Study Plan/Extra Questions - Metabolism, Osteoporosis, and Thyroid Disease

The nurse performing a nutritional assessment on an older adult should understand that which pancreatic​ age-related change can affect the​ client's nutritional​ needs? A. Intolerance of fatty foods B. Increase in fat absorption C. Increase in the production of lipase D. Decrease in absorption of​ water-soluble vitamins

A. Intolerance of fatty foods ​Rationale: In the older​ adult, there is a decrease in the production of lipase with reduced fat absorption and​ digestion, leading to intolerance of fatty foods and indigestion. Further changes in the pancreas of the older adult result in a decreased absorption of​ fat-soluble vitamins.

A client is admitted for treatment of possible cirrhosis. Which diagnostic test should the nurse expect to be prescribed for this​ client? (Select all that​ apply.) A. Lactate dehydrogenase​ (LDH) B. Alanine aminotransferase​ (ALT) C. Thyroid stimulating hormone​ (TSH) D. Aspartate aminotransferase​ (AST) E. Serum glutamic oxaloacetic transaminase​ (SGOT)

A. Lactate dehydrogenase​ (LDH) B. Alanine aminotransferase​ (ALT) D. Aspartate aminotransferase​ (AST) E. Serum glutamic oxaloacetic transaminase​ (SGOT) ​Rationale: Cirrhosis affects the liver. Diagnostic tests to assess liver enzymes include​ AST, ALT,​ LDH, and SGOT. TSH assesses thyroid function.

For which alteration in metabolism would the expertise of an exercise physiologist be​ applicable? (Select all that​ apply.) A. Osteoporosis B. Cirrhosis C. Obesity D. Diabetes E. Thyroid disease

A. Osteoporosis C. Obesity D. Diabetes Rationale: Exercise physiologists provide strategies to increase physical activity to control​ diabetes, obesity, and osteoporosis. The expertise of an exercise physiologist may not be helpful in the collaborative treatment of the client with cirrhosis or thyroid disease.

The nurse is teaching a group of adults at a community health fair about hypothyroidism. Which risk factor should the nurse include in the​ presentation? (Select all that​ apply.) A. Radioactive iodine treatment B. Autoimmune disease C. Thyroid surgery D. Radiation of the neck E. Male sex

A. Radioactive iodine treatment B. Autoimmune disease C. Thyroid surgery D. Radiation of the neck ​Rationale: Risk factors for hypothyroidism include having an autoimmune​ disease, having a family member with an autoimmune​ disease, previous treatment with radioactive​ iodine, radiation of the​ neck, thyroid​ surgery, and female sex.

The nurse is preparing a client with hyperthyroidism for radioactive iodine treatments. Which information should the nurse provide to the client prior to this​ procedure? (Select all that​ apply.) A. That the client may need lifelong thyroid replacement B. That radioactive iodine is given intravenously C. How to measure the radial pulse D. That the end results are immediately seen E. That hospitalization is usually required

A. That the client may need lifelong thyroid replacement C. How to measure the radial pulse ​Rationale: Clients are instructed on measuring their own pulse until stores of thyroid hormone are depleted and notifying the healthcare provider if the heart rate is over 100 beats per minute. The client will more than likely require lifelong thyroid replacement due to radiation effects on the remaining thyroid tissue. The results may take up to 6 to 8 weeks to notice. This procedure is performed with an oral contrast on an outpatient basis.

The nurse is preparing information about hormone imbalances associated with obesity. Which hormone should the nurse include in this​ presentation? (Select all that​ apply.) A. Thyroid hormone B. Epinephrine C. Insulin D. Leptin E. Norepinephrine

A. Thyroid hormone C. Insulin D. Leptin ​Rationale: Hormones involved in regulating obesity include thyroid​ hormone, insulin, and leptin. Epinephrine and norepinephrine stimulate the​ heart, constrict blood​ vessels, inhibit visceral​ muscles, dilate​ bronchioles, and increase respiration and metabolism.

The nurse is caring for a client newly diagnosed with osteoporosis who​ states, "I know I need the extra​ calcium, but I​ don't eat any dairy​ products." Which statement by the nurse provides the client with information for obtaining additional dietary​ calcium? A. ​"Increase your consumption of​ vegetables." B. ​"You can increase your consumption of​ meat." C. ​"Seafood is an excellent source of​ calcium." D. ​"Many types of pasta are an excellent source of​ calcium."

A. ​"Increase your consumption of​ vegetables." ​Rationale: The​ statement, "Increase your consumption of​ vegetables," provides information on an excellent source of calcium.​ Seafood, meat, and pasta are not excellent sources of calcium. Seafood should be consumed cautiously during​ pregnancy, as it contains high levels of mercury.

Which physical assessment is most appropriate to include when identifying thyroid​ problems? (Select all that​ apply.) A. Medication history B. Auscultation C. Observation D. Palpation E. Percussion

C. Observation D. Palpation Rationale: Observation,​ palpation, and taking a family history are useful ways of identifying thyroid health problems. Palpation is used to determine the​ location, size, and nodules of the thyroid. Auscultation and percussion are not appropriate methods for this assessment. A medication history would be assessed in the health​ history, not the physical assessment.

Which nursing intervention is most appropriate for a client experiencing a thyroid​ storm? A. Administering antithyroid medication B. Replacing lost fluids C. Padding the side rails D. Cooling the client

C. Padding the side rails Rationale: The client experiencing a thyroid storm is at high risk for developing seizures.​ Therefore, the nurse would promote safety by padding the side rails. Cooling the​ client, replacing lost​ fluids, and administering antithyroid medications are appropriate interventions to treat the disorder but are not related to promoting client safety.

The nurse includes which of the following when teaching the patient with osteoporosis about preventive measures for complications of osteoporosis? A.Infection B.Blood clots C.Fractures D.Contractures

C. Fractures In patients with osteoporosis, fractures are a potential complication due to decalcification of bones. Infection, blood clots, and contractures are not necessarily associated with osteoporosis.

•A 67-year-old patient asks the nurse about osteoporosis. The nurse responds that osteoporosis can be defined as which of the following? A.Loss of bone matrix B.New, weaker bone growth C.Loss of bone density D.Increased phagocytic activity

C. Loss of bone density • •Osteoporosis is loss of bone density. Specific causes in older adults include vitamin D and calcium deficiencies and the use of glucocorticoid drugs. Phagocytic activity is not a contributing factor here. Osteoporosis is bone degeneration, not growth. Bone matrix refers to the structure or scaffolding of the bone, which is not lost; the bone softens.

Which client is at the greatest risk for developing​ hypothyroidism? A. A​ 72-year-old man whose father had cardiovascular disease B. A​ 32-year-old man who has an uncle with type 1 diabetes mellitus C. A​ 21-year-old woman who has a mother with Graves disease D. A​ 57-year-old woman whose aunt had systemic lupus erythematosus

D. A​ 57-year-old woman whose aunt had systemic lupus erythematosus Risk factors for hypothyroidism include being a woman over the age of​ 50, having a close relative with an autoimmune​ condition, and having treatment for a thyroid disorder. The​ 57-year-old woman whose aunt had systemic lupus erythematosus has three risk​ factors: gender,​ age, and family history. The other individuals have only one or two risk factors.

The nurse is reviewing the chart of a child diagnosed with precocious puberty. Which factor should be monitored throughout the​ client's childhood and​ adolescence? A. Behavioral development B. Neurological development C. Cognitive development D. Musculoskeletal development

D. Musculoskeletal development ​Rationale: The​ child's musculoskeletal development will be closely monitored. Precocious puberty results in early puberty in​ children, typically before the age of 8 years in girls and before the age of 9 years in boys. Precocious puberty can result in early closure of epiphyseal plates in the bones and thus short stature. Precocious puberty does not affect​ behavioral, cognitive, or neurologic development.

