N3 Insulin Diabetes Metabolism
A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? "I will avoid friends and family members who are sick." "I will eat lots of chicken and dairy products." "I may stop taking this medication when I feel better." "I will see my ophthalmologist regularly for a check-up."
"I may stop taking this medication when I feel better." Explanation: The client requires additional teaching because he states that he may stop taking corticosteroids when he feels better. Corticosteroids should be gradually tapered by the physician. Tapering the corticosteroid allows the adrenal gland to gradually resume functioning. Corticosteroids increase the risk of infection and may mask the early signs of infection, so the client should avoid people who are sick. Corticosteroids cause muscle wasting in the extremities, so the client should increase his protein intake by eating foods such as chicken and dairy products. Corticosteroids have been linked to glaucoma and corneal lesions, so the client should visit his ophthalmologist regularly.
After teaching an older adult about measures to relieve constipation, which statement by the client indicates a need for additional teaching? "I should use a laxative every other day." "I'll make sure that I drink plenty of fluids each day." "I'm going to start walking every day for exercise." "I need to avoid foods that are high in fat."
"I should use a laxative every other day." Explanation: Factors that may cause constipation include prolonged use of laxatives. Therefore, the patient should avoid the regular use of laxatives. To promote gastrointestinal motility, the patient should ensure adequate fluid intake, engage in regular exercise, avoid foods high in fat.
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? "Don't take your insulin or oral antidiabetic agent if you don't eat." "It's okay for your blood glucose to go above 300 mg/dl while you're sick." "Test your blood glucose every 4 hours." "Follow your regular meal plan, even if you're nauseous."
"Test your blood glucose every 4 hours." Explanation: The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.
Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? "Your insulin will begin to act in 15 minutes." "You should expect your insulin to reach its peak effectiveness by 12 noon if you take it at 8:00 AM." "You should take your insulin after you eat breakfast and dinner." "Your insulin will last 8 hours, and you will need to take it three times a day."
"You should take your insulin after you eat breakfast and dinner." Explanation: NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 6 to 8 hours, and a duration of 12 to 16 hours. See Table 30-3 in the text.
When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day? 3 AM 5 AM 7 AM 9 AM
3 AM Explanation: During the dawn phenomenon, the patient has a relatively normal blood glucose level until about 3 AM, when the level begins to rise.
A nurse determines that a male patient has an increased risk for diabetes, heart disease, and hypertension based on the patient's waist circumference. Which waist circumference measurement would lead the nurse to suspect this? 32 inches 35 inches 38 inches 41 inches
41 inches Explanation: In men, a waist circumference greater than 40 inches indicates excess abdominal fat and places the patient at risk for diabetes, dyslipidemias, hypertension, cardiovascular disease, and atrial fibrillation.
Which statement is true regarding gestational diabetes? It occurs in most pregnancies. Onset usually occurs in the first trimester. A glucose challenge test should be performed between 24 and 28 weeks. There is a low risk for perinatal complications.
A glucose challenge test should be performed between 24 and 28 weeks. Explanation: A glucose challenge test should be performed between 24 and 28 weeks in women at average risk. It occurs in less than 10% of all pregnancies. Onset usually occurs in the second or third trimester. There is an above-normal risk for perinatal complications.
A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? Inserting a feeding tube and providing tube feedings Administering a 500-ml bolus of normal saline solution Administering 1 ampule of 50% dextrose solution, per physician's order Observing the client for 1 hour, then rechecking the fingerstick glucose level
Administering 1 ampule of 50% dextrose solution, per physician's order Explanation: The nurse should administer 50% dextrose solution to restore the client's physiological integrity. Feeding through a feeding tube isn't appropriate for this client. A bolus of normal saline solution doesn't provide the client with the much-needed glucose. Observing the client for 1 hour delays treatment. The client's blood glucose level co
A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? Albumin Bacteria Red blood cells White blood cells
Albumin Explanation: Nephropathy, or kidney disease secondary to diabetic microvascular changes in the kidney, is a common complication of diabetes. Consistent elevation of blood glucose levels stresses the kidney's filtration mechanism, allowing blood proteins to leak into the urine and thus increasing the pressure in the blood vessels of the kidney. Albumin is one of the most important blood proteins that leak into the urine, and its leakage is among the earliest signs that can be detected. Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria but in fewer than 5% of people without microalbuminuria. The urine should be checked annually for the presence of proteins, which would include microalbumin.
A client with gastric cancer is scheduled to undergo a Billroth II procedure. The client's spouse asks how much of the client's stomach will be removed. What would be the most accurate response from the nurse? Approximately 25% Approximately 50% Approximately 75% The amount will depend on the client's weight.
Approximately 75% Explanation: The Billroth II is a wide resection that involves removing approximately 75% of the stomach and decreases the possibility of lymph node spread or metastatic recurrence.
The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as? Constructional apraxia Fetor hepaticus Ataxia Asterixis
Asterixis Explanation: Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy
The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? B12 C A Folate
B12 Explanation: The medication metformin (Glucophage) increases the client's risk for developing B12 deficiency because the medication inhibits the absorption of B12.
