metabolism

After teaching the mother of a child with celiac disease about dietary management, which of the following statements by the mother indicates successful teaching? a) "I will be sure to give my child lots of milk." b) "I will plan to feed my child foods that contain rice." c) "I will feed my child foods that contain wheat products." d) "I will be sure my child gets oatmeal every day."

"I will plan to feed my child foods that contain rice." Explanation:Damage to intestinal mucosa in celiac disease is caused by gliadin, a part of the protein found in wheat, rye, barley, and oats. Foods containing these grains must be eliminated entirely from the diet of children with celiac disease. Foods containing rice and corn are a good substitute. Although an adequate intake of milk is important for any child, children with celiac disease do not need an increased milk intake.

When developing a nutritional plan for a child who needs to increase protein intake, the nurse should suggest which of the following foods? Select all that apply. a) Yogurt b) Bacon. c) Cooked dry beans. d) Apple e) Peanut butter.

Cooked dry beans. • Peanut butter. • Yogurt Explanation:Yogurt, dry beans, and peanut butter all contain protein in amounts that make them good sources of protein for the child. Bacon is high in fat; an apple is a carbohydrate..

A nurse is discussing nutrition and weight control with clients during a class about diabetes. Which statement best reflects the purpose of nutritional management of diabetes? a) To meet energy needs by eating all foods that keep blood glucose within a relatively normal range b) To monitor weight gain and recognize that 11-22 pounds (5-10 kg) is acceptable and treatable with all diabetic clients c) To maintain blood glucose levels as close as possible to the normal range to reduce the risk for long-term complications" d) To maintain or have moderately high serum lipid levels to reduce the risk for macrovascular complications

To maintain blood glucose levels as close as possible to the normal range to reduce the risk for long-term complications" Explanation:Nutrition and normal blood glucose will help reduce chronic disease processes associated with diabetes. All the other choices do not address best nutritional management in diabetes and place the client at risk for further long-term complications

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply. a) Aphasia b) Tingling c) Numbness d) Polydipsia e) Polyuria f) Muscle twitching and spasms

Numbness • Tingling • Muscle twitching and spasms Explanation:When the parathyroid gland is removed, the body may not produce enough parathyroid hormone to regulate calcium and phosphorous levels. The symptoms of hypocalcemia include peripheral numbness, tingling, and muscle spasms. Aphasia is not a symptom of calcium depletion. Polyuria and polydipsia are symptoms of diabetes mellitus.

A nurse is providing dietary teaching for the parents of a child with celiac disease. Which statement by the parents indicates effective teaching? a) "Our child should avoid eating prepared puddings." b) "Our child should avoid eating rice." c) "Our child should avoid eating vegetables." d) "Our child should avoid eating fruits."

Our child should avoid eating prepared puddings." Explanation:Teaching is effective if the parents identify prepared puddings as a food their child should avoid. A child with celiac disease mustn't consume foods containing gluten and therefore should avoid prepared puddings, commercially prepared ice cream, malted milk, and all food and beverages containing wheat, rye, oats, or barley. The other options don't contain gluten and are permitted on a gluten-free diet

The nurse is administering gastrostomy feedings to an infant after surgery to correct a tracheoesophageal fistula (TEF). To prevent air from entering the stomach once the syringe barrel is attached to the gastrostomy tube the nurse should: a) Pour all of the formula to be administered into the syringe barrel after opening the clamp. b) Maintain a continuous flow of formula down the side of the syringe barrel once the clamp is opened. c) Allow a small amount of formula to enter the stomach before pouring more formula into the syringe barrel. d) Unclamp the tube after pouring the complete amount of formula to be administered into the syringe barrel.

Unclamp the tube after pouring the complete amount of formula to be administered into the syringe barrel. Explanation: The best way to prevent air from entering the stomach when feeding an infant through a gastrostomy tube is to open the clamp after all the formula has been placed in the syringe barrel. Doing so prevents air from mixing with the formula and thus being introduced into the stomach. Pouring all the formula into the barrel after opening the clamp, maintaining a continuous flow of formula down the side of the barrel after unclamping the tube, and allowing a small amount of formula to enter the stomach before adding more formula to the barrel permit air to enter the stomac

Parents of a child with cystic fibrosis ask the nurse why their child must receive supplemental pancreatic enzymes. Which response by the nurse is most appropriate? a) "Pancreatic enzymes prevent intestinal mucus accumulation." b) "Pancreatic enzymes help prevent meconium ileus." c) "Pancreatic enzymes promote adequate rest." d) "Pancreatic enzymes promote absorption of nutrients and fat."

Pancreatic enzymes promote absorption of nutrients and fat." Explanation:Pancreatic enzymes are given to a child with cystic fibrosis to aid fat and protein digestion. They don't promote rest or prevent mucus accumulation or meconium ileus.

A 9-month-old child with cystic fibrosis does not like taking pancreatic enzyme supplement with meals and snacks. The mother does not like to force the child to take the supplement. The most important reason for the child to take the pancreatic enzyme supplement with meals and snacks is: a) The child will experience severe diarrhea if the supplement is not taken as prescribed. b) The child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates, and proteins. c) The child will become dehydrated if the supplement is not taken with meals and snacks. d) The child needs the pancreatic enzymes to aid in liquefying mucus to keep the lungs clear.

The child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates, and proteins. Explanation:The child must take the pancreatic enzyme supplement with meals and snacks to help absorb nutrients so he can grow and develop normally. In cystic fibrosis, the normally liquid mucus is tenacious and blocks three digestive enzymes from entering the duodenum and digesting essential nutrients. Without the supplemental pancreatic enzyme, the child will have voluminous, foul, fatty stools due to the undigested nutrients and may experience developmental delays due to malnutrition. Dehydration is not a problem related to cystic fibrosis. The pancreatic enzymes have no effect on the viscosity of the tenacious mucus. Diarrhea is not caused by failing to take the pancreatic enzyme supplement.

A nurse should expect a client with hypothyroidism to report: a) increased appetite and weight loss. b) puffiness of the face and hands. c) thyroid gland swelling. d) nervousness and tremors.

puffiness of the face and hands. Explanation:Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).

The mother of a child with celiac disease asks, "How long must he stay on this diet?" Which response by the nurse is best? a) "For the rest of his life." b) "Until his stools appear normal." c) "For the next 6 months." d) "Until the jejunal biopsy is normal."

