Metabolism and Exemplars

The nurse is teaching colleagues about hyperthyroidism. Which statement by a colleague indicates understanding of an indication for a​ thyroidectomy? (Select all that​ apply.) A. ​"A total thyroidectomy is performed to treat cancer of the​ thyroid." B. "A thyroidectomy may be performed if the thyroid is compromising the​ airway." C. "A thyroidectomy may be performed if the thyroid is placing pressure on the​ esophagus." D. "The client will not need surgery as long as she takes antithyroid​ medication." E. "The client may require a thyroidectomy for cosmetic​ reasons, such as a large​ goiter."

A, B, C Rationale: A total or partial thyroidectomy may be necessary to treat a thyroid that is placing pressure on the esophagus or obstructing the​ client's airway. Thyroid cancer can also be treated by a thyroidectomy. A goiter is not removed for purely cosmetic​ reasons; it is removed for hypothyroidism that produces too much​ thyroid-stimulating hormone. This can cause a potentially​ life-threatening condition called myxedema.

A client with type 1 diabetes mellitus is being taught to monitor her blood glucose level. Which factor affecting accurate glucose monitoring should the nurse include in the​ instruction? (Select all that​ apply.) A. Low hematocrit level B. Medication overdoses C. High hematocrit level D. Creatinine level E. White blood cell​ (WBC) count

A, B, C Rationale: Factors that affect accurate glucose monitoring include medication​ overdoses, a low hematocrit​ level, and a high hematocrit level. The WBC count and creatinine levels do not affect accurate glucose monitoring.

The nurse is teaching a group of young adults regarding nonmodifiable risk factors for the development of type 1 diabetes mellitus. Which attendee statement indicates a need for further​ instruction? (Select all that​ apply.) A. ​"Type 1 diabetes mellitus can be passed on from one recessive gene from one​ parent." B. "I can develop type 1 diabetes mellitus from bacterial​ infections." C. "Type 1 diabetes mellitus can be caused by exposure to excessive heat and​ temperatures." D. "Type 1 diabetes mellitus is caused by exposure to processing of metals and​ proteins." E. "There are genes such as the​ HLA-DR3 and​ HLA-DR4 genes that can cause type 1 diabetes​ mellitus."

A, B, C, D The individual with type 1 diabetes mellitus usually inherits the risk factor for the disorder from each parent, not just one parent. Environmental factors such as cold weather and exposure to a virus also contribute to the development of type 1 diabetes mellitus but this is modifiable. The genes​ HLA-DR3 and​ HLA-DR4 have been identified in people with type 1 diabetes mellitus. Exposure to processing of metals contributes to the development of cirrhosis.

Which assessment finding of a client diagnosed with cirrhosis should the nurse correlate with expected laboratory​ findings? (Select all that​ apply.) A. Frequent infections B. Peripheral edema C. Confusion D. Bruising easily E. Spider angiomas

A, B, C, D ​Rationale: Assessment findings that correlate with expected laboratory findings in the client with cirrhosis include bruising easily​ (coagulation studies), frequent infections​ (WBC count), peripheral edema​ (albumin levels), and confusion​ (ammonia levels). Although spider angiomas can be found in clients with​ cirrhosis, their presence is not associated with any laboratory testing.

The nurse cares for a client diagnosed with cirrhosis. Which clinical manifestation suggests to the nurse that the diagnosis is​ correct? (Select all that​ apply.) A. Esophageal varices B. Splenomegaly C. Hepatic encephalopathy D. Hypertension E. Ascites

A, B, C, E Rationale: Esophageal varices are enlarged veins in the esophagus. They're often due to obstructed blood flow through the portal vein, which carries blood from the intestine, pancreas and spleen to the liver. Because portal hypertension causes blood to be shunted into the splenic vein, the spleen enlarges, causing Splenomegaly. Blood cells are destroyed at a higher rate, causing anemia, leukopenia, and thrombocytopenia. Portal systemic encephalopathy (also known as hepatic encephalopathy) results from cerebral edema and the accumulation of neurotoxins in the blood. Ammonia, a by-product of protein metabolism, contributes to hepatic encephalopathy. Ascites is the accumulation of plasma-rich fluid in the abdominal cavity. Although portal hypertension is the primary cause of ascites, decreased serum proteins and increased aldosterone also contribute to the fluid accumulation.

Which physical assessment parameter is most appropriate for the nurse to include when assessing the client for possible​ hyperthyroidism? (Select all that​ apply.) A. Vision test B. Deep tendon reflexes C. Weight loss D. Confusion E. Vital signs

A, B, C, E Rationale: Hyperthyroidism may affect many systems in the​ body, and the nurse would include the weight of the client in the physical​ assessment, a vision​ test, vital​ signs, and a test of the tendon reflexes. Confusion is associated with hypothyroidism.

The nurse is taking a health history from a client who has type 1 diabetes mellitus. Which client symptom may indicate the development of​ complications? (Select all that​ apply.) A. Vision changes B. Frequent voiding of urine C. Numbness in the feet D. Quick wound healing E. Dizziness

A, B, C, E ​Rationale: Dizziness, vision​ changes, numbness in the​ feet, and frequent voiding of urine may indicate that the client has developed complications of type 1 diabetes mellitus. Clients with type 1 diabetes mellitus frequently experience prolonged wound​ healing; therefore, a report of quick wound healing would not indicate that the client has developed a complication of type 1 diabetes mellitus.

After performing a health history and physical assessment for a​ client, the nurse suspects type 2 diabetes mellitus. Which assessment finding is consistent with the​ nurse's suspicion?​ (Select all that​ apply.) A. Acanthosis nigricans B. Hyperglycemia C. Hypertension D. Decreased urination E. Extreme thirst

A, B, C, E ​Rationale: Symptoms that would lead the nurse to conclude the client has type 2 diabetes mellitus are extreme​ thirst, hyperglycemia,​ hypertension, and acanthosis nigricans​ (a condition in which the skin is velvety in texture and brownish black in color with hyperkeratotic​ plaques). A client with type 2 diabetes mellitus would have increased and not decreased urination.

The nurse is teaching a group of adults at a community health fair about hypothyroidism. Which risk factor should the nurse include in the​ presentation? (Select all that​ apply.) A. Radioactive iodine treatment B. Autoimmune disease C. Thyroid surgery D. Male sex E. Radiation of the neck

A, B, C, E ​ Rationale: Risk factors for hypothyroidism include having an autoimmune​ disease, having a family member with an autoimmune​ disease, previous treatment with radioactive​ iodine, radiation of the​ neck, thyroid​ surgery, and female sex.

The nurse is caring for a newborn diagnosed with hyperthyroidism after birth. Ongoing assessments during the first year of life should be conducted to monitor for which​ alteration? (Select all that​ apply.) A. Premature fontanelle closure B. Respiratory difficulties C. Nonpalpable thyroid gland D. Heart failure E. Bradycardia

A, B, D Rationale: An infant with hyperthyroidism would have higher metabolic​ rates, leading to tachycardia and heart failure. The infant may develop respiratory difficulties from an enlarged thyroid pressing on the trachea. The fontanelles will also close prematurely. The thyroid gland will be palpable.

The nurse is caring for a client newly diagnosed with Graves disease. The client asks the nurse how the goiter occurred. Which factor should the nurse include in the​ response? (Select all that​ apply.) A. The thyroid gland enlarges. B. The​ client's tissues form antibodies. C. The thyroid cells become hypoactive. D. Antibodies bind to the​ thyroid-stimulating hormones. E. The​ client's tissues form antigens.

A, B, D Rationale: Goiters can occur when the thyroid gland produces either too much thyroid hormone or not enough. Antibodies bind to the​ thyroid-stimulating hormones​ (TSH) in the thyroid follicles. As the gland​ enlarges, a goiter develops. The thyroid cells become hyperactive. The tissues form​ antibodies, not antigens.

The nurse is caring for a​ 15-year-old child newly diagnosed with type 2 diabetes mellitus. Which task should the nurse expect to be completed quarterly for this​ child? (Select all that​ apply.) A. Review glucose records. B. Discuss​ alcohol, tobacco, and drug use. C. Refer for an eye exam. D. Measure fasting glucose levels. E. Make a foot assessment.

A, B, D Rationale: When a child is diagnosed with type 2 diabetes​ mellitus, certain tasks should be scheduled quarterly and annually. Discussing​ alcohol, tobacco, and drug​ use, measuring fasting glucose​ levels, and reviewing glucose records are completed quarterly. Referral for an eye exam and a foot assessment should be completed​ annually; quarterly would be too often.

The nurse is caring for a client diagnosed with cirrhosis who has developed ascites. Which intervention should the nurse include in the plan of​ care? (Select all that​ apply.) A. Weigh the client daily. B. Monitor intake and output. C. Encourage fluid consumption. D. Assess the​ client's urine specific gravity. E. Measure abdominal girth weekly

A, B, D ​Rationale: Ascites occurs because of portal hypertension and hypoalbuminemia. For the client with​ ascites, measures to counteract fluid volume overload should be taken. These measures include monitoring intake and​ output, assessing the urine specific gravity​ (an indicator of hydration​ status), and weighing the client daily. Abdominal girth should also be measured​ daily, not​ weekly, and the client should be placed on a fluid restriction.

The nurse is preparing instructions for a client newly diagnosed with a metabolic disorder. Which information should the nurse include during the teaching session with this​ client? (Select all that​ apply.) A. Complications that can result from the condition B. Proper nutrition and exercise C. Potential for acupuncture to disrupt optimal body functioning D. Use and potential side effects of prescribed medications E. Use of monitoring​ devices, such as a glucometer

A, B, D, E ​Rationale: The nurse should provide a client with a metabolic disorder teaching about how and when to take the​ medications, what the side effects​ are, and when to report side effects or changes in their condition to the healthcare provider. The nurse should also provide client teaching related to the complications that could result from the condition and from not taking medications or supplements as prescribed. Client teaching related to the treatment plan also includes providing teaching about any monitoring devices that the client needs to​ use, such as a glucometer for individuals with diabetes mellitus​ (DM). The nurse can help the client by teaching about proper nutrition for the​ disorder, referring the client to a​ nutritionist, or encouraging the client to maintain an exercise routine that is appropriate for his health status. Complementary therapies such as acupuncture can help reduce stress and support optimal body​ functioning, including optimal functioning of the endocrine glands.

Which manifestation should the nurse monitor when caring for a client on thyroid hormone​ (TH) replacement​ therapy? (Select all that​ apply.) A. Symptoms of hyperthyroidism B. Improvement of symptoms of hypothyroidism C. Decrease in appetite D. Stable vital signs E. Report of dizziness

A, B, D, E ​Rationale: Vital signs should be assessed on every​ client, and those receiving TH replacement should be assessed for symptoms related to blood levels. Monitor improvement of symptoms. Dizziness and lack of sleep are some symptoms to report. The client would be expected to have an​ increase, not​ decrease, in appetite. If the client begins to experience symptoms of​ hyperthyroidism, it could indicate that the medication dose needs to be adjusted.

