Deck 12: Metabolism

Question 1

The nurse is planning care for a client admitted with diabetic ketoacidosis (DKA).On what should the nurse focus for this client's care? Select all that apply.

A)Administration of oral glucose
B)Monitoring for fluid volume overload
C)Frequent blood glucose monitoring
D)Intravenous fluid infusions
E)Insulin infusion

Answer 1

Frequent blood glucose monitoring
Intravenous fluid infusions
Insulin infusion

Question 2

The nurse is assessing a client.Which findings indicate a potential problem related to adrenal medulla function? Select all that apply.

A)Heart rate of 104
B)Weight decreased 10 lb since previous appointment
C)Respiratory rate of 22
D)Dry and cracked heels
E)Blood pressure of 132/84

Answer 2

Heart rate of 104
Weight decreased 10 lb since previous appointment
Respiratory rate of 22
Blood pressure of 132/84

Question 3

The nurse is caring for a 34-year-old woman who is pregnant with her third child.The client was diagnosed with hypothyroidism between her second and third pregnancies.What special considerations should the nurse include when caring for this client?

A)The client may need to change her dosage of levothyroxine (Synthroid).
B)The client is at higher risk for gestational diabetes.
C)The client may need to add a folic acid supplement to her medication regimen.
D)The client is at higher risk for diabetes insipidus.

Answer 3

The client may need to change her dosage of levothyroxine (Synthroid).

Question 4

A disorder in which endocrine gland could result in an increase in growth of the bones,organs,and muscles?

A)Pituitary gland
B)Thyroid gland
C)Parathyroid glands
D)Adrenal glands

Question 5

The nurse is preparing to teach a client who is newly diagnosed with type 1 diabetes mellitus on the preferred area to self-inject insulin.On which area should the nurse focus,based on insulin absorption rates?

A)Deltoid
B)Thigh
C)Hip
D)Abdomen

Question 6

The nurse is assessing the vital signs of a client experiencing hypoparathyroidism.While monitoring the blood pressure,the nurse notes the client's hand begins to spasm.Which term is appropriate for the nurse to use when documenting this assessment finding?

A)Trousseau sign
B)Chvostek sign
C)Turner sign
D)Cullen sign

Question 7

The nurse is caring for a client who is prescribed calcitonin-human (Cibacalcin)nasal spray.Which teaching point should the nurse include in this client's plan of care?

A)Always administer the nasal spray in the left nostril.
B)Administer the nasal spray in alternate nostrils each day.
C)Administer the nasal spray in both nostrils at each dose.
D)Always administer the nasal spray in the right nostril.

Question 8

A client who is newly diagnosed with type 1 diabetes has smoked for 30 years.When teaching the client on ways to optimize health outcomes,what should the nurse explain about the effects of smoking and diabetes?

A)Smoking is a major factor in the development of diabetic neuropathy.
B)Smoking increases insulin resistance.
C)Smoking accelerates atherosclerotic changes in blood vessels.
D)Smoking promotes weight gain.

Question 9

The destruction of which types of cells in the islets of Langerhans cause type 1 diabetes mellitus?

A)Alpha cells
B)Beta cells
C)Delta cells
D)Gamma cells

Question 10

An alteration in parathyroid hormone levels is likely to directly affect what other nursing concept related to metabolism?

A)Acid-base balance
B)Reproduction
C)Perfusion
D)Mobility

Question 11

An older client is diagnosed with disorders of fat metabolism,reduced absorption of fat-soluble vitamins,and a slightly elevated blood glucose level.When developing interventions for this client,the nurse considers that normal age-related changes in which endocrine organ are likely to contribute to reduced absorption of fat-soluble vitamins?

A)Pituitary
B)Thyroid
C)Pancreas
D)Adrenal medulla

Question 12

The nurse is providing care to a client who is receiving treatment for diabetic ketoacidosis (DKA).Which possible pathophysiologic cause should the nurse identify for the altered metabolism the client is experiencing?

A)Insulin deficiency
B)Decreased gluconeogenesis
C)Excess production of bicarbonate
D)Hypo-osmolarity

Question 13

Which intervention can the nurse implement independently to provide support to clients with an alteration in metabolism?

