PrepU-Metabolism
An 87-year-old client was just recently diagnosed with prehypertension. She is to meet with a dietitian and return for a follow-up with her cardiologist in 6 months. As her nurse, what would you expect her treatment to include?
Nonpharmacological interventions Nonpharmacologic interventions are used for clients with prehypertension.
An 87-year-old client was just recently diagnosed with prehypertension. She is to meet with a dietitian and return for a follow-up with her cardiologist in 6 months. As her nurse, what would you expect her treatment to include?
Nonpharmacological interventions Nonpharmacologic interventions are used for clients with prehypertension.
During a home visit to a primiparous client 1 week postpartum who is bottle-feeding her neonate, the client tells the nurse that her mother has suggested that she feed the neonate cereal so he will sleep through the night. What would be the nurse's best response?
"Formula is the food best digested by the baby until about 4 to 6 months of age." The American Academy of Pediatrics recommends that all neonates should receive only formula or breast milk for the first 4 to 6 months of life. Cereal will not help the neonate sleep through the night and may result in allergies and other digestive disorders.
When obtaining a health history, the nurse understands that which client statement indicates the need for further follow-up?
"No matter how much I drink, I am still thirsty all the time." Polydipsia, or increased thirst, is a classic clinical manifestation of diabetes. The excessive loss of fluids is the result of the osmotic diuresis that occurs with glycosuria. It is unlikely that shortness of breath, early awakening, or trouble urinating are related to diabetes mellitus
The client who is newly diagnosed with diabetes mellitus type 2 is concerned about eating products with sugar in them. What information does the nurse explain to the client regarding the use of sugar?
An excess increases demand on the pancreas. Excess sugar increases demand on the pancreas; therefore, less sugar should be used. The client who has diabetes mellitus type 2 already has a compromised pancreas. Further stress to the pancreas can cause further injury to the organ.
Which of the following older adults is at highest risk for medication-related toxicity?
A 65-year-old with renal insufficiency Many medications are excreted through the kidneys; therefore, the patient with the highest risk for drug toxicity is the patient with renal insufficiency. An older adult with chronic diarrhea has increased gastric motility which may decrease the absorption of the medication and not increase the risk of toxicity. A BMI of 22.6 is within the normal range; therefore, the patient is not at as high risk as someone that is underweight or overweight. Vascular changes do happen with diabetes mellitus, which may increase the risk for drug toxicity. Because the patient has been diagnosed with diabetes for only 2 years, vascular changes are usually not significant enough to put the patient at a higher risk than someone with known renal insufficiency.
A nurse prepares to administer medication by the buccal route. Where should the nurse place this medication?
Between the client's cheek and gum The nurse should place medication administered by the buccal route in the client's upper or lower buccal pouch, between the cheek and gum. She should apply a topical medication to the client's skin; place a sublingual medication under his tongue on the floor of the mouth; and administer an eye (ocular) medication in the conjunctival sac.
A client is experiencing septic shock and infrequent bowel sounds. To ensure adequate nutrition, the nurse administers
A continuous infusion of total parenteral nutrition Nutritional supplementation is initiated within 24 hours of the start of septic shock. If the client has reduced peristalsis, then parenteral feedings will be required. Full liquid diet and enteral nutrition require the oral route and would be contraindicated if the client is experiencing decreased peristalsis. Increasing the rate of crystalloids does not provide adequate nutrition. (less)
Which of the following disorders results from excessive secretion of somatotropin (growth hormone)?
Acromegaly The patient with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet. Cretinism occurs as a result of congenital hypothyroidism. Dwarfism is caused by insufficient secretion of growth hormone during childhood. Adrenogenital syndrome is the result of abnormal secretion of adrenocortical hormones, especially androgen.
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?
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.
ccording to the DASH diet, how many servings of vegetables should a person consume per day?
According to the DASH diet, how many servings of vegetables should a person consume per day? You selected: 4 or 5 Four or five servings of vegetables are recommended in the DASH diet.
