NU 272 Metabolism
When advising a morbidly obese client about the benefits of weight reduction, which statement would be most accurate to share? "All you need to do is stop drinking sodas and sugary drinks." "If your leptin [hormone] level is too low, you are at increased risk for developing high BP." "An increased waist-to-hip" ratio can lead to too much pressure on the liver and intestines." "A 10-pound loss of weight can produce a decrease in blood pressure."
"A 10-pound loss of weight can produce a decrease in blood pressure." Explanation: Weight reduction of as little as 4.5 kg (10 lbs) can produce a decrease in BP in a large proportion of overweight people with hypertension. There is no data to suggest this client has a high intake of sodas. An increased waist-to-hip ratio is associated with hypertension. Leptin acts on the hypothalamus to increase BP by activating the SNS.
A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching? "I'll schedule a follow-up visit with my physician as soon as I get home." "I'll call my physician if I notice tingling around my lips." "I will increase my fluid and calcium intake." "I will take my pain medications according to the schedule we developed."
"I will increase my fluid and calcium intake." Explanation: The client requires additional teaching if they state that they will increase their calcium intake. Hyperparathyroidism causes extreme increases in serum calcium levels. The client should increase their fluid intake, but should limit their calcium and vitamin D intake. The client should continue to take pain mediations as scheduled and have regular follow-up visits with their physician. Tingling around the lips is a sign of hypercalcemia and should be reported to the physician immediately.
It is suspected that a client has osteomalacia. What should the nurse teach the client about potential causes of this condition? "The etiology is idiopathic." "Decreased nutrition is the primary cause." "Insufficient calcium absorption and phosphate deficiency are the causes." "This condition is genetically influenced."
"Insufficient calcium absorption and phosphate deficiency are the causes." Explanation: Osteomalacia is a generalized bone condition in which there is inadequate mineralization of bone caused by insufficient calcium absorption from the intestine resulting from the following: lack of dietary calcium, deficiency of vitamin D, or resistance to the action of vitamin D. Phosphate deficiency is also cited as a cause.
The neonate displays a yellow discoloration of her skin on the second day of life. The neonatologist explains this condition to the parents. Which statement is most accurate? "Hyperbilirubinemia places the neonate at risk for a cardiac condition known as kernicterus." "Most neonatal jaundice resolves spontaneously after about 6 weeks." "The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown." "Breast-feeding will not affect the bilirubin levels."
"The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown." Explanation: Physiologic jaundice appears in term infants on the second or third day of life. The increase in bilirubin is related to the increased red cell breakdown and the inability of the immature liver to conjugate bilirubin. Many factors cause elevated bilirubin levels in the neonate, including breast-feeding. Hyperbilirubinemia places the neonate at risk for development of a neurologic syndrome called kernicterus. Most neonatal jaundice resolves spontaneously within 1 week.
What should the nurse do when a woman who stopped breast-feeding her infant 3 months ago complains of occasional milk leakage from her breasts? Encourage the woman to resume breast-feeding Advise the woman that this is a normal occurrence after stopping breast-feeding Communicate to the physician the woman's symptom of breast cancer Encourage the woman to stimulate her nipples with gentle massage
Advise the woman that this is a normal occurrence after stopping breast-feeding Explanation: After stopping breast-feeding, a woman may have leakage for 3 months to 1 year. Therefore, the nurse should advise the woman that this is a normal occurrence.
Which action should a nurse include in the care plan for a 2-month-old infant with heart failure? Allow the infant to rest before feeding. Weigh and bathe the infant before feeding. Feed the infant when the infant cries. Bathe the infant and administer medications before feeding.
Allow the infant to rest before feeding. Explanation: Because feeding requires so much energy, an infant with heart failure should rest before feeding. Bathing and weighing the infant and administering medications should be scheduled around feedings. An infant expends energy when crying; therefore, it's best if the infant doesn't cry.
