Metabolism prepU
A patient who is obese has been unable to lose weight successfully using lifestyle modifications and has mentioned the possibility of using weight-loss medications. What should the nurse teach the patient about pharmacologic interventions for the treatment of obesity? a) "There used to be a lot of hope that medications would help people lose weight, but it's been shown to be mostly a placebo effect." b) "Weight loss drugs have many side effects, and most doctors think they'll all be off the market in a few years." c) "Medications are rapidly become the preferred method of weight loss in people for whom diet and exercise have not worked." d) "Medications can be helpful, but few people achieve and maintain their desired weight loss with medications alone."
"Medications can be helpful, but few people achieve and maintain their desired weight loss with medications alone." Explanation: Though antiobesity drugs help some patients lose weight, their use rarely results in loss of more than 10% of total body weight. Patients are consequently unlikely to attain their desired weight through medication alone. They are not predicted to disappear from the market and results are not attributed to a placebo effect.
For which of the following patients is foot care likely the highest priority? a) A patient who has experienced postoperative pneumonia and has been placed on a ventilator b) A patient who has been diagnosed with Alzheimer disease and whose mobility is decreasing c) A patient who is obese and has a diagnosis of type 1 diabetes d) A patient who has chronic renal failure and requires hemodialysis three times weekly
A patient who is obese and has a diagnosis of type 1 diabetes Explanation: Patients with diabetes mellitus have an increased need for vigilant foot care, due to the risk of skin breakdown and foot wounds that often accompany the disease.
A client with gastric cancer is scheduled to undergo a Billroth II procedure. The client's spouse asks how much of the client's stomach will be removed. Which of the following would be the most accurate response from the nurse? a) The amount will depend on the client's weight. b) Approximately 25% c) Approximately 50% d) Approximately 75%
Approximately 75% Explanation: The Billroth II is a wide resection that involves removing approximately 75% of the stomach and decreases the possibility of lymph node spread or metastatic recurrence.
To gather subjective data on a client's nutrition and metabolic pattern, the nurse should a) Examine the hygiene of the client's teeth b) Inspect the client's abdomen for symmetry c) Weigh the client and measure his height d) Ask the client for a 24-hour diet recall
Ask the client for a 24-hour diet recall Explanation: Interview questions to focus a nutrition-metabolism assessment might include asking the client to tell you what has been eaten in the last 24 hours.
The nurse judges that the mother has understood the teaching about care of an infant with colic when the nurse observes the mother doing which of the following? a) Holding the infant in her lap to burp. b) Holding the infant prone while feeding. c) Burping the infant during and after the feeding. d) Placing the infant prone after the feeding.
Burping the infant during and after the feeding. Explanation: Infants with colic should be burped frequently during and after the feeding. Much of the discomfort of colic appears to be associated with the presence of air in the stomach and intestines. Frequent burping helps to relieve the air. Infants with colic should be held fairly upright while being fed, to help air rise. The preferred position for burping the infant with colic is to hold the infant at the mother's shoulder so that the infant's abdomen lies on the shoulder. This position causes more pressure to be exerted on the infant's abdomen, leading to a more forceful burp. The child should be placed in an infant seat after feedings.
A client discusses with the nurse that she abstains from meat on Fridays during Lent. The nurse interprets this to indicate that the client might belong to which of the following religious groups? a) Catholics b) Buddhists c) Jews d) Muslims
Catholics Explanation: Catholics abstain from meat on Ash Wednesday and on Fridays during Lent. Buddhists, Jews, and Muslims practice fasting at particular times.
Which of the following is an age-related change that may affect diabetes and its management? a) Increased bowel motility b) Hypotension c) Increased thirst d) Decreased renal function
Decreased renal function Decreased renal function affects the management of diabetes. Other age-related changes that may affect diabetes and its management include hypertension, decreased bowel motility, and decreased thirst.
The nurse administers phenytoin (Dilantin) 125 mg by mouth twice daily to a 6 year old child who is diagnosed with complex partial seizures. The nurse is most concerned about Dilantin toxicity when the child also has a disorder of which of the following organs? a) Pancreas b) Kidneys c) Stomach d) Liver
Liver Explanation: Phenytoin is metabolized in the liver. The pancreas isn't involved in the pharmacokinetic activity of phenytoin. The stomach absorbs orally administered phenytoin, which is excreted by the kidneys in the urine.
