quiz metabolism
A pregnant client with iron-deficiency anemia is prescribed a daily iron supplement. What nutrient should the nurse suggest that the client include in her diet to potentiate the effect of the iron supplement?
A: vitamin C, Iron absorption is pH dependent; therefore iron should be taken with a source of ascorbic acid to enhance duodenal absorption. Biotin, lecithin, and vitamin B complex are all unrelated to the absorption of iron.
A client with hyperthyroidism is being treated with propylthiouracil (PTU). What instruction should the nurse plan to include in the teaching plan regarding this drug? Select all that apply.
Abrupt discontinuation of the medication may result in thyroid crisis. PTU blocks the synthesis of T3 (triiodothyronine) and T4 (thyroxine). The therapeutic effect of the drug should result in increased weight, decreased pulse, and stability of mood. Sore throat, joint pain, fever, or oral lesions may indicate infection caused by drug-induced blood dyscrasias, such as leukopenia and agranulocytosis. The response to this drug may take up to three weeks. Over-the-counter medications and seafood containing iodine should be avoided.
A client with post-radiation enteritis is to continue receiving total parenteral nutrition (TPN) at home after discharge. What information should the nurse include in the client's teaching plan?
Blood glucose should be monitored because total parenteral nutrition (TPN) may cause hyperglycemia. Nutritional solutions for TPN are prepared by a pharmacist who adds electrolytes, vitamins, and trace elements to base solutions. Identifying the types of infusion pumps that can be used may be confusing.
A client is diagnosed as having type 2 diabetes. A priority teaching goal is, "The client will be able to:
Knowledge of the signs and treatment for hypoglycemia or hyperglycemia is critical to client health and well-being and essential for survival. Although performing foot care daily is important, it is not the priority. The client has type 2 diabetes, which usually is controlled by oral hypoglycemics. Self-serum glucose monitoring is more accurate than sugar and acetone (S&A) urine measurements to identify serum glucose levels.
During the progressive stage of shock, anaerobic metabolism occurs. For which complication should the nurse assess the client?
Metabolic acidosis occurs during the progressive stage of shock as a result of accumulated lactic acid. Metabolic alkalosis cannot occur with the buildup of lactic acid associated with the progressive stage of shock. Respiratory acidosis can result from decreased respiratory function in late shock, further compounding metabolic acidosis. Respiratory alkalosis occurs as a result of hyperventilation during early shock.
The nurse is caring for a client with diabetes mellitus that is scheduled to receive an intravenous (IV) administration of 25 units of insulin in 250 mL normal saline. The only type of insulin that is compatible with intravenous solutions is:
Novolin R insulin acts rapidly and is compatible with intravenous solutions. Lispro insulin is not compatible with intravenous solutions; it is a rapid-acting insulin. Glargine insulin is not compatible with intravenous solutions; it is a long-acting insulin. Novolin N insulin is not compatible with intravenous solutions; it is an intermediate-acting insulin.
When providing dietary instructions to a client who is being treated with continuous ambulatory peritoneal dialysis (CAPD) for chronic glomerulonephritis, the nurse should include the need for:
Proteins eaten should be high quality to replace those lost during dialysis. A high-calorie diet is encouraged. Usually there is a modest restriction of fluids when the client is on dialysis. Usually there is a restriction of high-potassium foods when the client is on dialysis.
A nurse is instructing a client with peptic ulcer disease (PUD) about the diet that should be followed during the acute phase. The nurse should stress that the diet most likely will consist of:
A bland, nonirritating diet is recommended during the acute symptomatic phase. Low carbohydrate foods do not decrease gastric acid secretion. Clients should be instructed to avoid substances that increase gastric acid secretion such as coffee, tea, and cola. Bed time snacks should be avoided because they may stimulate gastric acid secretion as well. Gluten free foods do not decrease gastric acid secretion.
A child with acute poststreptococcal glomerulonephritis requests a snack. Which is the most therapeutic selection of food the nurse can provide?
Applesauce provides nutrition without large additional amounts of potassium and sodium. Peanuts and pretzels are high in sodium, which increases fluid retention. Bananas are high in potassium, which is contraindicated.
A nursing instructor provides education for the students on thermoregulation in the nursery. The students determine that in the healthy full-term neonate, heat production is accomplished by:
Metabolism of brown fat releases energy and increases heat production in the newborn. Fatty acids are byproducts of the breakdown of brown fat. Shivering is the mechanism of heat production for an adult, not for a newborn. Increased muscular activity will not be successful unless there is an abundance of brown fat.
A client with cirrhosis of the liver has a prolonged prothrombin time and a low platelet count. A regular diet is prescribed. What should the nurse instruct the client to do considering the client's condition?