When caring for a client who is post-intracranial surgery what is the most important parameter to monitor? Extreme thirst Intake and output Nutritional status Body temperature
Body temperature Explanation: It is important to monitor the client's body temperature closely because hyperthermia increases brain metabolism, increasing the potential for brain damage. Therefore, elevated temperature must be relieved with an antipyretic and other measures. Extreme thirst, intake and output, and nutritional status are not the most important parameters to monitor.
A client is experiencing difficulty speaking and numbness on his right side. His wife calls a neighbor who is a nurse for help. Upon arrival at the scene, the nurse calls 911 immediately. Which of the following displays the nurse's critical clinical judgment? The blood supply to the heart is reduced. A decreased hemoglobin count lowers blood supply to the brain. This man needs to develop collateral circulation immediately. Brain cells without oxygen die in approximately 3 to 6 minutes.
Brain cells without oxygen die in approximately 3 to 6 minutes. Explanation: Ischemia results from intravascular clots that interfere with blood supply, which is what happens in a stroke. Brain cells need a constant supply of blood and will die within 3 to 6 minutes without blood. Therefore, it is necessary to seek health care immediately.
Evaluation of an adult client reveals oversecretion of growth hormone. Which of the following would the nurse expect to find? Excessive urine output Weight loss Bulging forehead Constant thirst
Bulging forehead Explanation: Oversecretion of growth hormone in an adult results in acromegaly, manifested by coarse features, a huge lower jaw, thick lips, thickened tongue, a bulging forehead, bulbous nose, and large hands and feet. Excessive urine output, weight loss, and constant thirst are associated with diabetes insipidus.
Which of the following inhibits bone resorption and promotes bone formation? Calcitonin Estrogen Parathyroid hormone Corticosteroids
Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis.
A nurse is assigned to care for a patient with increased parathormone secretion. Which of the following serum levels should the nurse monitor for this patient? Glucose Sodium Calcium Potassium
Calcium Explanation: Increased secretion of parathormone results in bone resorption. Calcium is released into the blood, increasing serum levels.
A client with calculi in the gallbladder is said to have Cholecystitis Cholelithiasis Choledocholithiasis Choledochotomy
Cholelithiasis Explanation: Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile; they vary greatly in size, shape, and composition. Cholecystitis is acute inflammation of the gallbladder. Choledocholithiasis is a gallstone in the common bile duct. Choledochotomy is an incision into the common bile duct.
A nurse cares for a client who is 5 feet 11 inches tall and weighs 225 pounds. What statement describes the client's BMI? Overweight Class I obesity Class II obesity Normal weight
Class I obesity Explanation: To calculate BMI, multiply weight in pounds by 703 and then divide that by height in inches squared. The client's BMI is 31.4 kg/m2. This falls under the Class I obesity category. Normal weight BMI is 18.5-25 kg/m2. Overweight BMI is 25-30 kg/m2. Class II obesity is a BMI 35-40 kg/m2.
The nurse is caring for a client recovering from acute pancreatitis. Which menu item should the nurse remove from the client's breakfast tray? Toast Coffee Oatmeal Orange slices
Coffee Explanation: Post-acute management of the client with acute pancreatitis includes the introduction of solid food. Oral feedings that are low in fat and protein are gradually initiated. Caffeine is eliminated from the diet and therefore coffee, which contains caffeine, should be removed from the client's breakfast tray. Even decaffeinated coffee has a small amount of caffeine but could serve as a compromise for chronic coffee drinkers. The other food items are appropriate for the client.
A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. When the client asks the nurse what his or her blood pressure should be, what is the nurse's most appropriate response? "Your blood pressure is fine. Just keep doing what you're doing." "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." "The lower the better. Blood pressure of 130/80 mm Hg is best for everyone." "Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."
Correct response: "Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg." Explanation: An individual with diabetes mellitus should strive for blood pressure of 120/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less
The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium concentration of 2.9 mEq/L (2.9 mmol/L). Which statement made by the client indicates the need for further teaching? "I can use laxatives and enemas but only once a week." "A good breakfast for me will include milk and a couple of bananas." "I will be sure to buy frozen vegetables when I grocery shop." "I will take a potassium supplement daily as prescribed."
Correct response: "I can use laxatives and enemas but only once a week." Explanation: The client is experiencing hypokalemia, most likely due to the diagnosis of bulimia. Hypokalemia is defined as a serum potassium concentration <3.5 mEq/L (3.5 mmol/L), and usually indicates a deficit in total potassium stores. Clients diagnosed with bulimia frequently suffer increased potassium loss through self-induced vomiting and misuse of laxatives, diuretics, and enemas; thus, the client should avoid laxatives and enemas. Prevention measures may involve encouraging the client at risk to eat foods rich in potassium (when the diet allows), including fruit juices and bananas, melon, citrus fruits, fresh and frozen vegetables, lean meats, milk, and whole grains. If the hypokalemia is caused by abuse of laxatives or diuretics, client education may help alleviate the problem.