"For the rest of his life." xplanation:Most children with celiac disease have a lifelong sensitivity to gluten, which requires that they maintain some type of diet restriction for the rest of their lives

A nurse administered neutral protamine Hagedorn (NPH) insulin to a client with diabetes mellitus at 7 a.m. (0700). At what time should the nurse expect the client to be most at risk for hypoglycemia? a) 4 p.m. (1600) b) Noon (1200) c) 10 a.m.(1000) d) 10 p.m. (2200)

4 p.m. (1600) Explanation:NPH is an intermediate-acting insulin that peaks 8 to 12 hours after administration. Because the nurse administered NPH insulin at 7 a.m. (0700), the client is at greatest risk for hypoglycemia from 3 (1500) to 7 p.m. (1900)

Which procedures can the nurse working on a pediatric floor safely delegate to the licensed practical nurse (LPN). Select all that apply. a) Calling the AM blood sugars to the physician. b) Inserting hearing aids. c) Administering gastrostomy tube feedings. d) Giving an IV push medication. e) Refilling a baclofen pump.

Administering gastrostomy tube feedings. • Inserting hearing aids. Explanation:In general, LPNs may perform skills related to feeding, oral medication administration, and activities of daily living, such as inserting a hearing aid. Refilling a baclofen pump constitutes administering an intrathecal medication and is beyond the scope of practice for LPNs in most areas. Some institutions allow LPNs to give IV push medicines; however, special training is required. Communicating with the primary health care provider would require discussion of the client's assessments and evaluations, which fall under the RN scope of practice.

Which of the following indicates a potential complication of diabetes mellitus? a) Hemoglobin of 9 g/dl (90 g/L). b) Blood pressure of 160/100 mm Hg. c) Stooped appearance. d) Inflamed, painful joints.

Blood pressure of 160/100 mm Hg. Explanation:The client with diabetes mellitus is especially prone to hypertension due to atherosclerotic changes, which leads to problems of the microvascular and macrovascular systems. This can result in complications in the heart, brain, and kidneys. Heart disease and stroke are twice as common among people with diabetes mellitus than among people without the disease. Painful, inflamed joints accompany rheumatoid arthritis. A stooped appearance accompanies osteoporosis with narrowing of the vertebral column. A low hemoglobin concentration accompanies anemia, especially iron deficiency anemia and anemia of chronic disease.

After teaching the parents of a child with celiac disease about diet, which of the following, if stated by the parents to be avoided, indicates effective teaching? Select all that apply. a) Chocolate candy. b) Corn tortillas. c) Bologna on rye sandwich. d) White rice. e) Hot dogs.

Chocolate candy. • Hot dogs. • Bologna on rye sandwich. Explanation:Children with celiac disease should avoid foods containing the protein gluten, which is found in wheat, oats, rye, and barley grains. Children are allowed to eat foods containing rice or corn. Labels need to be read carefully since these glutens are used as fillers in many food items including many types of chocolate candy and hot dogs.

Because of steroid excess after a bilateral adrenalectomy, the nurse should assess the client for: a) Malnutrition. b) Emboli. c) Delayed wound healing. d) Postoperative confusion.

Delayed wound healing. Explanation:Persistent cortisol excess undermines the collagen matrix of the skin, impairing wound healing. It also carries an increased risk of infection and of bleeding. The wound should be observed and documentation performed regarding the status of healing. Confusion and emboli are not expected complications after adrenalectomy. Malnutrition also is not an expected complication after adrenalectomy. Nutritional status should be regained postoperatively.

When caring for the neonate of a mother with gestational diabetes, which finding is most indicative of a hypoglycemic episode? a) Serum glucose level of 60 mg/dl (3.3 mmol/L) b) Jitteriness c) Hyperalert state d) Positive Babinski's reflex

Jitteriness Explanation:Hypoglycemia in a neonate is expressed as jitteriness, lethargy, diaphoresis, and a serum glucose level below 40 mg/dl (2.2 mmol/L). A hyperalert state suggests neurologic irritability and isn't associated with blood glucose levels. A positive Babinski's reflex is a normal finding in neonates and isn't associated with hypoglycemia. A serum glucose level of 60 mg/dl (3.3 mmol/L) is a normal level.

A nurse is caring for a child with celiac disease. How should the nurse evaluate the effectiveness of nutritional therapy? a) Measure intake and output. b) Measure blood urea nitrogen and serum creatinine levels. c) Monitor the appearance, size, and number of stools. d) Monitor vital signs every 4 hours.

Monitor the appearance, size, and number of stools. Explanation:A gluten-free diet should eliminate fat, bulky, foul-smelling stools in a child with celiac disease. This finding indicates that the disease is controlled and the child is using nutrients effectively. Taking vital signs, measuring blood urea nitrogen and serum creatinine levels, and measuring intake and output don't indicate the effectiveness of nutritional therapy

Which of the following conditions is the most significant risk factor for the development of type 2 diabetes mellitus? a) High-cholesterol diet. b) Cigarette smoking. c) Obesity. d) Hypertension.

Obesity. Explanation: The most important factor predisposing to the development of type 2 diabetes mellitus is obesity. Insulin resistance increases with obesity. Cigarette smoking is not a predisposing factor, but it is a risk factor that increases complications of diabetes mellitus. A high-cholesterol diet does not necessarily predispose to diabetes mellitus, but it may contribute to obesity and hyperlipidemia. Hypertension is not a predisposing factor, but it is a risk factor for developing complications of diabetes mellitus

When administering intermittent enteral feeding to an unconscious client, the nurse should: a) Heat the formula in a microwave. b) Weigh the client before administering the feeding. c) Place the client in a semi-Fowler's position. d) Obtain a sterile gavage bag and tubing.

Place the client in a semi-Fowler's position. Explanation:The client should be placed in a semi-Fowler's position to reduce the risk of aspiration. The formula should be at room temperature, not heated. Administering enteral tube feedings is a clean procedure, not a sterile one; therefore, sterile supplies are not required. Clients receiving enteral feedings should be weighed regularly, but not necessarily before each feeding.

The client who experiences angina has been told to follow a low-cholesterol diet. Which of the following meals would be best? a) Hamburger, salad, and milkshake. b) Baked liver, green beans, and coffee. c) Spaghetti with tomato sauce, salad, and coffee. d) Fried chicken, green beans, and skim milk.

Spaghetti with tomato sauce, salad, and coffee. Explanation:Pasta, tomato sauce, salad, and coffee would be the best selection for the client following a low-cholesterol diet. Hamburgers, milkshakes, liver, and fried foods tend to be high in cholesterol

When teaching the parents of an older infant with cystic fibrosis (CF) about the type of diet the child should consume, which of the following would be appropriate? a) High-calorie diet. b) Low-protein diet. c) High-fat diet. d) Low-carbohydrate diet.