A 55-year-old female client was admitted to the medical unit 2 days ago with liver failure secondary to alcohol abuse. She's on bed rest with bathroom privileges and has just been up to use the toilet. While helping the client to stand so she can wipe herself, the nurse notices a few drops of blood on top of the semiliquid, clay-colored stool in the toilet. What action should the nurse take next?
Ask the client if she has noted any blood in her stools lately. Any blood in the stool indicates an abnormal condition that needs to be assessed further. Clients with liver failure can develop coagulation problems that can lead to bleeding tendencies, such as bleeding gums. However, at this time it is more important to investigate the cause of the blood on the client's stool. Asking her if she's dizzy is a very broad closed-ended that would not elicit information specifically related to the rectal bleeding.
What food would the nurse provide for a patient who has hypokalemia?
Bananas Hypokalemia is a below normal potassium level. Bananas are high in potassium. Adding bananas to the diet can help increase the serum potassium level. Canned vegetables, cheese, and bread do not have a high potassium content.
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?
Blood glucose level 1,100 mg/dl (61.05 mmol/L) HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl (33.33 mmol/L) in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.
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 judgement?
Brain cells without oxygen die in approximately 3 to 6 minutes. 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.
Which of the following clinical characteristics is associated with type 2 diabetes (previously referred to as non-insulin dependent diabetes mellitus [NIDDM])?
Can control blood glucose through diet and exercise Oral hypoglycemic agents may improve blood glucose levels if dietary modification and exercise are unsuccessful. Individuals with type 2 diabetes are usually obese at diagnosis. Individuals with type 2 diabetes rarely demonstrate ketosis, except with stress or infection. Individuals with type 2 diabetes do not demonstrate islet cell antibodies.
The mother of a 6-month-old reports starting her infant on 2% milk. The nurse should first ask the mother:
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 1 year of age. The nurse needs to first assess if the parent switched the baby prematurely to due to lack of information or lack of resources. Then appropriate teaching or referrals may be determined. At 1 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.
During a visit to the prenatal clinic, a pregnant client at 32 weeks' gestation reports heartburn. The client needs further instruction when she says she must do what?
Consume liquids only between meals. Consuming most liquids between meals rather than at the same time as eating is an excellent strategy to deter nausea and vomiting in pregnancy but does not relieve heartburn. During the third trimester, progesterone causes relaxation of the sphincter and the pressure of the fetus against the stomach increases the potential of heartburn. Avoiding highly seasoned foods, remaining in an upright position after eating, and eating small, frequent meals are strategies to prevent heartburn.
Which of the following clients is likely to have altered metabolism of medications?
Elderly Metabolism is the process of chemically changing the drug in the body. Metabolism takes place in the liver. Alterations in liver function, including decreased functions that occurs with aging or disease, affect the rate at which drugs are metabolized.
A hypophysectomy is the treatment of choice for which endocrine disorder?
Cushing syndrome A hypophysectomy is the treatment of choice for the patient diagnosed with Cushing syndrome resulting from excessive production of adrenocorticotropic hormone (ACTH) by a tumor of the pituitary gland.
Which of the following biologically active vitamin functions to increase the amount of calcium in the blood?
D Biologically active vitamin D (Calcitrol) functions to increase the amount of calcium in the blood by promoting absorption of calcium from the gastrointestinal tract.
The nurse is planning an education program for women of childbearing years. The nurse recognizes that primary prevention of osteoporosis includes:
Ensuring adequate calcium and vitamin D intake Nutritional intake of calcium and vitamin D are essential for the prevention of osteoporosis.
Upon assessment, the nurse determines the patient has a body mass index (BMI) of 45. This finding indicates the patient is which of the following?
Extremely obese A person with a BMI below 18.5 is underweight, a BMI of 25 to 29.9 indicates an overweight individual, a BMI of 30 or greater indicates obesity, and a BMI of 40 or greater indicates extreme obesity.
Which of the following is an age-related change associated with the cardiovascular system?