Report signs of bleeding, no matter how slight. One of the many functions of the liver is the manufacture of clotting factors; there is interference in this process with cirrhosis of the liver, resulting in bleeding tendencies.
liver removes
ammonia which is converted to urea and sent out via kidneys
a patient is malnourished, what is the priortiy nursing intervention>
determine the patients food preference
cycle feeding tube
infusion is stopped for a specified time
bolus feeding tube
intermittent feeding of a specified amount of specified times
hemoglobin
low levels may indicate anemia, recent hemorrhage, or hemodilutions caused by fluid retention
hematocrit
low levels may reflect anemia, hemorrhage, excessive fluid, kidney disease, or cirrhosis
prealbumin
more sensitve indicator of protein deficiency because of its short half-life of 2 days
fissured tongue
niacin deficiency
Diabetic ketoacidosis signs and symptoms
often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. Without enough insulin, the body begins to break down fat as an alternate fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion. Frequent urination, not decreased, is a symptom. Weakness or fatigue, not hyperactivity, is a symptom.
total enteral nutrition (TEN) is contraindicted for which patient?
patient with intestinal obstruction that has progressed to diffuse peritonitis
the nurse asses for which potential complications in a patient who is malnourished?
poor wound healing, infection, lethargy, edema
hepatomegaly
protein deficiency
When caloric energy is inadequate, what does the body use for energy?
proteins
serum albumin lat test
reflects nutritional status a few weeks before testing
magenta tongue
riboflaving deficiency
cardiomyopathy
selenium deficiency
continuous feeding tube
small amounts are continually infused
confabulation
thiamine deficiency
what is the most reliable indicator of fluid status?
trends in weight
total lymphocyte count (TLC) lab test
used to assess immune function
cholesterol lab tests
values are typically low with malabsorption, liver disease, pernicious anemia, terminal stages of cancer, or sepsis
xerosis of conjunctiva
vitamin A deficiency
swollen, bleeding gums
vitamin C deficiency
osteomalacia, bone pain, rickets
vitamin D deficiency
Which signs/symptoms in an older adult can be an indication of "failure to thrive"
weakness, slow walking speed, low physical activity, unintentional weight loss, exhaustion
alopecia
zinc deficiency
A client is experiencing an exacerbation of ulcerative colitis. A low-residue, bland, high-protein diet and parental vitamins B, C, and K have been prescribed. The nurse explains that this dietary regimen is designed to reduce:
A low-residue, bland diet is designed to reduce colonic irritation, motility, and spasticity. Reduction of gastric acidity is the aim of bland diets used in the treatment of gastric ulcers. Reducing colonic irritation, motility, and spasticity hopefully will increase, not reduce, absorption. Electrolyte depletion may be prevented by reducing colonic irritation, but this is a secondary benefit.
A nurse who is monitoring the blood glucose level of the term infant of a diabetic mother (IDM) identifies a blood glucose level of 48 mg/dL. What should the nurse do?
A reading of 48 mg/dL is within the expected blood glucose range for a neonate (40 to 60 mg/dL) and requires no measures other than continued monitoring for the next 24 hours. Heel sticks are adequate for monitoring the blood glucose level of a neonate. Oral feedings of 10% dextrose in water are administered if the neonate's blood glucose level is low. Administering 50% dextrose intravenously will cause hyperglycemia in the neonate.
After a surgical thyroidectomy a client exhibits carpopedal spasm and some tremors. The client complains of tingling in the fingers and around the mouth. What medication should the nurse expect the primary health care provider to prescribe after being notified of the client's adaptations?
The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia. Potassium iodide is prescribed for hyperthyroidism because it inhibits the release of thyroid hormones. Magnesium sulfate is prescribed for hypomagnesemia or to treat pregnant women who have preeclampsia. Potassium chloride is prescribed for hypokalemia, not hypocalcemia.
A nurse plans an evening snack of milk, crackers, and cheese for a client who is receiving NPH insulin (Novolin N). What does this snack provide?
The protein in milk and cheese may be slowly converted to glucose (gluconeogenesis), providing the body with some glucose during sleep while the NPH insulin is still acting. The purpose of an evening snack is to cover for insulin activity during sleep. Encouraging the client to stay on the diet is not the purpose of the evening snack. Adding calories to promote weight gain is not the purpose of an evening snack for a person taking insulin. The foods chosen are rich in protein and will be used slowly.
While discussing dietary needs during pregnancy, a client tells the nurse, "I don't like to drink milk, because it makes me constipated." What should the nurse recommend?
Unless a lactose intolerance is present, the client should drink milk; eating dried fruits and high-fiber foods and increasing fluids and activity will help ease constipation. Nonfat milk is not as beneficial as whole milk and will cause constipation as well. Cheeses can cause constipation. Taking more prenatal vitamins than recommended can be harmful and is not a substitute for milk.
A client has a hiatal hernia. The client is 5 feet 3 inches tall and weighs 140 pounds. When the nurse discusses prevention of esophageal reflux, what should be included?
Weight reduction decreases intraabdominal pressure, thereby decreasing the tendency to reflux into the esophagus. Fats decrease emptying of the stomach, extending the period that reflux can occur; fats should be decreased. Lying down after eating increases the pressure against the diaphragmatic hernia, increasing symptoms. Drinking several glasses of fluid during each meal will increase pressure; fluid should be discouraged with meals.
