Metabolism Prep-U

A 70-year-old female client comes to the clinic with back pain. An x-ray reveals vertebral fractures and she is diagnosed with osteoporosis. Which factor most likely contributed to her condition? A. Decreased estrogen levels B. Prolonged standing C. Excessive dietary calcium D. Strenuous exercise

A. Decreased estrogen levels Estrogen reduces the number and function of the osteoclasts. Thus, the decrease in estrogen levels that occurs at menopause results in increased resorption of bone.

In collecting assessment data on the school-aged population, which factor could be the most significant predictor of childhood obesity? A. Having parents who are obese B. Low socioeconomic status C. Low self-esteem D. Living in a rural neighborhood

A. Having parents who are obese Though genetic research gives new insight into the genesis of obesity, environmental influence remains the major contributor to this worldwide issue. Influences such as family eating patterns contribute to overweight trends. The most significant risk for childhood obesity is having parents who are obese. This variable is more important than socioeconomic status, low self-esteem, or a rural or inner-city residence.

The nurse assessing a client with a diagnosis of cholelithiasis will look for pain in which area? A. Right upper quadrant B. Left upper quadrant C. Left lower quadrant D. Right lower quadrant

A. Right upper quadrant The pain is usually located in the upper right quadrant or epigastric area and may be referred to the upper back, right shoulder, or midscapular region. Typically, the pain is abrupt in onset, increases steadily in intensity, persists for 2 to 8 hours, and is followed by soreness in the upper right quadrant.

Which of the following hormones would the nurse identify as being secreted by the thyroid gland? A. Thyroxine B. Thymosin C. Parathormone D. Somatotropin

A. Thyroxine The thyroid gland secretes thyroxine (T4 or tetraiodothyronine), triiodothyronine (T3), and calcitonin. Parathormone is secreted by the parathyroid glands. Thymosin is secreted by the thymus gland. Somatotropin is secreted by the anterior pituitary gland.

Routine physical examination reveals a client has a new diagnosis of upper body obesity with central fat distribution. This diagnosis places the client at greater risk for developing which disease process? A. Chronic anemia B. Heart disease C. Reproductive cancers D. Osteoporosis

B. Heart disease Upper body obesity, more than other types of obesity, carries a high cardiometabolic risk. Obese people tend to develop joint problems and arthritis, but there is no direct association with osteoporosis. Chronic anemia is associated with malnutrition and starvation. Primary renal disease is unrelated to excessive weight.

A client experienced a stroke that damaged the hypothalamus. The nurse should anticipate that the client will have problems with: A. visual acuity. B. body temperature control. C. thinking and reasoning. D. balance and equilibrium.

B. body temperature control. The body's thermostat is located in the hypothalamus; therefore, injury to that area can cause problems with body temperature control. Balance and equilibrium problems are related to cerebellar damage. Visual acuity problems would occur following occipital or optic nerve injury. Thinking and reasoning problems are the result of injury to the cerebrum.

Hormone therapy decreases the risk of A. blood clots. B. stroke. C. hot flashes. D. heart attack.

C. hot flashes. Hormone therapy decreases the risk of hot flashes. It increases the risk of stroke, heart attack, and blood clots.

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? A. "I avoid exposure to the sun as much as possible." B. "I always carry hard candy to eat in case my blood sugar level drops." C. "I always wear my medical identification bracelet." D. "I skip lunch when I don't feel hungry."

D. "I skip lunch when I don't feel hungry." The client requires further teaching if he states that he skips meals. A client who is receiving an oral antidiabetic agent should eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia. Carrying hard candy, avoiding exposure to the sun, and always wearing a medical identification bracelet indicate effective teaching.

Nursing students are studying metabolic disorders of the skeletal system and correctly identify which factor to be the major cause of osteoporosis? A. Diet B. Heredity C. Sex D. Aging process

D. Aging process Although osteoporosis can occur as the result of a number of disorders and risk factors, it is most often associated with the aging process.

A client is being seen in the clinic to receive the results of the lab work to determine thyroid levels. The nurse observes the client's eyes appear to be bulging, and there is swelling around the eyes. What does the nurse know that the correct documentation of this finding is? A. Retinal detachment B. Bulging eyes C. Periorbital swelling D. Exophthalmos

D. Exophthalmos Exophthalmos is an abnormal bulging or protrusion of the eyes and periorbital swelling. These findings are not consistent with retinal detachment.

A client is being seen in the clinic to receive the results of the lab work to determine thyroid levels. The nurse observes the client's eyes appear to be bulging, and there is swelling around the eyes. What does the nurse know that the correct documentation of this finding is? A. Periorbital swelling B. Bulging eyes C. Retinal detachment D. Exophthalmos

D. Exophthalmos Exophthalmos--> is an abnormal bulging or protrusion of the eyes and periorbital swelling. These findings are not consistent with retinal detachment.

A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the: A. Common bile duct B. Cystic duct C. Duodenum D. Gallbladder

D. Gallbladder The gallbladder functions as a storage depot for bile.

A client with diabetic retinopathy develops a retinal bleed and asks the nurse, "How can I prevent this from happening again?" What response provides the most effective information? A. Wear glasses when reading and limit computer time. B. Control stress and monitor vision changes. C. Visit your eye health professional for annual exams. D. Maintain healthy blood pressure and blood sugar levels.

D. Maintain healthy blood pressure and blood sugar levels. Diabetic retinopathy--> occurs when blood vessels have increased permeability, develop microaneurysms, vascular proliferation, scarring, and retinal detachment. These conditions are worsened when the client has poor glycemic control, poorly controlled hypertension, and hyperlipidemia. Laser photocoagulation can be used to stop vessel proliferation and bleeding. An annual examination will evaluate the disease, but does not prevent recurrence. Eye use patterns do not change retinopathy.

The nurse is working with clients with digestive tract disorders. Which of the following organs does the nurse realize has effects as an exocrine gland and an endocrine gland? A. Liver B. Gallbladder C. Stomach D. Pancreas

D. Pancreas The pancreas is both an exocrine gland, one that releases secretions into a duct or channel, and an endocrine gland, one that releases substances directly into the bloodstream. The other organs have a variety of functions but do not have a combination function such as the pancreas.

A client is undergoing a diagnostic workup for suspected thyroid cancer. What is the most common form of thyroid cancer in adults? A. Follicular carcinoma B. Medullary carcinoma C. Anaplastic carcinoma D. Papillary carcinoma

D. Papillary carcinoma Papillary carcinoma accounts for about 70% of thyroid cancer cases in adults. Follicular carcinoma accounts for roughly 15%; anaplastic carcinoma, about 5%; and medullary carcinoma, about 5%.

After teaching a group of students about erectile dysfunction, the instructor determines that the teaching was successful when the students identify which of the following as true? A. Erectile dysfunction may be due to testosterone insufficiency. B. Erectile dysfunction is primarily a normal response to aging. C. Erectile dysfunction is unrelated to anxiety or depression. D. Erectile dysfunction rarely occurs in clients with diabetes mellitus.