High-calorie diet. Explanation:CF affects the exocrine glands. Mucus is thick and tenacious, sticking to the walls of the pancreatic and bile ducts and eventually causing obstruction. Because of the difficulty with digestion and absorption, a high-calorie, high-protein, high-carbohydrate, moderate-fat diet is indicated.

Which client is at greatest risk for coronary artery disease? a) A 65-year-old female who is obese with an LDL of 188 (10.4 mmol/l). b) A 32-year-old female with mitral valve prolapse who quit smoking 10 years ago. c) A 56-year-old male with an HDL of 60 (3.3 mmol/l) who takes atorvastatin. d) A 43-year-old male with a family history of CAD and cholesterol level of 158 (8.8 mmol/l).

A 65-year-old female who is obese with an LDL of 188 (10.4 mmol/l). Explanation:The woman who is 65 years old, overweight and has an elevated LDL is at greatest risk. Total cholesterol > 200 (11.1 mmol/l), LDL >100 (5.5 mmol/l), HDL < 40 (2.2 mmol/l) in men, HDL < 50 (2.8 mmol/l) in women, men 45 years and older, women 55 years and older, smoking and obesity increase the risk of CAD. Atorvastatin is a medication to reduce LDL and decrease risk of CAD. The combination of postmenopausal, obesity, and high LDL cholesterol places this client at greatest risk

A client with Cushing's syndrome is admitted to the hospital and scheduled for a dexamethasone suppression test. During this test, the nurse should: a) Administer an injection of adrenocorticotropic hormone (ACTH) 30 minutes before drawing blood to measure serum cortisol levels. b) Administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning. c) Collect a 24-hour urine specimen to measure serum cortisol levels. d) Draw blood samples before and after exercise to evaluate the effect of exercise on serum cortisol levels.

Administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning. Explanation: When Cushing's syndrome is suspected, a 24-hour urine collection for free cortisol is performed. Levels of 50-100 mcg/day (1379 to 2756 nmol/L) in adults indicate Cushing's syndrome. If these results are borderline, a high-dose dexamethasone suppression test is done. The dexamethsone is given at 11 pm to suppress secretion of corticotropin-releasing hormone. A plasma cortisol sample is drawn at 8:00 am. Normal cortisol level (less than 5 mcg/dl [140 nmol/L]) indicates normal adrenal response. (less)

Which of the following statements by a mother about her child would suggest to the nurse that the child may have celiac disease and should be referred to a health care provider? a) "He is so short." b) "His stools are large and smelly." c) "His urine is so dark in color." d) "His belly is so small."

His stools are large and smelly." Explanation:Celiac disease is a disorder involving intolerance to the protein gluten, which is found in wheat, rye, oats, and barley. The stools of a child with celiac disease are characteristically malodorous, pale, large (bulky), and soft (loose). Excessive flatus is common, and bouts of diarrhea may occur. Dark urine is commonly associated with concentrated urine, such as when a child has dehydration. The belly of a child with celiac disease, a malabsorption disorder, typically is protuberant. A small belly may be associated with a child who is thin. Short stature is not associated with this malabsorption disorder. (

A client's gestational diabetes is poorly controlled throughout her pregnancy. She goes into labor at 38 weeks and gives birth. Which priority intervention should be included in the care plan for the neonate during his first 24 hours? a) Administer insulin subcutaneously. b) Provide frequent early feedings with formula. c) Administer a bolus of glucose I.V. d) Avoid oral feedings.

Provide frequent early feedings with formula. Explanation:The neonate of a mother with gestational diabetes may be slightly hyperglycemic immediately after birth because of the high glucose levels that cross the placenta from mother to fetus. During pregnancy, the fetal pancreas secretes increased levels of insulin in response to this increased glucose amount that crosses the placenta from the mother. However, during the first 24 hours of life, this combination of high insulin production in the neonate coupled with the loss of maternal glucose can cause severe hypoglycemia. Frequent, early feedings with formula can prevent hypoglycemia. Insulin shouldn't be administered because the neonate of a mother with gestational diabetes is at risk for hypoglycemia. A bolus of glucose given I.V. may cause rebound hypoglycemia. If glucose is given I.V., it should be administered as a continuous infusion. Oral feedings shouldn't be avoided because early, frequent feedings can help avoid hypoglycemia

Which information should the nurse include about hypoglycemia when teaching a client newly diagnosed with type 2 diabetes mellitus? Select all that apply. a) Hypoglycemia will not occur unless the client is taking insulin. b) Symptoms of hypoglycemia can include irritability, hunger, shaking, and sweating. c) A carbohydrate food source should be available during strenuous exercise. d) Regular meals and a bedtime snack will decrease the incidence of hypoglycemia. e) Alcohol consumption can increase the incidence of hypoglycemia.

Regular meals and a bedtime snack will decrease the incidence of hypoglycemia. • Symptoms of hypoglycemia can include irritability, hunger, shaking, and sweating. • A carbohydrate food source should be available during strenuous exercise. • Alcohol consumption can increase the incidence of hypoglycemia. Explanation:Regular meals and snacks are encouraged to prevent hypoglycemia. Strenuous exercise and alcohol consumption can increase the likelihood of hypoglycemia. Therefore, monitoring blood glucose and dietary intake are suggested in these situations. Hypoglycemia can occur with oral diabetic agents even when the client is not taking insulin. Symptoms of hypoglycemia vary, but include irritability, hunger, shaking, sweating, confusion, and headache.

A client has been admitted with type 2 diabetes mellitus and asks to have the local medicine man come and help decide what traditional aboriginal medicines could help. What are the appropriate nursing interventions based on this client's request? a) Tell the client that traditional healing methods are not likely to work for control of diabetes. b) Suggest that the client inform and discuss with the interprofessional team how traditional therapies could be integrated into the plan of care. c) Recommend that the client wait until the diabetes is under control and he/she is discharged home before using traditional medicines. d) Let the client know there is a choice and a decision needs to be made as to whether traditional or medical means will be used to control the diabetes.

Suggest that the client inform and discuss with the interprofessional team how traditional therapies could be integrated into the plan of care. Explanation:Respecting the client's choice is an important ethical principle. Ensuring the safety of the combination of treatments is also part of a nurse's responsibilities.

A client with Cushing's disease tells the nurse that the physician said the morning serum cortisol level was within normal limits. The client asks, "How can that be? I'm not imagining all these symptoms!" The nurse's response will be based on which of the following concepts? a) Tumors tend to secrete hormones irregularly, and the hormones are generally not present in the blood. b) A single random blood test cannot provide reliable information about endocrine levels. c) The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern. d) Some clients are very sensitive to the effects of cortisol and develop symptoms even with normal levels.