The nurse is performing an assessment for a client diagnosed with cirrhosis. Which finding should lead the nurse to determine that treatment is​ effective? (Select all that​ apply.) A. Absence of bruising or bleeding B. Stable liver function tests C. Increasing abdominal girth measurements D. Decreasing blood urea nitrogen levels E. Increasing serum albumin levels

A, B, E​ Rationale: For treatment to be​ effective, liver function tests should remain stable during treatment. The client should exhibit the absence of bruising or bleeding. Serum albumin levels should increase. Abdominal girth measurements should decrease. Blood urea nitrogen levels are used to diagnose kidney​ failure, not liver failure.

A client is admitted for treatment of possible cirrhosis. Which diagnostic test should the nurse expect to be prescribed for this​ client? (Select all that​ apply.) A. Alanine aminotransferase​ (ALT) B. Thyroid stimulating hormone​ (TSH) C. Aspartate aminotransferase​ (AST) D. Serum glutamic oxaloacetic transaminase​ (SGOT) E. Lactate dehydrogenase​ (LDH)

A, C, D, E​ Rationale: Cirrhosis affects the liver. Diagnostic tests to assess liver enzymes include​ AST, ALT,​ LDH, and SGOT. TSH assesses thyroid function.

A client is admitted with hyperosmolar hyperglycemic state​ (HHS) and a blood glucose level of 550​ mg/dL. Which intervention should the nurse expect to include in the plan of​ care? (Select all that​ apply.) A. Give normal saline intravenously. B. Provide education about type 2 diabetes mellitus. C. Monitor serum potassium levels. D. Assess level of orientation. E. Obtain blood for hemoglobin A1C.

A, C, D​ Rationale: HHS can cause changes to a​ client's level of consciousness ranging from lethargy to​ coma; therefore, the nurse should assess the​ client's level of orientation. The hyperosmolarity of the blood causes severe dehydration and depletion of electrolytes.​ Therefore, the priority care for a client with HHS is to provide isotonic or colloid solutions intravenously. Potassium is​ depleted, so it must not only be​ monitored, but also replaced. This client is acutely​ ill, so the hemoglobin A1C should be​ reviewed, but it is not a priority. Education should wait until the​ client's blood glucose level is stabilized and the client is alert enough to be receptive to the teaching.

Which instruction should the nurse include when teaching a client about a newly prescribed bisphosphonate​ drug? (Select all that​ apply.) A. Take the medication on an empty stomach first thing in the morning with water. B. Dilute the medication in water or orange juice. C. Do not eat or drink anything else for 30 minutes after taking. D. Take the medication 1 hour before meals or 2 hours after meals. E. Remain upright for 30 minutes.

A, C, E ​Rationale: The nurse should instruct the client who is prescribed a bisphosphonate to remain upright for 30 minutes after taking it to reduce the risk of developing esophagitis. Nothing should be ingested for 30 minutes to improve absorption of the medication. The medication should be taken on an empty stomach first thing in the morning with water to improve absorption. Antithyroid agents may need to be diluted in water or orange juice. Thyroid agents should be taken 1 hour before or 2 hours after meals.

Which statement made by a client with type 1 diabetes mellitus indicates an understanding of instruction provided regarding disease​ management? (Select all that​ apply.) A. ​"I should obtain blood glucose levels prior to each insulin​ injection." B. "I should trim my toenails at an angle to prevent cutting the​ skin." C. "I should administer insulin during the day in multiple​ injections." D. "I should count calories consumed to determine insulin needs for each​ day." E. "I should maintain my hemoglobin A1C levels at or below​ 8%."

A, C​ Rationale: For better blood glucose​ control, the healthcare provider would instruct the client to administer insulin throughout the day in multiple injections and to obtain blood glucose levels prior to each injection. Hemoglobin A1C levels should be below​ 6.5%. The client should be instructed to count​ carbohydrates, not calories. Toenails should be cut straight across with a clipper and the edges and corners smoothed with an emery board. If the client is unable to see his feet or reach them​ easily, someone else can trim his nails. If the nails are very thick or​ ingrown, if toes​ overlap, or if circulation is​ poor, then a podiatrist should cut the​ client's toenails.

The nurse is teaching a group of older adults with type 2 diabetes mellitus. Which complication of the disease should the nurse​ include? (Select all that​ apply.) A. Cognitive impairment B. Pulmonary disease C. Autoimmune diseases D. Polypharmacy E. Functional disabilities

A, D, E Rationale: Older adults diagnosed with type 2 diabetes mellitus are at an increased risk of developing other complications as compared with younger clients. These include​ polypharmacy, or taking other medications that can increase the​ risk; functional disabilities that may lead to a​ slower, more sedentary​ lifestyle; and cognitive impairment. A diagnosis of type 2 diabetes mellitus does not place a client at higher risk of pulmonary or autoimmune disease.

The nurse is conducting discharge teaching with a client who has been newly diagnosed with type 1 diabetes mellitus. Which statement from the client indicates the need for additional​ teaching? A. ​"As long as​ I'm in my​ house, I can walk​ barefoot." B. "I need to stay hydrated during the​ day." C. "It is important to test my blood sugar at least four times a​ day." D. "I need to be alert for​ infections."

A. Rationale: Clients with diabetes should always wear shoes to protect their feet from injury. The client should be alert for infection or​ injuries, stay well​ hydrated, and test the blood sugar four times a day.

The nurse is caring for a client with advanced osteoporosis who implemented the use of a heating pad in the treatment of pain. Which action by the nurse demonstrates appropriate use of the heating​ pad? A. Removing the heat every 20 to 30 minutes B. Alternating the heat with an ice pack every 30 minutes C. Utilizing the heat if the prescribed pain medication does not work D. Encouraging the use of the heat before the client ambulates

A. Rationale: The heat should be removed every 20 to 30 minutes to avoid a rebound effect from too much heat. Ice is not used in the treatment of pain for the client with osteoporosis. The heat should be utilized when the client experiences discomfort and can be used with or without the use of pain medication.

The nurse is teaching an older adult how to manage Graves disease. Which information should the nurse​ include? A. The administration schedule for an antithyroid drug B. The schedule for lifelong radioactive iodine treatments C. Use of levothyroxine​ (Synthroid) and lab monitoring D. Preparation for surgical removal of the thyroid

A. ​Rationale: Hyperthyroidism in the older adult is usually managed with the administration of antithyroid drugs and then evaluation to determine if radioactive iodine treatments are necessary. Thyroidectomies are not usually performed in older adults due to preexisting cardiac and central nervous system disorders. Levothyroxine​ (Synthroid) and lab monitoring are used to treat hypothyroidism.

A client with Addison disease would like to incorporate complementary health approaches into the treatment. Which statement by the nurse is most ​appropriate? A. ​"I will get a referral to a healthcare practitioner with complementary health​ experience." B. "I will ask the dietician to recommend vitamins that are safe for you to take during​ treatment." C. "Many of the complementary health approaches are contraindicated in Addison​ disease." D. "I will contact an exercise​ physiologist, so you can integrate yoga into your​ treatment."

A. ​Rationale: Referring a client to a healthcare practitioner that has experience with both a complementary health approach and the​ client's specific metabolic disorder will provide the client safe options to integrate complementary health approaches into the treatment plan. Many of the complementary health approaches can be integrated into the​ client's treatment plan. An exercise physiologist and dietician are not appropriate consults to integrate complementary approaches into the​ client's treatment plan.

The client with hypothyroidism asks the nurse why the​ thyroid-stimulating hormone​ (TSH) level is increased if the thyroid is not working properly. Which response by the nurse is​ accurate? A. ​"Your TSH level is increased due to an inadequately functioning negative hormonal feedback​ process." B. "Your TSH level is increased due to an increase in metabolism noted in clients with​ hypothyroidism." C. "Your TSH level is increased because the thyroid is working harder to produce more​ hormone." D. "Your TSH level is increased from a malfunction in the​ hypothalamus, leading to thyroid​ insufficiency."

A. ​Rationale: The TSH level increases in clients with hypothyroidism due to a loss of the negative hormonal feedback​ system, not because the thyroid is working harder. Metabolism is decreased in​ hypothyroidism, not increased. The pituitary​ gland, not the​ hypothalamus, is responsible for TSH production.

The nurse is screening clients in the clinic for osteoporosis. Which client has the greatest risk factor for​ osteoporosis? A. The client taking selective serotonin reuptake inhibitors​ (SSRIs) B. The client who occasionally drinks a diet soda C. The client who walks at the park for 30 minutes each day D. The client with a BMI greater than 25 ​kg/m2

A. Rationale: Prolonged use of certain medications such as SSRIs increases the risk of developing osteoporosis. Underweight individuals have a​ two-fold increased risk for fracture when compared to people with a BMI greater than 25 kg/m2. A high intake of diet​ soda, not occasional​ consumption, can contribute to the development of osteoporosis. An individual who walks for 30 minutes in the park every day most likely gets sufficient vitamin​ D, which also helps prevent osteoporosis.

The nurse is caring for an older adult with a history of fractures as a result of osteoporosis. The client currently has a right radial fracture. Which is the priority nursing diagnosis for the​ client? A. Activity Intolerance B. Mobility: Physical, Impaired C. Pain, Chronic D. ​Nutrition, Imbalanced: Less than Body Requirements

A. Activity Intolerance ​Rationale: The priority nursing diagnosis for the client with right radial fracture is Activity Intolerance. The pain the client will experience with a new fracture is acute. The​ client's mobility should not be impaired with a right radial fracture. The nutritional status of the client can be assessed after the activity intolerance is addressed.​ (NANDA-I ©​ 2014)

The nurse is working a health fair and teaching the public about risk factors for type 1 diabetes mellitus. Which ethnicity would the nurse include as having the highest risk in the United​ States? A. Caucasian American B. Asian American C. African American D. Hispanic

A. Caucasian American

A client with blood glucose of 450​ mg/dL is diagnosed with hyperosmolar hyperglycemic state​ (HHS). Which assessment finding should the nurse​ expect? A. Increase in urinary output B. Open wound to the foot C. Lower extremity edema D. Capillary refill of 2 seconds

A. Increase in urinary output​ Rationale: A client in HHS would have an increase in urinary output due to the hyperosmolarity of the blood. Capillary refill should be less than 3 seconds. Lower extremity edema occurs from fluid volume overload. A client in HHS has a fluid volume deficit. An open wound to the foot is not directly related to HHS because it can come from an injury to the foot.

Which information should the nurse provide the client with type 2 diabetes​ mellitus? A. Inspect your feet on a daily basis for open sores. B. Include 100 minutes per week of activity and exercise. C. Treat hyperglycemia with concentrated sweets. D. Increase carbohydrate consumption in the diet.

A. Inspect your feet on a daily basis for open sores. ​Rationale: The client should inspect both feet every​ day, using a mirror if​ needed, to look for open sores.​ Hypoglycemia, not​ hyperglycemia, is treated with 15 grams of concentrated carbohydrates. The client should include 150 minutes of activity and exercise per week. The client should decrease carbohydrate consumption.

