NRN 161 Metabolism & Elimination
If a client takes 40 mg of a drug with a half-life of 2 hours, how much of the drug will remain 2 hours after administration? 10 mg 20 mg 30 mg 40 mg
20 mg Explanation: In this case, 20 mg will remain 2 hours after administration. The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one half of the peak level it previously achieved.
Which factor would contribute to a high-risk pregnancy? blood type O positive history of allergy to honey bee pollen type 1 diabetes first pregnancy at age 33
type 1 diabetes Explanation: A woman with a history of diabetes has an increased risk for perinatal complications, including hypertension, preeclampsia, and neonatal hypoglycemia. The age of 33 without other risk factors does not increase risk, nor does type O-positive blood or environmental allergens
The nurse is teaching dietary interventions to the parents of a child with an elevated blood lead level (EBLL). Which nutrient is least important to include in the child's diet? iron vitamin C calcium vitamin A
vitamin A Explanation: Vitamin A is not known to play a significant role in preventing EBLL. Calcium intake inhibits lead absorption. Children with EBLL levels often are anemic. While this relationship is not well understood, iron supplementation has been shown to improve developmental outcomes. Vitamin C improves iron absorption
A client's glucose level is 365 mg/dL (365 mmol/dL). The physician orders 10 units of regular insulin to be administered. The bottle of regular insulin is labeled 100 units/ml. How many milliliters of insulin should the nurse administer? Record your answer using one decimal place
0.1 Explanation: To find the correct administration amount, use the cross-product principle to set up the following equation: X/10 units = 1 ml/100 units Next, cross-multiply: 100 x X units = 10 units x 1 ml. Then divide both sides of the equation by 100 units to solve for X: X = 0.1 ml
Which assessment would lead the nurse to believe a postpartal woman is developing a urinary complication? Her perineum is obviously edematous on inspection. She says she is extremely thirsty. She has voided a total of 1000 mL in two voidings, each spaced 1 hour apart. At 8 hours postdelivery she has voided a total of 100 mL in four small voidings
At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. Explanation: Postpartal women who void in small amounts may be experiencing bladder overflow from retention
A client is suspected of having anorexia nervosa and meets the diagnostic criteria for the disorder. When conducting the physical examination, which would be a probable finding from the assessment? Complaints of heartburn Hypertension Heat intolerance Bradycardia
Bradycardia Explanation: Associated physical exam findings include cold intolerance, complaints of constipation and abdominal pain, hypotension, and bradycardia.
The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the mother to avoid an emergency situation? "Call the doctor immediately if the stoma is not pink/red and moist." "You may need adhesive remover to ease pouch removal." "Gather all of your supplies before you begin." "You must be meticulous in caring for the surrounding skin."
Call the doctor immediately if the stoma is not pink/red and moist." Explanation: A healthy stoma is pink and moist. If the stoma is dry or pale, the mother must notify the doctor immediately because it could indicate compromised circulation. Gathering supplies is important but would not be involved in avoiding an emergency situation. All of the other instructions are valid, but emphasizing the color of the healthy stoma is most important to avoid an emergency situation. Adhesive remover may be needed to ease pouch removal, but this action would not necessarily avoid an emergency situation. Meticulous skin care is important, but this action would not necessarily avoid an emergency situation
Which of the following is the most common presenting symptom of colon cancer? Anorexia Change in bowel habits Fatigue Weight loss
Change in bowel habits Explanation: The most common presenting symptom is a change in bowel habits. Fatigue, anorexia, and weight loss may occur, but none of these is the most common presenting symptom
Which of the following disorders is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? Addison's disease Graves' disease Cushing's syndrome Hashimoto's disease
Cushing's syndrome Explanation: The patient with Cushing's syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. In Addison's disease, the patient experiences chronic adrenocortical insufficiency. In Graves' disease, the patient experiences hyperthyroidism. The patient with Hashimoto's disease demonstrates inflammation of the thyroid gland, resulting in hypothyroidism.
A preschooler has celiac disease. Her mother is preparing a gluten-free diet. By preparing which breakfast foods would you believe she understands the diet? Eggs and orange juice Wheat toast and grape jelly Rye toast and peanut butter Cheerios (oat cereal) and skim milk
Eggs and orange juice Explanation: Children with celiac disease cannot digest the protein in common grains, such as wheat, rye, and oats.