The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern. Explanation:Cushing's disease is commonly caused by loss of the diurnal cortisol secretion pattern. The client's random morning cortisol level may be within normal limits, but secretion continues at that level throughout the entire day. Cortisol levels should normally decrease after the morning peak. Analysis of a 24-hour urine specimen is often useful in identifying the cumulative excess. Clients will not have symptoms with normal cortisol levels. Hormones are present in the blood.

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane (NPH) insulin to be taken before breakfast. At about 4:30 p.m. (1630), the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? a) The client is experiencing hyperglycemia due to the unusually small dosages of insulin. b) The isophane (NPH) insulin is peaking and causing hypoglycemia. c) The client's potassium level is low due to the hypokalemic effects of insulin. d) The regular insulin is at the end of its duration, which causes hypoglycemia.

The isophane (NPH) insulin is peaking and causing hypoglycemia. Explanation:Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl (3.88 mmol/L). Isophane (NPH) insulin typically peaks at 4-9 hours after administration. However, hypoglycemia may occur 4 to 18 hours after administration of isophane (NPH) insulin suspension or insulin zinc suspension (Lente), both of which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in which serum glucose level is above 180 mg/dl (10 mmol/L), causes such early manifestations as fatigue, malaise, and drowsiness. Intravenous insulin can cause an acute shift in potassium levels leading to hypokalemia, but these signs and symptoms would include muscle weakness and muscle cramps.

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult? a) "I don't understand this; I took the medication the doctor ordered and followed the diet." b) "I don't understand why this happened again; I didn't travel out of the country." c) "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." d) "I don't like oatmeal, so it doesn't matter that I can't have it."

"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." Explanation:The client stating that he ate roast beef on rye bread indicates the need for a dietary consult because rye bread contains gluten, which must be eliminated from the client's diet. The client stating that he's followed the ordered medication regimen and diet doesn't suggest that the client needs a dietary consult; a treatment regimen consisting of medications to improve symptoms and dietary modification is necessary to treat celiac disease. The client stating that he hasn't traveled outside of the country doesn't suggest that dietary concerns exist. The client saying that he can't have oatmeal shows an understanding of the dietary restrictions necessary with celiac disease

The nurse is caring for a client with a nasogastric tube who is due for an enteral feeding. Which of the following assessments by the nurse would indicate the need to withhold at this time? Select all that apply. a) Auscultation of air in the epigastric area when checking placement b) Watery contents upon aspiration with a pH of 5 c) Aspiration of milky contents and reports of nausea d) Distention of the upper abdomen with vomiting e) Material like coffee grounds noted in the nasogastric tube

Aspiration of milky contents and reports of nausea • Distention of the upper abdomen with vomiting • Material like coffee grounds noted in the nasogastric tube Explanation:The client has an order for enteral tube feedings. The aspiration of milky contents and reports of nausea would indicate that the prior feeding has not been tolerated or absorbed.

Which condition most commonly results in coronary artery disease (CAD)? a) Myocardial infarction b) Renal failure c) Diabetes mellitus d) Atherosclerosis

Atherosclerosis Explanation:Atherosclerosis (plaque formation), is the leading cause of CAD. Diabetes mellitus is a risk factor for CAD, but it isn't the most common cause. Myocardial infarction is a common result of CAD. Renal failure doesn't cause CAD, but the two conditions are related.

The nurse is reviewing the laboratory results of a client with hypothyroidism. An expected finding is:

Decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels. Explanation:The nurse should expect to find decreased levels of thyroxine and triiodothyronine and increased thyroid-stimulating hormone. Other indicators of hypothyroidism are the presence of antithyroid antibodies and elevation of the creatine phosphokinase (CPK-MM) level. Hypothyroidism has a metabolic effect on skeletal muscle. Muscle injury results, causing the CPK-MM to spill out of the damaged cells and into the bloodstream

A client is diagnosed with a goiter after traveling in a foreign country for 3 months. During the trip, the client could not tolerate food. Which signs and symptoms would the nurse expect to see in this client? Select all that apply. a) Nonpalpable thyroid gland b) Dysphagia c) Respiratory distress d) Oliguria e) Cardiomegaly f) Dizziness when raising the arms above the head

Dizziness when raising the arms above the head • Dysphagia • Respiratory distress Explanation:A goiter can result from inadequate dietary intake associated with changes in diet or malnutrition. It is caused by insufficient thyroid gland production and depletion of glandular iodine. Signs and symptoms of a goiter include enlargement of the thyroid gland, dizziness when raising the arms above the head, dysphagia, and respiratory distress. Cardiomegaly and oliguria are not associated with a goiter.

A student with type 1 diabetes tells the nurse she is feeling light-headed. The student's blood sugar is 60 mg/dL (3.3 mmol/L). Using the 15-15 rule, the nurse should: a) Give 15 grams of carbohydrate and retest the blood sugar in 15 minutes. b) Give 15 mLs of juice and give another 15 mL in 15 minutes. c) Give 15 ounces of juice and retest in 15 minutes d) Give 15 grams of carbohydrate and 15 grams of protein.

Give 15 grams of carbohydrate and retest the blood sugar in 15 minutes. Explanation:The 15-15 rule is a general guideline for treating hypoglycemia where the client consumes 15 grams of carbohydrate and repeats testing the blood sugar in 15 minutes. Fifteen grams of carbohydrate equals 60 calories and is roughly equal to ½ cup of juice or soda, 6-8 lifesavers, or a tablespoon of honey or sugar. The general recommendation is if the blood sugar is still low, the client may repeat the sequence. Fifteen mLs of juice would only provide 15 calories. This would not be sufficient carbohydrates to treat the hypoglycemia. Protein does not treat insulin-related hypoglycemia; however a protein-starch snack may be offered after the blood glucose improves. Fifteen ounces of juice would be almost 4 times the recommended 4 oz (120 mL) of juice.

An obese white male client, age 49, is diagnosed with hypercholesterolemia. The physician orders a low-fat, low-cholesterol, low-calorie diet to reduce blood lipid levels and promote weight loss. This diet is crucial to the client's well-being because his race, sex, and age increase his risk for coronary artery disease (CAD). To determine whether the client has other major risk factors for CAD, the nurse should assess for: a) alcoholism. b) a history of diabetes mellitus. c) a history of ischemic heart disease. d) elevated high-density lipoprotein (HDL) levels.

a history of diabetes mellitus. Explanation: Diabetes mellitus, smoking, and hypertension are other major risk factors for CAD. Elevated HDL levels aren't a risk factor for CAD; in fact, increased HDL levels seem to protect against CAD. Ischemic heart disease is another term for CAD, not a risk factor. Alcoholism hasn't been identified as a major risk factor for CAD.

A nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: a) increasing saturated fat intake and fasting in the afternoon. b) eating a candy bar if light-headedness occurs. c) increasing intake of vitamins B and D and taking iron supplements. d) consuming a low-carbohydrate, high-protein diet and avoiding fasting.

consuming a low-carbohydrate, high-protein diet and avoiding fasting. Explanation:To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn't help control hypoglycemia

The nurse teaches a client who has recently been diagnosed with hypertension about following a low-calorie, low-fat, low-sodium diet. Which of the following menu selections would best meet the client's needs? a) Hot dogs, baked beans, and celery and carrot sticks. b) Baked chicken, an apple, and a slice of white bread. c) Mixed green salad with blue cheese dressing, crackers, and cold cuts. d) Ham sandwich on rye bread and an orange.

Baked chicken, an apple, and a slice of white bread. Explanation:Processed and cured meat products, such as cold cuts, ham, and hot dogs, are all high in both fat and sodium and should be avoided on a low-calorie, low-fat, low-salt diet. Dietary restrictions of all types are complex and difficult to implement with clients who are basically asymptomatic.

A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?

Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome. (less)

Which of the following statements by the mother of a child who is receiving pancreatic enzymes for the treatment of cystic fibrosis indicates that the mother understands the teaching? a) "I'll give the medication when my child has diarrhea." b) "I can sprinkle the enzymes on food." c) "I should give the medicine about 1 hour before meals." d) "I'll give the enzymes when my child is sick."

I can sprinkle the enzymes on food." Explanation:One problem associated with cystic fibrosis is poor digestion and absorption of foods, especially fats. Pancreatic enzymes can help improve digestion and absorption of nutrients. Therefore, they are given with meals and can be sprinkled on food. They must be taken regularly, not just when the child is sick.

The nurse evaluates the client's understanding of nutritional modifications to manage his hypertension when he states: a) "A glass of red wine each day will lower my blood pressure." b) "If I include less fat in my diet, I'll lower my blood pressure." c) "I should eliminate caffeine from my diet to lower my blood pressure." d) "Limiting my salt intake to 2 grams per day will improve my blood pressure."

Limiting my salt intake to 2 grams per day will improve my blood pressure." Explanation:To lower blood pressure, a client should limit daily salt intake to 2 g or less. Alcohol intake is associated with a higher incidence of hypertension, poor compliance with treatment, and refractory hypertension. Chronic, moderate caffeine intake and fat intake do not affect blood pressure

A client is admitted with fatigue, shortness of breath, pale skin, and dried, cracked lips, tongue, and mouth. The hemoglobin is 9 g/dL (90 g/L) and red blood cell count is 3.5 million cells/mm (3.5 X 1012/L). Which of the following foods should the nurse teach this client to include in the diet? a) Fish, wine, and apples. b) Beef, beets, and cabbage. c) Lamb, applesauce, and mint jelly. d) Chicken, dumplings, and biscuits.

Beef, beets, and cabbage. Explanation:The client is demonstrating signs of anemia. Beef, beets, and cabbage are good sources of iron. Chicken, dumplings, biscuits, fish, applesauce, jelly, and wine are not major iron sources.

A client with microcytic anemia is having trouble selecting food from the hospital menu. Which food is best for the nurse to suggest for satisfying the client's nutritional needs? a) Egg yolks. b) Brown rice. c) Vegetables. d) Tea.

Brown rice. Explanation:Brown rice is a source of iron from plant sources (nonheme iron). Other sources of nonheme iron are whole-grain cereals and breads, dark green vegetables, legumes, nuts, dried fruits (apricots, raisins, dates), oatmeal, and sweet potatoes. Egg yolks have iron but it is not as well absorbed as iron from other sources. Vegetables are a good source of vitamins that may facilitate iron absorption. Tea contains tannin, which combines with nonheme iron, preventing its absorption

A client reports that she has gained weight and that her face and body are "rounder," while her legs and arms have become thinner. A tentative diagnosis of Cushing's disease is made. When examining this client, the nurse would expect to find: a) Decreased body hair. b) Bruised areas on the skin. c) Orthostatic hypotension. d) Muscle hypertrophy in the extremities.

Bruised areas on the skin. Explanation:Skin bruising from increased skin and blood vessel fragility is a classic sign of Cushing's disease. Hyperpigmentation and bruising are caused by the hypersecretion of glucocorticoids. Fluid retention causes hypertension, not hypotension. Muscle wasting occurs in the extremities. Hair on the head thins, while body hair increases. (less)

After a school-age child with insulin-dependent diabetes mellitus attends a teaching session about nutrition, the nurse determines that the teaching has been effective when the child states which of the following? a) "If I'm not hungry for a meal, I can eat the carbohydrates for a snack later." b) "When I don't finish a meal, I must make up the carbohydrates right then." c) "When I don't finish a meal, I just need to take more insulin." d) "If I don't eat all my meal, I can make up the carbohydrates at the next meal."

When I don't finish a meal, I must make up the carbohydrates right then." Explanation:The diabetic diet usually is based on an exchange system that takes into account the fact that some foods have similar fat, carbohydrate, and protein components and therefore can be exchanged one for another. The meal or snack must be eaten in its entirety because it is calculated together with the dose of insulin. If a child does not eat all the meal or snack, then a make-up meal should be given

At a follow-up appointment after being hospitalized, an adolescent with a history of cystic fibrosis (CF) describes his stools to the nurse. Which of the following descriptions should the nurse interpret as indicative of continued problems with malabsorption? a) Large and foul-smelling. b) Soft with little odor. c) Hard with streaks of blood. d) Loose with bits of food.

Large and foul-smelling. Explanation:In children with CF, poor digestion and absorption of foods, especially fats, results in frequent bowel movements that are bulky, large, and foul-smelling. The stools also contain abnormally large quantities of fat, which is called steatorrhea. An adolescent experiencing good control of the disease would describe soft stools with little odor. Stool described as loose with bits of food indicates diarrhea. Stool described as hard with streaks of blood may indicate constipation

Bone resorption is a possible complication of Cushing's disease. Which of the following interventions should the nurse recommend to help the client prevent this complication? a) Limit dietary vitamin D intake. b) Perform isometric exercises. c) Maintain a regular program of weight-bearing exercise. d) Increase the amount of potassium in the diet.

