NU272 EAQ: Metabolism (week 4)

Which medication is derived from a natural source and may be prescribed for the treatment of osteoporosis?

Calcitonin - Calcitonin is derived from natural sources such as fish; this medication may be prescribed to prevent osteoporosis. Raloxifene is prescribed to prevent postmenopausal osteoporosis. Clomiphene is prescribed to induce ovulation. Bisphosphonates are prescribed to treat osteoporosis; this medication is not derived from natural sources.

Which hormone regulates blood levels of calcium?

Parathyroid hormone (PTH) - Parathyroid hormone (PTH) regulates the blood levels of calcium and phosphorus. LH stimulates the production of sex hormones, promotes the growth of reproductive organs, and also stimulates reproductive processes. TSH stimulates the release of thyroid hormones and the growth and functioning of the thyroid gland. ACTH promotes the growth of the adrenal cortex and stimulates the release of corticosteroids.

Which information from the client's history would the nurse identify as a risk factor for developing osteoporosis?

Receives long-term steroid therapy - Increased levels of steroids will accelerate bone demineralization. Hyperparathyroidism, not hypoparathyroidism, accelerates bone demineralization. Weight-bearing that occurs with strenuous activity promotes bone integrity by preventing bone demineralization. Estrogen promotes deposition of calcium into bone which may prevent, not cause, osteoporosis.

A client is diagnosed with primary hypofunction of the adrenal gland. Which clinical manifestation is likely to be observed?

Uneven patches of pigment loss - Vitiligo is manifested by the presence of large patchy areas of pigment loss. This is mainly caused by primary hypofunction of the adrenal gland. Presence of edema at extremities indicates fluid and electrolyte imbalances mainly observed in a client with thyroid problems. Presence of reddish-purple stretch marks on the abdomen and "buffalo hump" between shoulders on the back of the neck often indicates excessive adrenocortical secretions.

Which client is most at risk for osteoporosis?

A 66-year-old white woman, body mass index (BMI) 18, who is a paralegal - A postmenopausal woman who is small-boned, underweight, and relatively sedentary is at risk for osteoporosis; other risk factors are family history and white or Asian ethnicity. A woman who is relatively heavy and does not smoke is at less risk for osteoporosis than is a thin postmenopausal woman. Postmenopausal women who are black are at lower risk for osteoporosis than are white and Asian women. A woman who takes a daily calcium supplement is at less risk for osteoporosis than a woman who does not take a calcium supplement.

The nurse is taking care of a client with cirrhosis of the liver. Which clinical manifestations would the nurse assess in the client? Select all that apply. One, some, or all responses may be correct.

Ascites, pruritus, jaundice - Ascites is a result of portal hypertension that occurs with cirrhosis. Pruritus is common because bile pigments seep into the skin from the bloodstream. Jaundice occurs because the bile duct becomes obstructed and bile enters the bloodstream. The appetite decreases because of the pressure on the abdominal organs from the ascites and the liver's decreased ability to metabolize food. Headache is not a common manifestation of cirrhosis of the liver.

When the nurse is performing an admission health history and physical assessment for this client, which assessment information is most important to obtain?

Heart rate and rhythm - This client is exhibiting exophthalmos, a symptom of Graves disease, which is characterized by overproduction of thyroid hormones. Because of the increased metabolic rate associated with excess thyroid hormones, the heart rate increases; the client is at risk for tachycardia, palpitations, and dysrhythmias (e.g., atrial fibrillation). Although the client probably will have an increased appetite and moist, warm skin, these physiological responses that are related to the increased metabolic rate are not life threatening. Although the client's respiratory rate will increase, the depth of respirations may or may not increase; these physiological responses are related to the increased metabolic rate and are not life threatening. Although the client will be intolerant to heat and lose weight because of the increased metabolic rate, these physiological responses are not life threatening.

A client is admitted to the hospital with the diagnosis of cancer of the thyroid, and a thyroidectomy is scheduled. What is important for the nurse to consider when caring for this client during the postoperative period?

Hoarseness and airway obstruction may result from laryngeal nerve damage. - Laryngeal nerve injury can cause laryngeal spasms, resulting in airway obstruction. Parathyroid damage results in hypocalcemia, not hypercalcemia. Thyroid storm (thyroid crisis) is characterized by the release of excessive levels of thyroid hormone, which increases the metabolic rate. An increase in the metabolic rate increases vital signs, resulting in hypertension, not hypotension, and tachycardia, not bradycardia. Tetany is caused by a decrease in parathormone, a parathyroid hormone, not a thyroid hormone.

A client is diagnosed with Cushing syndrome. The nurse would monitor the client for which cardiovascular complication?