Wallace Guterman, a 36-year-old construction manager, is being seen by a healthcare provider in the primary care group where you practice nursing. He presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What could be causing his symptoms? Panhypopituitarism Hypopituitarism Panhyperpituitarism Hyperpituitarism
Hyperpituitarism Explanation: Acromegaly (hyperpituitarism) is a condition in which growth hormone is oversecreted after the epiphyses of the long bones have sealed. A client with acromegaly has coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and large hands and feet. When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica are common
Which of the following would be inconsistent as a component of metabolic syndrome? Hypertension Hypotension Elevated triglyceride levels Abdominal obesity
Hypotension Explanation: Diabetes, obesity, dyslipidemia, hypertension, and elevated triglycerides are components of metabolic syndrome. Hypotension is not a component of metabolic syndrome
Although not being designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones which are involved in increasing blood pressure and volume and maturation of red blood cells? Kidneys Cardiac atria Brain Liver
Kidneys Explanation: The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys also secrete erythropoietin, a substance that promotes the maturation of red blood cells
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Select the correct example of how urine concentration is affected from among the following statements. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has scant urine output with a high specific gravity
On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. Explanation: On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has copious urine output with a low specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity remains relatively constant.
In the postoperative phase of abdominal surgery, the client complains of severe abdominal pain, and in the second postoperative day, the client's bowel sounds are absent. What does the nurse suspect? Abdominal infection Normal response Paralytic ileus Hernia development
Paralytic ileus Explanation: A potential complication after surgery is paralytic ileus, a condition in which there is decreased bowel functioning.
A nurse is assessing a client with a terminal illness and finds that the client has cachexia. The nurse interprets this as indicating which of the following? Profound protein loss Severe asthenia Extreme anorexia Starvation
Profound protein loss Explanation: Cachexia is associated with anabolic and catabolic changes in metabolism that relate to activity of neurohormones and proinflammatory cytokines, resulting in profound protein loss. Although anorexia may exacerbate cachexia, it is not a primary cause. Starvation refers to simple food deprivation and is not cachexia. Anorexia-cachexia syndrome, characterized by disturances in carbohydrate, protein, and fat metabolism, endocrine dysfunction, and anemia results in severe asthenia (loss of energy).
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? The severity of the client?s disease Risk factors and prevention of diabetes mellitus Medications used to treat diabetes mellitus The cellular metabolism of glucose
Risk factors and prevention of diabetes mellitus Explanation: 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 terminally ill client is receiving morphine around-the-clock for pain control. As part of the client's plan of care focusing on pain management, which nursing diagnosis would the nurse most likely identify? Impaired physical mobility related to sedative effects of the drug Caregiver role strain related to the need for around-the-clock pain control Risk for constipation related to the effects of an opioid Risk for ineffective cerebral tissue perfusion related to central nervous system effects of the drug
Risk for constipation related to the effects of an opioid Explanation: When an opioid is used for around-the-clock pain management, the nursing diagnosis, risk for constipation, would be most likely because of the opioid's effect on the gastrointestinal system. Therefore, a regimen to combat constipation is key. Although opioids depress the central nervous system and cause sedation, a risk for ineffection and impaired physical mobility would be less likely. Other factors involved in the client's care, not just the around-the-clock pain control, would contribute to caregiver role strain
Why should total parental nutrition (TPN) be used cautiously in clients with pancreatitis? Such clients cannot tolerate high-glucose concentration. Such clients can digest high-fat foods. Such clients are at risk for hepatic encephalopathy. Such clients are at risk for gallbladder contraction
Such clients 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
A nurse is teaching a patient with a new diagnosis of diabetes. Which example demonstrates cognitive learning by the patient? The patient prepares the skin for the administration of an insulin injection. The patient demonstrates proper technique for injecting insulin. The patient expresses a desire to improve his nutritional intake and lose weight. The patient describes signs and symptoms of hypoglycemia.
The patient describes signs and symptoms of hypoglycemia. Explanation: The patient's ability to describe the signs and symptoms of hypoglycemia demonstrates cognitive learning (the storing and recalling of new knowledge in the brain). Demonstrating a skill, such as insulin injection, is an example of psychomotor learning. Affective learning includes changes in attitudes, values, and feelings (e.g., desire to lose weight)
On the first postpartum day after a cesarean birth, the client is prescribed a full liquid diet as tolerated. Before providing a full liquid breakfast, the nurse should assess which factor? bowel sounds breath sounds degree of pain desire to eat
bowel sounds Explanation: Before providing the client with a full liquid meal, the nurse should first assess for the presence of bowel sounds to evaluate the functioning of the client's gastrointestinal tract. After cesarean birth, the client is at risk for paralytic ileus or intestinal obstruction due to the effects of the surgery or anesthesia used.