A nurse is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics. Treatment of high cholesterol using statins would be contraindicated in which client? A 72-year-old man who has emphysema and a long history of cigarette smoking A female client who had a laparoscopic cholecystectomy (gall bladder removal) earlier this year An obese male client who is a heavy alcohol user and who has cirrhosis of the liver A resident of a long-term care facility whose Alzheimer disease is being treated with donepezil (Aricept)
An obese male client who is a heavy alcohol user and who has cirrhosis of the liver Explanation: Active liver disease is a contraindication to the use of statins. As well, heavy alcohol use increases the risk of liver dysfunction. Respiratory disease, recent surgery, and organic cognitive deficits do not preclude the use of statins for high cholesterol.
A nurse caring for a 3-day-old neonate notices that the infant looks slightly jaundiced. How would the nurse first assess if jaundice is present? Palpate to determine the upper border of the liver. Perform a heel stick for bilirubin level. Blanche the skin on the sternum. Perform a complete ophthalmic exam.
Blanche the skin on the sternum. Explanation: The primary cause of neonatal jaundice is the immaturity of the liver and its inability to break down red cells effectively. When the newborn is suspected of being jaundiced, the nurse can first assess to see if jaundice is present by blanching the skin with digital pressure. This can be done on the bridge of the nose, sternum, or forehead. The liver size is not affected, so assessing it is unnecessary. Newborns should be assessed for jaundice each time the vital signs are taken. It must be assessed in a well-lit room. The sclera can also be assessed for jaundice, but this does not require a full ophthalmic exam. If jaundice is found, then the healthcare provider would need to be notified, and labs would need to be drawn for a bilirubin level.
A nurse researcher is reviewing data obtained from a developing nation on nutrition and metabolism issues facing that country. What is the nurse's understanding of the "double-burden" many developing nations now face? Both low metabolism and high metabolism Both undernutrition and sedentary lifestyles Both obesity and scare food sources Both undernutrition and obesity
Both undernutrition and obesity Explanation: The WHO mentions that many developing nations now face a double-burden of both undernutrition and obesity. Both of these issues occur simultaneously and create a public health burden to developing nations.
Which enzymes adhere to the border of the villus structures to allow access to carbohydrate and protein molecules? Chymotrypsin Brush border Activated trypsin Bile salts
Brush border Explanation: The brush border enzymes adhere to the border of the villus structures to allow access to carbohydrate and protein molecules as they come in contact with the absorptive surface of the intestines.
The nurse is caring for a group of hospitalized clients who require dietary prescriptions for their conditions. For which of these does the nurse encourage a diet with increased caloric intake? Select all that apply. Hypothyroidism Postoperative Burn injury Pregnant woman Fever
Burn injury Postoperative Fever Pregnant woman Explanation: More calories are expended during fever, due to the increased metabolic rate. There also may be an increased need for protein to support tissue repair after trauma or surgery. Pregnant women need approximately 300 kcal/day beyond their normal intake.
The nurse is caring for a client with end-stage liver disease who is at risk for hepatic encephalopathy. For which complications that increase the risk for hepatic encephalopathy should the nurse assess? Select all that apply. Hypoalbuminemia Hyponatremia Gastrointestinal bleeding High colonic pH Constipation
Constipation Gastrointestinal bleeding High colonic pH Explanation: Ammonia is produced in the colon by the bacterial degradation of proteins and amino acids, therefore more ammonia will be produced when the bacteria has access to either a greater protein load (such as when a person has bleeding in the gastrointestinal tract) or prolonged contact with colonic contents such as occurs with constipation. Normally, ammonia diffuses into the portal circulation and is transported to the liver, where it is converted to urea before entering the general circulation and then excreted via urine. When the liver is unable to convert ammonia to urea, ammonia accumulates and affects neurologic functioning. Using lactulose to create a more acidic colonic environment (low pH) is one treatment for hepatic encephalopathy. Therefore, a high colonic pH (more alkaline colonic environment) could result in more ammonia entering the circulation. While both low albumin and sodium levels are found in clients with liver failure, these are not associated with worsening hepatic encephalopathy.