Which is a true statement regarding pharmacologic aspects of aging? Elderly have a decreased percentage of body fat. Potential for drug-drug reactions decreases with the number of drugs prescribed. Absorption may be affected by changes in gastric pH. Medication compliance is a single-faceted issue among the elderly.
Correct response: Absorption may be affected by changes in gastric pH. Explanation: During the aging process, absorption may be affected by changes in gastric pH. The elderly have an increased percentage of body fat. The potential for drug-drug interaction increases with the number of drugs prescribed. The aged population tends to be less compliant with their medication regimen because of several factors, such as cost, vision changes, mobility issues, and education.
The nurse is caring for a client who has developed dumping syndrome while recovering from a gastrectomy. What recommendation should the nurse make to the client? Drink a minimum of 12 ounces of fluid with each meal. Eat several small meals daily spaced at equal intervals. Choose foods that are high in simple carbohydrates. Sit upright when eating and for 30 minutes afterward.
Correct response: Eat several small meals daily spaced at equal intervals. Explanation: The client with dumping syndrome should consume small meals at intervals to reduce symptoms. The client should not consume fluids with meals. Carbohydrates should be limited and sitting upright does not relieve the symptoms.
A nurse cares for a client with obesity who has type 2 diabetes. Which medication does the nurse recognize may assist in weight loss and is also approved to treat type 2 diabetes? Lorcaserin Orlistat Liraglutide Benzphetamine
Correct response: Liraglutide Explanation: Liraglutide (Saxenda), a GLP-1 receptor agonist, is used for both the treatment of obesity and type 2 diabetes. The other medications are used for the treatment of obesity only.
A nurse is assessing a patient's urinary output as an indicator of diabetes insipidus. The nurse knows that an hourly output of what volume over 2 hours may be a positive indicator? 50 to 100 mL/h 100 to 150 mL/h 150 to 200 mL/h More than 200 mL/h
Correct response: More than 200 mL/h Explanation: For patients undergoing dehydrating procedures, vital signs, including blood pressure, must be monitored to assess fluid volume status. An indwelling urinary catheter is inserted to permit assessment of renal function and fluid status. During the acute phase, urine output is monitored hourly. An output greater than 200 mL per hour for 2 consecutive hours may indicate the onset of diabetes insipidus (Hickey, 2009).
A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? Vitamin A Thiamine Riboflavin Vitamin K
Correct response: Vitamin A Explanation: Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.
During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted? decrease in hormonal levels increase in hormonal levels hormonal overproduction hormonal underproduction
Correct response: decrease in hormonal levels Explanation: Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland. In positive feedback, the opposite occurs.
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: sodium. potassium. magnesium. phosphorus.
Correct response: phosphorus. Explanation: PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.
A nurse is teaching a client about hormones within the endocrine system. Which hormones would be included as the hypothalamic hormones? Select all that apply. Arginine vasopressin Corticotropin-releasing hormone Thyrotropin-releasing hormone Gonadotropin-releasing hormone Prolactin hormone
Corticotropin-releasing hormone causes the anterior pituitary gland to secrete adrenocorticotropic hormone. Thyrotropin-releasing hormone stimulates the release of thyroid-stimulating hormone from the anterior pituitary gland. Gonadotropin-releasing hormone triggers sexual development at the onset of puberty and continues to cause the anterior pituitary gland to secrete luteinizing hormone and follicle-stimulating hormone. Arginine vasopressin is secreted from the posterior pituitary and prolactin hormone is secreted from the anterior pituitary gland.
The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin? D C B E
D Explanation: The actions of PTH are increased by the presence of vitamin D.
A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: Impaired adjustment. Defensive coping. Deficient knowledge (treatment regimen). Health-seeking behaviors (diabetes control).
Deficient knowledge (treatment regimen). Explanation: The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and seeing the physician regularly, the client has demonstrated the ability and willingness to modify his lifestyle as needed to manage the disease. This behavior eliminates the nursing diagnoses of Impaired adjustment and Defensive coping. Because the nurse, not the client, questioned the client's health practices related to diabetes management, the nursing diagnosis of Health-seeking behaviors isn't warranted.
After teaching a group of students about erectile dysfunction, the instructor determines that the teaching was successful when the students identify which of the following as true? Erectile dysfunction is unrelated to anxiety or depression. Erectile dysfunction is primarily a normal response to aging. Erectile dysfunction may be due to testosterone insufficiency. Erectile dysfunction rarely occurs in clients with diabetes mellitus.
Erectile dysfunction may be due to testosterone insufficiency. Explanation: Common causes of erectile dysfunction include neurologic disorder like spinal cord injury, perineal trauma, testosterone insufficiency, side effects of drug therapy such as antihypertensives or antidepressants, atherosclerosis, hypertension, and complications of diabetes mellitus. Erectile dysfunction may be related to anxiety or depression. It is not a normal aspect of aging.
Which of the following would the nurse expect to find in a client with severe hyperthyroidism? Tetany Exophthalmos Buffalo hump Striae
Exophthalmos Explanation: Exophthalmos that results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball is seen in clients with severe hyperthyroidism. Tetany is the symptom of acute and sudden hypoparathyroidism. Buffalo hump and striae are the symptoms of Cushing's syndrome.