Maintain a regular program of weight-bearing exercise. Explanation:Osteoporosis is a serious outcome of prolonged cortisol excess because calcium is resorbed out of the bone. Regular daily weight-bearing exercise (e.g., brisk walking) is an effective way to drive calcium back into the bones. The client should also be instructed to have a dietary or supplemental intake of calcium of 1,500 mg daily. Potassium levels are not relevant to prevention of bone resorption. Vitamin D is needed to aid in the absorption of calcium. Isometric exercises condition muscle tone but do not build bones.

A client hospitalized for treatment of hypertension is being prepared for discharge. Which teaching topic should the nurse should be sure to cover? a) Maintaining a low-potassium diet b) Maintaining a low-sodium diet c) Skipping a medication dose if dizziness occurs d) Receiving I.V. antihypertensive medications

Maintaining a low-sodium diet Explanation:The nurse must teach the hypertensive client how to modify his diet to restrict sodium and saturated fats. In addition to teaching about adverse effects of ordered antihypertensives, she must discuss the actions and dosages of these drugs. A client receiving antihypertensives may also take a diuretic as part of the drug regimen and thus may require dietary potassium supplements and high-potassium foods to avoid electrolyte disturbances. Instead of skipping medication if dizziness occurs, the client should notify the physician of this symptom. The client receiving antihypertensives at home takes them by mouth, not I.V

A diabetic client has been diagnosed with hypertension and the physician has prescribed atenolol (Tenormin), a beta blocker. When performing discharge teaching, it is important for the client to recognize that the addition of Tenormin can cause: a) An increase in the incidence of ketoacidosis. b) An increase in the hypoglycemic effects of insulin. c) A decrease in the incidence of ketoacidosis. d) A decrease in the hypoglycemic effects of insulin.

An increase in the hypoglycemic effects of insulin. Explanation:There is a direct interaction between the effects of insulin and those of beta blockers. The nurse must be aware that there is a potential for increased hypoglycemic effects of insulin when a beta blocker is added to the client's medication regimen. The client's blood sugar should be monitored. Ketoacidosis occurs in hyperglycemia. Although a decrease in the incidence of ketoacidosis could occur when a beta blocker is added, the direct result is an increase in the hypoglycemic effect of insulin

After surgery to repair a tracheoesophageal fistula, an infant receives gastrostomy tube feedings. After feeding the infant by this method, the nurse cradles and rocks the infant for about 15 minutes, primarily to help accomplish which of the following? a) Prevent regurgitation of formula. b) Relieve pressure on the surgical site. c) Promote intestinal peristalsis. d) Associate eating with a pleasurable experience.

Associate eating with a pleasurable experience. Explanation:The nurse can help meet the psychological needs of an infant being fed through a gastrostomy tube by rocking the infant after a feeding. The infant soon learns to associate eating with a pleasurable experience and learns to trust the caregiver. Rocking the infant will not promote peristalsis or prevent regurgitation. Holding the baby will not relieve pressure on the surgical site. However, holding the child right after feeding promotes comfort and pleasure.

Which nursing intervention should the nurse perform for a client receiving enteral feedings through a gastrostomy tube? a) Maintain the client on bed rest during the feedings. b) Maintain the head of the bed at a 15-degree elevation continuously. c) Change the tube feeding administration set at least every 24 hours. d) Check the gastrostomy tube for position every 2 days.

Change the tube feeding administration set at least every 24 hours. Explanation:The nurse should change tube feeding administration sets at least every 24 hours. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings

The nurse is assessing the client's use of medications. Which of the following medications may cause a complication with the treatment plan of a client with diabetes? a) Steroids. b) Sulfonylureas. c) Aspirin. d) Angiotensin-converting enzyme (ACE) inhibitors.

Steroids. Explanation:Steroids can cause hyperglycemia because of their effects on carbohydrate metabolism, making diabetic control more difficult. Aspirin is not known to affect glucose metabolism. Sulfonylureas are oral hypoglycemic agents used in the treatment of diabetes mellitus. ACE inhibitors are not known to affect glucose metabolism.

A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? a) Tetany b) Hemorrhage c) Thyroid storm d) Laryngeal nerve damage

Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

A client with type 2 diabetes mellitus needs instruction on proper foot care. Which instructions should the nurse include in client teaching? Select all that apply. a) Wear cotton socks. b) See a podiatrist regularly to have your feet checked. c) Go barefoot only when you know your home environment. d) Apply foot powder after bathing. e) Use scissors to trim toenails. f) Wear loose-fitting shoes.

Wear cotton socks. • Apply foot powder after bathing. • See a podiatrist regularly to have your feet checked. Explanation:Foot care for a client with diabetes mellitus includes keeping the feet dry with the application of foot powder and wearing cotton socks to absorb moisture. The client should have a podiatrist check the feet regularly to detect problems early. To prevent injury to the feet, the client should be instructed not to cut the toenails with scissors, walk barefoot, or wear loose-fitting shoes.

Which nursing intervention should the nurse perform for a client receiving enteral feedings through a gastrostomy tube? a) Check the gastrostomy tube for position every 2 days. b) Maintain the client on bed rest during the feedings. c) Maintain the head of the bed at a 15-degree elevation continuously. d) Change the tube feeding administration set at least every 24 hours.

Change the tube feeding administration set at least every 24 hours. Explanation:The nurse should change tube feeding administration sets at least every 24 hours. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to.

A client comes to the clinic because she has experienced a weight loss of 20 lb (9.1 kg) over the last month, even though her appetite has been "ravenous" and she hasn't changed her activity level. She's diagnosed with Graves' disease. Which other signs and symptoms support the diagnosis of Graves' disease? Select all that apply. a) Rapid, bounding pulse b) Mild tremors c) Constipation d) Bradycardia e) Nervousness f) Heat intolerance

Rapid, bounding pulse • Heat intolerance • Mild tremors • Nervousness Explanation:Graves' disease, or hyperthyroidism, is a hypermetabolic state that's associated with rapid, bounding pulses; heat intolerance; tremors; and nervousness. Bradycardia and constipation are signs and symptoms of hypothyroidism.

The nurse advises a client recovering from a myocardial infarction to decrease fat and sodium intake. Which foods should the nurse instruct the client to avoid? Select all that apply. a) Apple juice b) Soft drinks c) Pepperoni pizza d) Bacon e) Cheese f) Oatmeal

Soft drinks • Pepperoni pizza • Bacon • Cheese Explanation:Foods high in sodium include cheese, processed meats such as pepperoni and bacon, and soft drinks. Bacon and cheese also have a high fat content.

