Metabolism
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: a) myxedema coma. b) Hashimoto's thyroiditis. c) cretinism. d) thyroid storm.
A. myxedema coma Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.
The nurse is providing dietary teaching for a client with diabetes. Which of the following statements about the diet would be accurate? a) It is based on nutritional requirements that are the same for all clients. b) It is rigidly controlled to avoid similar diabetic emergencies. c) It is planned around a wide variety of commonly available foods. d) It does not include processed foods because they have too many variables.
C. It is planned around a wide variety of commonly available foods Each client should be given an individually devised diet selecting commonly used foods from the Diabetic Association exchange diet. Family members should be included in the diet teaching. Nutritional requirements are not the same for all clients. Flexibility is needed based on activity, not rigid control. Seasoning and processed food should be managed.
The client with diabetes mellitus says, "If I could just avoid what you call carbohydrates in my diet, I guess I would be okay." The nurse should base the response to this comment on the knowledge that diabetes affects metabolism of which of the following? a) Fats and carbohydrates only. b) Carbohydrates only. c) Proteins, fats, and carbohydrates. d) Protein and carbohydrates only.
C. Proteins, fats, and carbohydrates Diabetes mellitus is a multifactorial, systemic disease associated with problems in the metabolism of all food types. The client's diet should contain appropriate amounts of all three nutrients, plus adequate minerals and vitamins
A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? a) Hypothyroidism b) Deficient growth hormone c) Type 1 diabetes mellitus d) Acromegaly
D. Acromegaly Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and, commonly, sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism and growth hormone deficiency aren't associated with hyperglycemia.
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? a) "I will increase my fluid and calcium intake." b) "I will take my pain medications according to the schedule we developed." c) "I'll call my physician if I notice tingling around my lips." d) "I'll schedule a follow-up visit with my physician as soon as I get home."
A. "I will increase my fluid and calcium intake." The client requires additional teaching if he states that he will increase his calcium intake. Hyperparathyroidism causes extreme increases in serum calcium levels. The client should increase his fluid intake, but he should limit his calcium and vitamin D intake. The client should continue to take pain mediations as scheduled and have regular follow-up visits with his physician. Tingling around the lips is a sign of hypercalcemia and should be reported to the physician immediately.
In evaluating a client's response to nutrition therapy, which laboratory test would be of highest priority to examine? a) Albumin level b) Lymphocyte count c) Serum potassium level d) CBC differential
A. Albumin level Protein and vitamin C help build and repair injured tissue. Albumin is a major plasma protein; therefore, a client's albumin level helps gauge his nutritional status. Potassium levels indicate fluid and electrolyte status. Lymphocyte count and differential count help assess for infection.
Vasopressin is administered to the client with diabetes insipidus because it: a) Increases tubular reabsorption of water. b) Increases release of insulin from the pancreas. c) Decreases glucose production within the liver. d) Decreases blood pressure.
A. Increases tubular reabsorption of water The major characteristic of diabetes insipidus is decreased tubular reabsorption of water due to insufficient amounts of antidiuretic hormone (ADH). Vasopressin is administered to the client with diabetes insipidus because it has pressor and ADH activities. Vasopressin works to increase the concentration of the urine by increasing tubular reabsorption, thus preserving up to 90% water. Vasopressin is administered to the client with diabetes insipidus because it is a synthetic ADH. The administration of vasopressin results in increased tubular reabsorption of water, and it is effective for emergency treatment or daily maintenance of mild diabetes insipidus. Vasopressin does not decrease blood pressure or affect insulin production or glucose metabolism, nor is insulin production a factor in diabetes insipidus.
A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do? a) Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. b) Tell the client to ask her physician if she is taking the correct dosage of her medication. c) Tell the client that she looks fine and offer to help her with makeup. d) Tell the client she needs to learn to accept herself as she is and be compliant during treatment.
A. Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. Telling the client that she'll soon experience improvement is supportive and encouraging and offers direction in a way that motivates her to take her medication consistently. Telling the client to ask her physician about the medication dosage might cause her to alter her dosage on her own, and also is putting the client off instead of addressing her concerns. Telling the client that she looks fine discounts the feelings she's currently experiencing. Advising the client to accept herself is parental and direct at a time when the client needs support and understanding.
A nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: a) consuming a low-carbohydrate, high-protein diet and avoiding fasting. b) eating a candy bar if light-headedness occurs. c) increasing saturated fat intake and fasting in the afternoon. d) increasing intake of vitamins B and D and taking iron supplements.
A. consuming a low-carbohydrate, high-protein diet and avoiding fasting To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn't help control hypoglycemia.
The mother of a 6-month-old states that she started her infant on 2% milk. The nurse should ask the mother: a) "Do you think your baby will be fine with this milk?" b) "Can you tell me more about the reason you switched your baby to 2% milk?" c) "You cannot switch to 2% milk right now. Did your pediatrician tell you to do this?" d) "Is it possible for you to switch your baby to whole milk?"
B. "Can you tell me more about the reason you switched your baby to 2% milk?" The American Academy of Pediatrics and Canadian Pediatric Society recommend that infants remain on iron fortified formula or breast milk until one year of age. The nurse needs to first assess if the mother switched the baby prematurely to due to lack of information or lack of resources. Then appropriate teaching or referrals may be determined. At one year of age the infant may be switched to whole milk, which has a higher fat content than 2%. The higher fat content is needed for brain growth. Demanding clients change behaviors without addressing the cause is unlikely to produce desired results.