The nurse is planning care for a client with Cushing syndrome. Which complications will the nurse monitor for in this client? Select all that apply. Fluid balance Sodium intake Risk for infection Pain management Potential for injury Body image changes
Explanation: Cushing syndrome can be caused by the use of corticosteroid medications or excessive glucocorticoid production caused by hyperplasia of the adrenal cortex. Problems that can occur in this syndrome include fluid balance since fluid retention occurs in this condition. Sodium intake is an issue as this contributes to fluid retention. The client is at risk for infection because of the effect of the corticosteroids on immune function. The client with Cushing syndrome is at risk for injury because of the effects of corticosteroids on muscle tissue and bone structure. Corticosteroids can cause muscle wasting and redistribution of fat. The face becomes moon-shaped and a hump of tissue at the base of the neck can develop. These body image changes will need to be addressed. Pain is not a problem typically associated with Cushing syndrome.
The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? Gigantism Dwarfism Acromegaly Simmonds' disease
Gigantism Explanation: When oversecretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.
During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? Fasting blood glucose level Glucose via a urine dipstick test Glycosylated hemoglobin level Glucose via an oral glucose tolerance test
Glycosylated hemoglobin level Explanation: Glycosylated hemoglobin is a blood test that reflects the average blood glucose concentration over a period of approximately 2 to 3 months. When blood glucose is elevated, glucose molecules attach to hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycosylated hemoglobin level becomes.
Antithyroid medications are not generally recommended for elderly patients because of which side effect? Mental confusion Granulocytopenia Weight loss Fatigue
Granulocytopenia Explanation: Antithyroid medications are not generally recommended for elderly clients because of the increased incidence of side effects such as granulocytopenia and the need for frequent monitoring.
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? Hypothyroidism Hyperthyroidism Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Diabetes insipidus (DI)
Hyperthyroidism Explanation: Clients with hyperthyroidism characteristically are restless despite feeling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism. SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.
A client who is post op from bariatric surgery experiences dumping syndrome. What is the nurse's understanding of the cause of this condition? Hypertonic food draws extracellular fluid from the blood into the small intestines. Hypertonic food releases metabolic peptides. Hypotonic food pulls fluid from the blood and small intestines. Hypotonic food releases toxic substances.
Hypertonic food releases metabolic peptides. Explanation: The previous theory behind dumping syndrome was that the hypertonic food bolus drew extracellular fluid from the blood into the small intestines, causing symptoms. This theory has since been challenged and the newest theory suggests the rapid release of metabolic peptides that release from the hypertonic food bolus causes dumping syndrome symptoms.
A client with acromegaly has been given the option of a surgical approach or a medical approach. The client decides to have a surgical procedure to remove the pituitary gland. What does the nurse understand this surgical procedure is called? Hypophysectomy Hysteroscopy Thyroidectomy Ablation
Hypophysectomy Explanation: The treatment of choice is surgical removal of the pituitary gland (transsphenoidal hypophysectomy) through a nasal approach. The surgeon may substitute an endoscopic technique using microsurgical instruments to reduce surgical trauma. A hysteroscopy is a gynecologic procedure. The thyroid gland is not involved for a surgical procedure. Ablation is not a removal of the pituitary gland.
Which of the following is inconsistent as a condition related to metabolic syndrome? Hypotension Insulin resistance Abdominal obesity Dyslipidemia TAKE ANOTHER QUIZ
Hypotension Explanation: A diagnosis of metabolic syndrome includes three of the following conditions: insulin resistance, abdominal obesity, dyslipidemia, hypertension, proinflammatory state, and prothrombotic state.
A nurse is performing health education with a client who has a history of frequent, serious dental caries. When planning educational interventions, the nurse should identify a risk for what nursing diagnosis? Ineffective Tissue Perfusion Impaired Skin Integrity Aspiration Imbalanced Nutrition: Less Than Body Requirements
Imbalanced Nutrition: Less Than Body Requirements Explanation: Because digestion normally begins in the mouth, adequate nutrition is related to good dental health and the general condition of the mouth. Any discomfort or adverse condition in the oral cavity can affect a person's nutritional status. Dental caries do not typically affect the client's tissue perfusion or skin integrity. Aspiration is not a likely consequence of dental caries.
The nurse is caring for a client with chronic pancreatitis. Which symptom would indicate the client has developed secondary diabetes? Increased appetite and thirst Vomiting and diarrhea Low blood pressure and pulse Decreased urination and constipation
Increased appetite and thirst Explanation: When secondary diabetes develops in a client with chronic pancreatitis, the client experiences increased appetite, thirst, and urination. Vomiting, diarrhea, low blood pressure and pulse, and constipation do not indicate the development of secondary diabetes.