A client has been diagnosed with metabolic acidosis. What assessment finding does the nurse expect? Increased pH above 7.45 Decreased pH below 7.35 Decreased PCO2 below 35 mm/Hg (4.66 kPa) Increased PCO2 above 45 mm/Hg (5.99 kPa)
Decreased pH below 7.35 Explanation: In metabolic acidosis, the client's pH will decrease below 7.35 or normal range. In addition , the client's HCO3- will decrease to below 22 mEq/L (22 mmol/L)
From which pair of metabolic disorders must the nurse instruct the parents to eliminate breast and cow's milk from the diet? Maple syrup urine disease and galactosemia Galactosemia and phenylketonuria Turner syndrome and maple syrup urine disease Congenital hypothyroidism and phenylketonuria
Galactosemia and phenylketonuria Explanation: Both phenylketonuria and galactosemia are hereditary disorders in which the body cannot have milk. Maple syrup urine disease is an inborn error of metabolism of the branched chain amino acid. Congenital hypothyroidism is an error with the thyroid gland.
A current client, an overweight 61-year-old with a history of diabetes mellitus, is status post-MI 1 month and has returned for a cardiology follow-up. Along with dietary changes, the nurse will discuss which nonpharmacologic lifestyle modification to reduce microvascular changes? Increased nicotine use Maintaining weight Increased cholesterol consumption Glucose control
Glucose control Explanation: Glucose and blood pressure control can reduce the microvascular changes associated with diabetes mellitus. Increased cholesterol consumption, nicotine use, and maintaining overweight status will contribute to continued coronary artery disease.
A 29 year-old female has been admitted to the emergency department following a suicide attempt by overdose of acetaminophen. What physiologic changes in the client's liver and accompanying altered diagnostic results does the nurse anticipate? Allergic inflammation accompanied by an increase in serum IgE and basophils. Hepatocellular necrosis evidenced by increased ALT and AST levels. Rapid onset of hepatitis and increased GGT, ALT, and bilirubin Cholestatic reaction with increased bilirubin count
Hepatocellular necrosis evidenced by increased ALT and AST levels. Explanation: Acetaminophen is commonly implicated in cases of direct hepatotoxicity, a situation that is characterized by hepatocellular necrosis and increased ALT and AST levels. An allergic-type reaction is associated with idiosyncratic drug reactions and cholestatic reactions and development of viral hepatitis are not noted to be associated with acetaminophen.
Which factor is genetically determined and primarily responsible for dark skin tone? Superficial distribution of melanocytes Dense distribution of melanosomes High levels of tyrosinase High production of melanin
High production of melanin Explanation: Although the number of melanosomes in dark and light skin is the same, dark skin produces more melanin, and more quickly, than light skin. Dark-skinned persons do not possess a more superficial distribution of melanocytes or increased levels of tyrosinase.
You are admitting an insulin-dependent patient to the same-day surgical suite for carpal tunnel surgery. You know that this patient may be at risk for which metabolic disorder? Thyrotoxicosis Adrenal insufficiency Hyperglycemia Impaired acid base balance
Hyperglycemia Explanation: The patient with diabetes who is undergoing surgery is at risk for hypoglycemia and hyperglycemia. Hyperglycemia during the surgical procedure is a risk based on the body's defense mechanism to raise the blood sugar in the event of stress. Patients who have received corticosteroids are at risk of adrenal insufficiency. Patients with uncontrolled thyroid disorders are at risk for thyrotoxicosis. Because the kidneys are involved in excreting anesthetic medications and their metabolites and because acid-base status and metabolism are also important considerations in anesthesia administration, surgery is contraindicated when a patient has acute nephritis, acute renal insufficiency with oliguria or anuria, or other renal problems.