The nurse is preparing information about hormone imbalances associated with obesity. Which hormone should the nurse include in this​ presentation? (Select all that​ apply.) A. Leptin B. Thyroid hormone C. Norepinephrine D. Insulin E. Epinephrine

A. Leptin, B. Thyroid Hormone, D. Insulin ​ Rationale: Hormones involved in regulating obesity include thyroid​ hormone, insulin, and leptin. Epinephrine and norepinephrine stimulate the​ heart, constrict blood​ vessels, inhibit visceral​ muscles, dilate​ bronchioles, and increase respiration and metabolism.

The nurse is reviewing the chart of a client diagnosed with acromegaly. Which collaborative treatment should the nurse​ expect? A. Lowering the production of growth hormone B. Increasing dietary calcium C. Providing a synthetic growth hormone D. Initiating a thyroid stimulating hormone

A. Lowering the production of growth hormone Rationale: Acromegaly results from the abnormal secretion of growth hormone from the pituitary gland. The treatment for acromegaly focuses on lowering the production of the growth hormone. Initiating a thyroid stimulating​ hormone, administering a synthetic growth​ hormone, and increasing calcium in the diet are not treatment goals for a client with acromegaly.

The nurse determines a client diagnosed with cirrhosis is at risk for bleeding. Which intervention is the priority for the nurse to include in the plan of​ care? A. Monitor coagulation studies and platelet count. B. Administer albumin as prescribed. C. Provide nutritional supplements. D. Administer antihistamines as prescribed.

A. Monitor coagulation studies and platelet count. ​Rationale: Monitoring coagulation studies and platelet count help determine if the client is bleeding or is at imminent risk for​ bleeding, and if there is a need for treatment. Antihistamines are used to reduce itching. Albumin is administered to increase plasma oncotic pressure and reduce edema and ascites. Providing nutritional supplements is important but does not affect the risk for bleeding.

The nurse is reviewing the chart of a child diagnosed with precocious puberty. Which factor should be monitored throughout the​ client's childhood and​ adolescence? A. Musculoskeletal development B. Cognitive development C. Behavioral development D. Neurological development

A. Musculoskeletal development ​ Rationale: The​ child's musculoskeletal development will be closely monitored. Precocious puberty results in early puberty in​ children, typically before the age of 8 years in girls and before the age of 9 years in boys. Precocious puberty can result in early closure of epiphyseal plates in the bones and thus short stature. Precocious puberty does not affect​ behavioral, cognitive, or neurologic development.

The nurse is caring for a client diagnosed with hepatic encephalopathy. Which nursing action is most appropriate for this​ client? A. Observe the client for asterixis. B. Provide a​ high-protein diet. C. Administer medications to treat diarrhea. D. Avoid medications that stimulate the central nervous system.

A. Observe the client for asterixis Rationale: The signs of early encephalopathy are sometimes subtle. It is important to identify neurologic changes early to begin treatment promptly. Asterixis​ (flapping of the​ hands) or changes in handwriting are early signs of neurologic impairment. The client should avoid medications that depress the central nervous system. A​ low-protein diet is prescribed to decrease nitrogenous waste products that accumulate in the blood and lead to hepatic encephalopathy. Regular bowel elimination promotes protein and ammonia​ elimination; therefore, measures should be taken to prevent constipation.

The nurse is caring for a client with osteoporosis. Which medication taken by the client may have contributed to this​ diagnosis? A. Prednisone B. Vitamin D supplements C. Acetaminophen D. Calcium supplements

A. Prednisone ​Rationale: Glucocorticoids such as prednisone may have contributed to the development of osteoporosis. Calcium supplements and vitamin D supplements are both used to treat osteoporosis. Acetaminophen is a pain​ reliever; it is not associated with the development of osteoporosis.

The nurse is performing a physical assessment of a child. Which assessment finding should cause the nurse to suspect type 2 diabetes​ mellitus? A. Presence of acanthosis nigricans B. Pale mucous membranes C. Blood pressure of​ 110/78 mmHg D. Body mass index 21 ​kg/m2

A. Presence of acanthosis nigricans ​Rationale: Acanthosis nigricans is a condition in which the skin is velvety in texture and brownish black in color with hyperkeratotic​ plaques; it is usually found in skin folds. This condition is often found in clients with type 2 diabetes mellitus and should be reported to the healthcare provider. A blood pressure reading of​ 110/78 mmHg is a normal finding as is a body mass index of 21​ kg/m2. Pale mucous membranes could be a sign of​ anemia; darkened mucous membranes could indicate type 2 diabetes mellitus.

The nurse is caring for a client with osteoporosis with a primary focus on preventing injury at night. Which is the best nursing intervention for the nurse to implement to maintain the safety of the​ client? A. Providing lighting in toilet facilities B. Keeping the side rails up on the bed at all times C. Restricting fluids at night to decrease nocturia D. Increasing the​ client's use of assistive devices

A. Providing lighting in toilet facilities ​Rationale: The nursing intervention that will maintain the safety of the client with osteoporosis is to provide lighting in the toilet facilities. Increasing the use of assistive devices would be dependent on the​ client's overall health. The client should only use the assistive devices that are necessary on which she has been properly fitted and trained. Restricting fluids to decrease nocturia is inappropriate and places the client at risk for dehydration and hypovolemia. It is not necessary to keep the side rails up on the bed at all times. The side rails should be kept up if indicated to prevent the client from getting out of bed alone.

The nurse is caring for a client suspected of having Graves disease. Which serum laboratory test should the nurse anticipate will confirm the​ diagnosis? A. T3​, T4​, TSH B. Serum calcium C. Serum albumin D. Parathyroid hormone

A. T3, T4, TSH​ Rationale: Graves disease is an autoimmune disease that affects the thyroid gland. T3​, T4​, and TSH tests are used to support the diagnosis of the disease. Serum​ albumin, calcium, and parathyroid hormone tests are used to support the diagnosis of other endocrine disorders.

A​ heel-stick screening of a newborn reveals the presence of T4 deficiency along with elevated​ thyroid-stimulating hormone​ (TSH). The infant is diagnosed with hypothyroidism. Which information should the nurse provide the​ parents? A. The child will need lifelong thyroid medication supplementation. B. The child will eventually grow out of this and no longer need treatment. C. The child will require evaluation for radioactive iodine. D. The child will be involved in infertility treatment later in life.

A. The child will need lifelong thyroid medication supplementation. ​Rationale: Hypothyroidism detected in neonates requires lifelong supplementation of thyroid hormone. The drug of choice for children is oral levothyroxine. The child would not require radioactive​ iodine, as this is reserved for hyperthyroidism. Infertility is a possibility for those women with hypothyroidism who do not ovulate. The child will not grow out of​ this, and will need lifelong treatment.

The nurse is evaluating the plan of care for an obese client diagnosed with type 2 diabetes mellitus 6 months prior. Which finding indicates the client is successfully managing the​ disease? A. Weight loss of 40 pounds B. New foot wound with purulent drainage C. Hemoglobin A1C of​ 10.0% D. Fasting blood sugars averaging 150​ mg/dL

A. Weight loss of 40 pounds​ Rationale: The obese client demonstrating a​ 40-pound weight loss over the past 6 months indicates improvement in dietary compliance with lowering carbohydrate intake and exercising. The normal hemoglobin A1C for a client with diabetes mellitus is​ 6?6.5%. Fasting blood sugars should be less than 100​ mg/dL if the client has good control. A new foot wound with purulent drainage indicates an infection and poor​ circulation, so this does not show good glycemic control.

The nurse is preparing a client with hyperthyroidism for radioactive iodine treatments. Which information should the nurse provide to the client prior to this​ procedure? (Select all that​ apply.) A. That the end results are immediately seen B. How to measure the radial pulse C. That the client may need lifelong thyroid replacement D. That hospitalization is usually required E. That radioactive iodine is given intravenously

B, C ​Rationale: Clients are instructed on measuring their own pulse until stores of thyroid hormone are depleted and notifying the healthcare provider if the heart rate is over 100 beats per minute. The client will more than likely require lifelong thyroid replacement due to radiation effects on the remaining thyroid tissue. The results may take up to 6 to 8 weeks to notice. This procedure is performed with an oral contrast on an outpatient basis.

The nurse is providing teaching to a client with a new diagnosis of type 1 diabetes mellitus. The nurse should instruct the client about incorporating which treatment to help manage the​ disease? (Select all that​ apply.) A. Fluid restriction B. Medication C. Nutrition D. Exercise E. Daily weight checking

B, C, D Clients with type 1 diabetes mellitus are treated with​ exercise, nutrition, and medication. Fluid restriction and daily weight checking are not part of the treatment plan for clients with type 1 diabetes mellitus.

The nurse is discussing risk factors for cirrhosis with a group of community members. Which risk factor should the nurse include in the​ discussion? (Select all that​ apply.) A. Smoking B. Excessive alcohol use C. Injection drug use D. Hepatitis C infection E. Obesity

B, C, D ​Rationale: The leading risk factor for cirrhosis is excessive alcohol use. The use of injected drugs puts the client at risk of contracting viral hepatitis​ (B, C, or​ D). Obesity and smoking are not known risk factors for cirrhosis.

The nurse is caring for a child with type 2 diabetes mellitus. Which item in this​ child's history should the nurse recognize as a risk factor for this​ disease? (Select all that​ apply.) A. Sex B. ​High-fat diet C.Race D. Obesity E. Family history

B, C, D, E

Which priority should the nurse include in the teaching plan for a client with Graves​ disease? (Select all that​ apply.) A. Eat a​ low-calorie diet. B. Weigh yourself daily. C. Tape your eyelids closed at night. D. Drink six to eight glasses of water a day. E. Take antithyroid drugs as prescribed.

B, C, D, E ​Rationale: The client is prescribed an antithyroid medication such as​ propylthiouracil, which must be taken as prescribed. Due to weight​ loss, the weight is carefully monitored. Due to​ exophthalmos, the client must protect the​ eyes, apply eye​ drops, wear sunglasses when​ outside, and tape them closed at night. The client has a decreased appetite and weight loss. A​ high-calorie diet is recommended. The client may have frequent​ diarrhea, and maintaining hydration is a priority.

The nurse is providing teaching on the prevention of osteoporosis. Which modifiable risk factor can increase a​ client's risk of developing​ osteoporosis? (Select all that​ apply.) A. Moderate exercise B. Sedentary lifestyle C. Excessive alcohol consumption D. Consumption of milk products E. Smoking

B, C, E Rationale: Individuals who spend a lot of time sitting have a higher risk of osteoporosis than do their more active counterparts. Excessive alcohol consumption can interfere with the​ body's ability to absorb calcium. Tobacco use contributes to weak bones. The consumption of milk products and moderate exercise are both lifestyle choices that decrease the risk of​ osteoporosis, not contribute to the development of osteoporosis.