Which of the following statements indicates that the client with a peptic ulcer understands the dietary modifications he needs to follow at home? a) "I should eat a bland, soft diet." b) "I should avoid alcohol and caffeine." c) "It is important to eat six small meals a day." d) "I should drink several glasses of milk a day."
B. "I should avoid alcohol and caffeine." Caffeinated beverages and alcohol should be avoided because they stimulate gastric acid production and irritate gastric mucosa. The client should avoid foods that cause discomfort; however, there is no need to follow a soft, bland diet. Eating six small meals daily is no longer a common treatment for peptic ulcer disease. Milk in large quantities is not recommended because it actually stimulates further production of gastric acid.
A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland? a) Pancreas b) Adrenal cortex c) Parathyroid d) Adrenal medulla
B. Adrenal cortex Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone.
A female client is admitted with fatigue, cold intolerance, weight gain, and muscle weakness. The initial nursing assessment reveals brittle nails, dry hair, constipation, and possible goiter. The client is most likely experiencing signs and symptoms of: a) A pituitary tumor. b) Hypothyroidism. c) Cushing's disease. d) Hyperthyroidism.
B. Hypothyroidism This client is demonstrating classic symptoms of hypothyroidism. Primary hypothyroidism results from pathologic changes in the thyroid gland. In this case, the thyroid gland cannot secrete sufficient amounts of thyroid hormone, leading to a decrease in cellular metabolic activity, decreased oxygen consumption, and decreased heat production. Cushing's disease is manifested by a buffalo hump, moonface, hypertension, fatigability, and weakness, resulting from the inappropriate release of cortisol. Hyperthyroidism, or Graves' disease, is manifested by increased appetite with weight loss, increased anxiety, hand tremors, palpitations, heat intolerance, and insomnia. A pituitary tumor can have many symptoms, depending on the location.
A client is to take levothyroxine 100 mcg, digoxin, and simvastatin. The nurse considers teaching regarding the medications to be effective if the client takes: a) All medications before going to bed. b) The levothyroxine with breakfast and the other medications after breakfast. c) All medications together 1 hour after eating breakfast. d) The levothyroxine before breakfast and the other medications 4 hours later.
D. The levothyroxine before breakfast and the other medications 4 hours later Levothyroxine must be given at the same time each day on an empty stomach, preferably 30 to 60 minutes before breakfast. Other medications may impair the action of levothyroxine absorption; the client should separate doses of other medications by 4 to 5 hours.
When caring for a client with diabetes insipidus, the nurse expects to administer: a) vasopressin. b) regular insulin. c) 10% dextrose. d) furosemide.
A. vasopressin. Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.
A 42-year-old female is interested in making dietary changes to reduce her risk of colon cancer. What dietary selections should the nurse suggest? a) Croissant, granola and peanut butter squares, whole milk. b) Bran muffin, skim milk, stir-fried broccoli. c) Granola, bagel with cream cheese, cauliflower salad. d) Oatmeal, raisin cookies, baked potato with sour cream, turkey sandwich.
B. Bran muffin, skim milk, stir-fried broccoli. High-fiber, low-fat diets are recommended to reduce the risk of colon cancer. Stir-frying, poaching, steaming, and broiling are all low-fat methods to prepare foods. Croissants are made of refined flour. They are also high in fat, as are peanut butter squares and whole milk, granola, cream cheese, and sour cream.
Metoclopramide is a medication prescribed for which of the following conditions? a) Encephalopathy. b) Nephropathy. c) Cardiomyopathy. d) Gastropathy.
D. Gastropathy Metoclopramide is a dopamine antagonist that stimulates motility of the upper gastrointestinal (GI) tract, increases lower esophageal sphincter tone, and blocks dopamine receptors at the chemoreceptor trigger zone. It may be used for delayed gastric emptying secondary to diabetic gastroparesis. It is not prescribed for encephalopathy, nephropathy, or cardiomyopathy.
A mother asks the nurse if her child's iron-deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following? a) Children with iron-deficiency anemia are less susceptible to infection than are other children. b) Children with iron-deficiency anemia are more susceptible to infection than are other children. c) Little is known about iron-deficiency anemia and its relationship to infection in children. d) Children with iron-deficiency anemia are equally as susceptible to infection as are other children.
B. Children with iron-deficiency anemia are more susceptible to infection than are other children Children with iron-deficiency anemia are more susceptible to infection because of marked decreases in bone marrow functioning with microcytosis.
After a 3-month trial of dietary therapy, a client with type 2 diabetes still has blood glucose levels above 180 mg/dl (9.99mmol/L). The physician adds glyburide, 2.5 mg P.O. daily, to the treatment regimen. The nurse should instruct the client to take the glyburide: a) in mid-morning. b) at bedtime. c) at breakfast. d) 30 minutes after dinner.
C. at breakfast Like other oral antidiabetic agents ordered in a single daily dose, glyburide should be taken with breakfast. If the client takes glyburide later, such as in mid-morning, after dinner, or at bedtime, the drug won't provide adequate coverage for all meals consumed during the day.