Hypertension - Hypertension is a cardiovascular complication found in clients with Cushing syndrome due to increased metabolic demands and catecholamines. Chest pain is seen in clients with hyperthyroidism and hypothyroidism. Tachycardia and atrial fibrillation are manifestations of dysrhythmias, which are associated with hypothyroidism or hyperthyroidism, parathyroidism, and pheochromocytoma.

Which clinical manifestation is observed in a client with adrenal insufficiency?

Hyponatremia - Hyponatremia is a decrease in serum sodium levels, which is the cardiovascular manifestation of adrenal insufficiency. Fatigue is a neuromuscular manifestation observed in clients with adrenal insufficiency, whereas salt cravings and weight loss are the abdominal manifestations observed in clients with adrenal insufficiency.

Which definition would the nurse use to explain osteoporosis?

It involves a decrease in bone substance. - Osteoporosis involves a defect in the bone matrix formation that weakens bones, making them unable to withstand usual functional stresses. Avascular necrosis is the death of bone tissue that results from reduced circulation to bone. Pathological fractures can result from osteoporosis. Hyperplasia of osteoblasts is not related to osteoporosis. This occurs during bone healing.

Assessment findings of a client include fatigue, hair loss, weight gain, and diagnostic tests indicating anemia. The nurse anticipates a prescription for which therapy?

Levothyroxine - Fatigue, hair loss, weight gain, and anemia are the clinical manifestations of hypothyroidism, which occurs due to deficiency of thyroid hormones. Treatment includes restoration of euthyroid state by hormone therapy, such as levothyroxine. Iodine is used to prepare the client for thyroidectomy to treat thyrotoxicosis. Methimazole and propylthiouracil inhibit the synthesis of thyroid hormones and are used to treat hyperthyroidism.

Which finding in a client with hypothyroidism and hypertension who reports taking an extra dose of levothyroxine indicates the need to obtain a thyroid function panel? Select all that apply. One, some, or all responses may be correct.

Tremors, Diaphoresis, Nervousness, Temperature 101°F, Heart rate 116 beats/min - Clients with hypothyroidism can develop thyrotoxicosis from an acute overdose of thyroid hormone. Tremors, diaphoresis, and nervousness are all signs of thyrotoxicosis. Clients may also be hyperthermic and tachycardic.

The nurse educates an obese adolescent about healthy dietary habits and risk associated with obesity. Which statement by the adolescent indicates the need for further counseling?

"I should watch more TV to reduce the stress." - The cause of obesity can be stress, but rather than watching TV to reduce stress, some other activities like dancing, which involve physical movements, can be done. Any type of physical exercise helps in fat burning. Playing outdoor games not only is a physical exercise but also helps reduce stress. Reducing the consumption of a fat-rich diet and replacing it with vegetables will reduce the amount of fat consumed by the adolescent, and drinking a high amount of water helps detoxify the body.

During a physical assessment, a client was diagnosed with increased temperature due to an increased basal metabolic rate (BMR). Which hormonal imbalances would the client have? Select all that apply. One, some, or all responses may be correct.

Thyroid, Testosterone - Body temperature is assessed during physical assessment. An increased basal metabolic rate (BMR) increases the body temperature. Hormonal imbalances may alter the BMR. Testosterone regulates the BMR in males. Thyroid hormone regulates the BMR of the body. Increases in the levels of these hormones may increase the BMR, which may in turn raise body temperature. Cortisol regulates blood glucose levels. Estrogen and progesterone are female hormones that do not regulate the BMR.

The nurse teaches a student nurse about caring for a client with decreased bone density. Which statements made by the student nurse indicate effective learning? Select all that apply. One, some, or all responses may be correct.

"I will instruct the client to be very careful to prevent injuries.", "I will instruct the client to perform weight-bearing activities." - A decrease in ovarian production of estrogen results in low bone density. Therefore the nurse would instruct the client to be very careful while performing activities to prevent injuries and fractures due to weak bones. The client is advised to perform weight-bearing activities and engage in regular exercises, such as running, to help maintain bone density. Drinking 2 L of water daily is advised to a client to prevent vaginal dryness due to decreased ovarian production of estrogen, but it is not beneficial to maintain bone density. Decreased ovarian production of estrogen also causes dry and thin skin; therefore it is advised the client change positions every 2 hours to reduce the risk of injury. However, this intervention would not help the client maintain bone density.

A client with cirrhosis is scheduled for a liver biopsy. The client asks if there are any postprocedural risks. How would the nurse respond?