The nurse is teaching the caregivers of an adolescent with a new diagnosis of type 2 diabetes mellitus what they should do every 3 months to monitor the disease. The adolescent is currently taking metformin​ (Glucophage). Which information should the nurse​ include? (Select all that​ apply.) A. Assess injection sites. B. Review blood glucose logs. C. Discuss alcohol and drug use. D. Obtain an eye exam. E. Monitor hemoglobin A1C.

B, C, E ​Rationale: An adolescent with type 2 diabetes mellitus who takes metformin​ (Glucophage) should monitor the hemoglobin A1C and blood glucose logs every 3 months. The nurse should also discuss alcohol and drug abuse and its effects on type 2 diabetes mellitus every 3 months. An eye exam should be obtained​ annually, not quarterly. The nurse need not assess injection sites because the adolescent does not use insulin.

For which alteration in metabolism would the expertise of an exercise physiologist be​ applicable? (Select all that​ apply.) A. Cirrhosis B. Obesity C. Thyroid disease D. Diabetes E. Osteoporosis

B, D, E Rationale: Exercise physiologists provide strategies to increase physical activity to control​ diabetes, obesity, and osteoporosis. The expertise of an exercise physiologist may not be helpful in the collaborative treatment of the client with cirrhosis or thyroid disease.

A young client is admitted for lethargy and weight loss. Which clinical manifestation supports the​ nurse's suspicion of diagnosis of type 1 diabetes​ mellitus? (Select all that​ apply.) A. Weight gain B. Glucosuria C. Fever D. Blurred vision E. Polyuria

B, D, E Rationale: Manifestations of type 1 diabetes mellitus are caused by the lack of insulin to transport glucose into the cells for energy. The resulting hyperglycemia leads to​ polyuria, glucosuria, and blurred vision. Polyuria occurs because water is drawn into the general​ circulation, increasing renal blood flow. Once the blood glucose exceeds the renal​ threshold, which is 180​ mg/dL, glucose will spill into the urine. Blurred vision is caused by swelling of the lenses of the eyes in response to increased fluid volume. Clients with type 1 diabetes mellitus usually lose​ weight, because proteins and fats are metabolized for energy and water is lost in the urine. In​ addition, clients with type 1 diabetes mellitus are frequently unable to develop a fever when cellular fuel stores are depleted because of a lack of insulin.

The nurse is reviewing the laboratory results for a client suspected of having cirrhosis. Which result suggests to the nurse that the suspicion is​ correct? (Select all that​ apply.) A. Decreased bilirubin levels B. Decreased sodium levels C. Increased albumin levels D. Prolonged prothrombin time E. Elevated serum ammonia levels

B, D, E ​Rationale: In​ cirrhosis, prothrombin times are prolonged because the liver is unable to manufacture clotting factors. Serum ammonia levels are elevated because the liver lacks the ability to efficiently convert ammonia to ammonium for excretion as urea by the kidneys. Sodium levels are decreased because of hemodilution due to fluid retention. In​ cirrhosis, bilirubin levels are​ increased, and albumin levels are decreased.

A client with a family history of hyperthyroidism asks the​ nurse, "What can increase my risk of developing this​ disorder?" Which response by the nurse is​ accurate? A. ​"Arthritis can lead to the development of​ hyperthyroidism." B. "Invasive neck surgery can impact thyroid​ functioning." C. "Viral infections can cause the onset of​ hyperthyroidism." D. "Smoking can increase your risk for acquiring this disease.

B. Rationale: A viral infection can increase the risk of hyperthyroidism. Other risks include having an autoimmune​ disease, pregnancy, female​ sex, and being under the age of 40. Surgery in the neck area increases the risk of hypothyroidism. Smoking and arthritis are not risk factors for hyperthyroidism.

The nurse preceptor is teaching a new graduate nurse about hypoglycemic agents used to treat type 2 diabetes mellitus. Which information should the preceptor include related to how these medications lower blood​ sugar? (Select all that​ apply.) A. Increase breakdown of insulin B. Prevent breakdown of glycogen C. Stimulate hormones for hemodilution D. Increase insulin secretion E. Increase peripheral uptake of glucose by cells

B, D, E​ Rationale: Hypoglycemic agents are used to treat individuals with type 2 diabetes mellitus. These medications lower blood sugar by stimulating or increasing insulin​ secretion, preventing breakdown of glycogen to glucose by the​ liver, and increasing peripheral uptake of glucose by making cells less resistant to insulin. Peripheral uptake is uptake by muscles and fat in the arms and legs rather than in the trunk. Some hypoglycemic agents keep blood sugar low by blocking absorption of carbohydrates in the intestines. The most recent pharmacologic therapy in treating type 2 diabetes mellitus includes the incretin effect. Incretin​ hormones, which are hormones released from the gut endocrine cells during​ meals, play a significant role in insulin secretion.

Which metabolic effect should the nurse expect to find in the client with liver​ disease? (Select all that​ apply.) A. Increased plasma oncotic pressure B. Impaired bilirubin conversion C. Increased blood flow to the liver D. Disrupted glucose metabolism E. Impaired clotting factor production

B, D, E​ Rationale: Liver disease causes many metabolic effects. Impaired clotting factor production results in bleeding and bruising. Disrupted glucose metabolism results in either hyperglycemia or hypoglycemia. Impaired bilirubin conversion and excretion result in jaundice. Other effects of liver disease include disrupted blood flow to the liver resulting in portal hypertension and decreased plasma oncotic pressure from impaired protein metabolism. This results in edema and ascites.

The nurse is managing care for a client weighing 165 pounds who was admitted for the treatment of diabetic ketoacidosis​ (DKA). Which intervention would be most appropriate for the nurse to include in the plan of​ care? (Select all that​ apply.) A. Provide a​ high-protein diet. B. Measure intake and output every hour. C. Give 100 mL of normal saline bolus. D. Place the client on a telemetry monitor. E. Administer​ sliding-scale regular insulin.

B, D​ Rationale: The nurse would calculate intake and output on an hourly basis to determine fluid needs. The client would be placed on a telemetry monitor to monitor for dysrhythmias related to shifts in potassium levels. The client with DKA would be acutely ill and if able to​ eat, would be placed on a​ carbohydrate-controlled diet. The nurse would administer normal saline boluses at​ 10-20 mL/kg. A volume of 100 mL is not sufficient. Insulin would be administered​ intravenously, not sliding scale.

Which physical assessment is most appropriate to include when identifying thyroid​ problems? (Select all that​ apply.) A. Percussion B. Palpation C. Auscultation D. Medication history E. Observation

B, E ​Rationale: Observation,​ palpation, and taking a family history are useful ways of identifying thyroid health problems. Palpation is used to determine the​ location, size, and nodules of the thyroid. Auscultation and percussion are not appropriate methods for this assessment. A medication history would be assessed in the health​ history, not the physical assessment.

The nurse is caring for a client newly diagnosed with osteoporosis who​ states, "I know I need the extra​ calcium, but I​ don't eat any dairy​ products." Which statement by the nurse provides the client with information for obtaining additional dietary​ calcium? A. ​"Many types of pasta are an excellent source of​ calcium." B. "Increase your consumption of​ vegetables." C. "You can increase your consumption of​ meat." D. "Seafood is an excellent source of​ calcium."

B. ​Rationale: The​ statement, "Increase your consumption of​ vegetables," provides information on an excellent source of calcium.​ Seafood, meat, and pasta are not excellent sources of calcium. Seafood should be consumed cautiously during​ pregnancy, as it contains high levels of mercury.

The nurse is caring for a client who received a daily​ intermediate-acting insulin dose at​ 8:00 a.m. At which time of the day should the nurse provide the client a snack to prevent​ hypoglycemia? A. ​9:00 p.m. B. 2:00 p.m. C. 11:00 a.m. D. 6:00 p.m.

B. 2:00 pm​ Rationale: Intermediate-acting​ (NPH) insulin peaks 6-8 hours after the injection.​ Therefore, the nurse would prepare a snack for the client beginning at​ 2:00 p.m. If the client received short-acting insulin​ (regular), the snack would be required between 10 a.m. and​ 11:00 a.m. Giving a snack at​ 6:00 p.m. or​ 9:00 p.m. may be appropriate for​ long-acting insulins, but it is not appropriate for​ intermediate-acting insulins.

The nurse is seeing four clients today in the endocrinology clinic. Which client would the nurse expect to be at highest risk for Hashimoto​ disease? A. A​ 10-year-old child with congenital hypothyroidism B. A​ 40-year-old woman with a goiter C. A​ 50-year-old man with hypothyroidism D. A​ 60-year-old African American man

B. A 40-year-old woman with a goiter Rationale: Hashimoto thyroiditis occurs twice as often in women as in men. The disorder is not commonly seen in​ children, and it is not more commonly seen in African Americans than in other ethnic groups. Hashimoto is the most common cause of goiter and primary hypothyroidism in adults and children. In this autoimmune disorder, antibodies develop that destroy thyroid tissue. Functional thyroid tissue is replaced with fibrous tissue, and TH levels decrease.

The nurse is preparing a presentation on risk factors for type 2 diabetes mellitus. Which ethnic group should the nurse include as being amongst the highest diagnosed with this​ disease? A. Caucasian Americans B. American Indians C. Asian Americans D. African Americans

B. American Indians​ Rationale: The ethnicities that have the highest incidence of type 2 diabetes mellitus are the American Indians and Alaska Natives at​ 15.9%. Incidence rates for Asian​ Americans, African​ Americans, and Caucasian Americans are​ 9%, 13.2%, and​ 7.6%, respectively.

A client with a history of cirrhosis presents to the emergency department with bleeding esophageal varices. The healthcare provider inserts a Minnesota tube. Which assessment is most important for the nurse to make on the​ client? A. Monitor urine output. B. Auscultate breath sounds. C. Auscultate bowel sounds. D. Monitor urine specific gravity

B. Auscultate breath sounds ​Rationale: Following insertion of a Minnesota tube​ (a multiple lumen nasogastric tube with a gastric and esophageal​ balloon), it is a priority for the nurse to monitor the​ client's respiratory status. Balloon tamponade carries a number of​ risks, including​ aspiration, airway​ obstruction, and tissue ischemia and necrosis. Monitoring breath sounds will provide information about the​ client's respiratory status. Bowel​ sounds, urine specific​ gravity, and urine output are not affected by a Minnesota tube.

A client diagnosed with osteoporosis indicates reluctance to taking medication on a daily basis. Which class of medication should the nurse anticipate will be​ prescribed? A. Oral calcium supplement B. Bisphosphonate C. Calcium channel blocker D. Tetracycline

B. Bisphosphonate ​Rationale: Recent studies suggest that​ once-weekly dosing with bisphosphonates may give the same bone density benefits as daily dosing because of the extended duration of drug action. Tetracyclines and calcium channel blockers are not used to treat osteoporosis. Oral calcium supplements are typically taken on a daily basis.