Decreased cardiac output Age-related changes associated with the cardiovascular system include decreased cardiac output, increased blood pressure, decreased compliance of the heart muscle, and thickening of the heart valves.
Which of the following is an age-related change that may affect diabetes and its management?
Decreased renal function Decreased renal function affects the management of diabetes. Other age-related changes that may affect diabetes and its management include hypertension, decreased bowel motility, and decreased thirst.
Which of the following is an age-related change that may affect diabetes and its management?
Decreased renal function Decreased renal function affects the management of diabetes. Other age-related changes that may affect diabetes and its management include hypertension, decreased bowel motility, and decreased thirst.
A client with diabetes whose husband recently died reports elevated blood glucose levels. She admits she is barely eating anything; she does not feel hungry. How will the nurse best respond to this client?
Often with stress, glucose level increases because the body needs more energy." During stress, the sympathetic nervous system is stimulated to release hormones that produce metabolic effects, including an increased blood glucose level. The rise in glucose is caused by increased liver and mucle glycogen breakdown. This mechanism allows more energy to be available for the body to handle the stressor.
What is involved in the absorption, distribution, metabolism, and excretion of medication?
Pharmacokinetics Pharmacokinetics involves the absorption, distribution, metabolism, and excretion of a medication.
The greatest percentage of people have which type of diabetes?
Type 2 Type 2 diabetes accounts for 90% to 95% of all diabetes. Type 1 accounts for 5% to 10% of all diabetes. Gestational diabetes has an onset during pregnancy. Impaired glucose tolerance is defined as an oral glucose tolerance test value between 140 mg/dL and 200 mg/dL.
Which client is at greatest risk for inadequate nutrition?
the client with burns to 45% of the body With illness or injury, there is a need to heal or recover. To accomplish this, the client must consistently consume adequate nutrition (and protein) to maintain a positive nitrogen balance, and to experience necessary growth and/or healing. The client with burns has the greatest nutritional needs, due to the extent of the injury. Clients with diabetic neuropathy can be encouraged to follow the diabetic diet plan and manage pharmacological therapy to prevent further neuropathy. The client with a fractured femur is not at risk for inadequate nutrition unless there is also a reason the client is not eating. The client who is breastfeeding needs additional calories, but if the client is eating a well-balanced diet with additional calories, the client is not at risk for obtaining inadequate nutrition.
A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and:
vitamin D. Typically, clients with hypoparathyroidism are ordered daily supplements of vitamin D along with calcium because calcium absorption from the small intestine depends on vitamin D. Hypoparathyroidism doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client doesn't require daily supplements of these substances to maintain a normal serum calcium level.
A client has extreme fatigue and is malnourished, and laboratory tests reveal a hemoglobin level of 8.5 g/dL (85 g/L). The nurse should specifically ask the client about the intake of food high in which nutrients?
vitamins B6 and B12, folate, iron, and copper Many vitamin and mineral deficiencies can result in anemia. All of these vitamins and minerals need to be assessed, preferably through a nutrition assessment. Deficiencies of vitamins A, B6, and C result in a small cell, microcytic anemia. Folate and vitamin B12 deficiencies result in a large cell, macrocytic anemia. Iron, copper, and vitamin E deficiencies can also result in anemia.
A 60-year-old female is diagnosed with hypothyroidism. The nurse should assess the client for:
weight gain. Typical signs and symptoms of hypothyroidism include weight gain, fatigue, decreased energy, apathy, brittle nails, dry skin, cold intolerance, hair loss, constipation, and numbness and tingling in the fingers. Tachycardia is a sign of hyperthyroidism, not hypothyroidism. Diarrhea and nausea are not symptoms of hypothyroidism.
A client with diabetes is taking insulin lispro injections. The nurse should advise the client to eat:
within 10 to 15 minutes after the injection. Insulin lispro begins to act within 10 to 15 minutes and lasts approximately 4 hours. A major advantage of lispro is that the client can eat almost immediately after the insulin is administered. The client needs to be instructed regarding the onset, peak, and duration of all insulin, as meals need to be timed with these parameters. Waiting 1 hour to eat may precipitate hypoglycemia. Eating 2 hours before the insulin lispro could cause hyperglycemia if the client does not have circulating insulin to metabolize the carbohydrate.
