequence.

First stand behind the client and place the thumbs on the nape of the client's neck. Then use the index and middle fingers to feel the thyroid isthmus. Ask the client to flex the neck slightly forward and to the right to relax the neck muscles. Next palpate the sternocleidomastoid muscle with the index and middle fingers of the right hand. The thyroid will move up when the nurse asks the client to swallow water.

A nurse provides post-operative care to a client who has undergone a hypophysectomy. Which action should the nurse take if there is a yellowish discharge at the dressing site?

Inform primary HCP In order to reduce the risk of further complications, the nurse should inform the primary healthcare provider. Leakage of cerebrospinal fluid (CSF) may occur due to hypophysectomy. A yellowish discharge at the dressing site indicates the leakage of CSF. Changing the dressing, cleaning the wound with alcohol, and tightening the dressing may complicate the condition.

Which metabolic manifestations are likely to be observed in a client with hypothyroidism? Select all that apply.

Intolerance to cold Decreased body temperature Cold intolerance and decreased body temperature are the metabolic manifestations observed in a client with hypothyroidism. Impaired memory is the neuromuscular manifestation of hypothyroidism. Difficulty in breathing is the pulmonary manifestation observed in the client with hypothyroidism. Decreased blood pressure is the cardiovascular manifestation observed in the client with hypothyroidism.

Which clinical manifestations in a client indicate hyperfunctional thyroid gland? Select all that apply.

Moon face Hypersecretion of adrenocorticotrophic hormone results in Cushing's disease, which is characterized by "moon face" appearance, an abnormal distribution of fat in the face. Protrusion of the lower jaw is a feature of acromegaly, caused by excess secretion of growth hormone. Heat intolerance is seen in clients with excess secretion of thyrotropin. In acromegaly, the client presents with "barrel-shaped" chest appearance.

Which procedure is preferred to find out the composition of a thyroid nodule and ascertain the need for further surgical intervention in a client?

Needle biopsy Needle biopsy is an ambulatory surgical procedure. A fine needle is used to aspirate the contents of thyroid nodules to study the composition and ascertain the need for further surgical interventions. Mass spectrometry is an assay in which several different hormone concentrations can be simultaneously analyzed. Computed tomography scans are useful for evaluation of ovaries, adrenal glands, and the pancreas. The average blood glucose level over 2 to 3 months is revealed by a glycosylated hemoglobin test.

On reviewing the data of a client with thyroid disorder, the primary healthcare provider prescribed atenolol. Which assessment findings would indicate the need for atenolol therapy? Select all that apply.

Tachycardia Atrial fibrillation Systolic hypertension In hyperthyroidism, atenolol is prescribed to reduce cardiac manifestations. Tachycardia, atrial fibrillation, and systolic hypertension are cardiac manifestations associated with hyperthyroidism. Distant heart sounds are associated with hypothyroidism. The cardiac output is increased in hyperthyroidism.

After reviewing the reports of a client, the nurse suspects hypofunctioning of the adrenal gland. Which findings are consistent with hypofunctioning of the adrenal gland? Select all that apply.

Increased Serum Calcium Decreased serum Cortisol Decreased Serum Sodium Hypofunctioning of the adrenal gland is manifested by increased serum calcium, decreased serum cortisol, and decreased serum sodium levels. Decreased serum potassium and decreased serum bicarbonate levels are associated with hyperfunctioning of the adrenal gland. Normal to increased serum glucose is associated with hyperfunctioning of the adrenal gland.Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options.

A nurse is monitoring a client's laboratory results for a fasting plasma glucose level. Within which range of a fasting plasma glucose level does the nurse conclude that a client is considered to be diabetic?

126 to 140 mg/dL (7.0 to 7.8 mmol/L) Results in the range 126 to 140 mg/dL (7.0 to 7.8 mmol/L) indicate diabetes. Results in the range 40 to 60 mg/dL (2.2 to 3.3 mmol/L) indicate hypoglycemia. Results in the range 80 to 99 mg/dL (4.5 to 5.5 mmol/L) are considered expected (normal). Results in the range 100 to 125 mg/dL (5.6 to 6.9 mmol/L) indicate prediabetes according to the American Diabetes Association. (Results in the range of 6.1 to 6.9 mmol/L indicate prediabetes according to the Canadian Diabetes Association Guidelines.)

A client has a glycosylated hemoglobin measurement of 6%. What should the nurse conclude about this client when planning teaching strategies based on the results of this laboratory test?

The client has followed the treatment plan as prescribed The expected range of glycosylated hemoglobin (HbA1C) is 4.4% to 6.4%. A value of 6% is within the expected range. Glycosylated hemoglobin measures the average blood glucose level for the 90- to 120-day period before the blood sample is collected; thus, it is a reliable way to measure adherence to a therapy plan of insulin, diet, and exercise. A glycosylated hemoglobin measurement does not measure rebound hyperglycemia (Somogyi effect). The HbA1C fraction of hemoglobin is measured, and its value is not affected by short-term infractions of diet or the type of insulin the client takes. The client does not require further teaching regarding nutritional guidelines because the laboratory result is within the expected range, indicating adherence to a therapy plan of insulin, diet, and exercise.

The nurse is providing instructions about foot care for a client with diabetes mellitus. What should the nurse include in the instructions? Select all that apply.

Wear shoes when out of bed Dry between the toes after bathing Wearing shoes protects the feet from trauma; they should fit well and should be worn over clean socks. Drying between the toes after bathing prevents maceration and skin breakdown, thus maintaining skin integrity. Soaking the feet is contraindicated because it can cause macerations and skin breakdown, which allow a portal of entry for pathogenic organisms. Clients should not self-treat corns, calluses, warts, or ingrown toenails because of the potential for trauma and skin breakdown; these conditions should be treated by a podiatrist. Use of a heating pad, hot water bottle, or hot water is contraindicated because of the potential for burns; diabetic neuropathy, if present, does not allow the client to accurately evaluate the extremes of temperature.

After assessing a client's condition, the nurse suspects that the client has diabetes mellitus. Which statement made by the client would be most appropriate in helping the nurse reach this conclusion? Select all that apply.

"I am 55yrs. old" "I quite often feel thirsty" "I eat food every 2 hours" Diabetes mellitus is more common in older clients. Clients with diabetes mellitus may feel excessive thirst due to frequent urination and may also experience excessive hunger. Excessive sweating and respiratory disorders are mostly observed in clients with hyperthyroidism.