The wound care nurse is teaching a group of nurses about wound healing and, specifically, delays in wound healing. Which situations that interfere with wound healing, and could cause a delay in healing, should the nurse include in the discussion? Select all that apply. Children with wounds Infections Superficial wound Hyperglycemia Malnutrition
Hyperglycemia Infections Malnutrition Explanation: Clients with diabetes and hyperglycemia do not respond well to traditional methods of wound treatment because of their high blood glucose levels. Evidence shows delayed wound healing and complications such as prolonged infections in people with diabetes delay wound healing. Gaping wounds tend to heal more slowly because it is often impossible to effect wound closure with this type of wound. Successful wound healing depends in part on adequate stores of proteins, carbohydrates, fats, vitamins (C), and minerals. Children's wounds tend to heal well.
What is the term for an adaptation to environmental stress that occurs when tissue mass enlarges due to cell multiplication and increased stimulation? Hyperplasia Dysplasia Atrophy Metaplasia
Hyperplasia Explanation: Hyperplasia is an increase in the number of new cells in an organ or a tissue. Atrophy is shrinkage in the size of a cell, leading to a decrease in organ size. Dysplasia is a change in the appearance of cells after they have been subjected to chronic irritation. Metaplasia is a cell transformation in which highly specialized cells change to less specialized cells.
Maintenance of blood gas concentrations, water balance, and food consumption are controlled by which part of the brain? Hypothalamus Cerebral hemispheres Basal ganglia Cerebellum
Hypothalamus Explanation: The hypothalamus is the area of master level integration of homeostatic control of the body's internal environment. Maintenance of blood gas concentrations, water balance, food consumption, and major aspects of endocrine and autonomic nervous system control require hypothalamic function.
Following routine newborn testing, an infant has been diagnosed with an elevated phenylalanine level. The nurse teaches the parents to follow a strict low-protein diet to prevent which major complication for the infant? Thyroid metabolism errors Kidney failure Cardiac valvular disorders Impaired brain development
Impaired brain development Explanation: Infants and children with classic and mild PKU require dietary protein restrictions to prevent intellectual disability, microcephaly, and other signs of impaired neurologic development. Affected infants are normal at birth but within a few weeks begin to develop a rising phenylalanine level and signs of impaired brain development. Seizures, other neurologic abnormalities, decreased pigmentation of the hair and skin, and eczema often accompany the intellectual disability in untreated infants.
The liver has many jobs. One of the most important functions of the liver is to cleanse the portal blood of old and defective blood cells, bacteria in the bloodstream, and any foreign material. Which cells in the liver are capable of removing bacteria and foreign material from the portal blood? Kupffer cells Epstein cells Davidoff cells Langerhans cells
Kupffer cells Explanation: Kupffer cells are reticuloendothelial cells that are capable of removing and phagocytizing old and defective blood cells, bacteria, and other foreign material from the portal blood as it flows through the sinusoid. Langerhans cells are stellate dendritic cells found mostly in the stratum spinosum of the epidermis. Epstein cells do not exist. Davidoff cells are large granular epithelial cells found in intestinal glands.
A client with a diagnosis of end-stage liver failure has arterial blood gas results indicating altered pH. Which of these consequences of liver failure has most likely caused the acid-base disturbance? Low albumin and plasma globulin levels. Conservation or formation of new HCO3- by the kidneys. Renal excretion of HCO3- in the presence of excess base. Transcompartmental exchange of H+ and potassium ions.
Low albumin and plasma globulin levels. Explanation: Albumin and plasma globulins are key protein buffers in the vascular compartment; consequently, a low albumin level, as is common in liver failure, is apt to result in acid-base imbalances. The other distractors all convey normal physiological processes that help to maintain pH.
A nurse confers with the attending physician about a client with encephalopathy who has been attributed to mitochondrial gene mutation. Why do mutations of the mitochondria affect the brain? Mitochondrial mutations can affect neural gene expression. Mitochondrial mutations affect the ability of tissues to synthesize ATP, and tissues with high demands malfunction without enough ATP. Mitochondria are only active in the brain and silenced in other tissues. Mitochondrial gene products can cross the blood-brain barrier.