The nurse is caring for a client diagnosed with portal hypertension. For which complication should the nurse​ monitor? A. Hepatic encephalopathy B. Esophageal varices C. Fatty liver D. Hepatitis C

B. Esophageal varices ​Rationale: In portal​ hypertension, the venous drainage of the gastrointestinal tract becomes​ congested, leading to esophageal varices. Hepatitis C is caused by a viral infection. Hepatic​ (portal systemic) encephalopathy is due to the accumulation of toxic substances in the​ bloodstream, related to liver failure.​ Steatohepatitis, also known as fatty​ liver, is a condition in which fat cells build up in the​ liver, leading to liver enlargement and cirrhosis.

The graduate nurse is creating a care plan for a client diagnosed with cirrhosis. Which diagnosis assigned by the graduate nurse to the client should be questioned by the nursing​ preceptor? A. Skin​ Integrity: Impaired B. Fluid​ Volume: Deficient C. Protection: Ineffective D. Nutrition, Imbalanced: Less than Body Requirements

B. Fluid Volume: Deficient ​Rationale: Appropriate nursing diagnoses for a client with cirrhosis include Skin​ Integrity: Impaired due to pruritus as a result of bile salt deposits on the​ skin; ​Protection: Ineffective due to compromised mental​ status, and ​Nutrition, Imbalanced: Less than Body Requirements due to the​ client's salt and protein restrictions which may make the diet less palatable and appealing. Fluid​ Volume: Excess​, not Fluid​ Volume: Deficient​, is appropriate for a client with cirrhosis.​ (NANDA-I ©2014)

The healthcare provider prescribes metformin​ (Glucophage) to a client with newly diagnosed type 2 diabetes mellitus. Which information should the nurse provide to the​ client? A. This medication is unsafe for use by pregnant and lactating women. B. This medication can take up to 3 months to show effectiveness. C. This medication is used for clients who are unable to inject insulin. D. This medication is only used in the adult population due to side effects.

B. This medication can take up to 3 months to show effectiveness. ​Rationale: Metformin​ (Glucophage) is a relatively safe medication to use in the treatment of type 2 diabetes mellitus.​ However, it may take up to 3 months to show effectiveness. Metformin is used to stimulate insulin​ production, not used in place of insulin. It is safe for pregnant and lactating women and for children.

Which information is most important for the nurse to include in the discharge teaching for a client diagnosed with cirrhosis of the​ liver? A. Ways to increase fluid consumption B. How to institute bleeding precautions C. Importance of​ high-impact aerobic exercise D. Physical therapy consult

B. How to institute bleeding precautions ​Rationale: The client diagnosed with cirrhosis is at risk for bleeding because the​ liver's ability to manufacture clotting factors is impaired. The client should be taught how to institute bleeding precautions. A referral for home health​ services, dietary​ consultation, social​ services, and counseling may be​ needed; a physical therapy consult is not. Ways to manage fatigue and conserve energy should be​ taught; the client should not engage in​ high-impact aerobic exercise. Cirrhosis affects water and salt regulation because of portal​ hypertension, hypoalbuminemia, and​ hyperaldosteronism, which causes fluid volume overload.​ Therefore, the client will most likely be on fluid restriction.

An adult client reports a weight gain and feeling cold all the time. Which condition should the nurse​ suspect? A. Chronic renal failure B. Hypothyroidism C. Depression D. Hyperthyroidism

B. Hypothyroidism Rationale: Weight gain and feeling cold can be symptoms of hypothyroidism. The nurse would conduct an assessment to validate this assumption. Depression would not usually include weight gain or feeling cold. The weight gain of renal failure is usually associated with fluid retention. Hyperthyroidism presents with weight loss and increased sweating.

The nurse is planning a presentation on osteoporosis to clients in an​ assisted-living center. Which group would be appropriate for the nurse to exclude from the presentation as being at risk of developing this disease​ process? A. Asian American women B. Men with high testosterone levels C. Postmenopausal women D. Smokers

B. Men with high testosterone levels Rationale: Men with high testosterone levels are not at risk of developing​ osteoporosis; therefore, this should not be included in the presentation.​ Women, especially those who are postmenopausal and of Asian​ descent, are much more likely to develop osteoporosis. Smoking increases the​ client's risk of osteoporosis.

The nurse is reviewing the chart of an older adult client with a BMI of 19 ​kg/m2. Which implication does this clinical finding have on the risk for​ osteoporosis? A. The​ client's gender needs to be taken into consideration. B. The client is at risk for osteoporosis. C. The​ client's age in relation to the BMI should be factored in. D. The client is not at risk for osteoporosis.

B. The client is at risk for osteoporosis ​Rationale: Any individual with a BMI less than 20 ​kg/m2​, regardless of​ age, sex, or weight​ loss, is at a greater risk for both bone loss and subsequent risk for fracture.

The nurse is caring for a client diagnosed with hypoparathyroidism. Which assessment should the nurse integrate into the plan of​ care? A. Plantar response B. Trousseau sign C. Deep tendon reflexes D. Sensory testing

B. Trousseau Sign ​Rationale: The nurse should integrate assessment for Trousseau sign into the plan of care to monitor the client for complications of hypoparathyroidism. A positive Trousseau sign is related to decreased serum​ calcium, which is associated with hypoparathyroidism. Plantar response is a normal reflex found in a newborn. Sensory testing is done for a client with suspected peripheral neuropathy or​ paresthesia, which may occur in clients with​ diabetes, hypoparathyroidism, or acromegaly. Changes in deep tendon reflexes may occur in clients with​ hyper- or hypothyroidism.

The nurse is caring for a child who is hospitalized for the treatment of diabetic ketoacidosis​ (DKA). The​ child's parents ask why their child is receiving potassium. Which response by the nurse is​ accurate? A. ​"Potassium is administered to decrease blood glucose​ levels." B. "Potassium is administered to treat​ hypokalemia." C. "Potassium is administered to treat​ acidosis." D. "Potassium is administered to treat cerebral​ edema."

B.​ Rationale: Potassium is administered to treat hypokalemia.​ The fluids and insulin used to treat diabetic ketoacidosis can cause your potassium level to drop too low. A low potassium level can impair the activities of your heart, muscles and nerves. Insulin, not​ potassium, is administered to decrease blood glucose levels. Sodium​ bicarbonate, not​ potassium, is administered to treat acidosis.​ Mannitol, not​ potassium, is administered to treat cerebral edema.

The nurse is caring for a postmenopausal client prescribed estrogen therapy to reduce the risk of osteoporosis. Which client statement indicates the need for further​ teaching? A. ​"I will be sure to maintain all​ follow-up appointments for​ evaluation." B. "I have completed my smoking cessation​ program." C. "I am glad I am not at risk for osteoporosis​ anymore." D. "I understand that I may experience hot​ flashes."

C. ​Rationale: The client prescribed a selective estrogen receptor modulator to reduce the risk of osteoporosis should address other modifiable risk factors attributed to osteoporosis. Medication alone will not prevent osteoporosis. Hot flashes are a side effect of the medication. Smoking is a risk factor for osteoporosis. The client should maintain all​ follow-up appointments.

A teacher sends a child to the school nurse due to frequent thirst and urination. Upon​ assessment, the nurse suspects the child has type 1 diabetes mellitus. Which question should the nurse ask to gain data to support this​ suspicion? A. ​"Do you play outside a​ lot?" B. "When did you last see your healthcare​ provider?" C. "How is your​ appetite?" D. "Have you noticed any bruises on your​ legs?"

C. "How is your appetite?"​ Rationale: Polydipsia,​ polyuria, and polyphagia are the three hallmark signs of type 1 diabetes mellitus.​ Therefore, the nurse would ask about the​ child's appetite. Playing outside is not related to the onset of type 1 diabetes mellitus. Asking when the child last saw the healthcare provider is irrelevant to the current situation. Bruising to the legs can be from injuries or​ leukemia, not type 1 diabetes mellitus.

The nurse is teaching a group of clients newly diagnosed with type 1 diabetes mellitus. Which information should the nurse include in the​ teaching? A. ​"Take beta blockers daily to control blood​ pressure." B. "Have routine pedicures​ performed." C. "Schedule regular ophthalmology​ visits." D. "Monitor blood glucose levels​ weekly."

C. "Schedule regular ophthalmology​ visits." ​Rationale: The client with type 1 diabetes mellitus is at high risk for retinal damage.​ Therefore, the nurse would teach the client to schedule regular ophthalmology visits to monitor vision. The nurse would not encourage the client to have regular pedicures due to possible injury that can occur from macrovascular and microvascular deficits. Blood glucose levels should be monitored several times a​ day, not once a week. The client would be prescribed​ angiotensin-converting enzyme​ (ACE) inhibitors to protect the kidneys from vascular damage.

The nurse notes that a client with diabetes mellitus​ (DM) has a blood pressure of​ 184/92 mmHg. Which endocrine organ does the nurse identify as being responsible for the alteration in blood​ pressure? A. Parathyroid Glands B. Thyroid Glands C. Adrenal Cortex D. Anterior Pituitary

C. Adrenal Cortex Rationale: The adrenal cortex promotes kidney tubule resorption of sodium and water and excretion of potassium in response to elevated levels of potassium and low levels of​ sodium, thereby increasing blood pressure and blood volume. The thyroid gland maintains metabolic rate and growth and development of all tissues. The anterior pituitary promotes growth of body tissues by enhancing protein synthesis and promoting use of fat for energy to conserve glucose. The parathyroid glands maintain serum calcium levels by stimulating bone resorption and formation and by stimulating kidney resorption of calcium in response to falling levels of plasma calcium.

Which nursing assessment should the nurse monitor for when caring for a client with an adrenal gland​ disorder? A. Muscle tetany B. Abnormal circadian rhythms C. Alteration in perfusion D. Symptoms of hypoglycemia

C. Alteration in perfusion ​Rationale: Adrenal gland disorders affect the cardiovascular fluid volume of the client and therefore can alter tissue and organ perfusion. Muscle tetany is associated with hypoparathyroidism. Hypoglycemia is monitored in a client with​ diabetes, which is a pancreatic disorder. Abnormal circadian rhythms occur in the client with a pineal gland disorder.

A client diagnosed with cirrhosis of the liver states to the​ nurse, "This itching is driving me​ crazy." Which intervention is most appropriate for the nurse to​ implement? A. Wash the​ client's skin with cool water and soap daily. B. Turn the client every 4 hours. C. Apply an emollient lotion. D. Restrain the​ client's hands to prevent scratching.

C. Apply an emollient lotion ​Rationale: As ammonia levels rise in​ cirrhosis, bile salt deposits are deposited on the​ skin, which causes pruritus. To maintain skin integrity and ease​ itching, the nurse should apply an emollient lotion to moisturize the skin and reduce itching.​ Warm, not​ cool, water should be​ used, and soap should be​ avoided, as hot water and soap dry out the skin and increase pruritus. To maintain skin​ integrity, the client should be turned every 2 hours. Restraints should always be a last option to prevent a client from causing​ self-harm. Mittens are a better option to prevent scratching.