The nurse teaches the parents of a preschool child diagnosed with lactose intolerance how to incorporate dairy products into their child's diet. Which statement by the parent reflects the need for more teaching?
"It is best to drink milk alone, not with meals." Children with lactose intolerance often tolerate small amounts of dairy products better when they are consumed at mealtime with other foods. Most people with lactose intolerance can consume 2 to 4 oz (60 to 120 mL) of milk at a time without symptoms. Larger quantities are more likely to cause gas and bloating. Cheeses contain less lactose than milk and may be better tolerated. Yogurt also contains enzymes that are activated in the duodenum that substitute for natural lactase. Taking supplemental enzymes or drinking lactase-treated milk may also substitute for natural lactase.
A patient with Alzheimer's disease is prescribed donepezil (Aricept). When teaching the patient and family about this drug, which of the following would the nurse include?
"The drug helps to control the symptoms of the disease." Donepezil is a cholinesterase inhibitor used to control symptoms of Alzheimer's disease. It does not cure or slow progression. Typically cognitive ability improves within 6 to 12 months of therapy, but if stopped, cognitive progression occurs. It is recommended that treatment continue at least through the moderate stage of the illness. However, it usually is not prescribed as life-long therapy.
For which of the following patients is foot care likely the highest priority?
A patient who is obese and has a diagnosis of type 1 diabetes Patients with diabetes mellitus have an increased need for vigilant foot care, due to the risk of skin breakdown and foot wounds that often accompany the disease.
The nurse is caring for a patient who states that his religion prohibits him from eating meat. The nurse inquires if the patient practices which of the following religions?
Hinduism Hinduism prohibits consumption of all meats and animal shortening. Seventh-day Adventism prohibits consumption of pork. Judaism prohibits consumption of pork. Islam prohibits the consumption of pork and animal shortening. (
Which of the following is the progressive increase in blood glucose from bedtime to morning?
Insulin waning Insulin waning is a progressive rise in blood glucose form bedtime to morning. The dawn phenomenon occurs when there is a relatively normal blood glucose until about 3 AM, when the level begins to rise. The Somogyi effect occurs when there is a normal or elevated blood glucose at bedtime, a decrease at 2 to 3 AM to hypoglycemia levels, and a subsequent increase caused by the production of counter-regulatory hormones. DKA is caused by an absence or markedly inadequate amount of insulin. This deficit of insulin results in disorders in the metabolism of carbohydrates, proteins, and fats. The primary clinical features of DKA are hyperglycemia, ketosis, dehydration, electrolyte loss, and acidosis
Which commonly administered psychiatric medication is prescribed in individualized dosages according to the blood levels of the drug?
Lithium carbonate Dosages for lithium, an antimania drug, usually are individualized to achieve a maintenance blood level of 0.6 to 1.2 mEq/L. Although clozapine use requires monitoring of white blood cell counts and clonazepam use requires monitoring of complete blood count and liver function tests, these tests aren't used to individualize dosages of the drugs. Alprazolam dosages aren't based on blood levels of the drug.
Photochemotherapy involves a combination of psoralen methoxsalen and type A ultraviolet light. The psoralen methoxsalen is taken 1 to 2 hours before exposure to ultraviolet A. What problem is this used to treat?
Psoriasis Photochemotherapy is used to treat psoriasis.
The nurse is performing a nutritional assessment of an obese patient who visits a weight control clinic. What information should the nurse take into consideration when planning a weight reduction plan for this patient?
Psychological reasons for overeating should be explored, such as eating as a release for boredom. The nurse would need to take into consideration that psychological reasons for overeating should be explored. One pound of body fat is equal to approximately 3,500 calories. To lose 1 pound/week, the daily intake should be decreased by 500 calories per day. Obesity can be difficult to treat due to various factors.