Mitochondrial mutations affect the ability of tissues to synthesize ATP, and tissues with high demands malfunction without enough ATP. Explanation: Tissues that have a high demand for the energy provided by ATP malfunction very quickly when ATP cannot be produced fast enough. This includes the brain, the muscular system, the auditory system, and the retina. Mitochondria cannot be silenced by the cell. Mitochondrial proteins and mutations can affect the cell where they reside but not the entire organ.
When thyroxine (T4) in the thyroid is low, it triggers the pituitary to increase thyroid stimulating hormone (TSH), which then increases T4 secretion. This is an example of which of the following? Negative feedback mechanism Stress response Positive feedback mechanism General adaptation syndrome
Negative feedback mechanism Explanation: In a negative feedback mechanism, when the monitored function or value decreases below the set point of the system, the feedback mechanism causes the function or value to increase. In a positive feedback mechanism, the initiating stimulus produces more of the same. Neuroendocrine control systems that influence behavior are called the stress response. The general adaptation syndrome is a manifestation of the body's attempt to adapt to stimuli.
Which condition is characterized by a deficiency of the liver enzyme phenylalanine hydroxylase? Phenylketonuria Cri du Chat Tay-Sachs disease Cystic fibrosis
Phenylketonuria Explanation: Phenylketonuria (PKU) is a rare metabolic disorder that affects approximately 1 in every 15,000 infants in the United States. The disorder, which is inherited as a recessive trait, is caused by a deficiency of the liver enzyme phenylalanine hydroxylase. As a result of this deficiency, toxic levels of the amino acid phenylalanine accumulate in the blood and other tissues. Tay-Sachs disease is a variant of a class of lysosomal storage diseases, known as the gangliosidoses, in which there is failure of lysosomes to break down the GM2 ganglioside of cell membranes. Cystic fibrosis is the production of abnormally thick mucus, leading to the blockage of respiratory and glandular ducts. Cri du chat is a syndrome involving chromosome 5.
A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome? Gained 5 lb in one week Random blood glucose 85 mg/dL (4.72 mmol/L) Glycosylated hemoglobin 7.2% (.07) 1% ketones present in urine
Random blood glucose 85 mg/dL (4.72 mmol/L) Explanation: The goals of the nutritional plan for gestational diabetes mellitus (GDM) include normal glucose levels, no ketosis, proper weight gain for the pregnancy, and adequate nutrition for fetal health.
The Golgi complex, or Golgi bodies, consists of stacks of thin, flattened vesicles or sacs within the cell. These Golgi bodies are found near the nucleus and function in association with the endoplasmic reticulum (ER). What is one purpose of the Golgi complex? Produce bile Produce small carbohydrate molecules Produce excretory granules Receive proteins and other substances from the cell surface by a retrograde transport mechanism
Receive proteins and other substances from the cell surface by a retrograde transport mechanism Explanation: Recent data suggest that the Golgi apparatus has yet another function: it can receive proteins and other substances from the cell surface by a retrograde transport mechanism. Golgi bodies do not produce bile. They produce secretory, not excretory, granules, and they produce large carbohydrate molecules rather than small ones.
A client reports chronic cramping, bloating, and diarrhea and is diagnosed with a deficiency in brush border enzymes within the small intestine. Which meal/snack, high in carbohydrates and protein, will likely exacerbate the client's signs and symptoms? Grapefruit and prunes Tortilla chips and guacamole Tossed salad with an oil and vinegar dressing Roast beef and a baked potato
Roast beef and a baked potato Explanation: Brush border enzymes are primarily responsible for the metabolism of carbohydrates and proteins, substances best exemplified by a baked potato and roast beef, respectively. Of the meal choices, roast beef and a baked potato had both high protein and high carbohydrate content. Grapefruit and prunes, tossed salad with an oil and vinegar dressing, as well as tortilla chips and guacamole are not high in both carbohydrates and proteins.