The nurse is teaching a client how to prevent the development of cirrhosis. Which intervention should the nurse​ include? A. Get a yearly flu shot. B. Discontinue all medications. C. Avoid illegal drugs. D. Cut down on the use of alcohol.

C. Avoid illegal drugs ​Rationale: Clients with diagnosed liver disease are at increased risk for cirrhosis. To prevent cirrhosis from​ occurring, clients should avoid illegal drugs. They should​ avoid, not just cut down​ on, all alcohol and continue taking all medications as prescribed. Flu shots are not known to prevent cirrhosis.

The nurse is teaching the parents of a child with a new diagnosis of type 1 diabetes mellitus. Which information should the nurse include regarding the pathophysiology of the​ disease? A. Beta cells need help producing insulin. B. Hyperglycemia happens when​ 50% of alpha cells are damaged. C. Beta cells are destroyed. D. Delta cell destruction causes type 1 diabetes mellitus.

C. Beta cells are destroyed Rationale: Type 1 diabetes mellitus has a slow onset and symptoms are not evident until​ 80-90% of beta cells are​ destroyed, causing hyperglycemia. Beta cells are functional and need medication to help with insulin production in type 2 diabetes mellitus. Hyperglycemia happens from beta cell​ destruction, not alpha or delta cell destruction.

The nurse is caring for a child diagnosed with type 1 diabetes mellitus. The nurse should teach the child and parents that insulin dosing is based on which​ item? A. Urine output B. Weight C. Diet D. Age

C. Diet ​Rationale: Insulin dose is based on​ diet, specifically carbohydrate intake. Insulin dose is not based on​ weight, age, or urine output.

Which action by a parent of a​ 12-year-old child with a new diagnosis of type 1 diabetes mellitus indicates a need for further​ teaching? A. Scheduling a baseline exam with an ophthalmologist B. Counting carbohydrates with the child C. Discouraging​ after-school sports D. Allowing the child to check blood sugars

C. Discouraging after-school sports​ Rationale: Exercise is a part of blood glucose and disease management.​ Therefore, the nurse should reeducate the parent to allow​ after-school sports. The parent should involve the​ 12-year-old child, so counting carbohydrates with the child and allowing the child to perform​ self-blood glucose monitoring is appropriate. Due to potential retinopathy that can occur with​ diabetes, it is appropriate for the parent to schedule an ophthalmic appointment to determine baseline visual acuity.

A client reports hoarseness and feelings of tightness in the throat. During the​ examination, the nurse notes visible swelling at the base of the​ neck, neck vein​ distention, a rapid​ pulse, and sweating. The nurse should suspect which condition in this​ client? A. Exophthalmos B. Pretibial myxedema C. Graves disease D. Toxic multinodular goiter

C. Graves Disease​ Rationale: Graves disease involves an enlargement of the thyroid gland due to overproduction of thyroid hormones.​ Therefore, the nurse would note swelling and neck vein distention. Exophthalmos would be evident by protruding eyeballs. Pretibial myxedema is nonpitting edema and would be noted in hypothyroidism. Toxic multinodular goiter is characterized by small nodules on the thyroid.

The nurse is caring for a client with Addison disease. For which priority assessment will the nurse monitor the​ client? A. Muscle stiffness B. Edema C. Intake and output D. Renal calculi

C. Intake and Output Rationale: Monitoring intake and output is a priority assessment for the client with Addison disease. The client with Addison disease is at risk for hypovolemia due to a decrease in​ aldosterone, which results in sodium and water loss. The client with Cushing syndrome has an increased amount of​ aldosterone, causing increased sodium and water​ retention, which may result in hypervolemia. Renal calculi are associated with​ hyperparathyroidism, which is characterized by increased serum calcium levels. Muscle​ weakness, not​ stiffness, is characteristic of Addison disease.

The nurse performing a nutritional assessment on an older adult should understand that which pancreatic​ age-related change can affect the​ client's nutritional​ needs? A. Increase in the production of lipase B. Increase in fat absorption C. Intolerance of fatty foods D. Decrease in absorption of​ water-soluble vitamins

C. Intolerance of fatty foods ​Rationale: In the older​ adult, there is a decrease in the production of lipase with reduced fat absorption and​ digestion, leading to intolerance of fatty foods and indigestion. Further changes in the pancreas of the older adult result in a decreased absorption of​ fat-soluble vitamins.

The nurse is teaching health promotion behaviors to a client diagnosed with osteoporosis. Which behavior should the nurse​ include? A. Exercising four times a week B. Decreasing smoking C. Limiting alcohol intake D. Avoiding foods high in purine

C. Limiting alcohol intake​ Rationale: The client should be instructed to limit alcohol intake. Alcohol has a direct toxic effect on osteoblast​ activity, suppressing bone formation during periods of alcohol intoxication. The client should be instructed to stop smoking​ altogether, not just decrease smoking. Smoking decreases the blood supply to​ bones, and nicotine slows the production of osteoblasts and impairs the absorption of​ calcium, contributing to decreased bone density. The instruction on exercising needs to be specified. Foods high in purine are associated with gout.​ Weight-bearing exercises are recommended for approximately 30 minutes four times a week.

The nurse is creating a plan of care for a client diagnosed with cirrhosis who has experienced gastrointestinal bleeding. Which nursing intervention is most important for the nurse to perform for the​ client? A. Apply mittens to the hands to prevent scratching. B. Plan for consistent nursing care assignments. C. Monitor coagulation studies and platelet count. D. Teach the family the importance of maintaining diet restrictions.

C. Monitor coagulation studies and platelet count. Rationale: The nurse should take steps to minimize​ bleeding, which includes monitoring coagulation studies and platelet count. Blood in the intestinal tract is digested as a​ protein, which increases serum ammonia levels and the risk for hepatic encephalopathy. Consistent nursing care assignments help clients with impaired mental​ status; mittens help promote skin integrity in clients with​ pruritus; and maintaining diet restrictions help promote nutrition.​ However, these interventions are less urgent for the client who is at risk for bleeding.

Which nursing intervention is most appropriate for a client experiencing a thyroid​ storm? A. Replacing lost fluids B. Cooling the client C. Padding the side rails D. Administering antithyroid medication

C. Padding the side rails ​Rationale: The client experiencing a thyroid storm is at high risk for developing seizures.​ Therefore, the nurse would promote safety by padding the side rails. Cooling the​ client, replacing lost​ fluids, and administering antithyroid medications are appropriate interventions to treat the disorder but are not related to promoting client safety.

The nurse is caring for a client experiencing severe ascites. Which collaborative intervention should the nurse​ expect? A. Gastric lavage B. Transjugular intrahepatic portosystemic shunt​ (TIPS) C. Paracentesis D. Insertion of​ Sengstaken-Blakemore tube

C. Paracentesis ​Rationale: For severe​ ascites, the treatment of choice is​ paracentesis, which is removal of fluid from the peritoneal cavity. The goal of this treatment is to reduce respiratory distress. A​ Sengstaken-Blakemore tube is used to treat bleeding esophageal varices. Gastric​ lavage, irrigation of the stomach with large quantities of normal​ saline, is performed to improve visualization of the stomach. The TIPS procedure is performed to relieve portal hypertension.

At the conclusion of a health interview and physical​ assessment, the nurse suspects that an older adult client is experiencing hyperthyroidism. Which assessment finding supports the​ nurse's conclusion? A. Lower extremity paresthesia B. Nodular thyroid tissue C. Presence of exophthalmos D. Decreased deep tendon reflexes

C. Presence of exophthalmos​ Rationale: Exophthalmos, or protruding​ eyes, may be seen in clients with hyperthyroidism. Nodular thyroid tissue and decreased deep tendon reflexes may be normal findings in an older adult client. Lower extremity paresthesia may occur in clients with diabetes or hypothyroidism.

The nurse is reviewing the orders for a client with osteoporosis who has been prescribed a bisphosphonate. Which test should the nurse anticipate will be ordered while the client is on the​ medication? A. ​Dual-energy x-ray absorptiometry​ (DEXA) B. Alkaline phosphatase C. Serum bone Gla protein​ (osteocalcin) D. Ultrasound

C. Serum bone Gla protein (osteocalcin) Rationale: Serum bone Gla protein​ (osteocalcin) is most useful for evaluating the effects of treatment rather than to indicate the severity of the disease.​ Dual-energy x-ray absorptiometry​ (DEXA) and ultrasound both measure bone​ density, not efficacy of treatment. Alkaline phosphatase also does not indicate efficacy of treatment.

The nurse is caring for a client suspected of having hepatorenal syndrome. Which assessment finding leads the nurse to determine this is​ correct? A. Asterixis B. Esophageal varices C. Sodium retention D. Fever

C. Sodiium Retention​ Rationale: Hepatorenal syndrome causes sodium​ retention, oliguria, and hypotension. Asterixis develops with portal systemic​ encephalopathy, and fever occurs with bacterial peritonitis. Esophageal varices are a complication of cirrhosis.

The nurse is teaching a client with osteoporosis who has been prescribed calcium citrate supplements. Which information should the nurse include in the​ teaching? A. Take the calcium within 2 hours after meals. B. Take the calcium in the morning. C. Take the calcium with meals. D. Take the calcium on an empty stomach.

C. Take the calcium with meals ​Rationale: The client prescribed calcium citrate supplementation should be instructed to take the calcium with meals. It does not matter what time of day the client takes the calcium.

The nurse reviews the laboratory results for a client and notes that the T4 level is low. Which prescription should the nurse anticipate the healthcare provider to​ prescribe? A. Beta blocker B. Radioactive iodine C. Thyroid replacement D. Antithyroid medications

C. Thyroid replacement Rationale: The treatment of choice for hypothyroidism is the thyroid hormone replacement​ drug, levothyroxine.​ Therefore, the nurse would expect the healthcare provider to prescribe this medication. Radioactive iodine and antithyroid medications are used in the treatment of hyperthyroidism. A beta​ blocker, such as​ propranolol, is used to lower the heart rate in clients with hyperthyroidism.

Which treatment should the nurse anticipate for a client who is newly diagnosed with​ hypothyroidism? A. Nonsteroidal​ anti-inflammatory medications B. Partial thyroidectomy C. Treatment with synthetic hormone D. Radiation

C. Treatment with synthetic hormone Rationale: The expected treatment for hypothyroidism is replacement with synthetic thyroid hormone. Surgical​ management, such as partial​ thyroidectomy, is used for management of hyperthyroidism. Radiation may also be used in the treatment plan for a client with hyperthyroidism. Nonsteroidal​ anti-inflammatory medications may be used in the management of a client with thyroiditis.

A client suspected of having cirrhosis has prolonged prothrombin times. Which medication should the nurse expect to be​ prescribed? A. Vitamin B B. Nitrates C. Vitamin K D. Diuretics

C. Vitamin K Rationale: Prolonged prothrombin times indicate that the blood is taking longer to clot and the client is at risk for bleeding. Vitamin K is given to reduce the risk of bleeding. Diuretics are used to treat ascites. Nitrates are used along with a beta blocker to prevent rebleeding of esophageal varices. Vitamin B is not used for the treatment of cirrhosis.