A client with type 2 diabetes mellitus​ states, "I am so frustrated. I cannot stick to the diet that I am supposed​ to." Which intervention should the nurse consider most helpful in supporting the​ client? A. Scheduling the client to revisit the dietician B. Instructing the client to engage in more exercise C. Instructing the client to maintain a food log for 24 hours D. Obtaining a consult for behavioral therapy

D. Obtaining a consult for behavioral therapy Rationale: The intervention that will be most helpful to the client is to obtain a consult for behavioral therapy. A behavioral therapist may be helpful for clients who have difficulty making changes on their own. Revisiting the dietician will not change the​ client's behavior. A food log may be incorporated into the behavioral​ therapy, but maintaining a food log alone will not be helpful in changing the​ client's behavior. Dietary behavior cannot be corrected through exercise.

The nurse reviews the laboratory results for a client and notes that the T4 level is low. Which prescription should the nurse anticipate the healthcare provider to​ prescribe? A. Beta blocker B. Radioactive iodine C. Antithyroid medications D. Thyroid replacement

D. Thyroid replacement Rationale: The treatment of choice for hypothyroidism is the thyroid hormone replacement​ drug, levothyroxine.​ Therefore, the nurse would expect the healthcare provider to prescribe this medication. Radioactive iodine and antithyroid medications are used in the treatment of hyperthyroidism. A beta​ blocker, such as​ propranolol, is used to lower the heart rate in clients with hyperthyroidism.

A nurse is caring for an adult client recently diagnosed with hypothyroidism. After reviewing the nursing admission​ assessment, on which documented findings should the nurse plan care for this​ client? Select all that apply. A. Constipation B. Tachycardia C. Nausea D. Hypothermia E. Hot flashes

A. Constipation D. Hypothermia Hypothyroidism is often accompanied by hypothermia and​ constipation, among other symptoms. Hot​ flashes, tachycardia, and nausea are not symptoms of hypothyroidism.

Which nursing assessment should the nurse monitor for when caring for a client with an adrenal gland​ disorder? A. Alteration in perfusion B. Abnormal circadian rhythms C. Symptoms of hypoglycemia D. Muscle tetany

A. Alteration in perfusion ​Rationale: Adrenal gland disorders affect the cardiovascular fluid volume of the client and therefore can alter tissue and organ perfusion. Muscle tetany is associated with hypoparathyroidism. Hypoglycemia is monitored in a client with​ diabetes, which is a pancreatic disorder. Abnormal circadian rhythms occur in the client with a pineal gland disorder.

The nurse is caring for a newborn born to a mother with uncontrolled hyperthyroidism during pregnancy. What complication should the nurse monitor the newborn​ for? A. Breathing problems B. Slow heart rate C. Late closure of fontanels D. Rapid weight gain

A. Breathing problems Hyperthyroidism in a newborn can result in a rapid heart​ rate, leading to heart​ failure; early closure of​ fontanels; poor weight​ gain; and breathing issues due to an enlarged thyroid gland that presses against the trachea. Because of these possible clinical​ manifestations, it is essential that the newborn be closely monitored by the healthcare team.

A woman at​ 16-weeks' gestation asks the​ nurse, "How is my baby getting any nutrition to​ grow?" The​ nurse's response should be based on which​ understanding? A. Human placental lactogen helps provide maternal nutrition to the growing fetus. B. Progesterone and estrogen support the growing fetus. C. Prolactin stimulates the transfer of maternal nutrients to the growing fetus. D. Human chorionic gonadotropin​ (hCG) is produced by the cells and facilitates intrauterine nutrition.

A. Human placental lactogen helps provide maternal nutrition to the growing fetus. ​Rationale: Human placental lactogen plays a role in providing maternal nutrition to the growing fetus. Progesterone and estrogen stimulate uterine development and maintain the pregnancy. Human chorionic gonadotropin​ (hCG) is produced by the cells around the embryo and will eventually form the placenta. Prolactin stimulates milk production in the female breast after delivery.

The nurse is caring for a client with Addison disease. For which priority assessment will the nurse monitor the​ client? A. Intake and output B. Edema C. Renal calculi D. Muscle stiffness

A. Intake and output Rationale: Monitoring intake and output is a priority assessment for the client with Addison disease. The client with Addison disease is at risk for hypovolemia due to a decrease in​ aldosterone, which results in sodium and water loss. The client with Cushing syndrome has an increased amount of​ aldosterone, causing increased sodium and water​ retention, which may result in hypervolemia. Renal calculi are associated with​ hyperparathyroidism, which is characterized by increased serum calcium levels. Muscle​ weakness, not​ stiffness, is characteristic of Addison disease.

The nurse is reviewing the chart of a client diagnosed with acromegaly. Which collaborative treatment should the nurse​ expect? A. Lowering the production of growth hormone B. Increasing dietary calcium C. Providing a synthetic growth hormone D. Initiating a thyroid stimulating hormone

A. Lowering the production of growth hormone Rationale: Acromegaly results from the abnormal secretion of growth hormone from the pituitary gland. The treatment for acromegaly focuses on lowering the production of the growth hormone. Initiating a thyroid stimulating​ hormone, administering a synthetic growth​ hormone, and increasing calcium in the diet are not treatment goals for a client with acromegaly.

Which should be the​ nurse's priority assessment for a client diagnosed with a tumor in the thymus​ gland? A. Patent airway B. Cardiac output C. Neurological status D. Renal output

A. Patent airway ​Rationale: The priority nursing care for the client is to monitor the​ client's airway. A tumor that develops in the thymus can press on the trachea and make breathing difficult. Renal output will be affected if the​ client?s cardiac output decreases. Cardiac output should not be​ affected; however, a tumor on the thymus gland can also block the superior vena​ cava, causing swelling of the arms and face. The client will experience neurologic changes if not receiving adequate oxygenation.

The nurse is caring for a newborn diagnosed with hyperthyroidism after birth. Ongoing assessments during the first year of life should be conducted to monitor for which​ alteration? (Select all that​ apply.) A. Premature fontanelle closure B. Heart failure C. Respiratory difficulties D. Bradycardia E. Nonpalpable thyroid gland

A. Premature fontanelle closure B. Heart failure C. Respiratory difficulties Rationale: An infant with hyperthyroidism would have higher metabolic​ rates, leading to tachycardia and heart failure. The infant may develop respiratory difficulties from an enlarged thyroid pressing on the trachea. The fontanelles will also close prematurely. The thyroid gland will be palpable.

The nurse is caring for a client with osteoporosis with a primary focus on preventing injury at night. Which is the best nursing intervention for the nurse to implement to maintain the safety of the​ client? A. Providing lighting in toilet facilities B. Increasing the​ client's use of assistive devices C. Keeping the side rails up on the bed at all times D. Restricting fluids at night to decrease nocturia

A. Providing lighting in toilet facilities Rationale: The nursing intervention that will maintain the safety of the client with osteoporosis is to provide lighting in the toilet facilities. Increasing the use of assistive devices would be dependent on the​ client's overall health. The client should only use the assistive devices that are necessary on which she has been properly fitted and trained. Restricting fluids to decrease nocturia is inappropriate and places the client at risk for dehydration and hypovolemia. It is not necessary to keep the side rails up on the bed at all times. The side rails should be kept up if indicated to prevent the client from getting out of bed alone.

The nurse is caring for a client with advanced osteoporosis who implemented the use of a heating pad in the treatment of pain. Which action by the nurse demonstrates appropriate use of the heating​ pad? A. Removing the heat every 20 to 30 minutes B. Alternating the heat with an ice pack every 30 minutes C. Encouraging the use of the heat before the client ambulates D. Utilizing the heat if the prescribed pain medication does not work

A. Removing the heat every 20 to 30 minutes Rationale: The heat should be removed every 20 to 30 minutes to avoid a rebound effect from too much heat. Ice is not used in the treatment of pain for the client with osteoporosis. The heat should be utilized when the client experiences discomfort and can be used with or without the use of pain medication.