The nurse is discussing diabetes mellitus with the family members of a client recently diagnosed. In order to promote the health of the family members, what would be the most important information for the nurse to include?
Risk factors and prevention of diabetes mellitus An important nursing function is to enable clients to prevent illness. Since a member of the family has developed diabetes, the other family members are also at risk. The nurse would most appropriately educate the family about the risk factors and prevention of diabetes mellitus. Knowledge of the medications used to treat diabetes is not necessary at this time and does not help meet the family's needs. The severity of the client's disease does not have an impact on the family's health. Knowledge of the cellular metabolism of glucose is not necessary for the family's health.
A nurse is caring for a client with a kidney disorder. What role might the kidneys have in causing the client to have fluctuations in blood pressure?
The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. Renin is released from the kidneys and initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys secrete erythropoietin, a substance that promotes the maturation of red blood cells. Cholecystokinin released from cells in the small intestine stimulates contraction of the gallbladder to release bile when dietary fat is ingested. Gastrin is released within the stomach to increase the production of hydrochloric acid. (
When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect:
a blood pressure of 176/88 mm Hg. Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.
For a client with hyperthyroidism, treatment is most likely to include:
a thyroid hormone antagonist. 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.
A child is receiving total parenteral nutrition (TPN). During TPN therapy, the most important nursing action is:
monitoring the blood glucose level closely. Most TPN solutions contain a high glucose content, placing the client at risk for hyperglycemia. Therefore, the most important nursing action is to monitor the child's blood glucose level closely. A child receiving TPN isn't likely to require vital sign assessment every 30 minutes or elevation of the head of the bed. A daily bath isn't a priority.
Which food should the nurse eliminate from the diet of a client in alcohol withdrawal?
regular coffee Regular coffee contains caffeine, which acts as a psychomotor stimulant and leads to feelings of anxiety and agitation. Serving coffee to the client may add to tremors and wakefulness. Milk, orange juice, and eggs are part of a well-balanced, high-protein diet needed by the client in alcohol withdrawal, who is nutritionally depleted.
The nurse should instruct a client with heart disease to avoid which foods that contribute to increases in serum cholesterol?
saturated fat Saturated fats raise blood cholesterol. Polyunsaturated fats maintain blood cholesterol. Monounsaturated fats may help to maintain or lower blood cholesterol. Phospholipids do not have an effect on cholesterol but act as emulsifiers, keeping fats dispersed in water.
The client with pneumonia develops mild constipation, and the nurse administers docusate sodium as prescribed. This drug works by:
softening the stool. Docusate sodium is a stool softener that allows fluid and fatty substances to enter the stool and soften it. Docusate sodium does not lubricate the stool, increase stool bulk, or stimulate peristalsis.
A patient with Alzheimer's disease is prescribed donepezil (Aricept). When teaching the patient and family about this drug, which of the following would the nurse include?
"The drug helps to control the symptoms of the disease." Donepezil is a cholinesterase inhibitor used to control symptoms of Alzheimer's disease. It does not cure or slow progression. Typically cognitive ability improves within 6 to 12 months of therapy, but if stopped, cognitive progression occurs. It is recommended that treatment continue at least through the moderate stage of the illness. However, it usually is not prescribed as life-long therapy.
What is the term for an adaptation to environmental stress that occurs when tissue mass enlarges due to cell multiplication and increased stimulation?
Hyperplasia Hyperplasia is an increase in the number of new cells in an organ or a tissue. Atrophy is the shrinkage in the size of a cell, leading to a decrease in organ size. Dysplasia is the change in the appearance of cells after they have been subjected to chronic irritation. Metaplasia is a cell transformation in which highly specialized cells change to less specialized cells.
A patient with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which of the following symptoms when caring for this patient?
Hypoglycemia The nurse should observe the patient receiving an oral antidiabetic agent for the signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested.
Which of the following is inconsistent as a condition related to metabolic syndrome?