A)Administer hormone therapies.
B)Refer the client to a nutritionist.
C)Order blood tests.
D)Refer the client to an acupuncturist.

Question 14

A client newly diagnosed with type 1 diabetes mellitus tells the nurse that the diagnosis must be wrong because the client is not overweight,eats all of the time,and is thin.Which response by the nurse is most appropriate?

A)"Thin people can be diabetic,too."
B)"Your condition makes it impossible for you to gain weight."
C)"Your lab tests indicate the presence of diabetes."
D)"You are eating large quantities because your condition makes it difficult for your body to obtain energy from the foods taken in."

Question 15

The client with diabetes mellitus reports having difficulty trimming the toenails because they are thick and ingrown.What should the nurse recommend to this client?

A)Make an appointment with a podiatrist.
B)Offer to file the tops of the nails to reduce thickness after cutting.
C)Cut the nails straight across with a clipper after the bath.
D)Make an appointment with a nail shop for a pedicure.

Question 16

While performing an endocrine assessment on a client suspected of having an endocrine disorder,the nurse asks if the client has experienced recent weight changes.The nurse asks this question because he understands that alterations in which endocrine glands are most directly related to weight changes? Select all that apply.

A)Gonads
B)Pituitary gland
C)Thyroid gland
D)Adrenal gland
E)Parathyroid gland

Question 17

For clients with a deficiency in any hormone,what client teaching is important for the nurse to provide?

A)Teaching related to increasing fluid intake
B)Teaching related to decreasing body weight
C)Teaching related to taking hormone supplements as directed
D)Teaching related to regulating sugar intake

Question 18

The nurse is finalizing a plan of care for a school-age client newly diagnosed with type 1 diabetes mellitus.Which areas should the plan prioritize to achieve the maximum outcomes for this client? Select all that apply.

A)Ways to minimize the number of school days missed
B)Identification and referral to community resources
C)Physical activities that limit exposure to injuries
D)Self-management of glucose monitoring and medications
E)Signs and symptoms of hypoglycemia and actions to take

Question 19

The nurse is planning care for a 4-year-old child newly diagnosed with type 1 diabetes mellitus.The child's mother appears unconcerned with the diagnosis and is complaining about the cost of medication,as three additional children in the family have needs.On which nursing diagnoses should the nurse focus when planning this client's care? Select all that apply.

A)Chronic Pain
B)Deficient Knowledge
C)Compromised Family Coping
D)Risk for Unstable Blood Glucose Level
E)Disturbed Body Image

Question 20

The nurse is reviewing the laboratory test results for a client with an endocrine disorder.Which diagnostic tests would the nurse anticipate reviewing for this client? Select all that apply.

A)Prothrombin time
B)Serum albumin
C)Ammonia level
D)Liver enzymes
E)T₃ and T₄ levels

Question 21

Type 2 diabetes mellitus is characterized by which underlying pathophysiology?

A)Excessive insulin production
B)Insulin resistance
C)Inability of the pancreas to produce insulin
D)Impaired insulin uptake

Question 22

The nurse is concerned that a client with potential hepatic failure is at risk for developing ascites.Which assessment finding supports the development of liver failure as manifested by ascites?

A)Increased abdominal girth
B)Gallbladder pain
C)Yellow-tinged skin
D)Bleeding and bruising easily

Question 23

The nurse is completing an assessment interview with an older adult client being seen for a yearly physical examination.Which client statement would indicate a possible diagnosis of diabetes mellitus?

A)"I'm slightly winded when I walk up a flight of stairs,but it passes quickly."
B)"I feel a bit tired by mid-afternoon and take a 30-minute nap most days."
C)"I sometimes have muscle aches in my upper legs at night."
D)"I've been experiencing increased thirst during the past several months."

Question 24

A nurse is caring for a client who was recently admitted for treatment of cirrhosis.The client is currently experiencing ascites,+3 pitting edema,and oliguria.Which nursing diagnosis should the nurse select as a priority for this client?