A nurse is teaching the parents of a child with cystic fibrosis about proper nutrition. Which instruction should the nurse include? a) Encourage foods high in vitamin B. b) Limit salt intake to 2 g per day. c) Restrict fluids to 1,500 ml per day. d) Encourage a high-calorie, high-protein diet.

Encourage a high-calorie, high-protein diet. Explanation:The child should be encouraged to eat a high-calorie, high-protein diet. In cystic fibrosis, the pancreatic enzymes (lipase, trypsin, and amylase) become so thick that they plug the ducts. In the absence of these enzymes, the duodenum can't digest fat, protein, and some sugars; therefore, the child can become malnourished. A child with cystic fibrosis needs to drink plenty of fluid and take salt supplements, especially on warm days or when exercising, to help maintain hydration and adequate sodium levels. Water-soluble forms of the fat-soluble vitamins (A, D, E, and K) are essential

A nurse is reviewing laboratory values for a client diagnosed with hyperlipidemia 6 months ago. Which results indicate that the client has been following his therapeutic regimen? a) Low density lipoproteins (LDL) increase from 180 mg/dl (4.66 mmol/L to 190 mg/dl (4.92 mmol/L). b) Total cholesterol level increases from 250 mg/dl to 275 mg/dl (6.48 mmol/L to 7.12 mmol/L). c) High density lipoproteins (HDL) increase from 25 mg/dl (0.65 mmol/L) to 40 mg/dl (1.03 mmol/L). d) Triglycerides increase from 225 mg/dl (5.83 mmol/L) to 250 mg/dl (6.47 mmol/L).

High density lipoproteins (HDL) increase from 25 mg/dl (0.65 mmol/L) to 40 mg/dl (1.03 mmol/L). Explanation:The goal of treating hyperlipidemia is to decrease total cholesterol and LDL levels while increasing HDL levels. HDL levels should be greater than 35 mg/dl. This client's increased HDL levels indicate that he's followed his therapeutic regimen. Recommended total cholesterol levels are below 200 mg/dl. LDL levels should be less than 160 mg/dl, or, in clients with known coronary artery disease (CAD) or diabetes mellitus, less than 70 mg/dl. Triglyceride levels should be between 100 and 200 mg/d.

The nurse is teaching an adolescent with celiac disease about dietary changes that will help maintain a healthy lifestyle. Which of the following foods can the nurse safely recommend as part of the adolescent's diet? Select all that apply. a) Apples b) Pizza c) Corn d) Potatoes e) Bagels

Potatoes • Apples • Corn Explanation: Celiac disease is an intolerance to the gluten factor of protein found in grains. Specific grains to be removed from the diet include wheat, rye, oats, and barley. Clients with a diagnosis of celiac disease can tolerate corn, fruits, and vegetables

A nurse is giving nutritional counseling to the mother of a child with celiac disease. Which statement by the mother indicates understanding? a) "My son can safely eat frozen and packaged foods." b) "My son needs a gluten-rich diet." c) "My son can't eat wheat, rye, oats, or barley." d) "My son must avoid potatoes, rice, and cornstarch."

My son can't eat wheat, rye, oats, or barley." Explanation:A child with celiac disease must follow a gluten-free diet. If the child eats foods containing gluten, changes in the intestinal mucosa will prevent the absorption of fats and other foods. Therefore, all foods containing wheat, rye, oats, and barley must be eliminated from the diet. Such foods as potatoes, rice, and cornstarch may be included in a gluten-free diet. Frozen and packaged foods, which may contain gluten fillers, should be avoided.

he client with diabetes mellitus says, "If I could just avoid what you call carbohydrates in my diet, I guess I would be okay." The nurse should base the response to this comment on the knowledge that diabetes affects metabolism of which of the following? a) Fats and carbohydrates only. b) Proteins, fats, and carbohydrates. c) Carbohydrates only. d) Protein and carbohydrates only.

Proteins, fats, and carbohydrates. Explanation: Diabetes mellitus is a multifactorial, systemic disease associated with problems in the metabolism of all food types. The client's diet should contain appropriate amounts of all three nutrients, plus adequate minerals and vitamins.

During assessment of a child with celiac disease, the nurse should most likely note which of the following physical findings? a) Tender inguinal lymph nodes. b) Enlarged liver. c) Periorbital edema. d) Protuberant abdomen.

Protuberant abdomen. Explanation:The intestines of a child with celiac disease fill with accumulated undigested food and flatus, causing the characteristic protuberant abdomen. Celiac disease is not usually associated with any liver dysfunction, including poor liver functioning leading to liver enlargement. Tender inguinal lymph nodes are often associated with an infection. Periorbital edema, swelling around the eyes, is associated with nephritis.

After a bilateral adrenalectomy for Cushing's disease, the client will receive periodic testosterone injections. The expected outcome of these injections is: a) Stabilized mood swings. b) Stimulated protein metabolism. c) Restored sodium and potassium balance. d) Balanced reproductive cycle.

Stimulated protein metabolism. Explanation: Testosterone is an androgen hormone that is responsible for protein metabolism as well as maintenance of secondary sexual characteristics; therefore, it is needed by both males and females. Removal of both adrenal glands necessitates replacement of glucocorticoids and androgens. Testosterone does not balance the reproductive cycle, stabilize mood swings, or restore sodium and potassium balance.

The nurse is caring for an infant diagnosed with nonorganic failure to thrive. Which action should be included in the plan of care for the infant? a) Reporting the parents to social services for suspected abuse b) Requiring the parents to attend a community support group prior to discharge c) Suggesting to the infant's mother to continue to try to feed the infant even when the infant is crying d) Weighing the unclothed infant at the same time every day

Weighing the unclothed infant at the same time every day planation:Daily weights are an appropriate intervention for an infant with failure to thrive. It would be inappropriate for the nurse to encourage the mother to continue to try to feed the infant when crying because the infant may develop further aversion to eating. It is also inappropriate to assume that abuse has taken place; there is no information in the stem to suggest this. The parents would benefit from a community support group; however, the nurse cannot require the parents to attend a community support group prior to discharge

A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. His cholesterol profile is as follows: total cholesterol 265 mg/dl (6.845 mmol/L), low-density lipoprotein (LDL) 139 mg/dl (3.603 mmol/L), and high-density lipoprotein (HDL) 32 mg/dl (0.829 mmol/L). The client asks the nurse how to lower his cholesterol. The nurse should tell the client that: a) he should begin a running program, working up to 2 miles (3.2 km) per day. b) she'll ask the dietitian to talk with him about modifying his diet. c) his cholesterol is within the recommended guidelines and he doesn't need to lower it. d) he should take his statin medication and not worry about his cholesterol.

she'll ask the dietitian to talk with him about modifying his diet. Explanation:A dietitian can help the client decrease the fat in his diet and make other beneficial dietary modifications. This client's total cholesterol isn't within the recommended guidelines; it should be less than 200 mg/dl (5.172 mmol/L). LDL should be less than 79 mg/dl (2.043 mmol/L), and HDL should be greater than 40 mg/dl (1.034 mmol/L). Although this client should take his statin medication, he should still be concerned about his cholesterol level and make other lifestyle changes, such as dietary changes, to help lower it. The client should increase his activity level, but he doesn't need to run 2 miles (3.2 km) per day.