The nurse is providing teaching on the prevention of osteoporosis. Which modifiable risk factor can increase a​ client's risk of developing​ osteoporosis? (Select all that​ apply.) A. Smoking B. Excessive alcohol consumption C. Sedentary lifestyle D. Consumption of milk products E. Moderate exercise

A. Smoking B. Excessive alcohol consumption C. Sedentary lifestyle Rationale: Individuals who spend a lot of time sitting have a higher risk of osteoporosis than do their more active counterparts. Excessive alcohol consumption can interfere with the​ body's ability to absorb calcium. Tobacco use contributes to weak bones. The consumption of milk products and moderate exercise are both lifestyle choices that decrease the risk of​ osteoporosis, not contribute to the development of osteoporosis.

The nurse is reviewing the chart of a client with osteoporosis. Which physical assessment finding should the nurse​ anticipate? A. Spinal curvature B. Generalized pain C. Unsteady gait D. Poor posture

A. Spinal curvature ​Rationale: The assessment findings associated with osteoporosis include spinal curvature. An unsteady​ gait, poor​ posture, and generalized pain are not findings associated with the physical assessment findings of osteoporosis.

The nurse is caring for an older adult who is visually impaired and at risk for osteoporosis. Which activity is most appropriate to implement for the prevention of​ osteoporosis? A. Strength and balance training B. Walking on a treadmill C. Swimming D. Aerobics

A. Strength and balance training Rationale: Strength and balance training is the​ safest, most appropriate plan for exercise for the visually impaired client at risk for osteoporosis. Aerobics and walking on a treadmill are not the safest choices for a visually impaired client. The client may lose balance as well as not be able to adjust or stop a treadmill if needed. Swimming is not a​ weight-bearing exercise.​ Weight-bearing exercises influence the bone metabolism necessary to prevent osteoporosis.

The nurse is teaching a client with osteoporosis who has been prescribed calcium citrate supplements. Which information should the nurse include in the​ teaching? A. Take the calcium with meals. B. Take the calcium on an empty stomach. C. Take the calcium within 2 hours after meals. D. Take the calcium in the morning.

A. Take the calcium with meals. ​Rationale: The client prescribed calcium citrate supplementation should be instructed to take the calcium with meals. It does not matter what time of day the client takes the calcium.

The nurse is reviewing the chart of an older adult client with a BMI of 19 ​kg/m2. Which implication does this clinical finding have on the risk for​ osteoporosis? A. The client is at risk for osteoporosis. B. The​ client's gender needs to be taken into consideration. C. The​ client's age in relation to the BMI should be factored in. D. The client is not at risk for osteoporosis.

A. The client is at risk for osteoporosis. ​Rationale: Any individual with a BMI less than 20 ​kg/m2​, regardless of​ age, sex, or weight​ loss, is at a greater risk for both bone loss and subsequent risk for fracture.

The nurse is caring for a client newly diagnosed with Graves disease. The client asks the nurse how the goiter occurred. Which factor should the nurse include in the​ response? (Select all that​ apply.) A. The​ client's tissues form antibodies. B. The​ client's tissues form antigens. C. The thyroid gland enlarges. D. Antibodies bind to the​ thyroid-stimulating hormones. E. The thyroid cells become hypoactive.

A. The​ client's tissues form antibodies. C. The thyroid gland enlarges. D. Antibodies bind to the​ thyroid-stimulating hormones. ​Rationale: Goiters can occur when the thyroid gland produces either too much thyroid hormone or not enough. Antibodies bind to the​ thyroid-stimulating hormones​ (TSH) in the thyroid follicles. As the gland​ enlarges, a goiter develops. The thyroid cells become hyperactive. The tissues form​ antibodies, not antigens.

The nurse is preparing instructions for a client newly diagnosed with a metabolic disorder. Which information should the nurse include during the teaching session with this​ client? (Select all that​ apply.) A. Use and potential side effects of prescribed medications B. Potential for acupuncture to disrupt optimal body functioning C. Use of monitoring​ devices, such as a glucometer D. Proper nutrition and exercise E. Complications that can result from the condition

A. Use and potential side effects of prescribed medications C. Use of monitoring​ devices, such as a glucometer D. Proper nutrition and exercise E. Complications that can result from the condition Rationale: The nurse should provide a client with a metabolic disorder teaching about how and when to take the​ medications, what the side effects​ are, and when to report side effects or changes in their condition to the healthcare provider. The nurse should also provide client teaching related to the complications that could result from the condition and from not taking medications or supplements as prescribed. Client teaching related to the treatment plan also includes providing teaching about any monitoring devices that the client needs to​ use, such as a glucometer for individuals with diabetes mellitus​ (DM). The nurse can help the client by teaching about proper nutrition for the​ disorder, referring the client to a​ nutritionist, or encouraging the client to maintain an exercise routine that is appropriate for his health status. Complementary therapies such as acupuncture can help reduce stress and support optimal body​ functioning, including optimal functioning of the endocrine glands.

The nurse is teaching colleagues about hyperthyroidism. Which statement by a colleague indicates understanding of an indication for a​ thyroidectomy? (Select all that​ apply.) A. ​"A thyroidectomy may be performed if the thyroid is placing pressure on the​ esophagus." B. ​"A total thyroidectomy is performed to treat cancer of the​ thyroid." C. ​"The client may require a thyroidectomy for cosmetic​ reasons, such as a large​ goiter." D. ​"A thyroidectomy may be performed if the thyroid is compromising the​ airway." E. ​"The client will not need surgery as long as she takes antithyroid​ medication."

A. ​"A thyroidectomy may be performed if the thyroid is placing pressure on the​ esophagus." B. ​"A total thyroidectomy is performed to treat cancer of the​ thyroid." D. ​"A thyroidectomy may be performed if the thyroid is compromising the​ airway." ​Rationale: A total or partial thyroidectomy may be necessary to treat a thyroid that is placing pressure on the esophagus or obstructing the​ client's airway. Thyroid cancer can also be treated by a thyroidectomy. A goiter is not removed for purely cosmetic​ reasons; it is removed for hypothyroidism that produces too much​ thyroid-stimulating hormone. This can cause a potentially​ life-threatening condition called myxedema.

The nurse suspects that a client is experiencing hypothyroidism. Which question should the nurse ask during the health​ history? A. ​"Have you had unexplained weight​ gain?" B. ​"Is your skin often​ clammy?" C. ​"Do you have​ brown, shiny patches on your​ legs?" D. ​"Are you intolerant to​ heat?"

A. ​"Have you had unexplained weight​ gain?" The client experiencing hypothyroidism often gains weight even though they are eating less. Heat intolerance is associated with hyperthyroidism.​ Cool, clammy skin is found in clients with low blood sugar.​ Brown, shiny patches on the lower extremities are associated with poor circulation.

The nurse identifies the nursing diagnosis Imbalanced​ Nutrition: Less Than Body Requirements as appropriate for a client with osteoporosis. Which client statement indicated to the nurse that this nursing diagnosis was​ appropriate? A. ​"I am allergic to dairy​ products." B. ​"I am trying to eat a​ low-carb diet." C. ​"I plan to start eating out​ less." D. ​"I like to remove all of the fat from the meat I​ eat."

A. ​"I am allergic to dairy​ products." The client who is allergic to dairy products may not take in much​ calcium, which increases the risk of​ osteoporosis, so focusing on diet would be a priority for this client. The statements about removing​ fat, eating a​ low-carb diet, and eating out less are healthy changes for many individuals that help reduce calorie​ intake, but they would not address one of the root causes of​ osteoporosis, deficient calcium intake.

The nurse is caring for a woman who is at 14​ weeks' gestation with her first child. The woman asks the​ nurse, "Am I at risk for osteoporosis since my baby takes calcium from my​ body?" What response by the nurse is​ correct? A. ​"If you eat a diet that is rich in​ calcium, any bone mass that is lost during pregnancy and breastfeeding will be restored within several months of weaning the​ child." B. ​"You may lose small amounts of bone mass with each​ pregnancy, but if you only have one​ child, the bone loss should not be significant enough to cause​ osteoporosis." C. ​"The baby​ won't require enough calcium during development to affect your bone mass or cause​ osteoporosis." D. ​"When bone mass is lost during​ pregnancy, it is very difficult to​ restore, and you may be at increased risk for osteoporosis later in life. You should take a calcium supplement to prevent​ this."