A. Erectile dysfunction may be due to testosterone insufficiency. Common causes of erectile dysfunction include neurologic disorder like spinal cord injury, perineal trauma, testosterone insufficiency, side effects of drug therapy such as antihypertensives or antidepressants, atherosclerosis, hypertension, and complications of diabetes mellitus. Erectile dysfunction may be related to anxiety or depression. It is not a normal aspect of aging.

The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale? A. Diet and drug histories are related to the family history. B. Endocrine disorders can be inherited. C. An allergy to iodine is inherited. D. It helps determine the client's general status.

B. Endocrine disorders can be inherited. Some endocrine disorders are inherited or have a tendency to run in families. Therefore, it is essential to take a complete family history. A complete blood count and chemistry profile are performed to determine the client's general status and to rule out disorders. Obtaining information about an allergy to iodine is important because diagnostic testing may involve the use of contrast dyes. However, an allergy to iodine is not related to endocrine disorders. Diet and drug histories, although important information, are not associated with the family history.

Digestion of starch begins in which structure? A. Small intestine B. Mouth C. Large intestine D. Stomach

B. Mouth Digestion of starch begins in the mouth by the action of amylase.

What is the source of nutrition for the epidermis? A. Pigment membranes B. The dermis C. Melanocytes D. Bullae

B. The dermis The dermis is the connective tissue layer that separates the epidermis from the subcutaneous fat layer. It supports the epidermis and serves as its primary source of nutrition.

According to the DASH diet, how many servings of vegetables should a person consume each day? A. 2 or fewer B. 2 or 3 C. 4 or 5 D. 7 or 8

C. 4 or 5 Four or five servings of vegetables are recommended in the DASH diet. The diet recommends two or fewer servings of lean meat, fish, and poultry; two or three servings of low-fat or fat-free dairy foods; and seven or eight servings of grains and grain products.

What is a physiologic basis for albinism? A. Accelerated keratinization B. Lichenification C. Lack of tyrosinase D. Separation of the epidermis from the dermis

C. Lack of tyrosinase Although there are more than 10 different types of albinism, the most common type is recessively inherited oculocutaneous albinism, in which there is a normal number of melanocytes but they lack tyrosinase, the enzyme needed for synthesis of melanin.

An extremely lethargic client arrives by ambulance at the emergency department. His blood glucose level is 32 mg/dL (1.78 mmol/L). The nurse will anticipate that this client will be diagnosed with: A. Dawn phenomenon B. Autonomic neuropathy C. Diabetic ketoacidosis D. Hypoglycemia

D. Hypoglycemia Hypoglycemia is a blood glucose level of less than 60 mg/dL (3.33 mmol/L). Blood glucose levels would be elevated in diabetic ketoacidosis and in the dawn phenomenon. Autonomic neuropathy causes disorders of autonomic (for example, cardiovascular) function.

When preparing teaching plan for a client with an endocrine disorder, the nurse includes information about hormone regulation. Which of the following would the nurse include? A. The gland slows hormone secretion when the hormone level decreases. B. Hormone secretion occurs as a straight-line continuous process. C. The gland becomes enlarged leading to a deficiency of the hormone. D. Most disorders result from over- or underproduction of the hormone.

D. Most disorders result from over- or underproduction of the hormone. Most endocrine disorders result from an overproduction or underproduction of specific hormones. A negative feedback loop controls hormone levels, such that a decrease in levels stimulates the releasing gland. Glandular enlargement is not involved with hormonal regulation.

A nurse is assessing a female client prior to educating about healthy lifestyle changes. The client has a body mass index (BMI) of 32.4. According to the BMI, the nurse would classify this client as: A. overweight. B. underweight. C. normal weight range. D. obese.

D. obese. A BMI of 32.4 is considered to be in the obese range, which is 30.0-34.9. Underweight would be a BMI of <18.5. The normal range of BMI is considered 18.5-24.9. Overweight range is 25.0-29.9.

The common bile duct opens into which part of the gastrointestinal tract? A. Duodenum B. Ileum C. Jejunum D. Cecum

A. Duodenum The duodenum contains the opening for the common bile duct and the main pancreatic duct.

A client with diabetes has started thyroid hormone replacement therapy. The nurse should monitor closely for which effects? A. Increased thirst B. Decreased oral fluid intake C. Oliguria D. Decreased appetite

A. Increased thirst The client with diabetes who begins thyroid replacement hormones should be monitored closely for signs of hyperglycemia: increased thirst, increased hunger, polyuria (increased urine output) and hot, dry skin.

Hormones are chemical messengers that provide which function in the body? A. Regulate body functions B. Transport fatty acids and lipids C. Cause one specific tissue effect D. Initiate immune reactions

A. Regulate body functions Hormones regulate and integrate body functions. Hormones act on specific target cells, but they cause a variety of effects on tissues. Hormones do not transport other substances; hormones are transported and present in body fluids at all times.

The nurse is assessing a client. What assessment findings should the nurse interpret as suggesting a sympathetic response? A. increase in blood pressure and decreased bowel sounds B. decreased sweating and respiratory rate C. evidence of inflammation and decreased heart rate D. increased bowel sounds and pupil constriction

A. increase in blood pressure and decreased bowel sounds When stimulated, the sympathetic nervous system prepares the body to flee or to turn and fight. Cardiovascular activity increases, as do blood pressure, heart rate, and blood flow to the skeletal muscles. Respiratory efficiency also increases; bronchi dilate to allow more air to enter with each breath, and the respiratory rate increases. Pupils dilate to permit more light to enter the eye, to improve vision in darkened areas (which helps a person to see to fight or flee). Sweating increases to dissipate heat generated by the increased metabolic activity.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: A. subnormal serum glucose and elevated serum ammonia levels. B. subnormal clotting factors and platelet count. C. elevated liver enzymes and low serum protein level. D. elevated blood urea nitrogen and creatinine levels and hyperglycemia.

A. subnormal serum glucose and elevated serum ammonia levels. In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

An adult client with a possible growth hormone (GH)-secreting tumor is undergoing testing. If a glucose load is given, which response by the body would confirm the client has a GH-secreting tumor? A. No change in blood level after the glucose load B. Elevated GH level after a glucose load C. Development of gigantism D. Suppression of the GH level

B. Elevated GH level after a glucose load When a GH-secreting tumor is suspected, the GH response to a glucose load is measured as part of the diagnostic workup. Normally, a glucose load would suppress GH levels. However, in adults with GH-secreting tumors (a condition known as acromegaly), GH levels are not suppressed.