"The major risk is bleeding." - The major postprocedural risk for this client is bleeding. In many clients with liver dysfunction, such as cirrhosis, the liver has lost its ability to synthesize proteins, such as clotting factors. The major postprocedural risks are not pneumonia, infection, or liver failure; bleeding is a higher risk.

While performing a physical assessment of a female client, the nurse notices hair on the client's upper lip, chin, and cheeks. Which condition may result in this condition?

Endocrine disease - Endocrine diseases such as hirsutism will result in excessive hair growth on the upper lip, chin, and cheeks. Aging and poor nutrition will result in decreased hair growth. Arterial insufficiency will result in decreased hair growth due to compromised blood supply.

A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. The nurse will monitor the client for which adverse medication effect?

Hyperkalemia - Spironolactone is a potassium-sparing diuretic that is used to treat clients with ascites; therefore the nurse would monitor the client for signs and symptoms of hyperkalemia. Bruising and purpura are associated with cirrhosis, not with the administration of spironolactone. Spironolactone does not cause tachycardia. Spironolactone does not cause hypoglycemia.

The registered nurse teaches a student nurse about performing cortisol tests. Which statement made by the student nurse indicates effective learning?

"A cortisol blood test is usually done twice a day—once in the morning and again at approximately 4:00 PM." - A cortisol test is used to help diagnose disorders of the adrenal gland. These include Cushing syndrome and Addison disease. Because cortisol levels change throughout the day, the timing of a cortisol test is important. A cortisol blood test is usually done twice a day - once in the morning when cortisol levels are at their highest, and again around 4:00 PM, when levels are much lower. For a cortisol urine test, the client is instructed to collect all urine during a 24-hour period. A 24-hour urine collection is used because cortisol levels vary throughout the day. A cortisol saliva test is usually done late at night, when cortisol levels are lower. For the saliva test, the client is instructed to insert the swab into the mouth, roll the swab in the mouth for about 2 minutes so it gets covered in saliva, and place the swab into the container within the kit that is provided.

When providing anticipatory teaching for a client scheduled for gastric bypass to treat morbid obesity, which statement indicates the client understands how to prevent dumping syndrome? Select all that apply. One, some, or all responses may be correct.

"I will not drink fluids when I eat meals."., "I will avoid artificially sweetened foods.", "I will eat small, frequent meals instead of 3 large meals a day." - Total fluid intake does not have to be restricted; however, clients must not drink fluids immediately before, during, or after a meal because they promote rapid stomach emptying. Clients may safely ingest fluids before or after meals. Avoid concentrated sweets because they pass rapidly out of the stomach and increase fluid shifts. Clients may manage dumping syndrome after gastric surgery by nutrition changes that include decreasing the amount of food taken at one time. Small feedings reduce the amount of bulk passing into the jejunum and reduce the fluid that shifts into the jejunum. A bland diet is not necessary. The diet should be low to moderate in carbohydrates, high in protein, and high in fat to promote tissue repair and provide energy.

The nurse cares for a client with an abnormal cortisol level. The nurse recalls which information about cortisol?

Cortisol stimulates gluconeogenesis. - Cortisol maintains the blood glucose concentration by stimulating the liver for gluconeogenesis. Gluconeogenesis involves formation of glucose from amino acids and fatty acids. Cortisol mobilizes free fatty acids and inhibits protein synthesis. The blood levels of cortisol increase in stressful conditions.

The nurse administers lactulose to a client with cirrhosis of the liver. Which laboratory test change leads the nurse to determine that the lactulose is effective?

Decreased ammonia - Lactulose destroys intestinal flora that break down protein and, in the process, give off ammonia. In clients with cirrhosis, ammonia is inadequately detoxified by the liver and can build to toxic levels. Amylase levels are associated with pancreatic problems. Increased potassium levels are associated with kidney failure. Hemoglobin is increased when the body needs more oxygen-carrying capacity, such as in smokers, or in high altitudes.

Six weeks after discharge, a client with a jejunoileal bypass for morbid obesity returns to an outpatient clinic reporting palpitations, abdominal cramps, diarrhea, and dizziness 30 minutes after meals. Which complication would the nurse consider that the client is most likely experiencing?

Dumping syndrome - When ingested food rapidly enters the jejunum without having gone through the usual mixing and digestive process, the hypertonic bolus causes rapid movement of extracellular fluid into the bowel; this rapid shift decreases the circulating blood volume. Decreased peripheral vascular resistance, visceral pooling of blood, and reactive hypoglycemia also are implicated. Additionally, the distended jejunum increases intestinal peristalsis and motility. Backward flow of gastric contents into the esophagus, or gastric reflux, causes heartburn, dysphagia, water brash, acid regurgitation, or belching (eructation). Reflux gastritis is a chronic inflammation of the lining of the stomach caused by reflux of duodenal contents; epigastric pain, nausea, vomiting, and hematemesis are common clinical manifestations. Abdominal peritonitis is an inflammation of the peritoneal membrane; rigidity of abdominal muscles, abdominal pain, low-grade fever, malaise, absent bowel sounds, and shallow respirations are common clinical manifestations.