A client with diabetes carries insulin with him at all times. At 11:35, he obtains a blood glucose reading of 218 mg/dL (12.1 mmol/L) and self-administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject? Short acting Intermediate acting Premixed Long acting
Short acting Explanation: Short-acting (regular) insulin is used to facilitate metabolism of the food that is being eaten. Premixed insulin is possible, but is not used as commonly. Intermediate- and long-acting insulin would have too distant an onset.
A 51-year-old male has been diagnosed with alcohol-induced liver disease. He admits to the nurse he does not understand what the liver does in the body. Which of these statements best explains the liver's function? The liver maintains a balanced level of electrolytes and pH in the body and stores glucose, minerals and vitamins. The liver metabolizes most components of food and also cleans the blood of bacteria and drugs. The liver contributes to the metabolism of ingested food and provides the fluids that the GI tract requires. The liver is responsible for the absorption of most dietary nutrients as well as the production of growth hormones.
The liver metabolizes most components of food and also cleans the blood of bacteria and drugs. Explanation: Protein, carbohydrate and fat metabolism are performed by the liver. As well, it metabolizes drugs and removes bacteria by Kupffer's cells. Absorption of nutrients takes place in the intestines and the liver does not produce the bulk of fluids secreted in the GI tract. The liver does not have a primary role in the maintenance of acid-base or electrolyte balance.
Which physiologic process would be considered a positive feedback mechanism? Increased production of white blood cells (WBC) in response to a microorganism The platelet-aggregation mechanism activating clot formation Shivering in response to low environmental temperature The release of anti-diuretic hormone (ADH) from the posterior pituitary gland
The platelet-aggregation mechanism activating clot formation Explanation: When platelets are activated at an injured site, they release chemicals that attract more platelets to promote clotting. Thus, the initial stimulus results in a greater but same response. This differs from the negative feedback systems used to oppose the effects of a stimulus. For example, because ADH counters the increase in plasma osmolality by promoting free water retention in the renal tubules, this is a negative feedback response. Shivering is an attempt to counter low temperature. WBC release is a response to the potential homeostatic instability of an infectious process.
The nurse is observing a student nurse perform an irrigation of a client's nasogastric (NG) tube. Which action by the student nurse would cause the nurse to stop the procedure? The student nurse allows the fluid in the syringe to flow by gravity into the NG tube. The student nurse irrigates the NG tube through the blue air vent port. The student nurse disconnects the suction tubing from the NG tube. The student nurse puts on clean gloves instead of sterile gloves.
The student nurse irrigates the NG tube through the blue air vent port. Explanation: The student nurse would not want to instill fluid through the blue air vent port - this is reserved for air only and is a way to decrease pressure that can build up into the stomach when suction is used. The student nurse should wear clean not sterile gloves because it is not a sterile procedure. The student nurse would disconnect the suction tubing in order to attach the syringe and can use gravity versus pushing the fluid in to instill it.
Which explanation identifies correctly how the G protein-linked receptors are similar? Their cytosolic domain has intrinsic enzyme activity. Insulin is an example of the second messenger cyclic AMP (cAMP), which binds to an enzyme-linked receptor. They have a ligand-binding extracellular receptor component, which causes changes that activate the G protein on the cytoplasmic side of the cell membrane. These linked receptors are involved in rapid synaptic signaling between cardiac electrical cells.
They have a ligand-binding extracellular receptor component, which causes changes that activate the G protein on the cytoplasmic side of the cell membrane. Explanation: Although there are differences among the G protein-linked receptors, all share a number of features. They all have a ligand-binding extracellular receptor component, which recognizes a specific ligand or first messenger. Upon ligand binding, they all undergo conformational changes that activate the G protein found on the cytoplasmic side of the cell membrane. Instead of having a cytosolic domain that associates with a G protein, enzyme-linked receptors have cytosolic domain either that has intrinsic enzyme activity or that associates directly with an enzyme. The binding of the hormone to a special transmembrane receptor results in activation of the enzyme adenylyl cyclase at the intracellular portion of the receptor. This enzyme then catalyzes the formation of the second messenger cAMP, which has multiple effects on cell function. Insulin, for example, acts by binding to an enzyme-linked receptor. Ion channel-linked receptors are involved in the rapid synaptic signaling between electrically excitable cells.