A 30-year-old janitor from Russia tells the nurse in the clinic that he drinks a fifth of vodka daily and that he's had a recent weight gain of 3 lb (1.35 kg) in 3 days. Further questioning by the nurse reveals that he was an intravenous drug user in the past but is now "clean." His sclerae and skin have a yellowish tinge, and he has a large abdominal girth. Which assessment finding supports the nurse's conclusion that the client has liver dysfunction? A. Pallor B. Jaundice C. Erythema D. Cyanosis

B. Jaundice Jaundice is a yellow color of the skin resulting from elevated amounts of bilirubin in the blood. It is associated with liver and gallbladder disease, some types of anemia, and excessive hemolysis. Cyanosis is a bluish or grayish discoloration of the skin in response to inadequate oxygenation. Erythema (redness of the skin) is caused by dilation of superficial blood vessels. It is associated with sunburn, inflammation, fever, trauma, and allergic reactions. Pallor is caused by decreased hemoglobin in the circulating blood and causes inadequate oxygenation of the body tissues.

What observation should the nurse instruct the client with an ileostomy to report immediately? A. occasional presence of undigested food in the effluent B. absence of drainage from the ileostomy for 6 or more hours C. temperature of 99.8° F (37.7° C) D. passage of liquid stool from the stoma

B. absence of drainage from the ileostomy for 6 or more hours Any sudden decrease in drainage or onset of severe abdominal pain should be reported to the health care provider (HCP) immediately because it could mean that an obstruction has developed. The ileostomy drains liquid stool at frequent intervals throughout the day. Undigested food may be present at times. A temperature of 99.8° F (37.7° C) is not necessarily abnormal or a cause for concern.

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? A. Slow, shallow respirations B. Arm and leg trembling C. Rapid, thready pulse D. Cool, moist skin

C. Rapid, thready pulse This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations. Cool, moist skin and arm and leg trembling are associated with hypoglycemia. Rapid respirations — not slow, shallow ones — are associated with hyperglycemia.

A young, healthy adult helps lift a sofa to move it 25 feet. The nurse knows that which source of energy will the client most likely use in this process? A. Amino acids B. Glucose C. Stored ATP D. Fatty acids

C. Stored ATP Stored ATP, creatine phosphate, and muscle glycogen are among the first energy sources utilized during aerobic exercise. Amino acids, fatty acids, and glucose are utilized after prolonged periods of exercise.

The nurse is assessing clients for basal metabolic rate (BMR). Which client would the nurse suspect would have an increased BMR? A. an older adult client B. a client who is asleep C. a client who has a fever D. a client who is fasting

C. a client who has a fever A client who has a fever would have an increased BMR. The energy needs of the body are increased due to the client's fever. The BMR is decreased in an older adult client, a client who is fasting, and a client who is asleep.

What is the recommended dietary treatment for a client with chronic cholecystitis? A. high-fiber diet B. low-protein diet C. low-fat diet D. low-residue diet

C. low-fat diet The bile secreted from the gallbladder helps the body absorb and break down dietary fats. If the gallbladder is not functioning properly, then it will not secrete enough bile to help digest the dietary fat. This can lead to further complications; therefore, a diet low in fat can be used to prevent complications.

A client with diabetes mellitus states, "I can eat as many carbohydrates as I want and it will not affect my blood sugar." What is the nurse's best response? A. "Carbohydrates do not affect blood glucose." B. "You are correct." C. "Clients with diabetes cannot eat carbohydrates." D. "Carbohydrates are broken down into monosaccharides before being absorbed."

D. "Carbohydrates are broken down into monosaccharides before being absorbed." The client with diabetes mellitus should be taught that carbohydrates are broken down into monosaccharides before being absorbed.

When discussing luteinizing hormone and follicle-stimulating hormone with students, the instructor will emphasize that these hormones are under the control of: A. Posterior adrenal cortex B. Anterior pituitary gland C. Pancreas D. Thyroid gland

B. Anterior pituitary gland The pituitary gland has been called the master gland because its hormones control the functions of many target glands and cells. The anterior pituitary gland or adenohypophysis contains five cell types: (1) thyrotrophs, which produce thyrotropin, also called TSH; (2) corticotrophs, which produce corticotropin, also called ACTH; (3) gonadotrophs, which produce the gonadotropins, LH, and FSH; (4) somatotrophs, which produce GH; and (5) lactotrophs, which produce prolactin.

A client with Parkinson's disease is hospitalized on a medical unit. The nurse would be correct in identifying which neurotransmitter decreased in this disease? A. Acetylcholine B. Dopamine C. Neurontin D. Serotonin

B. Dopamine Parkinson's disease develops from decreased availability of dopamine, while acetylcholine binding to muscle cells is impaired in myasthenia gravis. Therefore acetylcholine, neurontin, and serotonin are incorrect.

Which nursing action would the nurse include when caring for a client with endemic goiter and experiencing respiratory symptoms? A. Providing a diet high in iodine. B. Elevating the head of the bed. C. Avoiding physical exertion. D. Providing proper air circulation in the room.

B. Elevating the head of the bed. The nurse should monitor the respiratory status and elevate the head of the bed to relieve respiratory symptoms. A high-iodine diet does not relieve respiratory distress. Although proper air circulation in the room and avoiding physical exertion may be important, these actions do not address the respiratory symptoms.

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? A. 50% dextrose B. Hydrocortisone C. Glucagon D. Epinephrine

C. Glucagon During a hypoglycemic reaction, a layperson may administer glucagon, an antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral carbohydrate. Epinephrine isn't a treatment for hypoglycemia. Although 50% dextrose is used to treat hypoglycemia, it must be administered I.V. by a skilled health care professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia.

A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes. The best diagnostic indicator that would support the client's response would be: A. Fasting blood glucose level B. Capillary blood glucose sample C. Glycosylated hemoglobin, hemoglobin A1C (HbA1C) D. Urine test

C. Glycosylated hemoglobin, hemoglobin A1C (HbA1C) Glycosylated hemoglobin, hemoglobin A1C (HbA1C), and A1C are terms used to describe hemoglobin into which glucose has been incorporated. Glycosylation is essentially irreversible, and the level of A1C present in the blood provides an index of blood glucose levels over the previous 6 to 12 weeks. In uncontrolled diabetes or diabetes with hyperglycemia, there is an increase in the level of A1C. The other options would not reflect the 2-month period.

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? A. Insulin is absorbed more slowly at abdominal injection sites than at other sites. B. Insulin is absorbed unpredictably at all injection sites. C. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. D. Insulin is absorbed rapidly regardless of the injection site.

C. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at sites on the anterior thigh. Absorption after injection in the buttocks is less predictable.

A pregnant woman determined to be at high risk for gestational diabetes is undergoing a 1-hour glucose challenge test. The nurse schedules the client for a 3-hour glucose tolerance test based on which result? A. 126 mg/dL B. 146 mg/dL C. 134 mg/dL D. 118 mg/dL

B. 146 mg/dL Any blood glucose level over 140 mg/dL with a 1-hour glucose challenge test is considered abnormal and warrants follow up testing with a 3-hour glucose tolerance test.