Which condition would the nurse expect to see in the laboratory reports of a client who has Cushing syndrome?

Hypokalemia - With glucocorticoid excess, aldosterone hypersecretion occurs and sodium is retained; therefore potassium is excreted, leading to hypokalemia. Hypervolemia occurs because of sodium and water retention precipitated by aldosterone. Hypocalcemia is not associated with aldosteronism. Aldosterone hypersecretion causes sodium retention and hypernatremia, not hyponatremia.

A client is being considered for bariatric surgery. Which client health problem does the nurse identify as consistent with morbid obesity?

Hypoventilation syndrome - Ventilation insufficiency occurs in response to inadequate chest wall expansion caused by weight of adipose tissue on the rib cage and the body's need for oxygen to all body cells. Diarrhea, distention, and abdominal cramps often occur in the postoperative period after gastric bypass in response to the hyperosmolar shift of fluid from the intravascular compartment into the intestine in response to rapid emptying of hyperosmolar food without usual dilution in the stomach (dumping syndrome); this fluid shift initiates the systemic response of weakness, tachycardia, and diaphoresis. Compartment syndrome generally is a complication of trauma; increased pressure within the limited anatomical space (e.g., muscle compartment) contributes to decreased microcirculation, which causes nerve and muscle anoxia and necrosis of tissue. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is excessive secretion of the antidiuretic hormone , a hypo-osmolar state with a dilutional hyponatremia; the most common cause is oat cell carcinoma of the lung, in addition to other malignant tumors that produce ADH.

The nurse is caring for a client who is experiencing an underproduction of thyroxine (T4). This condition is associated with which diagnosis?

Myxedema - Myxedema is the severest form of hypothyroidism. Decreased thyroid gland activity means reduced production of thyroid hormones. Acromegaly results from excess growth hormone in adults once the epiphyses are closed. Graves disease results from an excess, not a deficiency, of thyroid hormones. Cushing disease results from excess glucocorticoids.

A client had a gastric bypass procedure to treat morbid obesity. After surgery, the client reports weakness, sweating, palpitations, and dizziness after eating. Which should the nurse recommend?

1Divide daily caloric intake into six smaller meals. - The client's clinical manifestations are related to dumping syndrome from the gastric bypass procedure. Smaller meals along with other interventions will help minimize this response. After gastric bypass, a bolus of hypertonic fluid enters the intestines before carbohydrates and electrolytes are diluted. Extracellular fluid is drawn into the bowel lumen; this causes a decrease in plasma volume, distention of the bowel lumen, and rapid intestinal transit. Protein intake should be increased, not decreased, to meet energy needs and promote healing. Fluids should be avoided at mealtimes because they increase volume in the stomach and decrease the transit time of gastric contents from the stomach to the intestine, which contributes to dumping syndrome. An upright position decreases the transit time of gastric contents moving from the stomach to the intestines via gravity, which contributes to dumping syndrome; clients may lie flat for a short time after eating.

A client with a long history of alcohol abuse develops cirrhosis of the liver. The client exhibits the presence of ascites. Which would the nurse conclude is the most likely cause of the client's ascites?

Impaired portal venous return - The congested liver impairs venous return, leading to increased portal vein hydrostatic pressure and an accumulation of fluid in the abdominal cavity. Although lymph channels in the abdomen become congested, facilitating the leakage of plasma into the peritoneal cavity, it is primarily the increased portal vein hydrostatic pressure that causes the accumulation of fluid in the abdominal cavity. Increased serum albumin causes hypervolemia, not ascites. As fluid is trapped in the peritoneal cavity, circulating blood volume drops and aldosterone secretion increases, not decreases; aldosterone secretion is related to the renin-angiotensin system.

The plan of care for a client with osteoporosis includes active and passive exercises, calcium supplements, and daily vitamins. Which finding would indicate that the therapy is helping?

Mobility increases. - This regimen limits bone demineralization and reduces bone pain, thereby promoting increased mobility and activity. The occurrence of fewer muscle spasms is unrelated to osteoporosis; it would be an expected outcome if the client were receiving calcium for hypocalcemia. A more regular heartbeat is unrelated to osteoporosis or its therapy. The occurrence of fewer bruises than before therapy is unrelated to osteoporosis; it would be expected if the client were receiving vitamin C for capillary fragility.