Hypotension A diagnosis of metabolic syndrome includes three of the following conditions: insulin resistance, abdominal obesity, dyslipidemia, hypertension, proinflammatory state, and prothrombotic state.
The nurse is caring for an elderly client who has a large unhealed sacral wound. The client is thin and malnourished. The client informs the nurse that today she (the client) must fast due to religious reasons. The nurse is aware that the client requires good nutrition and extra protein to heal. Which of the following would be the best way for the nurse to respond to the client?
In order for your wound to heal, you need to eat, but I will respect your decision." It is important to explain why nutrition is necessary for the client's wound to heal, but in the end, the client's wishes must be respected.
A nurse is caring for a patient who is acutely ill and has included vigilant oral care in the patient's plan of care. Why are patients who are ill at increased risk for developing dental caries?
Inadequate nutrition and decreased saliva production can cause cavities Many ill patients do not eat adequate amounts of food and therefore produce less saliva, which in turn reduces the natural cleaning of the teeth. Stress response is not a factor, infections generally do not attack the enamel of the teeth, and the fluoride level of the patient is not significant in the development of dental caries in the ill patient.
The nurse is providing education to a client who reports a poor calcium intake. Which of the following does the nurse tell the client is most likely to develop as a result of poor calcium intake?
Osteoporosis Osteoporosis is a condition in which there is a reduction in bone density. Factors contributing to the development of osteoporosis may include chronically insufficient calcium intake, decreased estrogens, heredity factors, smoking, race, and decreased physical activity.
A school nurse is called to assess a 12-year-old child with type 1 diabetes mellitus who is experiencing lightheadedness, tachycardia, pallor, headache, and confusion during gym class. What is the priority action by the nurse?
Provide a snack of hard candy or raisins. The increased exercise has caused a drop in serum glucose levels, producing symptoms of hypoglycemia. The first action is to give the child a sugary snack to raise the glucose level.
Photochemotherapy involves a combination of psoralen methoxsalen and type A ultraviolet light. The psoralen methoxsalen is taken 1 to 2 hours before exposure to ultraviolet A. What problem is this used to treat?
Psoriasis Photochemotherapy is used to treat psoriasis.
A home care nurse is teaching a patient with diabetes how to self-administer insulin. Which teaching point would the nurse include in the teaching plan?
Rotate the injection site.
Which laboratory study is used to detect pancreatic injury?
Serum amylase Serum amylase analysis is done to detect increasing levels of the amylase enzyme, which suggest pancreatic injury or perforation of the GI tract. A white blood cell count is done to detect an elevation. A urinalysis is done to detect hematuria. A hemoglobin and hematocrit is done to evaluate trends reflecting the presence or absence of bleeding.
After resuming feedings in an infant who has undergone a pyloroplasty, which action would be most appropriate?
Starting feedings with 5 to 10 ml, slowly increasing amounts as tolerated. The child who has undergone pyloroplasty commonly vomits after the first feeding because peristalsis that has been in the right-to-left direction before repair has not reverted to the normal left-to-right direction. Peristalsis reverses as a result of the tightening of the pyloric sphincter, thus not allowing stomach contents to enter the small intestine. Therefore, small feedings of 5 to 10 mL are given and slowly increased as tolerated. The use of oral electrolyte solutions is unnecessary. Because there is a chance of vomiting, it is advisable to place an infant on its right side, which may help the fluid flow through the pyloric valve by gravity. The child will have an abdominal incision, so a prone position would be uncomfortable.
Which of the following may be a potential cause of hypoglycemia in the patient diagnosed with diabetes mellitus?
The patient has not consumed food and continues to take insulin or oral antidiabetic medications. Hypoglycemia occurs when a patient with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications. Hypoglycemia does not occur when the patient has not been compliant with the prescribed treatment regimen. If the patient has eaten and has not taken or received insulin, DKA is more likely to develop.
A nurse is educating a group of adolescent girls on bone and teeth growth. Which fat-soluble vitamin assists to build bone and teeth?