The nurse is caring for a client newly diagnosed with type 2 diabetes mellitus. Prior to any teaching about​ medications, the client informs the​ nurse, "I cannot give myself any​ injections." How should the nurse​ respond? A. ​"Insulin administration helps with better blood glucose​ management." B. "Why do you think you will have to give yourself​ injections?" C. "Type 2 diabetes mellitus can usually be managed with​ pills, diet, and​ exercise." D. "It is understandable to be upset about a new medical​ diagnosis."

C. ​ Rationale: The nurse should reassure the client with type 2 diabetes mellitus that the disease can be managed with oral hypoglycemic​ medications, diet, and exercise and may not require insulin. The nurse would not ask why the client thinks he would have to administer insulin. This is not therapeutic communication and is not the best way to obtain information. It is understandable for the client to be​ upset, but this statement does not alleviate the fears or provide information. Insulin administration helps with blood glucose management in type 1 diabetes mellitus.

The nurse is caring for several clients on the unit. Which client is at the greatest risk for​ osteoporosis? A. The client with impaired vision B. The client treated for an eating disorder C. The client with early onset Alzheimer disease D. The client treated for withdrawal delirium tremens

D. Rationale: The client being treated for withdrawal delirium tremens is at the greatest risk for osteoporosis. Delirium tremens occurs as a result of alcohol withdrawal. The client who is an alcoholic is at risk for osteoporosis. Impaired vision does not place the client at risk for osteoporosis. The client with an eating disorder will require counseling and a nutritional consultation. The client with early onset Alzheimer disease is mobile and can walk.

A client newly diagnosed with type 2 diabetes mellitus asks the nurse how to​ "get rid​ of" this disease. How should the nurse​ respond? A. ​"You will always have type 2 diabetes mellitus. You cannot get rid of​ it." B. "You seem concerned about this diagnosis and we will do our best to help you control​ it." C. "Type 2 diabetes mellitus cannot be cured. It will eventually progress to type 1​ diabetes." D. "Type 2 diabetes mellitus can sometimes be eliminated by weight​ loss, diet, and​ exercise."

D. Rationale: Type 2 diabetes occurs in people who live a sedentary​ lifestyle, are​ obese, and eat a​ high-carbohydrate diet.​ Therefore, the nurse would explain to the client that the disease may be eliminated with​ diet, exercise, and weight loss. The first statement stating the client will always have type 2 diabetes mellitus is inaccurate because the disease can be eliminated. Type 1 and type 2 diabetes mellitus are two separate disorders with commonalities. One type does not progress to the other. Although it is accurate that the client is concerned about the​ diagnosis, this response does not answer the​ client's question

The nurse is conducting a health fair to screen for type 2 diabetes mellitus. Which participant should the nurse consider to be at highest​ risk? A. ​40-year-old kindergarten teacher who works in a classroom B. 60-year-old retired architect who works at job site C. 30-year-old nurse who works in an intensive care unit D. 50-year-old office worker who sits at the computer

D. ​Rationale: A sedentary lifestyle is a risk factor for type 2 diabetes mellitus. The​ 50-year-old office worker who sits at the computer would be at highest risk for type 2 diabetes mellitus. All the other participants are physically active and are at lower risk.

The nurse is teaching a child with type 1 diabetes mellitus and his family about sick day guidelines. Which statement by the family indicates successful​ teaching? A. ​"We will test for ketones when the blood glucose level reaches 160​ mg/dL." B. "We will test for ketones when the blood glucose level reaches 200​ mg/dL." C. "We will test for ketones when the blood glucose level reaches 180​ mg/dL." D. "We will test for ketones when the blood glucose level reaches 240​ mg/dL."

D. ​Rationale: Blood glucose levels of 160​ mg/dL, 180​ mg/dL, and 200​ mg/dL are​ elevated, but they would not require testing for ketones. Once the blood glucose level exceeds 240​ mg/dL, the child and family should test the urine for ketones.

The nurse is reviewing the chart of a client with osteoporosis. Which physical assessment finding should the nurse​ anticipate? A. Poor posture B. Unsteady gait C. Generalized pain D. Spinal curvature

D. ​Rationale: The assessment findings associated with osteoporosis include spinal curvature. An unsteady​ gait, poor​ posture, and generalized pain are not findings associated with the physical assessment findings of osteoporosis.

The nurse is caring for a client diagnosed with cirrhosis. The client asks the​ nurse, "Why does my skin itch so​ much?" How should the nurse​ respond? A. ​"Your skin itches because your protein levels are​ low." B. "Your skin itches because you have been bleeding​ internally." C. "Your skin itches because your fluid levels are​ low." D. "Your skin itches because your liver cannot eliminate bile​ salts."

D. Rationale: In liver​ disease, the client becomes jaundiced with bile salts being deposited on the skin. This causes pruritus.​ Bleeding, low fluid​ levels, and low protein levels do not cause itching.

Which statement by the nurse indicates an understanding of the effects of vitamin D and calcium on​ osteoporosis? A. ​"Acidosis causes calcium to be deposited into​ bone." B. ​"A high intake of​ high-phosphate foods can help increase serum​ calcium." C. "Vitamin D is needed for renal absorption of phosphorus and​ calcium." D. "Impaired vitamin D activation reduces the serum calcium​ level."

D. Rationale: The statement made by the​ nurse, "Impaired vitamin D activation reduces the serum calcium​ level," demonstrates an understanding of the effects of vitamin D and calcium and their association with osteoporosis. Vitamin D is essential because it facilitates calcium absorption from the intestines into the blood. Acidosis does not cause calcium to be deposited in the bone. Vitamin D increases renal absorption of calcium in the distal​ tubule, but the phosphate level is not affected by vitamin D. Foods high in phosphate decrease serum calcium.

The nurse is developing a plan of care for a client with ineffective peripheral tissue perfusion related to microvascular changes. Which assessment finding supports this nursing​ diagnosis? A. Hemoglobin A1C of​ 6.4% B. Fasting blood glucose of 100​ mg/dL C. Capillary refill of 3 seconds D. Absent pedal pulses

D. Absent pedal pulses ​Rationale: Absence of pedal pulses indicates the peripheral tissue is not receiving adequate oxygenation and in turn is the basis of the nursing diagnosis Tissue​ Perfusion: Peripheral, Ineffective. A hemoglobin A1C of​ 6.4%, capillary refill of 3​ seconds, and fasting blood glucose of 100​ mg/dL are all normal findings.​ (NANDA-I ©2014)

The nurse is reviewing the chart of a pediatric client at risk for osteoporosis. Which factor in the​ client's history should the nurse identify as placing the client at risk for​ osteoporosis? A. Congenital cardiac disease B. Systemic lupus erythematosus C. Cystic fibrosis D. Diabetes

D. Diabetes ​Rationale: Diabetes is associated with a lower bone​ mass, placing the client at risk for osteoporosis. Cystic​ fibrosis, congenital cardiac​ disease, and systemic lupus erythematosus do not place the client at risk for osteoporosis. If the client has periods of​ immobility, the nurse can collaborate with physical therapy to provide the client with preventative exercises.

Which finding in the medical record indicates a client has good control of type 1 diabetes​ mellitus? A. Fasting blood sugar 200​ mg/dL B. Free of amputations C. Blood pressure​ 150/90 mmHg D. Hemoglobin A1C​ 5.4%

D. Hemoglobin A1C 5.4%​ Rationale: The finding that the client is maintaining a hemoglobin A1C of less than​ 6.5% indicates good diabetic control over the past 3 months. The client not having amputations indicates good peripheral​ circulation, but it does not indicate good disease management. Blood pressure of​ 150/90 mmHg is​ elevated, but it does not indicate good diabetes control. The fasting blood sugar should be under 125​ mg/dL. The finding of 200​ mg/dL is elevated.

The nurse is caring for a client with diabetes mellitus​ (DM). For which assessment finding will the nurse monitor the​ client? A. Sleeplessness B. Low blood pressure C. Weight loss D. Hyperglycemia

D. Hyperglycemia ​Rationale: A client with diabetes mellitus​ (DM) will experience​ hyperglycemia, presenting with blurred​ vision, thirst, frequent​ urination, increased susceptibility to​ infections, and fatigue​ (not sleeplessness). Weight​ gain, not weight​ loss, is associated with DM. High blood pressure is more likely to occur with DM than low blood pressure.

A client with type 2 diabetes mellitus​ states, "I am so frustrated. I cannot stick to the diet that I am supposed​ to." Which intervention should the nurse consider most helpful in supporting the​ client? A. Instructing the client to maintain a food log for 24 hours B. Instructing the client to engage in more exercise C. Scheduling the client to revisit the dietician D. Obtaining a consult for behavioral therapy

D. Obtaining a consult for behavioral therapy ​Rationale: The intervention that will be most helpful to the client is to obtain a consult for behavioral therapy. A behavioral therapist may be helpful for clients who have difficulty making changes on their own. Revisiting the dietician will not change the​ client's behavior. A food log may be incorporated into the behavioral​ therapy, but maintaining a food log alone will not be helpful in changing the​ client's behavior. Dietary behavior cannot be corrected through exercise.

Which should be the​ nurse's priority assessment for a client diagnosed with a tumor in the thymus​ gland? A. Cardiac output B. Neurological status C. Renal output D. Patent airway

D. Patent airway​ Rationale: The priority nursing care for the client is to monitor the​ client's airway. A tumor that develops in the thymus can press on the trachea and make breathing difficult. Renal output will be affected if the​ client?s cardiac output decreases. Cardiac output should not be​ affected; however, a tumor on the thymus gland can also block the superior vena​ cava, causing swelling of the arms and face. The client will experience neurologic changes if not receiving adequate oxygenation.

The nurse is developing a teaching plan for carbohydrate counting for a client newly diagnosed with type 1 diabetes mellitus. Which type of carbohydrate should the nurse instruct the client to​ restrict? A. Complex carbohydrates B. Dietary fructose C. Simple sugars D. Refined sugars

D. Refined sugars Rationale: Refined sugars come from sugar cane and are used as natural sweeteners. The client should restrict the intake of refined sugars. Simple sugars are found in​ fruit, honey, and dairy products. Dietary​ fructose, which comes from dietary fruit and vegetable​ consumption, causes a slower rise in blood glucose levels. Complex carbohydrates come from​ peas, beans, whole​ grains, and vegetables.

The nurse is caring for an older adult who is visually impaired and at risk for osteoporosis. Which activity is most appropriate to implement for the prevention of​ osteoporosis? A. Aerobics B. Walking on a treadmill C. Swimming D. Strength and balance training

D. Strength and balance training ​Rationale: Strength and balance training is the​ safest, most appropriate plan for exercise for the visually impaired client at risk for osteoporosis. Aerobics and walking on a treadmill are not the safest choices for a visually impaired client. The client may lose balance as well as not be able to adjust or stop a treadmill if needed. Swimming is not a​ weight-bearing exercise.​ Weight-bearing exercises influence the bone metabolism necessary to prevent osteoporosis.