Microscopic examination of tissue samples from a deceased client's liver reveal that the hepatocytes contain pathologic vacuoles of fat. The nurse should understand what significance of this finding? This phenomenon may have been reversible if the client had undertaken lifestyle changes. The changes to the client's liver resulted from undiagnosed liver metastases. The client may have had high levels of exposure to free radicals early in life. The presence of fat in the cytoplasm of liver cells was likely the result of a genetic predisposition.
This phenomenon may have been reversible if the client had undertaken lifestyle changes. Explanation: Fatty changes are considered to be reversible. This phenomenon is not known to have a genetic predisposition and it is not the result of metastasis or free radicals.
A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? Syndrome of inappropriate diuretic hormone Diabetes insipidus Type 1 diabetes mellitus Hypothyroidism
Type 1 diabetes mellitus Explanation: Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.
When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect a blood pressure of 130/70 mm Hg. bradycardia. a blood glucose level of 130 mg/dl (7.2 mmol/L). a blood pressure of 176/88 mm Hg.
a blood pressure of 176/88 mm Hg. Explanation: Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.
For a client with hyperthyroidism, treatment is most likely to include a thyroid hormone antagonist. emollient lotions. thyroid extract. a synthetic thyroid hormone.
a thyroid hormone antagonist.Explanation:Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.
The nurse is admitting a 10-pound (4.5-kg) newborn to the nursery. What is important for the nurse to monitor during the transition period? heart rate blood sugar Apgar score temperature
blood sugar Explanation: Most facilities have protocols to guide nursing care in the treatment of hypoglycemia. Many pediatricians have preprinted orders that can be initiated if the glucose level falls below a predetermined level (usually 40-50 mg/dl).
The nurse is providing care for an adult client whose current medication regimen includes calcitonin and a bisphosphonate. The nurse should recognize the likely need for: assessment for the presence of genu varum or genu valgum. limitations on weight-bearing exercise. orthopedic surgery. bone density testing on a scheduled basis.
bone density testing on a scheduled basis. Explanation: Calcitonin and bisphosphonates are commonly used in the treatment of osteoporosis, in order to slow bone resorption; individuals with osteoporosis are encouraged to undergo regular bone density testing. Weight-bearing exercise is beneficial, provided it is performed within safe limits. Surgery is not normally indicated. Genu varum and genu valgum are congenital misalignments of the knee joint that do not affect bone resorption.
Hormone therapy decreases the risk of hot flashes. stroke. heart attack. blood clots.
hot flashes. Explanation: Hormone therapy decreases the risk of hot flashes. It increases the risk of stroke, heart attack, and blood clots.
As you are walking in the park, a huge black Labrador [dog] runs up to you and places his paws on your shoulders. Immediately your heart starts racing, you feel palpations, anxiety, and your hands become a little shaky. The nurse knows that this response is primarily caused by: increased levels of glucocorticoids by the adrenal glands that result in an increase in epinephrine level. fear of dogs that make you feel like your chest is being tightened and that you have lost control of the situation. stimulation of the release of β2 adrenergic receptors, which will open the airway and increase oxygenation. response of the cholinergic muscarinic receptors on innervational targets of postganglionic fibers.
increased levels of glucocorticoids by the adrenal glands that result in an increase in epinephrine level. Explanation: Any situation sufficiently stressful to evoke increased levels of glucocorticoids also increases epinephrine levels. Increased epinephrine levels results in tachycardia, palpitations, anxiety, and tremors. Cholinergic muscarinic receptors and beta-blockers do not help in times of immediate stress.