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? A. "Follow your regular meal plan, even if you're nauseous." B. "Don't take your insulin or oral antidiabetic agent if you don't eat." C. "Test your blood glucose every 4 hours." D. "It's okay for your blood glucose to go above 300 mg/dl while you're sick."

C. "Test your blood glucose every 4 hours." The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.

What is the length of time a client undergoes a complete sleep cycle? A. 30-60 minutes B. 60-80 minutes C. 90-110 minutes D. 120-160 minutes

C. 90-110 minutes A complete sleep cycle takes about 90-110 minutes.

Primary gout is often caused by an inherited disorder in which type of metabolism? A. Fat B. Glucose C. Carbohydrate D. Purine

D. Purine Primary gout is often caused by an inherited disorder in purine metabolism. Primary gout is not a disorder of altered carbohydrate, fat, or glucose metabolism.

A client has received dietary instructions as part of the treatment plan for diabetes type 1. Which statement by the client would alert the nurse of needing additional instructions? A. "I can eat whatever I want as long as I cover the calories with sufficient insulin." B. "I'll need a bedtime snack because I take an evening dose of NPH insulin." C. "I can have an occasional low-calorie drink as long as I include it in my meal plan." D. "I should eat meals as scheduled, even if I'm not hungry, to prevent hypoglycemia."

A. "I can eat whatever I want as long as I cover the calories with sufficient insulin." Diabetes mellitus is a chronic condition associated with abnormally high glucose in the blood. The goal of dietary therapy in diabetes mellitus is to attain and maintain ideal body weight. Each client is prescribed a specific caloric intake and insulin regimen to help accomplish this goal. The other statements are correct.

Total parenteral nutrition (TPN) has been ordered for a client. The nurse is aware that the assessment criteria for ordering TPN is what? Select all that apply. A. A debilitating condition for more than 2 weeks B. Client is not able to absorb nutrients properly C. Intact gastrointestinal tract D. Tolerating a full-fluid diet E. Renal or hepatic failure

A. A debilitating condition for more than 2 weeks B. Client is not able to absorb nutrients properly E. Renal or hepatic failure Assessment data to determine if a client is eligible for TPN include inability to absorb nutrients, a debilitating condition lasting more than 2 weeks, and renal or hepatic failure. If the client has an intact gastrointestinal tract then the client should be able to adhere to a regular diet. Tolerating a full-fluid diet also assesses that the gastrointestinal tract is functional and TPN is not warranted.

During a humanitarian trip to an underdeveloped country, a medical student is assessing a 6-year-old male who has a protuberant abdomen, dry hair, and wrinkled skin. The child's heart rate is 59 beats per minute, blood pressure 89/50 and temperature 95.2°F (35.1°C). What is the most likely etiology of the child's health problems? A. A diet deficient in both protein and calories. B. A diet that is low in high in carbohydrates but low in fat. C. Fluid and electrolyte imbalances secondary to low carbohydrate intake. D. A diet lacking in fat-soluble vitamins.

A. A diet deficient in both protein and calories. The child's presentation is typical of marasmus, a diagnosis caused by deficiencies in protein and calorie intake.

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? A. Administering 1 ampule of 50% dextrose solution, per physician's order B. Observing the client for 1 hour, then rechecking the fingerstick glucose level C. Administering a 500-ml bolus of normal saline solution D. Inserting a feeding tube and providing tube feedings

A. Administering 1 ampule of 50% dextrose solution, per physician's order The nurse should administer 50% dextrose solution to restore the client's physiological integrity. Feeding through a feeding tube isn't appropriate for this client. A bolus of normal saline solution doesn't provide the client with the much-needed glucose. Observing the client for 1 hour delays treatment. The client's blood glucose level could drop further during this time, placing him at risk for irreversible brain damage.

The nurse is caring for a patient with hyperparathyroidism and observes a calcium level of 16.2 mg/dL. What interventions does the nurse prepare to provide to reduce the calcium level? Select all that apply. A. Administration of calcitonin B. Intravenous isotonic saline solution in large quantities C. Administration of calcium carbonate D. Monitoring the patient for fluid overload Administration of a bronchodilator

A. Administration of calcitonin B. Intravenous isotonic saline solution in large quantities D. Monitoring the patient for fluid overload Administration of a bronchodilator

What happens when a cell is confronted with a decrease in work demands? A. Cell becomes smaller. B. Energy expenditure increases. C. Cell size increases. D. Cell dies.

A. Cell becomes smaller. As a cell's work demands decrease, the size of the cell decreases or atrophies. The size of the cell does not increase, but energy expenditure decreases. The cell does not die, but it adapts.

Which physiologic changes result in menopause? A. Cessation of ovarian function and decreased estrogen levels B. Changes in anterior pituitary function that alter ovarian hormone production C. Gradual resistance of ovarian target cells to luteinizing hormone (LH) and follicle-stimulating hormone (FSH) stimulation D. Decreased levels of gonadotropin-releasing hormone (GnRH)

A. Cessation of ovarian function and decreased estrogen levels The physiology of menopause involves a gradual cessation of ovarian function and resultant diminished levels of estrogen. The process is not rooted in pituitary or hypothalamic function, and it does not occur because of resistance by ovarian target cells.

Which of these is an endocrine regulator of pituitary and adrenal activity and a neurotransmitter involved in autonomic nervous system activity, metabolism, and behavior? A. Corticotropin-releasing factor B. Immune factor C. Allostatic factor D. Fight-or-flight hormone

A. Corticotropin-releasing factor Corticotropin-releasing factor is a small peptide hormone found in both the hypothalamus and in extrahypothalamic structures, such as the limbic system and the brain stem. It is both an important endocrine regulator of pituitary and adrenal activity and a neurotransmitter involved in autonomic nervous system activity, metabolism, and behavior. The sympathetic nervous system manifestation of the stress reaction has been called the "fight or flight" response. This is the most rapid of the stress responses and represents the basic survival response of our primitive ancestors when confronted with the perils of the wilderness and its inhabitants. The term allostasis has been used by some investigators to describe the physiologic changes in the neuroendocrine, autonomic, and immune systems that occur in response to either real or perceived challenges to homeostasis. The hallmark of the stress response, as first described by Selye, is the endocrine-immune interaction.

Which form of signal transduction resulting from ligand-receptor binding has the potential to produce effects in the entire body system? A. Endocrine B. Paracrine C. Local mediation D. Autocrine

A. Endocrine Cells communicate in several ways. In endocrine signaling, the cells release chemical mediators (hormones) that enter the bloodstream, then bind to cell receptors throughout the body. A ligand is a substance with a high affinity for the receptor. In autocrine signaling, a cell releases a chemical to the extracellular fluid, which changes its own activity. In paracrine signaling, a cell releases a chemical to the extracellular fluid, but enzymes rapidly metabolize the chemicals so they only act on nearby cells.