The nurse is caring for an adolescent who has been admitted several times with uncontrolled type 1 diabetes. The child is now stabilized and is preparing for discharge. Which of the following should be the priority focus for the nurse when conducting discharge teaching? a) Relocating closer to the hospital b) Management of the therapeutic regimen c) Coping with a chronic disease d) Risk for injury and readmission
Management of the therapeutic regimen Explanation: The priority immediately after recovery is therapy management, including reviewing that the interruption of insulin administration may result in diabetic ketoacidosis. The multiple admissions imply that the adolescent either does not understand the consequences of the disease or is making choices that are not consistent with the health teaching. This is an opportunity to review those choices.
A painter who recently fractured his tibia worries about his finances because he can't work. To treat his anxiety, his physician orders buspirone, 5 mg by mouth three times per day. Which drugs interact with buspirone? a) Antiparkinsonian drugs b) Beta-adrenergic blockers c) Monoamine oxidase (MAO) inhibitors d) Antineoplastic drugs
Monoamine oxidase (MAO) inhibitors Explanation: Buspirone interacts only with MAO inhibitors, producing a hypertensive reaction. Administration of beta-adrenergic blockers, antineoplastic drugs, or antiparkinsonian drugs wouldn't cause an interaction, so they can be administered simultaneously with buspirone.
The nurse is evaluating a child's skills in self-administering insulin (see figure). The nurse should: a) Remind the child to rotate sites. b) Ask the child to place the needle at a 45-degree angle. c) Tell the child to use a site lower on her thigh. d) Have the child use both hands on the syringe.
Remind the child to rotate sites. The child is using correct injection technique, and the nurse can remind the child to rotate sites. The nurse should also reinforce that the child has used correct technique and praise the child for doing so. If the child can manipulate the plunger of the syringe with one hand, this is appropriate. Insulin is administered at a 90-degree angle as shown. The child should identify appropriate sites on the thighs as one hand-breadth below the hip and above the knee; the child is using appropriate sites.
Which of the following is included as a dietary guideline for a patient who has had bariatric surgery? a) Limit soda to 1 can per day. b) Make sure to drink liquids while eating. c) Eat four small meals a day. d) Restrict total meal size to less than 1 cup.
Restrict total meal size to less than 1 cup. Explanation: Dietary guidelines would include a restriction of total meal size to less than 1 cup. The patient should eat three meals per day. Avoid liquid calories such as soda. The patient should drink plenty of water, from 90 minutes after each meal to 15 minutes before the next meal.
A 60-year-old female is diagnosed with hypothyroidism. The nurse should assess the client for which of the following? a) Nausea. b) Tachycardia. c) Diarrhea. d) Weight gain.
Weight gain. Explanation: Typical signs and symptoms of hypothyroidism include weight gain, fatigue, decreased energy, apathy, brittle nails, dry skin, cold intolerance, hair loss, constipation, and numbness and tingling in the fingers. Tachycardia is a sign of hyperthyroidism, not hypothyroidism. Diarrhea and nausea are not symptoms of hypothyroidism.
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: a) exophthalmos and conjunctival redness. b) decreased body temperature and cold intolerance. c) flushed, warm, moist skin. d) systolic murmur at the left sternal border.
decreased body temperature and cold intolerance. Explanation: Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.
While shopping at a mall, a woman experiences an episode of extreme terror accompanied by anxiety, tachycardia, trembling, and fear of going crazy. A friend drives her to the emergency department, where a physician rules out physiologic causes and refers her to the psychiatric resident on call. To control the client's anxiety, the nurse caring for this client expects the resident to order: a) bupropion (Wellbutrin). b) lorazepam (Ativan). c) paroxetine (Paxil). d) haloperidol (Haldol).
lorazepam (Ativan). Explanation: Lorazepam (Ativan) is a schedule IV drug used to treat anxiety. Reducing the client's anxiety will help her cope with stress. Haloperidol is an antipsychotic agent. Bupropion is an antidepressant. Paroxetine is a selective serotonin reuptake inhibitor used to treat depression.