The nurse is caring for a client with a​ long-term history of type 1 diabetes mellitus who has developed peripheral vascular disease. The nurse is unable to palpate the​ client's pedal pulses and the skin is cold to the touch. Which​ long-term goal is most appropriate for this​ client? A. The client will remain free of injury. B. The​ client's fasting blood glucose levels will stay between 70 and 110​ mg/dL. C. The client will remain free from infection. D. The​ client's skin integrity will remain intact.

D. The client's skin integrity will remain intact​ Rationale: The client has impaired circulation as evidenced by cold skin and absent pedal pulses that indicate a risk for impaired skin integrity due to gangrene. There is no evidence the client is at risk for injury or has an infection. Having fasting blood glucose levels in the normal range indicates good disease​ management, but it does not relate to the impaired circulation.

The nurse in the fertility clinic is working with a female client who has had repeated miscarriages. Which information in the​ client's history may be a precipitating​ factor? A. History of toxic multinodular goiter B. Type 2 diabetes mellitus C. Hyperemesis gravidarum D. Uncontrolled hypothyroidism

D. Uncontrolled hypothyroidism ​Rationale: Uncontrolled hypothyroidism can lead to​ miscarriages, stillbirths,​ preeclampsia, and low birth weights. Type 2 diabetes mellitus can lead to newborns that are large for gestational age. Hyperemesis gravidarum can cause hyperthyroidism in pregnancy. A history of toxic multinodular goiter would not cause repeated miscarriages later in life.

The nurse is preparing medication teaching on a bisphosphonate for a client newly diagnosed with osteoporosis. The nurse should teach the client to monitor for which adverse​ effect? A. Tinnitus B. Headaches C. Anorexia D. Vomiting

D. Vomiting Rationale: Adverse effects that may occur in a client taking a bisphosphonate include gastrointestinal problems such as​ nausea, vomiting, abdominal​ pain, and esophageal irritation.​ Tinnitus, anorexia, and headaches are not adverse effects of taking bisphosphonates.

A woman at​ 16-weeks' gestation asks the​ nurse, "How is my baby getting any nutrition to​ grow?" The​ nurse's response should be based on which​ understanding? A. Prolactin stimulates the transfer of maternal nutrients to the growing fetus. B. Progesterone and estrogen support the growing fetus. C. Human chorionic gonadotropin​ (hCG) is produced by the cells and facilitates intrauterine nutrition. D. Human placental lactogen helps provide maternal nutrition to the growing fetus.

D. ​ Rationale: Human placental lactogen plays a role in providing maternal nutrition to the growing fetus. Progesterone and estrogen stimulate uterine development and maintain the pregnancy. Human chorionic gonadotropin​ (hCG) is produced by the cells around the embryo and will eventually form the placenta. Prolactin stimulates milk production in the female breast after delivery.

Medication used in liver disease to draw levels of ammonia from the blood into the colon where it is removed from the body

Lactulose : Lowers the pH of the colon, which inhibits the diffusion of ammonia from the colon into the blood, thereby reducing blood ammonia levels. Can cause belching, cramps, and diarrhea. Given PO 30-45 mL, 3-4 times per day ● Assess patient for abdominal distention, presence of bowel sounds, and normal pattern of bowel function. ● Assess color, consistency, and amount of stool produced. ● PSE: Assess mental status (orientation, level of consciousness) before and periodically throughout course of therapy. ● Lab Test Considerations: blood ammonia concentrations by 25- 50%. ● May cause blood glucose levels in diabetic patients. ● Monitor serum electrolytes periodically when used chronically. May cause diarrhea with resulting hypokalemia and hypernatremia. ● Encourage patients to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid intake, and increasing mobility. Normal bowel habits are individualized and may vary from 3 times/day to 3 times/wk

Intermediate acting insulin

NPH (Humulin N, Novolin N) Onset: 2h Peak: 6h - 8h Duration: 12h - 16h

Synthetic thyroid (synthroid) medication used in patients suffering from hypothyroidism

Levothyroxine: Replacement of or supplementation to endogenous thyroid hormones. Restores normal balance of hormones. Increases metabolic rate of body tissues. Suppression of thyroid cancer. Can cause hyperthyroidism if taken in large doses, sweating, heat intolerance, weight loss, insomnia, tachycardia, diarrhea/vomiting. Given PO initially in 50 mcg doses, can be increased every 2-3 weeks by 25 mcg/day. Maintenance does is usually 75-125 mcg/day. Administer with a full glass of water preferably in the morning before meals to prevent insomnia. ● Assess apical pulse and BP prior to and periodically during therapy. Assess for tachyarrhythmias and chest pain. ● Lab Test Considerations:Monitor thyroid function studies prior to and during therapy. Monitor thyroid-stimulating hormone serum levels in adults 8- 12 wks after changing from one brand to another. ● Monitor blood and urine glucose in diabetic patients. Insulin or oral hypoglycemic dose may need to be increased. ● Toxicity and Overdose: Overdose is manifested as hyperthyroidism (tachycardia, chest pain, nervousness, insomnia, diaphoresis, tremors, weight loss). Usual treatment is to withhold dose for 2- 6 days then resume at a lower dose. Acute overdose is treated by induction of emesis or gastric lavage, followed by activated charcoal. Sympathetic overstimulation may be controlled by antiadrenergic drugs (beta blockers), such as propranolol. Oxygen and supportive measures to control symptoms are also used. ● Explain to patient that medication does not cure hypothyroidism; it provides a thyroid hormone supplement. Therapy is lifelong. ● Advise patient to notify health care professional if headache, nervousness, diarrhea, excessive sweating, heat intolerance, chest pain, increased pulse rate, palpitations, weight loss 2 lb/wk, or any unusual symptoms occur.

Rapid acting insulin

Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra) Onset: 15m Peak: 1h - 1h30m Duration: 3h - 4h

Beta-blocker medication used for hypertension/angina/arrhythmias, also used for management of thyrotoxicosis and has an unlabeled use for the treatment of esophageal varices related to liver disease

Propranolol (Inderal): Blocks stimulation of beta-adrenergic receptor sites; can lower BP associated with thyrotoxicosis and hepatic-portal hypertension and is effective in the prevention of variceal bleeding. Can cause fatigue, drowsiness, bradycardia, bronchospasm, orthostatic hypotension, pulmonary edema Assess apical pulse for 1 full minute before administering. If <50 bpm, withhold medication and notify HCP ● Monitor BP and pulse frequently during dose adjustment period and periodically during therapy. ● Abrupt withdrawal of propranolol may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia ● Teach patient and family how to check pulse daily and BP biweekly. Advise patient to hold dose and contact health care professional if pulse is 50 bpm or BP changes significantly. ● May cause drowsiness or dizziness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known. ● Advise patients to change positions slowly to minimize orthostatic hypotension, especially during initiation of therapy or when dose is increased. ● Caution patient that this medication may increase sensitivity to cold. - Davis Drug Guide for Nurses

Medication used for patients with Graves disease associated with hyperthyroidism who cannot tolerate surgery or radioactive iodine therapy

Propylthiouracial (PTU): Antithyroid agent that inhibits the synthesis of thyroid hormones Can cause drowsiness, vertigo, N/V, hepatotoxicity, and hypothyroidism in large doses Given PO 100 mg q8hr, may be increased up to 400 mg/day. Usual maintenance dose is 100-150 mg/day. Taken at the same time with meals every day. ● Monitor response of symptoms of hyperthyroidism or thyrotoxicosis (tachycardia, palpitations, nervousness, insomnia, fever, diaphoresis, heat intolerance, tremors, weight loss, diarrhea). ● Assess patient for development of hypothyroidism (intolerance to cold, constipation, dry skin, headache, listlessness, tiredness, or weakness). Dose adjustment may be required. ● Instruct patient to take medication exactly as directed, around the clock. If a dose is missed, take as soon as remembered; take both doses together if almost time for next dose; check with health care professional if more than 1 dose is missed. Consult health care professional prior to discontinuing medication. ● Instruct patient to monitor weight 2- 3 times weekly. Report significant changes - Davis Drug Guide for Nurses

Short acting insulin

Regular (Humulin R, Novolin R) Onset: 30m - 1h Peak: 2h - 3h Duration: 4h - 6h

Oral antidiabetic medication for Type 2 Diabetes that can be used alongside Metformin, Sulfonylureas, or Insulin

Rosiglitazone (Avandia): Improves sensitivity to insulin by acting as an agonist at receptor sites involved in insulin responsiveness and glucose production/utilization. Requires for insulin to be present in order for there to be activity; maintains glycemic control without the effects of hypoglycemia. Can cause, stroke, HF, MI, edema, new onset or worsening of diabetic macular edema, hepatitis, anemia, and weight gain Taken PO 2 mg once daily or 4 mg twice daily with or without food ● Observe patient taking concurrent insulin for signs and symptoms of hypoglycemia (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety). ● Assess patient for edema and signs of HF (dyspnea, rales/crackles, peripheral edema, weight gain, jugular venous distention). May require discontinuation of rosiglitazone. ● Lab Test Considerations: Monitor serum glucose and glycosylated hemoglobin periodically during therapy to evaluate effectiveness. ● Monitor CBC with differential periodically during therapy. May cause rise in hemoglobin, hematocrit, and WBC, usually during the first 4- 8 wk of therapy; then levels stabilize. ● Instruct patient to take medication as directed. If dose for 1 day is missed, do not double dose the next day. Explain the Rosiglitazone REMS Program to patient. ● Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term. - Davis Drug Guide for Nurses

Long acting insulin

glargine (Lantus), detemir (Levemir) Onset: 2h Peak: 16h - 20h Duration: 24h+

A client recently diagnosed with type 2 diabetes mellitus reports difficulty managing the disease. To which professional should the nurse refer the client for help with caloric​ intake? A. Personal trainer B. Dietitian C. Social worker D. Primary healthcare provider

​B. Dietician Rationale: The dietitian would best be able to help the client develop meal plans and incorporate foods that the client likes. The social worker would help the client find community resources to meet financial needs. A personal trainer would help the client increase activity. The primary healthcare provider manages the disease process as well as the multidisciplinary healthcare team.

A client with a newly prescribed medication for hypothyroidism asks the​ nurse, "What should I know about this​ drug?" Which statement by the nurse should be included in the​ nurse's teaching? A. ​"The medication helps stabilize your​ thyroid, so the hormonal production returns to​ normal." B. "If you miss a dose of your​ medication, make sure you take the missed pill with the next​ dose." C. "You will need to return to your healthcare provider to monitor hormone​ levels." D. "Once your thyroid hormone is​ replaced, you will no longer need the​ medication."

​C. Rationale: The client taking medication for hypothyroidism will need to return to the healthcare provider for​ follow-up, which includes monitoring hormone levels and adjusting the medication as needed. The client should be aware that treatment is ongoing and should not stop when hormone levels return to normal. Thyroid replacement therapy is for life. The client should not be instructed to double a dose of medication if a dose is missed.