A. ​"If you eat a diet that is rich in​ calcium, any bone mass that is lost during pregnancy and breastfeeding will be restored within several months of weaning the​ child." During​ pregnancy, the growing fetus requires calcium to develop the skeleton. Calcium is also required for milk production. If the mother does not eat a diet rich in​ calcium, the baby draws what it needs from the​ mother's bones, causing a decrease in bone mass. Any bone mass that is lost during pregnancy or breastfeeding is typically easily restored several months after the infant is weaned from the breast. Studies indicate that the more times women are​ pregnant, the greater the​ mother's bone density.

The nurse is caring for an older adult client who is taking calcium for the treatment of osteoporosis. Which statements will the nurse include when educating the client about this​ medication? Select all that apply. A. ​"The most common adverse effect is hypercalcemia caused by taking too much of the​ supplement." B. ​"If you have a condition called ventricular​ fibrillation, this medication might​ help." C. ​"Oral calcium supplements are best taken on an empty​ stomach." D. ​"Adults 50 years of age and over should obtain at least 500 to 750 mg per day of elemental​ calcium." E. ​"Report symptoms of​ weakness, increased​ urination, and​ thirst."

A. ​"The most common adverse effect is hypercalcemia caused by taking too much of the​ supplement." E. ​"Report symptoms of​ weakness, increased​ urination, and​ thirst." Calcium gluconate and other calcium compounds are used to treat and prevent osteoporosis. Oral calcium supplements are best taken with meals or within 1 hour following meals. It is recommended that adults 50 years of age and over obtain at least 1000 to 1200 mg per day of elemental calcium. The most common adverse effect is hypercalcemia caused by taking too much of the supplement. Symptoms include​ lethargy, drowsiness,​ weakness, headache,​ anorexia, nausea and​ vomiting, increased​ urination, and thirst. Calcium supplementation is contraindicated in clients with ventricular fibrillation.

The nurse is planning care for a female adult client who is​ high-risk for developing osteoporosis. Which interventions will decrease the​ client's risk of developing this health​ problem? Select all that apply. A. ​Weight-bearing exercises such as walking B. A diet with adequate amounts of calcium and vitamin D C. Having a yearly​ dual-energy x-ray absorptiometry​ (DEXA) test D. Isometric exercise for at least 30 minutes three times per week E. Increasing the intake of alcoholic beverages

A. ​Weight-bearing exercises such as walking B. A diet with adequate amounts of calcium and vitamin D Interventions that may decrease this​ client's risk of developing osteoporosis include regular​ weight-bearing exercise, such as​ walking, as this activity slows bone loss. Other intervention include encouraging clients to consume adequate amounts of calcium and vitamin D in their diets to prevent osteoporotic fracture. A DEXA test measures bone​ density, but it does not decrease the​ client's risk for developing osteoporosis. Measures to prevent or treat osteoporosis include limiting the intake of beverages containing​ alcohol, caffeine, and phosphorus. Isometric exercises are not effective against osteoporosis.

•The physician prescribes a Biphosphonate medication (alendronate, Fosamax) for a 65-year-old female for which of the following purposes? A.Inhibiting osteoclastic activity and decreasing the incidence of vertebral and nonvertebral fractures B.Decreasing spinal fractures and preventing formation of thrombosis C.Binding bile acids in the gastrointestinal tract to enhance calcium resorption D.Suppressing inflammation and the normal immune response and enhancing metabolic processes

A.Inhibiting osteoclastic activity and decreasing the incidence of vertebral and nonvertebral fractures •Alendronate is a bisphosphonate that inhibits osteoclastic activity and help to decrease the incidence of vertebral and nonvertebral fractures in postmenopausal women. The actions of these drugs do not include preventing thrombus formation, binding bile acids, or acting as an anti-inflammatory agent.

The nurse is seeing four clients today in the endocrinology clinic. Which client would the nurse expect to be at highest risk for Hashimoto​ disease? A. A​ 60-year-old African American man B. A​ 40-year-old woman with a goiter C. A​ 50-year-old man with hypothyroidism D. A​ 10-year-old child with congenital hypothyroidism

B. A​ 40-year-old woman with a goiter ​Rationale: Hashimoto disease occurs twice as often in women as in men. The disorder is not commonly seen in​ children, and it is not more commonly seen in African Americans than in other ethnic groups.

A client diagnosed with osteoporosis indicates reluctance to taking medication on a daily basis. Which class of medication should the nurse anticipate will be​ prescribed? A. Tetracycline B. Bisphosphonate C. Oral calcium supplement D. Calcium channel blocker

B. Bisphosphonate ​Rationale: Recent studies suggest that​ once-weekly dosing with bisphosphonates may give the same bone density benefits as daily dosing because of the extended duration of drug action. Tetracyclines and calcium channel blockers are not used to treat osteoporosis. Oral calcium supplements are typically taken on a daily basis.

Which physical assessment parameter is most appropriate for the nurse to include when assessing the client for possible​ hyperthyroidism? (Select all that​ apply.) A. Confusion B. Deep tendon reflexes C. Vital signs D. Weight loss E. Vision test

B. Deep tendon reflexes C. Vital signs D. Weight loss E. Vision test ​Rationale: Hyperthyroidism may affect many systems in the​ body, and the nurse would include the weight of the client in the physical​ assessment, a vision​ test, vital​ signs, and a test of the tendon reflexes. Confusion is associated with hypothyroidism.

The nurse is providing care for a young adult client with exophthalmos. Which nursing diagnosis would be the most appropriate for this​ client? A. Ineffective Coping B. Disturbed Body Image C. Risk for Injury D. Activity Intolerance

B. Disturbed Body Image Exophthalmos is a clinical manifestation associated with hyperthyroidism and may be a problem for a young client. The nurse would plan to assess​ self-esteem and make appropriate referrals. Activity intolerance and risk for injury are not particular to this medical diagnosis. The​ client's ability to cope could be an​ issue, but it would probably stem from the disturbed body image.

Which priority should the nurse include in the teaching plan for a client with Graves​ disease? (Select all that​ apply.) A. Eat a​ low-calorie diet. B. Drink six to eight glasses of water a day. C. Tape your eyelids closed at night. D. Take antithyroid drugs as prescribed. E. Weigh yourself daily.

B. Drink six to eight glasses of water a day. C. Tape your eyelids closed at night. D. Take antithyroid drugs as prescribed. E. Weigh yourself daily. ​Rationale: The client is prescribed an antithyroid medication such as​ propylthiouracil, which must be taken as prescribed. Due to weight​ loss, the weight is carefully monitored. Due to​ exophthalmos, the client must protect the​ eyes, apply eye​ drops, wear sunglasses when​ outside, and tape them closed at night. The client has a decreased appetite and weight loss. A​ high-calorie diet is recommended. The client may have frequent​ diarrhea, and maintaining hydration is a priority.

The nurse is caring for a client with diabetes mellitus​ (DM). For which assessment finding will the nurse monitor the​ client? A. Sleeplessness B. Hyperglycemia C. Low blood pressure D. Weight loss

B. Hyperglycemia ​Rationale: A client with diabetes mellitus​ (DM) will experience​ hyperglycemia, presenting with blurred​ vision, thirst, frequent​ urination, increased susceptibility to​ infections, and fatigue​ (not sleeplessness). Weight​ gain, not weight​ loss, is associated with DM. High blood pressure is more likely to occur with DM than low blood pressure.

Which manifestation should the nurse monitor when caring for a client on thyroid hormone​ (TH) replacement​ therapy? (Select all that​ apply.) A. Decrease in appetite B. Improvement of symptoms of hypothyroidism C. Report of dizziness D. Stable vital signs E. Symptoms of hyperthyroidism

B. Improvement of symptoms of hypothyroidism C. Report of dizziness D. Stable vital signs E. Symptoms of hyperthyroidism Rationale: Vital signs should be assessed on every​ client, and those receiving TH replacement should be assessed for symptoms related to blood levels. Monitor improvement of symptoms. Dizziness and lack of sleep are some symptoms to report. The client would be expected to have an​ increase, not​ decrease, in appetite. If the client begins to experience symptoms of​ hyperthyroidism, it could indicate that the medication dose needs to be adjusted.