A nurse is assessing a patient with posttraumatic stress disorder (PTSD) who is exhibiting physiologic manifestations. The nurse interprets these manifestations as being the result of which of the following? Increased sympathetic activity Decreased plasma catecholamine levels Decreased urinary epinephrine levels Increased parasympathetic activity
Increased sympathetic activity Explanation: The physiologic responses associated with PTSD result from increased activity of the sympathetic nervous system, increased plasma catecholamine levels, and increased urinary epinephrine and norepinephrine levels.
A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? Insulin is absorbed more slowly at abdominal injection sites than at other sites. Insulin is absorbed rapidly regardless of the injection site. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Insulin is absorbed unpredictably at all injection sites.
Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Explanation: Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at
A young adult client with type 1 diabetes does not want to have to self-administer insulin injections several times a day. Which medication approach would the nurse recommend that best controls the condition and meets the client's needs? Insulin pump 1 injection per day 2 injections premixed Injection before each meal
Insulin pump Explanation: The insulin pump most closely mimics regular pancreas function and increases meal and exercise flexibility. The use of the pump would meet the client's needs of not wanting to self-administer several injections of insulin every day. With one injection per day, there is difficulty controlling fasting blood glucose if the type of insulin does not last. The client could also develop afternoon hypoglycemia if the single dose is increased in order to control the morning fasting glucose level. Two injections per day might meet the client's needs of minimal self-injections; however, for this regimen, there needs to be a fixed schedule of meals and exercise and it is difficult to adjust the dose if premixed insulin is used. Self-administering insulin before each meal will not meet the client's needs since this requires more injections than any other regimen.
A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage? Iron chelation therapy Oxygen therapy Therapeutic phlebotomy Anticoagulation therapy
Iron chelation therapy Explanation: Iron overload is a complication unique to people who have had long-term PRBC transfusions. One unit of PRBCs contains 250 mg of iron. Patients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. Over time, the excess iron deposits in body tissues and can cause organ damage, particularly in the liver, heart, testes, and pancreas. Promptly initiating a program of iron chelation therapy can prevent end-organ damage from iron toxicity.
Which statement is correct regarding glargine insulin? Its peak action occurs in 2 to 3 hours. It cannot be mixed with any other type of insulin. It is absorbed rapidly. It is given twice daily.
It cannot be mixed with any other type of insulin. Explanation: Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is no peak in action. It is approved to give once daily.
The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following? Kidney stones Neurogenic bladder Chronic renal failure Fistula
Kidney stones Explanation: A client with hyperparathyroidism is at risk for kidney stones. The client with diabetes mellitus is a risk factor for developing chronic renal failure and neurogenic bladder. A client with radiation to the pelvis is at risk for urinary tract fistula.
A client has monthly laboratory tests done. The nurse notes a decrease in the albumin level. What condition in the client's history could alter the albumin level? Dehydration Liver disease Pituitary cyst Endometriosis
Liver disease Explanation: Albumin levels are used as measures of protein in adults. Albumin synthesis depends on normal liver function. Decreased albumin levels may be caused by overhydration, liver or renal disease, or excessive protein loss.
A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for? Magnetic resonance imaging (MRI) Radioactive iodine uptake test Radioimmunoassay A nuclear scan
Magnetic resonance imaging (MRI) Explanation: A computed tomography (CT) or magnetic resonance imaging (MRI) scan is performed to detect a suspected pituitary tumor or to identify calcifications or tumors of the parathyroid glands. A radioactive iodine uptake test would be useful for a thyroid tumor. Radioimmunoassay determines the concentration of a substance in plasma.
The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension? Reduce smoking to no more than four cigarettes per day Limit aerobic physical activity to 15 minutes, three times per week Stop alcohol intake Maintain adequate dietary intake of fruits and vegetables
Maintain adequate dietary intake of fruits and vegetables Explanation: Guidelines include adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan: consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced amounts of saturated and total fat; reduce dietary sodium intake to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride); engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week); moderate alcohol consumption, limiting consumption to no more than two drinks (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than one drink per day in women and lighter-weight people. Tobacco should be avoided because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.
Which intervention is the most critical for a client with myxedema coma? Administering an oral dose of levothyroxine (Synthroid) Warming the client with a warming blanket Measuring and recording accurate intake and output Maintaining a patent airway
Maintaining a patent airway Explanation: Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.
When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? Report the condition to the physician immediately. Measure abdominal girth according to a set routine. Provide the client with nonprescription laxatives. Ask the client about food intake.
Measure abdominal girth according to a set routine. Explanation: If the abdomen appears enlarged, the nurse measures it according to a set routine. The nurse reports any change in mental status or signs of gastrointestinal bleeding immediately. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis.
A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? Metformin Glyburide Repaglinide Glipizide
Metformin Explanation: Metformin is a biguanide and along with the thiazolidinediones (rosiglitazone and pioglitazone) are categorized as insulin sensitizers; they help tissues use available insulin more efficiently. Glyburide and glipizide which are sulfonylureas, and repaglinide, a meglitinide, are described as being insulin releasers because they stimulate the pancreas to secrete more insulin.