A daughter is concerned because her elderly parent has been diagnosed with osteomalacia. The daughter asks the nurse why this happened. The best response would be that: her parent is not using any sunscreens to help with absorption. her parent is consuming a diet high in calcium. intestinal absorption slows as natural aging occurs. there is an absorption of too much vitamin D.
intestinal absorption slows as natural aging occurs. Explanation: The incidence of osteomalacia is high among older adults because of diets deficient in calcium and vitamin D, a problem often compounded by the intestinal malabsorption that accompanies with aging. Melanin is extremely efficient in absorbing UVB radiation; thus, decreased skin pigmentation markedly reduces vitamin D synthesis, as does the use of sunscreens. Osteomalacia also may occur in persons on long-term treatment with medications such as anticonvulsants (e.g., phenytoin, carbamazepine, valproate) that decrease the activation of vitamin D in the liver.
The nurse explains the main purpose of the hypothalamus in regulating the central nervous system (CNS), autonomic nervous system (ANS), and endocrine system is the: maintenance of homeostasis. maximization of overall body metabolism. creation and maintenance of a diurnal rhythm. regulation of negative feedback systems.
maintenance of homeostasis. Explanation: The hypothalamus maintains internal homeostasis by sensing blood chemistries and by stimulating or suppressing endocrine, autonomic, and CNS activity. The negative feedback system is one way homeostasis is maintained, but it is not the overall goal or purpose of the system. Diurnal rhythm refers to the release of hormones at various times of the day, which is not the goal of the system. Metabolic activity accompanies all of the endocrine system's functions but is not the purpose of the system.
Which client would be the least appropriate candidate for bariatric surgery? 60-year-old male client who has had a body mass index (BMI) between 40 and 45 for the entire adult life 22-year-old female client with a body mass index (BMI) of 42 very obese client with type 2 diabetes whose weight loss efforts have been unsuccessful morbidly obese client who does not wish to change the diet or perform exercise to lose weight
morbidly obese client who does not wish to change the diet or perform exercise to lose weight Explanation: The question is asking who would not be a good canditdate. Bariatric surgery is usually limited to persons whose attempts at weight loss using diet and exercise have been unsuccessful. Therefore, the client who has not made these lifestyle change efforts would be the least appropriate candidate. It is not normally used as an intervention of first resort. Having diabetes, being 60 or 22 years of age are not contraindications for these procedures.
A nurse is discussing nutrition and weight control with clients during a class about diabetes. Which statement best reflects the purpose of nutritional management of diabetes? to increase exercise and monitor weight to stay within a recommended healthy weight range to maintain blood glucose levels close to the normal range to reduce risk for long-term complications to meet energy needs by eating only foods that keep blood glucose within a relatively normal range to maintain cholesterol levels to prevent the long-term complications of vascular disease
to maintain blood glucose levels close to the normal range to reduce risk for long-term complications Explanation: Maintaining normal blood glucose is the most important factor in preventing long-term complications associated with diabetes. Therefore, the most important purpose of nutritional management is maintaining blood glucose as close to normal as possible to prevent long-term complications. Following nutritional recommendations will meet energy needs, may contribute to weight control, and keep cholesterol levels within acceptable ranges, but the most important reason for nutritional management is to maintain blood sugars in the normal range.
A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and potassium. folic acid. iron. vitamin D.
vitamin D. Explanation: Typically, clients with hypoparathyroidism are ordered daily supplements of vitamin D along with calcium because calcium absorption from the small intestine depends on vitamin D. Hypoparathyroidism doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client doesn't require daily supplements of these substances to maintain a normal serum calcium level.
A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and vitamin D. potassium. iron. folic acid.
vitamin D. Explanation: Typically, clients with hypoparathyroidism are ordered daily supplements of vitamin D along with calcium because calcium absorption from the small intestine depends on vitamin D. Hypoparathyroidism doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client doesn't require daily supplements of these substances to maintain a normal serum calcium level.