The nurse is caring for a client with osteoporosis. Which medication taken by the client may have contributed to this​ diagnosis? A. Vitamin D supplements B. Prednisone C. Acetaminophen D. Calcium supplements

B. Prednisone ​Rationale: Glucocorticoids such as prednisone may have contributed to the development of osteoporosis. Calcium supplements and vitamin D supplements are both used to treat osteoporosis. Acetaminophen is a pain​ reliever; it is not associated with the development of osteoporosis.

At the conclusion of a health interview and physical​ assessment, the nurse suspects that an older adult client is experiencing hyperthyroidism. Which assessment finding supports the​ nurse's conclusion? A. Nodular thyroid tissue B. Presence of exophthalmos C. Decreased deep tendon reflexes D. Lower extremity paresthesia

B. Presence of exophthalmos ​Rationale: Exophthalmos, or protruding​ eyes, may be seen in clients with hyperthyroidism. Nodular thyroid tissue and decreased deep tendon reflexes may be normal findings in an older adult client. Lower extremity paresthesia may occur in clients with diabetes or hypothyroidism.

Which instruction should the nurse include when teaching a client about a newly prescribed bisphosphonate​ drug? (Select all that​ apply.) A. Take the medication 1 hour before meals or 2 hours after meals. B. Remain upright for 30 minutes. C. Take the medication on an empty stomach first thing in the morning with water. D. Do not eat or drink anything else for 30 minutes after taking. E. Dilute the medication in water or orange juice.

B. Remain upright for 30 minutes. C. Take the medication on an empty stomach first thing in the morning with water. D. Do not eat or drink anything else for 30 minutes after taking. ​Rationale: The nurse should instruct the client who is prescribed a bisphosphonate to remain upright for 30 minutes after taking it to reduce the risk of developing esophagitis. Nothing should be ingested for 30 minutes to improve absorption of the medication. The medication should be taken on an empty stomach first thing in the morning with water to improve absorption. Antithyroid agents may need to be diluted in water or orange juice. Thyroid agents should be taken 1 hour before or 2 hours after meals.

The nurse is assessing a postmenopausal client. Which question should the nurse ask to assess for signs of​ osteoporosis? A. ​"Are you having problems with swelling in your​ feet?" B. ​"Are you having any low back​ pain?" C. ​"Have you experienced any​ palpitations?" D. ​"Is constipation a problem for​ you?"

B. ​"Are you having any low back​ pain?" A client with osteoporosis will often present with low back pain as well as a decrease in height.​ Palpitations, constipation, and swelling are not early signs of osteoporosis.

The nurse is preparing an education session for nurses who work in an endocrinology clinic caring for older adult clients. Which statement about the thyroid should the nurse include in her​ teaching? A. Hypothyroidism is a congenital disease that manifests in older adult clients. B. Symptoms of hypothyroidism in this group of clients are often confused with symptoms of aging. C. Thyroid hormone is often increased for older adult clients. D. Hypothyroidism presents with pitting edema for this group of clients.

B. Symptoms of hypothyroidism in this group of clients are often confused with symptoms of aging. The nurse educator must emphasize that the diagnosis is often missed for this group of clients as the clinical manifestations are confused with symptoms of aging. Not all hypothyroidism is​ congenital, and it is inaccurate to state that older adult clients develop the disease due to congenital defects. Thyroid hormone is decreased in all clients with hypothyroidism. The older adult client will present with nonpitting edema.

The nurse is caring for a client suspected of having Graves disease. Which serum laboratory test should the nurse anticipate will confirm the​ diagnosis? A. Parathyroid hormone B. T3​, T4​, TSH C. Serum albumin D. Serum calcium

B. T3​, T4​, TSH ​Rationale: Graves disease is an autoimmune disease that affects the thyroid gland. T3​, T4​, and TSH tests are used to support the diagnosis of the disease. Serum​ albumin, calcium, and parathyroid hormone tests are used to support the diagnosis of other endocrine disorders.

The nurse is screening clients in the clinic for osteoporosis. Which client has the greatest risk factor for​ osteoporosis? A. The client who walks at the park for 30 minutes each day B. The client taking selective serotonin reuptake inhibitors​ (SSRIs) C. The client with a BMI greater than 25 ​kg/m2 D. The client who occasionally drinks a diet soda

B. The client taking selective serotonin reuptake inhibitors​ (SSRIs) Rationale: Prolonged use of certain medications such as SSRIs increases the risk of developing osteoporosis. Underweight individuals have a​ two-fold increased risk for fracture when compared to people with a BMI greater than 25 ​kg/m2.

The nurse is screening clients in the clinic for osteoporosis. Which client has the greatest risk factor for​ osteoporosis? A. The client who walks at the park for 30 minutes each day B. The client taking selective serotonin reuptake inhibitors​ (SSRIs) C. The client with a BMI greater than 25 ​kg/m2 D. The client who occasionally drinks a diet soda

B. The client taking selective serotonin reuptake inhibitors​ (SSRIs) Rationale: Prolonged use of certain medications such as SSRIs increases the risk of developing osteoporosis. Underweight individuals have a​ two-fold increased risk for fracture when compared to people with a BMI greater than 25 ​kg/m2. A high intake of diet​ soda, not occasional​ consumption, can contribute to the development of osteoporosis. An individual who walks for 30 minutes in the park every day most likely gets sufficient vitamin​ D, which also helps prevent osteoporosis.

The nurse is caring for several clients on the unit. Which client is at the greatest risk for​ osteoporosis? A. The client treated for an eating disorder B. The client treated for withdrawal delirium tremens C. The client with impaired vision D. The client with early onset Alzheimer disease

B. The client treated for withdrawal delirium tremens​ Rationale: The client being treated for withdrawal delirium tremens is at the greatest risk for osteoporosis. Delirium tremens occurs as a result of alcohol withdrawal. The client who is an alcoholic is at risk for osteoporosis. Impaired vision does not place the client at risk for osteoporosis. The client with an eating disorder will require counseling and a nutritional consultation. The client with early onset Alzheimer disease is mobile and can walk.

Which change in bone structure contributes to​ osteoporosis? A. The diaphysis of the bone becomes longer. B. The diameter of the bone increases. C. Trabeculae are increased in cancellous bone. D. The outer cortex of the bone becomes thicker.

B. The diameter of the bone increases. In​ osteoporosis, the diameter of the bone​ increases, thinning the outer supporting cortex. Trabeculae are lost from cancellous bone. Osteoporosis does not affect the length of the bone.

Which treatment should the nurse anticipate for a client who is newly diagnosed with​ hypothyroidism? A. Radiation B. Treatment with synthetic hormone C. Nonsteroidal​ anti-inflammatory medications D. Partial thyroidectomy

B. Treatment with synthetic hormone Rationale: The expected treatment for hypothyroidism is replacement with synthetic thyroid hormone. Surgical​ management, such as partial​ thyroidectomy, is used for management of hyperthyroidism. Radiation may also be used in the treatment plan for a client with hyperthyroidism. Nonsteroidal​ anti-inflammatory medications may be used in the management of a client with thyroiditis.

The nurse in the fertility clinic is working with a female client who has had repeated miscarriages. Which information in the​ client's history may be a precipitating​ factor? A. History of toxic multinodular goiter B. Uncontrolled hypothyroidism C. Type 2 diabetes mellitus D. Hyperemesis gravidarum

B. Uncontrolled hypothyroidism Rationale: Uncontrolled hypothyroidism can lead to​ miscarriages, stillbirths,​ preeclampsia, and low birth weights. Type 2 diabetes mellitus can lead to newborns that are large for gestational age. Hyperemesis gravidarum can cause hyperthyroidism in pregnancy. A history of toxic multinodular goiter would not cause repeated miscarriages later in life.