Which of the following medications, used in the treatment of GERD, accelerate gastric emptying? Metoclopramide (Reglan) Famotidine (Pepcid) Nizatidine (Axid) Esomeprazole (Nexium)
Metoclopramide (Reglan) Explanation: Prokinetic agents which accelerate gastric emptying, used in the treatment of GERD, include bethanechol (Urecholine), domperidone (Motilium), and metoclopramide (Reglan). If reflux persists, the patient may be given antacids or H2 receptor antagonists, such as famotidine (Pepcid) or nizatidine (Axid). Proton pump inhibitors (medications that decrease the release of gastric acid, such as esomeprazole (Nexium) may be used, also.
A client with pheochromocytoma is scheduled for an adrenalectomy. Which of the following would the nurse perform preoperatively? Begin administering prescribed corticosteroid. Initiate intravenous access for fluid therapy. Monitor blood pressure (BP) frequently. Check for the signs of adrenal insufficiency.
Monitor blood pressure (BP) frequently. Explanation: The nurse should monitor BP frequently before surgery when a client has a pheochromocytoma. When bilateral adrenalectomy is scheduled, the nurse may start IV administration of a solution containing a corticosteroid preparation the morning of surgery. Some surgeons prefer to initiate corticosteroid administration during removal of the adrenals. The nurse monitors for signs of adrenal insufficiency after the surgery.
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication? Exophthalmos Thyroid storm Myxedema coma Tibial myxedema
Myxedema coma Explanation: Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Exophthalmos (protrusion of the eyeballs) is seen with hyperthyroidism. Although thyroid storm is life-threatening, it's caused by severe hyperthyroidism. Tibial myxedema (peripheral mucinous edema involving the lower leg) is associated with hypothyroidism but isn't life-threatening.
Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? Thyroid storm Myxedemic coma Addison's disease Acromegaly
Myxedemic coma Explanation: Severe hypothyroidism is called myxedema and if untreated, it can progress to myxedemic coma, a life-threatening event. Thyroid storm is an acute, life-threatening form of hyperthyroidism. Addison's disease refers to primary adrenal insufficiency. Acromegaly refers to an oversecretion of growth hormone by the pituitary gland during adulthood.
A patient who is diagnosed with type 1 diabetes would be expected to: Be restricted to an American Diabetic Association diet. Have no damage to the islet cells of the pancreas. Need exogenous insulin. Receive daily doses of a hypoglycemic agent.
Need exogenous insulin. Explanation: Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.
A nurse, working in a health clinic, treats a variety of conditions on a daily basis. One disorder that is rapidly increasing and is the leading cause of secondary morbidity is: Kidney disease Coronary heart disease Obesity Pneumonia
Obesity Explanation: Currently about 30 % of adults and 16% of children are classified as obese (CDC, 2009). Obesity is the leading cause of secondary illnesses ranging from cancer to diabetes.
The nurse is working with clients with digestive tract disorders. Which of the following organs does the nurse realize has effects as an exocrine gland and an endocrine gland? Gallbladder Pancreas Stomach Liver
Pancreas Explanation: The pancreas is both an exocrine gland, one that releases secretions into a duct or channel, and an endocrine gland, one that releases substances directly into the bloodstream. The other organs have a variety of functions but do not have a combination function such as the pancreas.
While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following? Positive Trousseau's sign Positive Chvostek's sign Hyperactive deep tendon reflex Tetany
Positive Chvostek's sign Explanation: If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. The nurse may elicit a positive Trousseau's sign by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Deep tendon reflexes include the biceps, brachioradialis, triceps, and patellar reflexes. Tetany would be manifested by reports of numbness and tingling in the fingers or toes or around the lips, voluntary movement that may be followed by an involuntary, jerking spasm, and muscle cramping. Tonic (continuous contraction) flexion of an arm or a finger may occur.
A client has sustained a traumatic brain injury with involvement of the hypothalamus. The health care team is concerned about the complication of diabetes insipidus. Which of the following would be an appropriate nursing intervention to monitor for early signs of diabetes insipidus? Assess frequent vital signs. Reposition frequently. Assess for pupillary response frequently. Record intake and output.
Record intake and output. Explanation: A record of intake and output is maintained for the client with a traumatic brain injury, especially if the client has hypothalamic involvement and is at risk for the development of diabetes insipidus. Excessive output will alert the nurse to possible fluid imbalance early in the process.
A client with gallstones is diagnosed with acute pancreatitis and is requesting information about the physiology of the gallbladder. Which information will the nurse include about the function of this organ? Serves as a storage unit for glucagon Digests carbohydrates in the jejunum Releases bile in response to cholecystokinin Controls the flow of trypsin to digest proteins
Releases bile in response to cholecystokinin Explanation: The gallbladder is a pear-shaped, hollow, saclike organ that lies in a shallow depression on the inferior surface of the liver. When food enters the duodenum, the gallbladder contracts and the sphincter of Oddi relaxes. Relaxation of this sphincter allows the bile to enter the intestine. This response is mediated by secretion of the hormone cholecystokinin (CCK) from the intestinal wall. Gallstones can block the bile duct and digestive juices to the pancreas causing acute pancreatitis. The gallbladder functions as a storage depot for bile. Bile does not digest carbohydrates in the jejunum. The liver controls the flow of trypsin to digest proteins.