Vitamin D Vitamin D stimulates the absorption of calcium, which is an essential component for building strong, healthy bones bones and teeth. Vitamin A is essential in maintaining visual acuity, cell growth, and the immune system. Vitamin E is an antioxidant and also functions in promoting healing and healthy skin (cell growth). Vitamin K is essential in clotting.
A nurse is caring for a client undergoing IV therapy. The nurse knows that intravenous administration of medication is appropriate in which of the following situations?
When the client has disorders that affect the absorption of medications Intravenous administration may be chosen when clients have disorders, such as severe burns, that affect the absorption and metabolism of medications. IV therapy is also used in an emergency when a quick response is needed. Intravenous administration is not chosen when a client wants to avoid the discomfort of an intradermal injection but rather when the client wants to avoid the discomfort of repeated intramuscular injections. A single administration of a drug does not indicate the need for intravenous administration.
The nurse is assessing a postoperative patient's surgical incision site. The nurse anticipates which of the following findings?
Wound edge approximated Surgical sites heal by first intention. In first-intentional healing, the wound edges are approximated, little scar formation occurs, and the wound heals without granulation tissue. Additionally, in first-intentional healing, cell functionality is preserved.
An elderly client with type 2 diabetes had hyperglycemic hyperosmolar syndrome (HHS). The nurse should monitor the infusion for too rapid correction of the blood glucose in order to prevent:
cerebral edema. HHS can be caused by acute illness, such as an infection like pneumonia or sepsis. In HHS, there is a residual amount of insulin that suppresses ketosis but cannot control hyperglycemia. This leads to severe dehydration and impaired renal function. Ketone bodies are usually absent in HHS, and they do not form as a result of too rapid correction of blood glucose. The nurse should assess the client for a major vascular accident in the elderly as an etiology for a hyperglycemic crisis. Volume depletion must be treated first in HHS. Cerebral edema is a risk with too rapid correction of blood glucose.
Before supper, an adult client who has type-2 diabetes and requires insulin tells the nurse about having tremors, being weak and anxious. The nurse should:
have the client drink a glass of milk or orange juice. Hypoglycemia is a blood glucose level below 70 mg/dl. The signs and symptoms of hypoglycemia include confusion, irritability, diaphoresis, tremors, hunger, weakness, and visual disturbances. Untreated hypoglycemia can progress to loss of consciousness, seizures, coma, and death. With effective treatment, hypoglycemia can usually be quickly reversed. If the client has manifestations of hypoglycemia and monitoring equipment is not available, hypoglycemia is assumed, and treatment is initiated. Hypoglycemia is treated by ingesting 10 to 15 g of simple (fast-acting) carbohydrate, such as 4 to 8 ounces of fruit juice or regular (nondiet) soft drink or 8 ounces of low-fat milk. The nurse can tell the client to eat the regularly scheduled meal or a snack that has protein, such as cheese or peanut butter, to prevent hypoglycemia from recurring. Without treating the possible hypoglycemia, the blood glucose level will go down even lower and the client may lose consciousness, develop seizures, or go into a coma. Contacting the HCP would delay treating the possible hypoglycemia. Decreasing the insulin dose or increasing the meal plan may prevent episodes of hypoglycemia in the future. Administering insulin would cause the blood sugar to go even lower.
While shopping at a mall, a woman experiences an episode of extreme terror accompanied by anxiety, tachycardia, trembling, and fear of going crazy. A friend drives her to the emergency department, where a physician rules out physiologic causes and refers her to the psychiatric resident on call. To control the client's anxiety, the nurse caring for this client expects the resident to order:
lorazepam. Lorazepam is a schedule IV drug used to treat anxiety. Reducing the client's anxiety will help her cope with stress. Haloperidol is an antipsychotic agent. Bupropion is an antidepressant. Paroxetine is a selective serotonin reuptake inhibitor used to treat depression.
The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate?
low-protein, low-sodium, low-potassium Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high-carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.