The nurse is caring for a client with a condition of deficiency of antidiuretic hormone (ADH). When assessing the client, which finding does the nurse anticipate? A. Excessive urine output B. Low blood pressure C. Retention of chloride D. Retention of sodium

A. Excessive urine output ADH regulates the ability of the kidneys to concentrate urine. When ADH is present, the water that moved from the blood into the urine filtrate in the glomeruli is returned to the circulatory system, and when ADH is absent, the water is excreted in the urine. Pathologically, deficiency of ADH leads to polyuria and dehydration.

The nurse is caring for a client who received regular insulin at 7 am. Four hours later the nurse finds the client diaphoretic, cool, and clammy. Which of these interventions is the priority? A. Give the client a concentrated carbohydrate. B. Repeat the dose of insulin. C. Bathe the client with tepid water. D. Place the client in the supine position.

A. Give the client a concentrated carbohydrate. The client is displaying symptoms of hypoglycemia, which include headache, difficulty in problem solving, altered behavior, coma, and seizures. Hunger may occur. Activation of the sympathetic nervous system may cause anxiety, tachycardia, sweating, and cool and clammy skin.

Cellular injury alters the ability of the cell to maintain homeostasis. Which agent can cause fluid and electrolyte imbalance? A. Glucose B. Ethanol alcohol C. Hydrochloric acid D. Prescription medications

A. Glucose Injury is defined as a disorder in steady-state regulation. Any stressor can lead to injury. Large amounts of glucose can cause osmotic shifts. The shift can affect fluid and electrolyte balance.

A client has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal? A. Hypocalcemia B. Hypokalemia C. Hypophosphatemia D. Hyponatremia

A. Hypocalcemia Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the provider immediately, as laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not an expected response to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.

The diagnosis of type 1 diabetes would be confirmed by which principle? A. Insulin is not available for use by the body. B. Small amounts of insulin are produced daily. C. Insulin is produced but unavailable for use in the body. D. Insulin is present in large amounts for use by the body.

A. Insulin is not available for use by the body. Type 1 diabetes is a catabolic disorder characterized by an absolute lack of insulin. In type 2 diabetes, some insulin is produced.

After teaching a class about the endocrine system, the instructor determines that the students need additional instruction when they identify which of the following as an endocrine gland? A. Kidneys B. Adrenal gland C. Pancreas D. Testes

A. Kidneys Although the kidneys secrete renin and erythropoietin, they are typically not considered endocrine glands. The pancreas, adrenal glands, and testes are considered endocrine glands.

When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? A. Measure abdominal girth according to a set routine. B. Provide the client with nonprescription laxatives. C. Ask the client about food intake. D. Report the condition to the physician immediately.

A. Measure abdominal girth according to a set routine. If the abdomen appears enlarged, the nurse measures it according to a set routine. The nurse reports any change in mental status or signs of gastrointestinal bleeding immediately. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis.

The nurse is caring for a client with a traumatic brain injury who has developed increased intracranial pressure resulting in syndrome of inappropriate antidiuretic hormone (SIADH). While assessing this client, the nurse expects which of the following findings? A. Oliguria and serum hyponatremia B. Oliguria and serum hyperosmolarity C. Excessive urine output and decreased urine osmolality D. Excessive urine output and serum hyponatremia

A. Oliguria and serum hyponatremia SIADH is the result of increased secretion of antidiuretic hormone (ADH). The client becomes volume overloaded, urine output diminishes, and serum sodium concentration becomes dilute.

A client is suspected of having the onset of alcoholic liver disease. The nurse should be assessing for which manifestation related to the necrosis of liver cells? A. Rapid onset of jaundice B. Tremors of the hands C. Development of multiple skin nodules D. Long muscle group atrophy

A. Rapid onset of jaundice Alcoholic hepatitis--> is the intermediate stage between fatty changes and cirrhosis and is characterized by inflammation and necrosis of liver cells. The condition is always serious and sometimes fatal. The cardinal sign of alcoholic hepatitis--> is rapid onset of jaundice. Hand tremors are not specific to alcoholic hepatitis. Long muscle group atrophy can occur but is not the primary sign. Development of nodules is not caused by alcoholic hepatitis.

A parent arrives in the endocrinology clinic with her 8-year-old son, concerned about his rapid development and tall stature. What significant assessment finding does the nurse recognize is important to report to the physician related to the development of precocious puberty? A. Significant genital enlargement B. The child is 20 lb over his target weight for height C. Enlarged head circumference D. Multiple dental caries

A. Significant genital enlargement Diagnosis of precocious puberty is based on physical findings of early thelarche, adrenarche, and menarche. The most common sign in boys is early genital enlargement. Radiologic findings may indicate advanced bone age. People with precocious puberty are unusually tall for their age as children but short as adults because of the early closure of the epiphyses.

A client who has just undergone a thyroidectomy is experiencing high fever, tachycardia, and extreme restlessness. The nurse would interpret these findings as manifestations of which complication? A. Thyroid storm B. Hypothyroidism C. Addisonian crisis D. Myxedema coma

A. Thyroid storm The symptoms this client is experiencing are related to thyroid storm and must be treated immediately to prevent death. Myxedema coma -->is related to hypothyroidism but typically does not occur after a thyroidectomy. Addisonian crisis--> is related to hypoadrenalism.

A client with pancreatitis is admitted with weight loss, nausea, and vomiting. To maintain nutrition, the physician orders parenteral nutrition to be started. Knowing that a major side effect of parenteral nutrition is a hyperosmolar hyperglycemic state, the nurse should assess the client for which clinical manifestations? A. Irritability, bradycardia, wheezing noted on inspiration. B. Dry lips, excess urine output, and seizures. C. Fever, chills, elevated BP of 170/101. D. Facial tics, shuffling gait, stiff joints.

B. Dry lips, excess urine output, and seizures. Hyperosmolar hyperglycemic state is characterized by high blood glucose (>600 mg/dL [33.3 mmol/L]), dehydration (dry lips), depression of sensorium, hemiparesis, seizures, and coma. The client may also experience weakness, polyuria, and excessive thirst. HHS may occur in various conditions, including type 2 diabetes, acute pancreatitis, severe infection, MI, and treatment with oral or parenteral nutrition solutions.

Which pathophysiologic phenomenon may result in a diagnosis of Cushing disease? A. Autoimmune destruction of the adrenal cortex B. Excess ACTH production by a pituitary tumor C. Malfunction of the HPA system D. Hypopituitarism

B. Excess ACTH production by a pituitary tumor Three important forms of Cushing syndrome result from excess glucocorticoid production by the body. One is a pituitary form, which results from excessive production of ACTH by a tumor of the pituitary gland. Hypopituitarism and destruction of the adrenal cortex are associated with Addison disease. Disruption of the HPA system is not implicated in the etiology of Cushing disease.