A nurse is conducting a health history on an older adult client. Which assessment finding indicates the client is at risk for​ osteoporosis? A. Drinking three glasses of skim milk daily B. Using glucocorticoids for 10 years because of a chronic lung disorder C. Eating three to five servings of shrimp and liver per week D. Having a body mass index​ (BMI) that indicates obesity

B. Using glucocorticoids for 10 years because of a chronic lung disorder ​Long-time use of corticosteroids is a risk factor for developing osteoporosis. Obesity is not a risk factor for osteoporosis. Skim milk is a good source of calcium and vitamin​ D, which prevents or slows osteoporosis. A diet rich in shellfish and organ meats is high in​ purine, which may predispose the client to gout.

The nurse is preparing medication teaching on a bisphosphonate for a client newly diagnosed with osteoporosis. The nurse should teach the client to monitor for which adverse​ effect? A. Tinnitus B. Vomiting C. Anorexia D. Headaches

B. Vomiting ​Rationale: Adverse effects that may occur in a client taking a bisphosphonate include gastrointestinal problems such as​ nausea, vomiting, abdominal​ pain, and esophageal irritation.​ Tinnitus, anorexia, and headaches are not adverse effects of taking bisphosphonates.

The nurse is caring for a postmenopausal client prescribed estrogen therapy to reduce the risk of osteoporosis. Which client statement indicates the need for further​ teaching? A. ​"I have completed my smoking cessation​ program." B. ​"I am glad I am not at risk for osteoporosis​ anymore." C. ​"I will be sure to maintain all​ follow-up appointments for​ evaluation." D. ​"I understand that I may experience hot​ flashes."

B. ​"I am glad I am not at risk for osteoporosis​ anymore." ​Rationale: The client prescribed a selective estrogen receptor modulator to reduce the risk of osteoporosis should address other modifiable risk factors attributed to osteoporosis. Medication alone will not prevent osteoporosis. Hot flashes are a side effect of the medication. Smoking is a risk factor for osteoporosis. The client should maintain all​ follow-up appointments.

A client with a family history of hyperthyroidism asks the​ nurse, "What can increase my risk of developing this​ disorder?" Which response by the nurse is​ accurate? A. ​"Arthritis can lead to the development of​ hyperthyroidism." B. ​"Viral infections can cause the onset of​ hyperthyroidism." C. ​"Invasive neck surgery can impact thyroid​ functioning." D. ​"Smoking can increase your risk for acquiring this disease.

B. ​"Viral infections can cause the onset of​ hyperthyroidism." ​Rationale: A viral infection can increase the risk of hyperthyroidism. Other risks include having an autoimmune​ disease, pregnancy, female​ sex, and being under the age of 40. Surgery in the neck area increases the risk of hypothyroidism. Smoking and arthritis are not risk factors for hyperthyroidism.

A postmenopausal adult client is concerned about the development of osteoporosis and wants to begin preventative activities. Which statement by the nurse is​ appropriate? A. ​"You should first determine if you are at risk for the development of​ osteoporosis." B. ​"Weight-bearing exercise and calcium supplements are helpful in the prevention of​ osteoporosis." C. ​"Hormone replacement therapy should be initiated as soon as​ possible." D. ​"After menopause, the decline is too rapid to begin preventative​ interventions."

B. ​"Weight-bearing exercise and calcium supplements are helpful in the prevention of​ osteoporosis." Osteoporosis risk factors increase after menopause. Preventative activities include implementing​ weight-bearing exercise and beginning calcium supplements. It is not too late to begin prevention activities. Without additional​ information, it is not possible to determine if the client is a candidate for hormone replacement therapy. The client in the scenario has two risk factors presented. Although a full analysis would be​ beneficial, it does not answer the​ client's request for information.

•The nurse is working with breast feeding patients in the clinic setting. The nurse is aware that breastfeeding can cause what potential complication related to overall bone health? A.Breastfeeding mothers are more at risk for osteoporosis later in life. B.Breastfeeding mothers may temporarily lose up to 5% of bone mass while breastfeeding but after weaning the bone mass returns to normal. C.There is no correlation to breastfeeding and bone loss. D.Women who have a family history of osteoporosis should not breastfeed

B. Breastfeeding mothers may temporarily lose up to 5% of bone mass while breastfeeding but after weaning the bone mass returns to normal. Evidence suggests that some women may lose up to 5% of their bone mass while breastfeeding. Restoration occurs within several months once the infant is weaned from the breast. There is no evidence that breastfeeding mothers are more at risk for osteoporosis later in life or if there is a family history of osteoporosis they should not breastfeed.

•Although all of the following nursing diagnoses are important when planning care for the patient with osteoporosis, which will the nurse select as most significant in terms of long-term disability? A.Chronic Pain B.Risk for Falls C.Activity Intolerance D.Acute Pain

B. Risk for Falls Risk for Falls is the most significant nursing diagnosis in terms of long-term disability because falls that would result in no injury to the healthy adult may cause fractures to the patient with osteoporosis. Chronic pain, acute pain, and activity intolerance are important, but in terms of disability, falls will have the most impact on the patient's condition.

A client with Graves disease requests that the nurse explain the results of recent laboratory tests. Which results would the nurse anticipate discussing with the​ client? Select all that apply. A. A decrease in T3 uptake B. A decrease in serum T4 C. An increase in serum T3 D. An increase in thyroid antibodies E. An increase in TSH levels

C. An increase in serum T3 D. An increase in thyroid antibodies Graves​ disease, or primary​ hyperthyroidism, has alterations in normal lab work. With this​ condition, TSH levels are decreased. Thyroid​ antibodies, serum T4​, serum T3​, and T3 uptake tests are all increased.

What is the primary cause of loss of height in individuals with​ osteoporosis? A. Cervical lordosis B. Decrease in length of long bones C. Collapse of vertebral bodies D. Flexion of the knees and hips

C. Collapse of vertebral bodies The loss of height in individuals with osteoporosis occurs primarily as a result of vertebral body collapse. Osteoporosis also contributes to cervical​ lordosis, and the knees and hips flex to help maintain the center of​ gravity; however, these do not contribute to overall loss of height. Osteoporosis does not cause a decrease in the length of long bones.

An older adult client with​ new-onset atrial fibrillation is sweating excessively. After reviewing the​ client's recent laboratory​ results, the nurse concludes that which might be causing the​ client's symptoms? A. A Hgb level of 13.8​ g/dL B. A​ thyroid-stimulating hormone​ (TSH) level of 0.25​ mU/mL C. A TSH level of 18​ mU/mL D. A hemoglobin​ (Hgb) level of 11.0​ g/dL

C. A TSH level of 18​ mU/mL ​New-onset atrial fibrillation and excessive sweating are potential symptoms of hyperthyroidism. A TSH level above 5.5​ mU/mL is considered high. TSH 0.25​ mU/mL is indicative of hypothyroidism. Hgb 13.8​ g/dL and Hgb 11.0​ g/dL are both normal hemoglobin levels.

The nurse is caring for an older adult with a history of fractures as a result of osteoporosis. The client currently has a right radial fracture. Which is the priority nursing diagnosis for the​ client? A. ​Mobility: Physical, Impaired B. ​Nutrition, Imbalanced: Less than Body Requirements C. Activity Intolerance D. ​Pain, Chronic

C. Activity Intolerance ​Rationale: The priority nursing diagnosis for the client with right radial fracture is Activity Intolerance. The pain the client will experience with a new fracture is acute. The​ client's mobility should not be impaired with a right radial fracture. The nutritional status of the client can be assessed after the activity intolerance is addressed.​ (NANDA-I ©​ 2014)

A client reports hoarseness and feelings of tightness in the throat. During the​ examination, the nurse notes visible swelling at the base of the​ neck, neck vein​ distention, a rapid​ pulse, and sweating. The nurse should suspect which condition in this​ client? A. Pretibial myxedema B. Exophthalmos C. Graves disease D. Toxic multinodular goiter

C. Graves disease Rationale: Graves disease involves an enlargement of the thyroid gland due to overproduction of thyroid hormones.​ Therefore, the nurse would note swelling and neck vein distention. Exophthalmos would be evident by protruding eyeballs. Pretibial myxedema is nonpitting edema and would be noted in hypothyroidism. Toxic multinodular goiter is characterized by small nodules on the thyroid.