A)Excess Fluid Volume
B)Ineffective Peripheral Tissue Perfusion
C)Deficient Fluid Volume
D)Impaired Skin Integrity

Question 25

The healthcare provider prescribes sitagliptin (Januvia)for a client with type 2 diabetes mellitus.For which potential side effect should the nurse monitor in this client?

A)Elevated blood lipid levels
B)Hyperglycemia
C)Pancreatitis
D)Renal insufficiency

Question 26

The nurse is caring for a client recovering from a liver transplant necessitated by cirrhosis of the liver.Which postoperative outcome would be a priority for this client?

A)Moist membranes of the mouth
B)Normal serum bilirubin levels
C)Ability to move the legs
D)Normal pupil reaction

Question 27

The nurse is caring for a 76-year-old client with type 2 diabetes who is recovering from surgery following a hip fracture.In addition to blood glucose level,what should the nurse recognize as a sign of hyperosmolar hyperglycemic state (HHS)?

A)Excessive sweating
B)Increased urine output
C)Insomnia
D)Edema

Question 28

The nurse is providing education to the caregivers of a client with cirrhosis of the liver.The caregivers indicate that they've heard of portal hypertension,but they aren't sure which symptoms could indicate that their loved one is experiencing this condition.Which symptoms of portal hypertension should the nurse discuss with the caregivers?

A)Muscle wasting
B)Hypothermia
C)Bleeding gums
D)Hemorrhoids

Question 29

Which test is commonly used to screen for type 2 diabetes in the general population?

A)Fasting plasma glucose
B)Oral glucose tolerance test
C)Urine ketone levels
D)Serum cholesterol levels

Question 30

The nurse is planning care for a client with type 2 diabetes mellitus.Which nursing diagnosis would be most appropriate for this client?

A)Self Neglect
B)Risk for Infection
C)Risk for Decreased Cardiac Tissue Perfusion
D)Impaired Tissue Integrity

Question 31

What collaborative interventions are likely to improve outcomes for an 11-year-old client diagnosed with type 2 diabetes mellitus? Select all that apply.

A)Weaning off oral medications
B)Food intake based on age,sex,and physical activity
C)Obtaining adequate rest and sleep
D)Physical activity to be at least 30 to 60 minutes per day most days of the week
E)Family participation in the lifestyle change

Question 32

Health promotion and prevention related to type 1 diabetes should include

A)teaching clients at high risk how to prevent type 1 diabetes.
B)teaching clients with type 1 diabetes how to prevent complications.
C)providing clients with vaccinations against viruses that cause type 1 diabetes.
D)referring clients to a nutritionist and exercise therapist.

Question 33

Which potential cause of type 2 diabetes influences insulin's ability to regulate glucose metabolism and uptake by the liver,skeletal muscles,and adipose tissue?

A)Viral infection
B)Exposure to toxins
C)Young age
D)Obesity

Question 34

The nurse is caring for a client who complains of jaundice and pruritus.The healthcare provider suspects that the client has liver disease.What modifiable risk factor for cirrhosis of the liver might the nurse see in the client's history?

A)Smokes two packs of cigarettes per day
B)Drinks a six-pack of beer each evening
C)History of occupational exposure to hepatic toxins
D)Family history of fatty liver disease

Question 35

The nurse is identifying risk factors for liver disease among individuals who visit the community health center.Which does the nurse recognize as factors contributing to increased risk among certain ethnic groups? Select all that apply.

A)Pollution
B)Variations in alcohol metabolism
C)Stress due to socioeconomic factors
D)Consuming alcohol with food
E)Climate

Question 36

The nurse is counseling a couple who is planning a pregnancy.The woman was diagnosed with type 1 diabetes when she was 14 years old.She is now 27.Which examination should the nurse prepare the woman to have before,during,and after the pregnancy?

A)Gastrointestinal examination for gastric hypotony
B)Neural examination for diabetic peripheral neuropathy
C)Eye examination for diabetic retinopathy
D)Renal examination for urinary incontinence

Question 37

After reviewing the population demographics for an urban community,the community health nurse determines that community members would benefit from teaching on type 2 diabetes mellitus in children.What findings support this nurse's conclusion? Select all that apply.