A client with obesity is interested in trying orlistat for weight loss. Which disease or condition in the client's medical history alert the nurse of potential complications if the client uses this medication? Chronic obstructive pulmonary disease Renal insufficiency Diabetes mellitus Anemia
Renal insufficiency Explanation: Clients with a history of renal sufficiency or liver disease should use caution while taking this medication as it has been linked to increase rates of cholelithiasis and liver failure. The other conditions do not pose an increase risk with this medication.
The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find? Complaints of sleepiness Thick hard nails Inability to tolerate cold Reports of increased appetite
Reports of increased appetite Explanation: Signs and symptoms of hyperthyroidism reflect the increased metabolic rate and would include reports of increased appetite, weight loss, and intolerance to heat. Sleepiness, thick hard nails, and intolerance to cold are associated with hypothyroidism.
A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder? Serum potassium level Serum sodium level Arterial blood gas (ABG) values Serum osmolarity
Serum osmolarity Explanation: Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.
A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? Three meals and 120 ml fluid daily Three meals and three snacks and 120 mL fluid daily Six small meals and 120 mL fluid daily Six small meals daily with 120 mL fluid between meals
Six small meals daily with 120 mL fluid between meals Explanation: After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.
Parathyroid hormone (PTH) has which effects on the kidney? Stimulation of calcium reabsorption and phosphate excretion Stimulation of phosphate reabsorption and calcium excretion Increased absorption of vitamin D and excretion of vitamin E Increased absorption of vitamin E and excretion of vitamin D
Stimulation of calcium reabsorption and phosphate excretion Explanation: PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.
The nurse is teaching a client that the body needs iodine for the thyroid to function. What is the function of iodine? Maintaining body metabolism in a steady state Maintaining effective oxygen consumption Synthesis of thyroid hormones Altering the responsiveness of body tissue to other hormones
Synthesis of thyroid hormones Explanation: Iodine is essential to the thyroid for synthesis of its hormones. Thyroxine (T4), a relatively weak hormone, maintains body metabolism in a steady state. Triiodothyronine (T3) is about five times as potent as T4 and has a metabolic action that is more rapid. These hormones accelerate all bodily processes that contribute to oxygen consumption and altering the responsiveness of tissues to other hormones.
A nurse explains to a client with thyroid disease that the thyroid gland normally produces: iodine and thyroid-stimulating hormone (TSH). thyrotropin-releasing hormone (TRH) and TSH. TSH, triiodothyronine (T3), and calcitonin. T3, thyroxine (T4), and calcitonin.
T3, thyroxine (T4), and calcitonin. Explanation: The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.
A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? Tetany Hemorrhage Thyroid storm Laryngeal nerve damage
Tetany Explanation: Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.
The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience vomiting. hemorrhage. pain 2 to 3 hours after a meal. weight loss.
The client with a duodenal ulcer often awakens between 1 and 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the client with duodenal ulcer. Hemorrhage is less likely in the client with duodenal ulcer than in the client with gastric ulcer. The client with a duodenal ulcer may experience weight gain.
A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following? The concentration of a substance in plasma Details about the size of the organ and its location The functioning of endocrine glands The client's blood sugar level
The functioning of endocrine glands Explanation: Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.
The nurse observes that a client's medical report indicates that the client has Cushing syndrome. During inspection, the nurse notes that the client's BMI is 31, waist circumference is 40 inches, and localized fat pads exist around the neck and upper part of the back. Which of the following must the nurse keep in mind while planning the client's care? A BMI of 31 indicates obesity, and the nurse instructs the patient to keep a record of food actually consumed over the next 3 to 7 days. The nurse knows that a waist circumference of 40 places the client at risk. The nurse instructs the client to remember all food consumed over the next 24-hour period. The nurse recognizes that the client's obesity may be specifically related to the endocrine disorder. The nurse performs a thorough nutritional assessment. Knowing that the client is obese, the nurse plans to provide dietary education to reduce the daily caloric int
The nurse recognizes that the client's obesity may be specifically related to the endocrine disorder. The nurse performs a thorough nutritional assessment. Explanation: Certain signs and symptoms that suggest possible nutritional deficiency, such as muscle wasting, poor skin integrity, loss of subcutaneous tissue, and obesity, are easy to note because they are specific; these symptoms should be studied further. Food records, 24-hour diet recall, and dietary education directed at weight loss do not account for the client's medical condition as a factor in the client's weight or nutritional status, although each method helps estimate whether food intake is adequate and appropriate.
When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands? The secretions are released directly into the blood stream. The glands contain ducts that produce the hormones. The secreted hormones act like target cells. The glands play a minor role in maintaining homeostasis.
The secretions are released directly into the blood stream. Explanation: The endocrine glands secrete hormones, chemicals that accelerate or slow physiologic processes, directly into the bloodstream. This characteristic distinguishes endocrine glands from exocrine glands, which release secretions into a duct. Hormones circulate in the blood until they reach receptors in target cells or other endocrine glands. They play a vital role in regulating homeostatic processes.