An adult client reports a weight gain and feeling cold all the time. Which condition should the nurse​ suspect? A. Chronic renal failure B. Hyperthyroidism C. Hypothyroidism D. Depression

C. Hypothyroidism ​Rationale: Weight gain and feeling cold can be symptoms of hypothyroidism. The nurse would conduct an assessment to validate this assumption. Depression would not usually include weight gain or feeling cold. The weight gain of renal failure is usually associated with fluid retention. Hyperthyroidism presents with weight loss and increased sweating.

Increasing circulating levels of thyroid hormone heighten the sympathetic nervous​ system's physiologic response to stimulation. What effect does this have on the cardiac​ system? A. Decreases blood pressure B. Decreases cardiac rate C. Increases stroke volume D. Lengthens the QRS interval

C. Increases stroke volume The sensitizing effect of abnormally elevated thyroid hormone levels increases the cardiac rate and stroke volume. As a​ result, cardiac output and peripheral blood flow increase. The increased cardiac rate would result in a shortened QRS interval. Stimulation of the sympathetic nervous system increases blood pressure.

An adult client who resides in a​ long-term care facility is diagnosed with osteoporosis. The client has a history of falls and dementia. Which nursing intervention will best aid in meeting an outcome goal of injury prevention for this​ client? A. Using furniture as obstacles to keep the client in the bed B. Keeping a nightlight on in the hallway C. Keeping the bed in the lowest position D. The use of wrist restraints

C. Keeping the bed in the lowest position Keeping the bed in the lowest position will reduce the incidence of injury should the client attempt to get up. The use of restraints could increase the incidence of injury. Using the furniture as an obstacle could cause injury if the client is able to get up. In a​ long-term care​ facility, a nightlight should be provided in the room so the client can see to use the restroom.

The nurse is planning a presentation on osteoporosis to clients in an​ assisted-living center. Which group would be appropriate for the nurse to exclude from the presentation as being at risk of developing this disease​ process? A. Smokers B. Asian American women C. Men with high testosterone levels D. Postmenopausal women

C. Men with high testosterone levels ​Rationale: Men with high testosterone levels are not at risk of developing​ osteoporosis; therefore, this should not be included in the presentation.​ Women, especially those who are postmenopausal and of Asian​ descent, are much more likely to develop osteoporosis. Smoking increases the​ client's risk of osteoporosis.

The nurse is caring for an​ 8-year-old client with cerebral palsy and limited walking ability. The parents are very protective and perform most activities for the child. Which intervention is essential in promoting bone growth and reducing the risk of​ osteoporosis? A. Refer the client to a dietitian to increase calcium and vitamin D intake. B. Provide client teaching related to using restraints to prevent falls. C. Provide client teaching related to assistive devices to encourage walking. D. Refer the client to an occupational therapist to increase limb movement.

C. Provide client teaching related to assistive devices to encourage walking. The most effective way to prevent osteoporosis is to perform​ weight-bearing activities and exercise. The client has limited walking ability rather than complete​ paralysis, so with​ practice, help from​ parents, and the appropriate use of assistive​ devices, the child could learn to walk independently. This would help stimulate bone growth. The nurse can inform the client and parents about the importance of calcium and vitamin D in the diet without referral to a dietitian. The nurse may need to refer the client to a physical​ therapist, not an occupational​ therapist, to help teach the client to walk independently. Appropriate restraints may be required to prevent falls for clients with cerebral palsy who do not have adequate body control.​ However, use of restraints will not increase bone growth in these clients.

The nurse is reviewing the orders for a client with osteoporosis who has been prescribed a bisphosphonate. Which test should the nurse anticipate will be ordered while the client is on the​ medication? A. ​Dual-energy x-ray absorptiometry​ (DEXA) B. Alkaline phosphatase C. Serum bone Gla protein​ (osteocalcin) D. Ultrasound

C. Serum bone Gla protein​ (osteocalcin) ​Rationale: Serum bone Gla protein​ (osteocalcin) is most useful for evaluating the effects of treatment rather than to indicate the severity of the disease.​ Dual-energy x-ray absorptiometry​ (DEXA) and ultrasound both measure bone​ density, not efficacy of treatment. Alkaline phosphatase also does not indicate efficacy of treatment.

The nurse is teaching an older adult how to manage Graves disease. Which information should the nurse​ include? A. Preparation for surgical removal of the thyroid B. The schedule for lifelong radioactive iodine treatments C. The administration schedule for an antithyroid drug D. Use of levothyroxine​ (Synthroid) and lab monitoring

C. The administration schedule for an antithyroid drug Rationale: Hyperthyroidism in the older adult is usually managed with the administration of antithyroid drugs and then evaluation to determine if radioactive iodine treatments are necessary. Thyroidectomies are not usually performed in older adults due to preexisting cardiac and central nervous system disorders. Levothyroxine​ (Synthroid) and lab monitoring are used to treat hypothyroidism.

The nurse is reviewing the chart of a pediatric client at risk for osteoporosis. Which factor in the​ client's history should the nurse identify as placing the client at risk for​ osteoporosis? A. Systemic lupus erythematosus B. Cystic fibrosis C. Congenital cardiac disease D. Diabetes

D. Diabetes ​Rationale: Diabetes is associated with a lower bone​ mass, placing the client at risk for osteoporosis. Cystic​ fibrosis, congenital cardiac​ disease, and systemic lupus erythematosus do not place the client at risk for osteoporosis. If the client has periods of​ immobility, the nurse can collaborate with physical therapy to provide the client with preventative exercises.

A​ heel-stick screening of a newborn reveals the presence of T4 deficiency along with elevated​ thyroid-stimulating hormone​ (TSH). The infant is diagnosed with hypothyroidism. Which information should the nurse provide the​ parents? A. The child will require evaluation for radioactive iodine. B. The child will eventually grow out of this and no longer need treatment. C. The child will need lifelong thyroid medication supplementation. D. The child will be involved in infertility treatment later in life.

C. The child will need lifelong thyroid medication supplementation. ​Rationale: Hypothyroidism detected in neonates requires lifelong supplementation of thyroid hormone. The drug of choice for children is oral levothyroxine. The child would not require radioactive​ iodine, as this is reserved for hyperthyroidism. Infertility is a possibility for those women with hypothyroidism who do not ovulate. The child will not grow out of​ this, and will need lifelong treatment.

What causes edema in adults with​ hypothyroidism? A. Increased capillary permeability in the extremities B. Excess reabsorption of water and sodium in the kidneys C. Water retention in mucoprotein deposits in the interstitial spaces D. Decreased plasma oncotic pressure in the capillaries

C. Water retention in mucoprotein deposits in the interstitial spaces The hypothyroid state in adults is sometimes called​ myxedema, which reflects the accumulation of nonpitting edema in connective tissues throughout the body. The edema is the result of water retention in mucoprotein deposits in the interstitial spaces. This redistribution of water may trigger increased reabsorption of water and sodium in the​ kidneys, but excess reabsorption is not the cause of the edema. Decreased plasma oncotic pressure and increased capillary permeability are less common causes of edema and are usually due to other etiologies.

A nurse is educating a group of adults about the risks for osteoporosis. Which statements will the nurse include when discussing the use of alcohol and​ cigarettes? Select all that apply. A. ​"Alcohol has a direct toxic effect on osteoclast​ activity, suppressing bone​ formation." B. ​"Nicotine increases calcium​ absorption, leading to decreased bone​ density." C. ​"Heavy alcohol use may be associated with nutritional deficiencies that contribute to​ osteoporosis." D. ​"Moderate alcohol consumption in postmenopausal women actually may increase bone mineral​ content." E. ​"Smoking decreases nerve supply to the​ bones."