Most physiologic control systems function under positive feedback mechanisms. A. True B. False

B. False The reason most physiologic control systems function under negative rather than positive feedback mechanisms is that a positive feedback mechanism interjects instability rather than stability into a system.

Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenolysis? A. Cholecystokinin B. Glucagon C. Somatostatin D. Insulin

B. Glucagon Glucagon is a hormone released by the alpha islet cells of the pancreas that raises blood glucose levels by stimulating glycogenolysis (the breakdown of glycogen into glucose in the liver). Somatostatin is a hormone secreted by the delta islet cells that helps to maintain a relatively constant level of blood glucose by inhibiting the release of insulin and glucagons. Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises beyond normal limits. Cholecystokinin is released from the cells of the small intestine that stimulates contraction of the gall bladder to release bile when dietary fat is ingested.

You are admitting an insulin-dependent patient to the same-day surgical suite for carpal tunnel surgery. You know that this patient may be at risk for which metabolic disorder? A. Adrenal insufficiency B. Hyperglycemia C. Thyrotoxicosis D. Impaired acid base balance

B. Hyperglycemia The patient with diabetes who is undergoing surgery is at risk for hypoglycemia and hyperglycemia. Hyperglycemia during the surgical procedure is a risk based on the body's defense mechanism to raise the blood sugar in the event of stress. Patients who have received corticosteroids are at risk of adrenal insufficiency. Patients with uncontrolled thyroid disorders are at risk for thyrotoxicosis. Because the kidneys are involved in excreting anesthetic medications and their metabolites and because acid-base status and metabolism are also important considerations in anesthesia administration, surgery is contraindicated when a patient has acute nephritis, acute renal insufficiency with oliguria or anuria, or other renal problems.

Which gland acts as a signal relaying bridge between multiple body systems and the pituitary gland? A. Thyroid B. Hypothalamus C. Posterior pituitary D. Parathyroid

B. Hypothalamus The activity of the hypothalamus is regulated by both hormonally mediated signals (e.g., negative feedback signals) and by neuronal input from a number of sources. Neuronal signals are mediated by neurotransmitters such as acetylcholine, dopamine, norepinephrine, serotonin, gamma-aminobutyric acid (GABA), and opioids. Cytokines that are involved in immune and inflammatory responses, such as the interleukins, also are involved in the regulation of hypothalamic function. This is particularly true of the hormones involved in the hypothalamic-pituitary-adrenal axis. Thus, the hypothalamus can be viewed as a bridge by which signals from multiple systems are relayed to the pituitary gland. This cannot be said of the other options.

Review the following four examples of ideal body weight (IBW), actual weight, and body mass index (BMI). Using three criteria for each example, select the body weight that indicates morbid obesity. A. IBW = 150 lbs; weight = 190 lbs; BMI = 26 kg/m2 B. IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2 C. IBW = 132 lbs; weight = 184 lbs; BMI = 28 kg/m2 D. IBW = 175 lbs; weight = 265 lbs; BMI = 29 kg/m2

B. IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2 The criteria for morbid obesity are a body weight that is twice IBW and a BMI that exceeds 30 kg/m2.

A client has a dysfunction in one of his glands that is causing a decrease in the level of calcium in the blood. What gland should be evaluated for dysfunction? A. Adrenal gland B. Parathyroid gland C. Thymus gland D. Thyroid gland

B. Parathyroid gland The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level. The thyroid, thymus, and adrenal gland do not secrete calcium.

Which statement most accurately describes the function of the secretory glands in the gastrointestinal (GI) tract? A. Secretory activity is increased with sympathetic stimulation. B. The secretory glands produce mucus to lubricate and protect the mucosal layer of the GI tract wall. C. Each day approximately 2000 mL of fluid is secreted into the GI tract. D. The secretions are mainly albumin with sodium and potassium.

B. The secretory glands produce mucus to lubricate and protect the mucosal layer of the GI tract wall. Secretory glands in the GI tract serve two basic functions: production of mucus to lubricate and protect the GI tract wall and secretion of fluids and enzymes to aid in digestion and absorption of nutrients. Each day approximately 7000 mL of fluid is secreted into the GI tract. Secretory activity is increased with parasympathetic stimulation and inhibited with sympathetic activity. The secretions are mainly water with sodium and potassium.

The nurse is caring for a client with possible Cushing's syndrome undergoing diagnostic testing. The health care provider orders lab work and a dexamethasone suppression test. Which parameter would the nurse assess on the dexamethasone suppression test? A. changes in certain body chemicals, which are altered in depression B. cortisol levels before and after the system is challenged with a synthetic steroid C. the amount of dexamethasone in the system D. cortisol levels after the system is challenged

B. cortisol levels before and after the system is challenged with a synthetic steroid The dexamethasone suppression test measures cortisol levels before and after the system is challenged with a synthetic steroid. The dexamethasone suppression test does not measure dexamethasone or body chemicals altered in depression. Dexamethasone is used to challenge the cortisol level.

As you are walking in the park, a huge black Labrador [dog] runs up to you and places his paws on your shoulders. Immediately your heart starts racing, you feel palpations, anxiety, and your hands become a little shaky. The nurse knows that this response is primarily caused by: A. fear of dogs that make you feel like your chest is being tightened and that you have lost control of the situation. B. increased levels of glucocorticoids by the adrenal glands that result in an increase in epinephrine level. C. stimulation of the release of β2 adrenergic receptors, which will open the airway and increase oxygenation. D. response of the cholinergic muscarinic receptors on innervational targets of postganglionic fibers.

B. increased levels of glucocorticoids by the adrenal glands that result in an increase in epinephrine level. Any situation sufficiently stressful to evoke increased levels of glucocorticoids also increases epinephrine levels. Increased epinephrine levels results in tachycardia, palpitations, anxiety, and tremors. Cholinergic muscarinic receptors and beta-blockers do not help in times of immediate stress.

Which structure controls the functions of the greatest number of target glands and cells? A. Pancreas B. Thyroid gland C. Adrenal cortex D. Pituitary gland

D. Pituitary gland The pituitary gland has been called the master gland because its hormones control the functions of many target glands and cells. It supersedes the importance of the thyroid, adrenal cortex, or pancreas in this regulatory role.

The nurse explains to a client how important it is that the client is eating properly even though the client is in a personal crisis over the loss of a loved one. The client wants to know why this matters. What is the nurse's best response? A. "Eating regular meals gives you something to focus on." B. "Not eating will make your other family members worry about you." C. "It is important to give your body nutrition to manage this crisis." D. "You can spend some time during meals with your other family members."

C. "It is important to give your body nutrition to manage this crisis." The client in crisis needs nutrition to have the physical resources to manage a crisis- in this case, the loss of a loved one. Having a crisis affects a client by being physically exhausting and the client needs nutritional stores to help reduce the potential for injury. Eating regular meals will give the client something to focus on, and the client can spend time with other family members, who will worry less about the client, but these are not primary reasons for the client to eat.