Which of the following hormones would the nurse identify as being secreted by the thyroid gland? Parathormone Thymosin Thyroxine Somatotropin
Thyroxine Explanation: The thyroid gland secretes thyroxine (T4 or tetraiodothyronine), triiodothyronine (T3), and calcitonin. Parathormone is secreted by the parathyroid glands. Thymosin is secreted by the thymus gland. Somatotropin is secreted by the anterior pituitary gland.
A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing? Riboflavin deficiency Folic acid deficiency Vitamin A deficiency Vitamin K deficiency
Vitamin K deficiency Explanation: Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency leads to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Pyridoxine deficiency results in skin and mucous membrane lesions and neurologic changes. Vitamin C deficiency results in the hemorrhagic lesions of scurvy. Vitamin K deficiency results in hypoprothrombinemia, characterized by spontaneous bleeding a
A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing? Riboflavin deficiency Folic acid deficiency Vitamin A deficiency Vitamin K deficiency
Vitamin K deficiency Explanation: Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency leads to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Pyridoxine deficiency results in skin and mucous membrane lesions and neurologic changes. Vitamin C deficiency results in the hemorrhagic lesions of scurvy. Vitamin K deficiency results in hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses. Folic acid deficiency results in macrocytic anemia.
For a client with hyperthyroidism, treatment is most likely to include: a thyroid hormone antagonist. thyroid extract. a synthetic thyroid hormone. emollient lotions.
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 digestion of carbohydrates is aided by lipase. amylase. trypsin. secretin.
amylase. Explanation: Amylase is secreted by the exocrine pancreas. Lipase aids in the digestion of fats. Trypsin aids in the digestion of proteins. Secretin is the major stimulus for increased bicarbonate secretion from the pancreas.
Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: cannot tolerate high-glucose concentration. are at risk for gallbladder contraction. are at risk for hepatic encephalopathy. can digest high-fat foods.
cannot tolerate high-glucose concentration. Explanation: Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.
During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted? decrease in hormonal levels increase in hormonal levels hormonal overproduction hormonal underproduction
decrease in hormonal levels Explanation: Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland. In positive feedback, the opposite occurs.
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: exophthalmos and conjunctival redness. flushed, warm, moist skin. systolic murmur at the left sternal border. decreased body temperature and cold intolerance.
decreased body temperature and cold intolerance. Explanation: Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: hypotension. thick, coarse skin. deposits of adipose tissue in the trunk and dorsocervical area. weight gain in arms and legs.
deposits of adipose tissue in the trunk and dorsocervical area. Explanation: Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
A client is experiencing some renal secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed in urine? glucose potassium creatinine chloride
glucose Explanation: Amino acids and glucose typically are reabsorbed and not excreted in the urine. The filtrate that is secreted as urine usually contains water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid.
A client with a 30-year history of type 2 diabetes is having an annual physical and blood work. Which test result would the physician be most concerned with when monitoring the client's treatment compliance? glycosylated hemoglobin hematocrit B1C postprandial glucose CAT scan
glycosylated hemoglobin Explanation: Once a client with diabetes receives a treatment regimen to follow, the physician can assess the effectiveness of treatment and the client's compliance by obtaining a hemoglobin A1c test. The results of this test reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days. Normally, the level of glycosylated hemoglobin is less than 7%. Amounts of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months.
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.
A client comes to the clinic and reports frequent headaches and daily fatigue that is interfering with normal functioning. During collection of psychosocial history, the nurse notes a stressor sequence that may be causing the physical deviations. Which series of events represents a stressor sequence? birth of twins, vacationing, and starting a new job studying for law-school entrance examinations, beginning a new job, and starting a family job loss, bankruptcy, and loss of house diagnosis of coronary artery disease, buying a new house, and traveling
job loss, bankruptcy, and loss of house Explanation: A stressor sequence is a series of stressful events that result from an initial event. In this case, the job loss led to bankruptcy and subsequently the loss of the house. People experiencing long-term stress have a high incidence of psychosomatic disease. Birth of twins and vacationing may not be stressful and negative but joyous. Studying for a law exam and starting a family may not be negative. Traveling and buying a new house may not be negative.
A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by: dry, waxy swelling and abnormal mucin deposits in the skin. protruding eyes and a fixed stare. a wide, staggering gait. more than 10 beats/minute difference between the apical and radial pulse rates.
protruding eyes and a fixed stare. Explanation: Exophthalmos is characterized by protruding eyes and a fixed stare. Dry, waxy swelling and abnormal mucin deposits in the skin typify myxedema, a condition resulting from advanced hypothyroidism. A wide, staggering gait and a differential between the apical and radial pulse rates aren't specific signs of thyroid dysfunction.
A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: elevated liver enzymes and low serum protein level. subnormal serum glucose and elevated serum ammonia levels. subnormal clotting factors and platelet count. elevated blood urea nitrogen and creatinine levels and hyperglycemia.
subnormal serum glucose and elevated serum ammonia levels. Explanation: In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.