C. ​"Heavy alcohol use may be associated with nutritional deficiencies that contribute to​ osteoporosis." D. ​"Moderate alcohol consumption in postmenopausal women actually may increase bone mineral​ content." Both cigarette smoking and excess alcohol intake are risk factors for osteoporosis. Smoking decreases the blood supply to​ bones, and nicotine slows the production of osteoblasts and impairs the absorption of​ calcium, contributing to decreased bone density. Alcohol has a direct toxic effect on osteoblast​ activity, suppressing bone formation during periods of alcohol intoxication. In​ addition, heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis.​ Interestingly, moderate alcohol consumption in postmenopausal women actually may increase bone mineral​ content, possibly by increasing levels of estrogen and calcitonin.

The client with hypothyroidism asks the nurse why the​ thyroid-stimulating hormone​ (TSH) level is increased if the thyroid is not working properly. Which response by the nurse is​ accurate? A. ​"Your TSH level is increased from a malfunction in the​ hypothalamus, leading to thyroid​ insufficiency." B. ​"Your TSH level is increased due to an increase in metabolism noted in clients with​ hypothyroidism." C. ​"Your TSH level is increased due to an inadequately functioning negative hormonal feedback​ process." D. ​"Your TSH level is increased because the thyroid is working harder to produce more​ hormone."

C. ​"Your TSH level is increased due to an inadequately functioning negative hormonal feedback​ process." ​Rationale: The TSH level increases in clients with hypothyroidism due to a loss of the negative hormonal feedback​ system, not because the thyroid is working harder. Metabolism is decreased in​ hypothyroidism, not increased. The pituitary​ gland, not the​ hypothalamus, is responsible for TSH production.

A client with hyperthyroidism is scheduled for surgery in a few days. Which collaborative intervention would address cardiovascular symptoms that may prevent the client from undergoing the​ procedure? A. A combination treatment with levothyroxine​ (Synthroid) and amiodarone​ (Cordarone) B. ​Nothing, because there is little effect on the quality of life in older adults. C. The ingestion of radioactive​ iodine, I-131 D. Administration of antithyroid medications with propranolol

D. Administration of antithyroid medications with propranolol Cardiovascular symptoms can be decreased rapidly by adding a​ beta-blocker, such as​ propranolol, to initial treatment with antithyroid medications. Levothyroxine increases thyroid hormone​ levels, so it would not be helpful for this client. Radioactive iodine treatment takes several weeks to take​ effect, and it​ doesn't directly address cardiovascular symptoms.

The nurse notes that a client with diabetes mellitus​ (DM) has a blood pressure of​ 184/92 mmHg. Which endocrine organ does the nurse identify as being responsible for the alteration in blood​ pressure? A. Parathyroid glands B. Thyroid gland C. Anterior pituitary D. Adrenal cortex

D. Adrenal cortex ​Rationale: The adrenal cortex promotes kidney tubule resorption of sodium and water and excretion of potassium in response to elevated levels of potassium and low levels of​ sodium, thereby increasing blood pressure and blood volume. The thyroid gland maintains metabolic rate and growth and development of all tissues. The anterior pituitary promotes growth of body tissues by enhancing protein synthesis and promoting use of fat for energy to conserve glucose. The parathyroid glands maintain serum calcium levels by stimulating bone resorption and formation and by stimulating kidney resorption of calcium in response to falling levels of plasma calcium.

The nurse is teaching health promotion behaviors to a client diagnosed with osteoporosis. Which behavior should the nurse​ include? A. Exercising four times a week B. Decreasing smoking C. Avoiding foods high in purine D. Limiting alcohol intake

D. Limiting alcohol intake ​Rationale: The client should be instructed to limit alcohol intake. Alcohol has a direct toxic effect on osteoblast​ activity, suppressing bone formation during periods of alcohol intoxication. The client should be instructed to stop smoking​ altogether, not just decrease smoking. Smoking decreases the blood supply to​ bones, and nicotine slows the production of osteoblasts and impairs the absorption of​ calcium, contributing to decreased bone density. The instruction on exercising needs to be specified. Foods high in purine are associated with gout.​ Weight-bearing exercises are recommended for approximately 30 minutes four times a week.

The nurse is providing teaching to a young adult who is at risk for​ early-onset osteoporosis. Which intervention should the nurse​ suggest? A. The client should stop all physical activity. B. The client should start estrogen replacement therapy. C. The client should reduce the intake of dairy in the diet. D. The client should increase intake of calcium and vitamin D.

D. The client should increase intake of calcium and vitamin D. An appropriate goal for this client is a diet rich in calcium and vitamin D. Walking and​ weight-bearing exercise help prevent​ osteoporosis, so the client should not stop all physical activity. Dairy is rich in​ calcium, so reducing intake of dairy is not recommended. Due to the​ client's age, it is not likely that the client needs estrogen replacement therapy at this time.

The nurse is caring for a client diagnosed with hypoparathyroidism. Which assessment should the nurse integrate into the plan of​ care? A. Plantar response B. Deep tendon reflexes C. Sensory testing D. Trousseau sign

D. Trousseau sign ​Rationale: The nurse should integrate assessment for Trousseau sign into the plan of care to monitor the client for complications of hypoparathyroidism. A positive Trousseau sign is related to decreased serum​ calcium, which is associated with hypoparathyroidism. Plantar response is a normal reflex found in a newborn. Sensory testing is done for a client with suspected peripheral neuropathy or​ paresthesia, which may occur in clients with​ diabetes, hypoparathyroidism, or acromegaly. Changes in deep tendon reflexes may occur in clients with​ hyper- or hypothyroidism.

A client with Addison disease would like to incorporate complementary health approaches into the treatment. Which statement by the nurse is most ​appropriate? A. ​"I will ask the dietician to recommend vitamins that are safe for you to take during​ treatment." B. ​"Many of the complementary health approaches are contraindicated in Addison​ disease." C. ​"I will contact an exercise​ physiologist, so you can integrate yoga into your​ treatment." D. ​"I will get a referral to a healthcare practitioner with complementary health​ experience."

D. ​"I will get a referral to a healthcare practitioner with complementary health​ experience." ​Rationale: Referring a client to a healthcare practitioner that has experience with both a complementary health approach and the​ client's specific metabolic disorder will provide the client safe options to integrate complementary health approaches into the treatment plan. Many of the complementary health approaches can be integrated into the​ client's treatment plan. An exercise physiologist and dietician are not appropriate consults to integrate complementary approaches into the​ client's treatment plan.

Which statement by the nurse indicates an understanding of the effects of vitamin D and calcium on​ osteoporosis? A. ​"Acidosis causes calcium to be deposited into​ bone." B. ​"A high intake of​ high-phosphate foods can help increase serum​ calcium." C. ​"Vitamin D is needed for renal absorption of phosphorus and​ calcium." D. ​"Impaired vitamin D activation reduces the serum calcium​ level."

D. ​"Impaired vitamin D activation reduces the serum calcium​ level." ​Rationale: The statement made by the​ nurse, "Impaired vitamin D activation reduces the serum calcium​ level," demonstrates an understanding of the effects of vitamin D and calcium and their association with osteoporosis. Vitamin D is essential because it facilitates calcium absorption from the intestines into the blood. Acidosis does not cause calcium to be deposited in the bone. Vitamin D increases renal absorption of calcium in the distal​ tubule, but the phosphate level is not affected by vitamin D. Foods high in phosphate decrease serum calcium.

A client with a newly prescribed medication for hypothyroidism asks the​ nurse, "What should I know about this​ drug?" Which statement by the nurse should be included in the​ nurse's teaching? A. ​"The medication helps stabilize your​ thyroid, so the hormonal production returns to​ normal." B. ​"If you miss a dose of your​ medication, make sure you take the missed pill with the next​ dose." C. ​"Once your thyroid hormone is​ replaced, you will no longer need the​ medication." D. ​"You will need to return to your healthcare provider to monitor hormone​ levels."

D. ​"You will need to return to your healthcare provider to monitor hormone​ levels." ​Rationale: The client taking medication for hypothyroidism will need to return to the healthcare provider for​ follow-up, which includes monitoring hormone levels and adjusting the medication as needed. The client should be aware that treatment is ongoing and should not stop when hormone levels return to normal. Thyroid replacement therapy is for life. The client should not be instructed to double a dose of medication if a dose is missed.