The nurse should instruct a client with heart disease to avoid which foods that contribute to increases in serum cholesterol? polyunsaturated fat monounsaturated fat phospholipids saturated fat
saturated fat Explanation: 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.
You care for a 12-year-old girl with Crohn disease. A primary assessment you would want to make when caring for her would be to note if: lung sounds are clear. she has a headache. her joints are not swollen. she has a temperature
she has a temperature. Explanation: Because Crohn disease leads to patches of inflammation in the bowel, the temperature increases if more patches become involved
A client is asking about dietary modifications to counteract the long-term effects of prednisone. What is the most appropriate information for the nurse to give the client? "Increase your intake of polyunsaturated fats." "Increase your intake of dietary sodium." "Increase your intake of complex carbohydrates." "Increase your intake of calcium and vitamin D."
"Increase your intake of calcium and vitamin D." Explanation: Problems associated with long-term corticosteroid therapy include sodium retention, osteoporosis, and hyperglycemia. An increase in calcium and vitamin D is needed to help prevent bone deterioration. Dietary modifications need to reduce sodium, maintain high protein levels for tissue repair, and reduce carbohydrates, as there is a tendency toward hyperglycemia. Increased intake of complex carbohydrates is not indicated because of hyperglycemia. There should be decreased fat intake because there is a tendency for central fat deposition
A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. Which of the following is being tested? Parathyroid functioning Thyroid functioning Adrenal functioning Thymus functioning
Adrenal functioning Explanation: The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress. The adrenal cortex manufactures and secretes cortisol
A client is being seen by an endocrinologist at the endocrinology group. At this visit, the client will receive results of previously ordered diagnostics. During the client education session, the nurse describes the role of endocrine glands. Which homeostatic processes are regulated by hormones? Growth Electrolyte balance Energy use All options are correct
All options are correct Explanation: 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 such as metabolism, growth, fluid and electrolyte balance, reproductive processes, energy use, sleep and wake cycles, etc.
Which action should a nurse include in the care plan for a 2-month-old infant with heart failure? Bathe the infant and administer medications before feeding. Weigh and bathe the infant before feeding. Feed the infant when he cries. Allow the infant to rest before feeding.
Allow the infant to rest before feeding. Explanation: Because feeding requires so much energy, an infant with heart failure should rest before feeding. Bathing and weighing the infant and administering medications should be scheduled around feedings. An infant expends energy when crying; therefore, it's best if the infant doesn't cry.
Which of the following digestive enzymes aids in the digesting of starch? Trypsin Amylase Lipase Bile
Amylase Explanation: Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein; amylase, which aids in digesting starch; and lipase, which aids in digesting fats. Bile is secreted by the liver and is not considered a digestive enzyme
The nurse is conducting a gastrointestinal assessment. When the patient complains of the presence of mucus and pus in his stools, the nurse assesses for additional signs/symptoms of which of the following disease/conditions? Ulcerative colitis Disorders of the colon Intestinal malabsorption Small-bowel disease
Ulcerative colitis Explanation: The presence of mucus and pus in the stools suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption
Which assessment finding would suggest that a child's postoperative feeding schedule following pyloric stenosis surgery should be slowed? Vomiting Semiformed bowel movements Flatulence Falling asleep at each feeding
Vomiting Explanation: Vomiting after a feeding suggests the pyloric valve is not yet able to accommodate feedings well, possibly from edema
When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: bradycardia. a blood glucose level of 130 mg/dl (7.2 mmol/L). a blood pressure of 130/70 mm Hg. a blood pressure of 176/88 mm Hg
a blood pressure of 176/88 mm Hg. Explanation: Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia
The nurse is explaining the pharmacokinetics of a drug being administered to a client. What is meant by the term "pharmakokinetics?" actions of drugs dosages of drugs treatment of overdoses route of administration
actions of drugs Explanation: Pharmacokinetics refers to the actions of drugs. The route of administration refers to the route or method by which a medication is administered. Treatment of overdoses and dosages of drugs are separate but related concepts
The primary function of the thyroid gland includes which of the following? Reabsorption of water Facilitation of milk ejection Reduction of plasma level of calcium Control of cellular metabolic activity
Control of cellular metabolic activity Explanation: The primary function of the thyroid hormone is to control cellular metabolic activity. Oxytocin facilitates milk ejection during lactation and increases the force of uterine contraction during labor and delivery. Antidiuretic hormone (ADH) release results in reabsorption of water into the bloodstream rather than excretion by the kidneys. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.