A student is comparing the different parts of the gastrointestinal (GI) tract. Which statement demonstrates understanding? A. "The esophagus is where most of the absorptive processes occur." B. "The jejunum serves as a storage channel for the elimination of waste." C. "The mouth is the receptacle where initial digestive processes take place." D. "The cecum is where most digestive and absorptive processes occur."

C. "The mouth is the receptacle where initial digestive processes take place." The GI tract can be divided into three parts: upper, middle, and lower segments. The upper part contains the mouth and esophagus and acts as a receptacle through which food passes and initial digestive processes take place. The middle portion, containing the jejunum, is where most digestive and absorptive processes occur. The lower segment, containing the cecum, serves as a storage channel for the efficient elimination of waste.

A group of students are reviewing material in preparation for a test on the male and female breasts. The students demonstrate understanding of the material when they identify which of the following? A. Progesterone is primarily responsible for the growth of breast tissue. B. Striated muscle in the nipples contract causing them to become erect. C. A primary function of the female breast is to produce milk. D. The breasts contain a limited supply of blood vessels.

C. A primary function of the female breast is to produce milk. A primary function of the female breast is to produce milk, a process called lactation. The breasts contain an abundant supply of blood vessels and lymphatics. Estrogen is the hormone primarily responsible for the growth and development of breast tissue. Smooth muscle in the nipples contracts, causing them to become erect when cold, touched, or sexually stimulated.

A health care provider suspects a client may have developed pancreatitis. Which laboratory value will confirm this diagnosis? A. Chymotrypsin level and fibrinogen level B. Altered alkaline phosphatase and red blood cell count C. High serum amylase and lipase D. Change in platelet count and prothrombin level

C. High serum amylase and lipase Laboratory criteria for the diagnosis of pancreatitis are serum amylase or lipase greater than three times the upper limit of normal. Altered alkaline phosphatase and prothrombin levels may indicate liver disease. Alkaline phosphatase is one kind of enzyme found in the body. It can show signs of liver disease or a bone disorder. The red blood cell count is used to measure the number of oxygen-carrying blood cells in a volume of blood. Chymotrypsin digests proteins in the intestine. Fibrinogen is a soluble protein in the plasma that is broken down to fibrin by the enzyme thrombin to form clots. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Having more than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia. Prothrombin time is a blood test that measures how long it takes blood to clot.

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? A. Lispro (Humalog) B. Iletin II C. NPH D. Glargine (Lantus)

C. NPH Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting.

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? A. Gynecomastia and testicular atrophy B. Ascites and orthopnea C. Purpura and petechiae D. Dyspnea and fatigue

C. Purpura and petechiae A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

Following destruction of the pituitary gland, ACTH stimulation stops. Without ACTH to stimulate the adrenal glands, the adrenal glands' production of cortisol drops. This is an example of which type of endocrine disorder? A. Tertiary B. Somatic C. Secondary D. Primary

C. Secondary In secondary disorders of endocrine function, the target gland is essentially normal, but defective levels of stimulating hormones or releasing factors from the pituitary system alter its function.

Which of the following endocrine disorder causes the patient to have dilutional hyponatremia? A. Hyperthyroidism B. Diabetes insipidus (DI) C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) D. Hypothyroidism

C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Patients diagnosed with SIADH retain water and develop a subsequent sodium deficiency known as dilutional hyponatremia. In DI, there is excessive thirst and large volumes of dilute urine. Patients with DI, hypothyroidism, or hyperthyroidism do not exhibit dilutional hyponatremia

A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following? A. The concentration of a substance in plasma B. Details about the size of the organ and its location C. The functioning of endocrine glands D. The client's blood sugar level

C. The functioning of endocrine glands Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.

Which neurotransmitter has been implicated in the development of ALS? A. deficient glutamate B. excessive serotonin C. excessive glutamate D. deficient serotonin

C. excessive glutamate Excessive levels of the neuroexcitatory neurotransmitter glutamate have been implicated in neurodegenerative diseases such as ALS, Huntington's disease, and the sequelae of strokes (Lau & Tymianski, 2010; Sheldon, 2007).

Parathyroid hormone (PTH) has which effects on the kidney? A. Increased absorption of vitamin D and excretion of vitamin E B. Increased absorption of vitamin E and excretion of vitamin D C. Stimulation of phosphate reabsorption and calcium excretion D. Stimulation of calcium reabsorption and phosphate excretion

D. Stimulation of calcium reabsorption and phosphate excretion PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.

A client is diagnosed with Addison disease. What statement by the client indicates an understanding of the discharge instructions by the nurse? A. "If I have surgery, it will cure me." B. "I should be able to control my condition with diet and exercise." C. "Once the symptoms go away, I will be able to stop taking my medication." D. "I will have to take my medication for the rest of my life."

D. "I will have to take my medication for the rest of my life." Addison disease-->, like type I diabetes, is a chronic metabolic disorder that requires lifetime hormone replacement therapy. The daily regulation of the chronic phase of Addison disease is usually accomplished with oral replacement therapy, with higher doses being given during periods of stress.

A young child develops type 1A diabetes. The parents ask, "They tell us this is genetic. Does that mean our other children will get diabetes?" The best response by the health care provider would be: A. "We don't know what causes diabetes, so we will just have to wait and see." B. "Probably not. Since genetically your other children have a different cellular makeup, they just might not become diabetic." C. "If you put all your children on a low-carbohydrate diet, maybe they won't get diabetes." D. "This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes."

D. "This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes." Type 1 diabetes is subdivided into two types: type 1A, immune-mediated diabetes, and type 1B, idiopathic diabetes. Type 1A diabetes is characterized by autoimmune destruction of beta cells. The other choices are not absolutely correct. The fact that type 1 diabetes is thought to result from an interaction between genetic and environmental factors led to research into methods directed at prevention and early control of the disease. These methods include the identification of genetically susceptible persons and early intervention in newly diagnosed persons with type 1 diabetes.

Which statement would a nurse tell a client that best describes a lab finding of metaplasia? A. "This is a decrease in the oxygen-carrying capacity of the cells." B. "This is a decrease in the size of the cell." C. "This is a change in the number of cells as they adapt to change." D. "This is a change in cell form as it adapts to increased work demands or threats to survival."

D. "This is a change in cell form as it adapts to increased work demands or threats to survival." Metaplasia--> is a change in the cell's form as it adapts to increased work demands or threats to survival. Hyperplasia--> is the change in the number of cells, and atrophy and hypertrophy are changes in a cell's size. Hypoxia or hypoxemia--> are decreases in oxygen.