Choice Multiple question - Select all answer choices that apply. A nurse is reviewing dietary guidelines with a client who recently had Roux-en-Y gastric bypass (RYGB) surgery. Which of the following would be included? Select all that apply. a) Encourage consumption of foods such as doughy breads, pasta, rice, skins and seeds of fruits and vegetables, nuts, and popcorn. b) Avoid all sweets. c) Sip on clear liquids with meals d) Gradually progress to five or six small meals daily, with each feeding providing protein, fat, and complex carbohydrate. Restrict total amount to less than one cup.
• Gradually progress to five or six small meals daily, with each feeding providing protein, fat, and complex carbohydrate. Restrict total amount to less than one cup. • Avoid all sweets. Explanation: Initially, the stomach will be about the size of an egg, stretching slowly over time to about the size of a cup. Sweets will trigger the symptoms associated with dumping syndrome. Take fluids between meals to prevent dumping syndrome and delay gastric emptying. Avoid commonly problematic foods, such as doughy breads, pasta, rice, skins and seeds of fruits and vegetables, nuts, and popcorn.
Cells in which of the following organs are unable to regenerate? a) Pancreas b) Kidney c) Liver d) Brain
Brain Explanation: The brain cells are not able to regenerate. Stable cells in some organ systems have a latent ability to regenerate under normal physiologic processes. Examples of regenerative cells include functional cells of the kidney, liver, and pancreas.
While caring for a mother and her 1-day-old neonate born vaginally at 30 weeks' gestation, the nurse explains about the neonate's need for gavage feeding at this time instead of the mother's plan for bottle feeding. Which of the following should the nurse include as the rationale for this feeding plan? a) This type of feeding, easily given in the isolette, decreases the neonate's risk of cold stress. b) A high-calorie formula, presently needed at this time, is more easily delivered via gavage. c) Gavage feedings can minimize the neonate's increased risk of developing hypoglycemia. d) The neonate has difficulty coordinating sucking, swallowing, and breathing.
The neonate has difficulty coordinating sucking, swallowing, and breathing. Explanation: Before 32 weeks' gestation, most neonates have difficulty coordinating sucking and swallowing reflexes along with breathing. Increased respiratory distress may occur with bottle feeding. Bottle feedings can be given after the neonate shows sucking and swallowing behaviors. High-calorie formulas can be given by bottle or by gavage feeding. Although frequent feeding prevents hypoglycemia, the feeding does not have to be given via a gavage tube. Although these neonates can be stressed by cold, they can be kept warm with blankets while being bottle-fed or fed while in the warm isolette environment.
A patient has undergone rigid fixation for the correction of a mandibular fracture suffered in a fight. What area of care should the nurse prioritize when planning this patient's discharge education? a) Promotion of adequate nutrition b) Pain control c) Strategies for promoting communication d) Resumption of activities of daily living
Promotion of adequate nutrition Explanation: The patient who has had rigid fixation should be instructed not to chew food in the first 1 to 4 weeks after surgery. A liquid diet is recommended, and dietary counseling should be obtained to ensure optimal caloric and protein intake. The nature of this surgery threatens the patient's nutritional status; this physiologic need would likely supersede the resumption of ADLs. Pain should be under control prior to discharge and communication is not precluded by this surgery.
Which of the following medications used for obesity improves cardiovascular disease risk factors in obese patients with metabolic syndrome? a) Alli b) Orlistat (Xenical) c) Rimonabant (Acomplia) d) Sibutramine (Meridia)
Rimonabant (Acomplia) Explanation: Acomplia is the newest medication used to treat obesity. It stimulates weight reduction and improves cardiovascular disease risk factors in obese patients with metabolic syndrome. Meridia was recently pulled from the market because of the increased risk of heart attack and stroke associated with this medication. Orlistat, available by prescription and over the counter as Alli, reduces caloric intake by binding to gastric and pancreatic lipase to prevent digestion of fats.