An increase in the number of new cells in an organ or tissue that is reversible when the stimulus for production of new cells is removed is which of the following? Hyperplasia Hypertrophy Atrophy Neoplasia
Hyperplasia Explanation: Hyperplasia occurs as cells multiply and are subjected to increased stimulation resulting in tissue mass enlargement. Hypertrophy is an increase in size and bulk of tissue that does not result from an increased number of cells. Atrophy refers to reduction in size of a structure after having come to full maturity. With neoplasia, the increase in the number of new cells in an organ or tissue continues after the stimulus is removed
The client reports to the clinic as ordered by her primary care provider for counseling on weight loss to improve overall health. The client received printed information in the mail to review before the session, and states having read through it before the appointment. Which of the client's statements alerts the nurse to a need for clarification and further education? ?I can monitor my caloric intake by measuring portions.? ?I will be doing well if I lose between 5 and 10 pounds a week." ?I can lower my blood pressure by losing weight.? ?Osteoarthritis in my knees may be because of my weight.
I will be doing well if I lose between 5 and 10 pounds a week." Explanation: Blood pressure can be reduced with weight loss. Osteoarthritis may be caused by destruction of cartilage from the pressure on the knee joints caused by excessive weight. Measuring portions is essential to understanding caloric intake. Healthy weight loss is generally accepted as 1-2 pounds per week, or a reduction of 500-1000 calories per day, which includes decreased intake of foods and burning calories with exercise.
A nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex. The nurse knows that the client should have which test completed before initiation of drug therapy? Liver function Thyroid level Cardiac enzymes White blood cell (WBC) count
Liver function Explanation: Baseline liver function tests and a complete blood count with platelets should be obtained before starting therapy, and clients with known liver disease should not be given divalproex sodium. There is a boxed warning for hepatotoxicity. Thyroid level, WBC count, and cardiac enzymes do not have to be performed routinely before starting this medication
A client at the health care facility has been diagnosed with total urinary incontinence. How could the nurse describe the condition of the client? Loss of urine control because of inaccessibility of a toilet Loss of urine without any identifiable pattern or warning Loss of small amount of urine when intraabdominal pressure rises Need to void perceived frequently, with short-lived ability to sustain control of flow
Loss of urine without any identifiable pattern or warning Explanation: The nurse could describe the client's condition as the loss of urine without any identifiable pattern or warning. Stress incontinence can be described as loss of a small amount of urine when intraabdominal pressure rises; whereas, urge incontinence can be described as the need to void perceived frequently with a short-lived ability to sustain control of flow. Functional urinary incontinence can be described as the loss of control over urination because of the inaccessibility of a toilet.
A client had an open cholecystectomy (gall bladder removal) 36 hours earlier, and the nurse's assessment this morning confirms that the client has not yet had a bowel movement since prior to surgery. How should the nurse best respond to this assessment finding? Immediately administer a cleansing enema. Monitor the client closely and promote fluid intake. Increase the rate of the client's intravenous infusion. Contact the physician to come assess the client.
Monitor the client closely and promote fluid intake. Explanation: Bowel function does not typically return immediately after surgery, but it can be promoted by encouraging fluid and fiber intake as appropriate to the client and his or her surgery. A medical assessment is likely unnecessary at this early postoperative stage, and an enema would likely be premature. The nurse may not independently increase the client's IV infusion, and doing so would not necessarily promote a bowel movement
The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis? "Your child will receive counseling so the underlying concerns will be addressed." "Your child will be treated with oral iron preparations to correct the anemia." "We will give enemas until clear and then teach you how to do these at home." "The treatment for the disorder will be a surgical procedure."
The treatment for the disorder will be a surgical procedure." Explanation: Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Chronic anemia may be present, but iron will not correct the disorder. Enemas may be given to initially achieve bowel elimination, but they will not treat the disorder. Differentiation must be made between this condition and psychogenic megacolon because of coercive toileting or other emotional problems. The child with aganglionic megacolon does not withhold stools or defecate in inappropriate places, and no soiling occurs.