The unconscious client is to receive 200 mL of tube feeding every 4 hours. The nurse checks for the client's gastric residual before administering the next scheduled feeding and obtains 40 mL of gastric residual. The nurse should: a) Dispose of the residual and continue with the feeding. b) Delay feeding the client for 1 hour and then recheck the residual. c) Readminister the residual to the client and continue with the feeding. d) Withhold the tube feeding and notify the physician.

Readminister the residual to the client and continue with the feeding. Explanation:Gastric residuals are checked before administration of enteral feedings to determine whether gastric emptying is delayed. A residual of less than 50% of the previous feeding volume is usually considered acceptable. In this case, the amount is not excessive and the nurse should reinstill the aspirate through the tube and then administer the feeding. If the amount of gastric residual is excessive, the nurse should notify the physician and withhold the feeding. Disposing of the residual can cause electrolyte and fluid losses

A client is diagnosed with diabetes mellitus. Which assessment findings best support a nursing diagnosis of ineffective coping related to diabetes mellitus? Select all that apply. a) Failure to purchase diabetic test strips for glucose monitor b) Skipping insulin doses during illness c) Changes the subject whenever diabetes is mentioned d) Refuses to attend diabetic support meetings e) Recent weight gain of 20 lb. (9.1 kg)

Refuses to attend diabetic support meetings • Changes the subject whenever diabetes is mentioned Explanation:Ineffective coping includes denial or lack of acceptance of the disease. Weight gain, skipping insulin, and failure to purchase strips indicates noncompliance. The other options, refuses to attend and changing the subject, indicates denial or refusal to accept the disease

If a client displays risk factors for coronary artery disease, such as smoking cigarettes, eating a diet high in saturated fat, or leading a sedentary lifestyle, techniques of behavior modification may be used to help the client change the behavior. The nurse can best reinforce new adaptive behaviors by: a) Instilling mild fear into the client to extinguish the behavior. b) Withholding praise until the new behavior is well established. c) Explaining how the risk factor behavior leads to poor health. d) Rewarding the client whenever the acceptable behavior is performed.

Rewarding the client whenever the acceptable behavior is performed. Explanation:A basic principle of behavior modification is that behavior that is learned and continued is behavior that has been rewarded. Other reinforcement techniques have not been found to be as effective as reward.

The antenatal clinic nurse is educating a client with gestational diabetes soon after diagnosis. Outcome evaluation for this client session will include which of the following? (Select all that apply.) a) The client states the need to maintain blood glucose levels between 70 to 110 mg/dl (3.9 to 6.2 mmol/l). b) The client verbalizes the need to maintain a dietary intake of less than 1500 calories/day to prevent hyperglycemia. c) The client will continue her prenatal vitamins, iron, and folic acid. d) The client will strive to maintain a hemoglobin A1C < 6% (0.06). e) The client describes the walking program she will continue while pregnant.

The client states the need to maintain blood glucose levels between 70 to 110 mg/dl (3.9 to 6.2 mmol/l). • The client describes the walking program she will continue while pregnant. • The client will strive to maintain a hemoglobin A1C < 6% (0.06). • The client will continue her prenatal vitamins, iron, and folic acid. Explanation:The client with gestational diabetes needs to maintain blood glucose levels as close to "normal" as the pregnant woman without diabetes. Walking is an excellent form of exercise for anyone and works well for pregnant women with diabetes because it burns calories, accelerates the heart rate, and as a result maintains the blood glucose at a lower level. During pregnancy continuously high blood glucose levels (HgbA1C > 6 mg/dl [0.06]) carry risks for the dyad. The suggested diet for a client with gestational diabetes is 1800 to 2400 calories/day to avoid the body breaking down maternal fat to maintain blood glucose levels. Continuing prenatal vitamins, iron, and folic acid (800 mcg/day) are general nutritional recommendations for pregnancy

A nurse records a client's history and discovers several risk factors for coronary artery disease (CAD). Which cardiac risk factors can the client control? a) Diabetes, age, and gender b) Age, gender, and heredity c) Diabetes, hypercholesterolemia, and heredity d) Diabetes, hypercholesterolemia, and hypertension

Diabetes, hypercholesterolemia, and hypertension Explanation:Controllable risk factors for CAD include hypertension, hypercholesterolemia, obesity, lack of exercise, smoking, diabetes mellitus, stress, alcohol abuse, and use of hormonal contraceptives. Uncontrollable risk factors for CAD include gender, age, and heredity

Which nursing action is essential when providing continuous enteral feeding? a) Elevating the head of the bed b) Adding methylene blue to the enteral feeding to detect aspiration c) Positioning the client on his left side d) Warming the formula before administering it

Elevating the head of the bed Explanation:Elevating the head of the bed during enteral feeding minimizes the risk of aspiration and allows the formula to flow into the client's intestines. When such elevation is contraindicated, the client should be positioned on his right side. The nurse should give enteral feedings at room temperature to minimize GI distress. Because methylene blue can cause adverse effects, it isn't a recommended enteral feeding additive.

At a previous visit, the parents of an infant with cystic fibrosis received instruction in the administration of pancrelipase (Pancrease). At a follow-up visit, which finding in the infant suggests that the parents require more teaching about administering the pancreatic enzymes? a) Bloody stools b) Normal stools c) Fatty stools d) Liquid stools

Fatty stools Explanation:Pancreatic enzymes normally aid in food digestion in the intestine. In a child with cystic fibrosis, however, these natural enzymes cannot reach the intestine because mucus blocks the pancreatic duct. Without these enzymes, undigested fats and proteins produce fatty stools. If the parents were administering the pancreatic enzymes correctly, the child would have stools of normal consistency. Noncompliance doesn't cause liquid or bloody stools