The health care provider (HCP) has prescribed insulin detemir for a client with type 2 diabetes requiring insulin. The nurse should tell the client:
"You do not mix insulin detemir; the solution is clear." Insulin detemir is used only if the solution appears clear and colorless with no visible particles. Insulin detemir is not diluted or mixed with any other insulin preparations. As with any insulin therapy, lipodystrophy may occur at the injection site and delay insulin absorption. Continuous rotation of the injection site within a given area may help to reduce or prevent this reaction. The client should continue to follow the prescribed diet and monitor glucose levels when taking insulin detemir. Insulin detemir is available in a prefilled insulin pen. When the insulin pen is empty, it may not be refilled; instead the pen is discarded.
Which of the following results would indicate that levothyroxine sodium is effectively resolving the symptoms of a client with hypothyroidism?
Increased energy, weight loss, and a higher temperature and pulse rate The thyroid replacement medication will result in an increased rate of metabolism, indicated by the increase in temperature and pulse rate. As the metabolic rate increases, the client will have more energy and should lose the excess edema associated with myxedema or hypothyroidism. Vital signs will increase from the effects of thyroid hormone. A higher metabolic rate will burn more calories, so gaining weight will not usually occur. Lower oxygen saturation levels should not occur.
The nurse understands that which of the following physiologic changes that influence the pain response occur in the gerontologic population?
Increased sensitivity to medications The older population experiences increased sensitivity to medication and increased risk for drug toxicity. They tend to have higher blood level of medications due to a slower metabolism. In this population, there is also an increased use of prescription and OTC medications.
The nurse is teaching a class about caloric intake. The reason that men and women differ in the amount of calories they require on a daily basis is what?
Men have a larger muscle mass and so require more calories. Because of increased size and muscle mass, men require more calories than women. The other choices are not accurate statements, so they are incorrect.
Wendy Corcoran, a 34-year-old teacher, is being seen at the primary care group where you practice nursing. She is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by her altered thyroid function?
Metabolic rate The thyroid concentrates iodine from food and uses it to synthesize thyroxine (T4) and triiodothyronine (T3). These two hormones regulate the body's metabolic rate. Metabolic rate would be altered.
Clients from which of the following religious groups would be most likely to shun the use of caffeine-containing beverages?
Mormonism Those who practice Mormonism do not allow the ingestion of beverages containing caffeine stimulants. Hinduism does not allow the ingestion of meat. Jews do not eat pork and shelfish (among other foods), and followers of Islam do not ingest meat and alcoholic beverages.
The nurse is caring for a neonate at 38 weeks' gestation when the nurse observes marked peristaltic waves on the neonate's abdomen. After this observation, the neonate exhibits projectile vomiting. The nurse notifies the health care provider (HCP) because these signs are indicative of which problem?
pyloric stenosis Marked visible peristaltic waves in the abdomen and projectile vomiting are signs of pyloric stenosis. If the condition progresses without surgical intervention, the neonate will become dehydrated and develop metabolic alkalosis. Signs of esophageal atresia include coughing and regurgitation with feedings. Diaphragmatic hernia, a life-threatening event in which the abdominal contents herniate into the thoracic cavity, may be evidenced by breath sounds being heard over the abdomen and significant respiratory distress with cyanosis. Signs of hiatal hernia include vomiting, failure to thrive, and short periods of apnea.
A 3-year old with dehydration has vomited three times in the last hour and continues to have frequent diarrhea stools. The child was admitted 2 days ago with gastroenteritis caused by rotavirus. The child weighs 22 kg, has a normal saline lock in his right hand, and has had 30 mL of urine output in the last four hours. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the health care provider (HCP) with the recommendation for:
starting a fluid bolus of normal saline. The child is dehydrated, is not able to retain oral fluids, and continues to have diarrhea. A normal saline bolus should be given followed by maintenance of IV fluids. Antidiarrheal medications are not recommended for children and will prolong the illness. The child has gastroenteritis caused by a viral illness. IV antibiotics are not indicated for viral illnesses. Strict I&O;is important in all children with gastroenteritis.