A 51-year-old male professional is in the habit of consuming 6 to 8 rum and Cokes each evening after work. He assures the nurse practitioner who is performing his regular physical exam that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the client's statement? A. "In spite of that, the amount of alcohol you are drinking is likely to result first in cirrhosis and, if you continue, in hepatitis or fatty liver changes." B. "You are more than likely inflicting damage on your liver, but this damage would cease as soon as you quit drinking." C. "That may be the case, but you are still creating a high risk of hepatitis A or B or liver cancer." D. "When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic by-products."

D. "When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic by-products." The hepatic effects of alcohol use are related to the accumulation of toxic metabolites in the hepatocytes and blood. Damage can continue even after an individual stops drinking. Specific consequences do not usually include HAV, HBV or liver cancer. Cirrhosis represents the culmination, not the beginning, of negative hepatic effects.

A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: A. 90 mg/dL before meals. B. 80 mg/dL, 1 hour postprandial. C. 120 mg/dL, 1 hour postprandial. D. 138 mg/dL, 2 hours postprandial.

D. 138 mg/dL, 2 hours postprandial. The goals for a 2-hour, postprandial blood glucose level are less than 120 mg/dL in a patient who might develop gestational diabetes.

A nurse determines that a male patient has an increased risk for diabetes, heart disease, and hypertension based on the patient's waist circumference. Which waist circumference measurement would lead the nurse to suspect this? A. 32 inches B. 35 inches C. 38 inches D. 41 inches

D. 41 inches In men, a waist circumference greater than 40 inches indicates excess abdominal fat and places the patient at risk for diabetes, dyslipidemias, hypertension, cardiovascular disease, and atrial fibrillation.

When educating a client about type 1 diabetes, the nurse will mention that this type is caused by which mechanism? A. Overuse of steroids, making pancreatic cells resistant to glucose B. Idiopathic, abnormally large pancreatic cells C. Genetic predisposition D. Autoimmune destruction of pancreatic beta cells

D. Autoimmune destruction of pancreatic beta cells Type 1 diabetes involves autoimmune destruction of beta cells. The pathophysiology of type 2 diabetes has both genetic and acquired factors.

After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering? A. Potassium chloride B. Sodium bicarbonate C. Sodium phosphorus D. Calcium gluconate

D. Calcium gluconate Immediate treatment for a client who develops hypocalcemia and tetany after thyroidectomy is calcium gluconate. Potassium chloride and sodium bicarbonate aren't indicated. Sodium phosphorus wouldn't be given because phosphorus levels are already elevated.

A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first? A. Administer glucose B. Provide cheese and crackers C. Notify the physician D. Check blood glucose

D. Check blood glucose Hypoglycemia is a medical emergency. Because other conditions can also cause these symptoms, the blood glucose level should be checked first. Then glucose should be given. The client should follow this with a protein and complex carbohydrate to avoid a recurrence of hypoglycemia. Blood glucose should be tested about 15 minutes after the glucose is given to monitor progress.

During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur? A. Portal hypertension B. Adrenal hyperplasia C. Hepatomegaly D. Hyperglycemia

D. Hyperglycemia In predisposed persons, the prolonged elevation of glucocorticoid hormones can lead to hyperglycemia and the development of diabetes mellitus and starvation. They stimulate gluconeogenesis by the liver, sometimes producing a 6- to 10-fold increase in hepatic glucose production. A prolonged increase in glucocorticoid hormones does not cause hepatomegaly, portal hypertension, or adrenal hyperplasia.

The nurse is caring for the client with pancreatic cancer. The nurse monitors the client for which complication? A. Nutritional imbalance due to inability to synthesize protein B. Bleeding related to lack of clotting factors C. Gallstones related to inability to digest fat D. Hyperglycemia due to inability to synthesize insulin

D. Hyperglycemia due to inability to synthesize insulin The endocrine pancreas supplies the insulin needed to lower glucose levels in the blood; damage to the pancreas may alter this function, causing hyperglycemia.

Maintenance of blood gas concentrations, water balance, and food consumption are controlled by which part of the brain? A. Cerebral hemispheres B. Cerebellum C. Basal ganglia D. Hypothalamus

D. Hypothalamus The hypothalamus is the area of master level integration of homeostatic control of the body's internal environment. Maintenance of blood gas concentrations, water balance, food consumption, and major aspects of endocrine and autonomic nervous system control require hypothalamic function.

The nurse is caring for an infant with DiGeorge syndrome. Which organ does the nurse know will be underdeveloped or absent? A. Pituitary gland and thyroid gland B. Kidney and bladder C. Liver and spleen D. Parathyroid and thymus glands

D. Parathyroid and thymus glands Infants born with DiGeorge syndrome usually have partial or complete failure of development of the thymus and parathyroid glands and have congenital defects of the head, neck, palate, and heart. In some children, the thymus is not absent but is extremely small and located outside of the mediastinum.

A nurse is caring for a client with hypothyroidism. The client is extremely upset about altered physical appearance. The client doesn't want to take the medication because "it isn't doing any good." What should the nurse do? A. Tell the client to ask the physician if the medication dosage is correct. B. Tell the client to practice self-acceptance and be compliant during treatment. C. Tell the client that the appearance is fine and offer to help with additional improvements. D. Tell the client that as the medication corrects the hormone deficiency improvement in looks can be expected soon.

D. Tell the client that as the medication corrects the hormone deficiency improvement in looks can be expected soon. Stating that the client will soon experience improvement is supportive and encouraging and offers direction in a way that motivates continued medication compliance. Stating that the client should ask the physician about the medication dosage might cause the client alter the dosage, and also is putting the client off instead of addressing the concerns. Stating that the client looks fine discounts the client's feelings. Advising the client to practice self-acceptance is parental and direct at a time when the client needs support and understanding.

The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the physician? A. When a lactate dehydrogenase concentration is 300 units B. When a serum globulin concentration reaches 2.8 g/dL C. When a serum albumin concentration is 5.0 g/dL D. When the patient's blood ammonia concentration reaches 180 mg/dL

D. When the patient's blood ammonia concentration reaches 180 mg/dL The liver is important in the biotransformation of anesthetic compounds. Disorders of the liver may substantially affect how anesthetic agents are metabolized. Acute liver disease is associated with high surgical mortality; preoperative improvement in liver function is a goal. Careful assessment may include various liver function tests (see Chapter 49).

A client has been diagnosed with hypothyroidism and started on synthetic levothyroxine for thyroid replacement therapy. Which effect is the most important to report to the physician? A. increased temperature and metabolic rate B. insomnia and loss of weight C. increased energy level and reduction of edema D. palpitations and chest pain on exertion

D. palpitations and chest pain on exertion Assessment of the effects of severe hypothyroidism on the circulatory system is important. Serum cholesterol levels are also elevated in clients with hypothyroidism. As the metabolic rate increases with the thyroid replacement therapy, there is more demand on the heart, and angina and palpitations may occur. All of the choices are expected effects once the replacement hormone is started. There is an increase in temperature, a loss in weight, and increased energy levels.