A)60% of community families have both parents diagnosed with type 2 diabetes mellitus.
B)35% of school-age children do not routinely receive the annual flu vaccination.
C)50% of children between the ages of 10 and 19 are African American.
D)25% of children between the ages of 10 and 19 are Hispanic.
E)75% of school-age children are raised in families where both parents are unemployed.

Question 38

Which goal would be most appropriate to include in the nursing care plan of a client with type 2 diabetes?

A)The client will record daily fat intake.
B)The client will use hand hygiene when toileting.
C)The client will monitor fasting glucose levels.
D)The client will inspect feet at least once daily.

Question 39

Which type of infection has been implicated in destruction of pancreatic beta cells and thus causes type 1 diabetes?

A)Fungal
B)Parasitic
C)Viral
D)Bacterial

Question 40

The nurse,teaching a class to a group of community members about the importance of weight loss in decreasing the risk of type 2 diabetes mellitus,is asked why weight loss reduces the risk associated with the development of this health problem.Which response by the nurse is most appropriate?

A)"Excess body weight impairs the body's release of insulin."
B)"The amount of food taken in by those who are overweight requires more insulin to adequately metabolize,resulting in diabetes."
C)"The physical inactivity associated with obesity causes a reduced ability by the body to produce insulin."
D)"Thin people are less likely to become diabetic."

Question 41

Which change in bone structure contributes to osteoporosis?

A)The diaphysis of the bone becomes longer.
B)Trabeculae are increased in cancellous bone.
C)The outer cortex of the bone becomes thicker.
D)The diameter of the bone increases.

Question 42

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 reduce the intake of dairy in the diet.
C)The client should increase intake of calcium and vitamin D.
D)The client should start estrogen replacement therapy.

Question 43

A nurse is conducting a health history on an older adult client.Which assessment finding indicates the client is at risk for osteoporosis?

A)Having a body mass index (BMI)that indicates obesity
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)Drinking three glasses of skim milk daily

Question 44

What is the primary cause of loss of height in individuals with osteoporosis?

A)Collapse of vertebral bodies
B)Decrease in length of long bones
C)Flexion of the knees and hips
D)Cervical lordosis

Question 45

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 like to remove all of the fat from the meat I eat."
B)"I am trying to eat a low-carb diet."
C)"I plan to start eating out less."
D)"I am allergic to dairy products."

Question 46

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 the bed in the lowest position
C)Keeping a nightlight on in the hallway
D)The use of wrist restraints

Question 47

Restricted blood flow through the liver results in which condition?

A)Portal hypertension
B)Cirrhosis
C)Jaundice
D)Biliary atresia

Question 48

When individuals engage in excessive alcohol consumption,which liver function is impacted,leading to subsequent liver damage?

A)Metabolism
B)Synthesis
C)Detoxification
D)Glycogen storage

Question 49

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)"Oral calcium supplements are best taken on an empty stomach."
C)"Adults 50 years of age and over should obtain at least 500 to 750 mg per day of elemental calcium."
D)"If you have a condition called ventricular fibrillation,this medication might help."
E)"Report symptoms of weakness,increased urination,and thirst."

Question 50

A client who is at risk for developing osteoporosis asks what can be done to decrease the risk of actually developing the disease.Which intervention would be the most beneficial for this client?

A)Decreasing the amount of calcium in the client's diet
B)Providing the client with assisted range of motion exercising twice daily
C)Increasing regular weight-bearing activities
D)Protecting the client's bones with strict bedrest

Question 51

A new mother brings her 2-week-old infant in for a checkup because he looks jaundiced and his stools are white.The provider suspects the infant might have biliary atresia.What findings does the nurse anticipate upon assessment of the infant?

A)Above average weight gain
B)Increased urine output
C)Abdominal distention
D)Reduced rooting reflex

Question 52

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)"After menopause,the decline is too rapid to begin preventative interventions."
C)"Weight-bearing exercise and calcium supplements are helpful in the prevention of osteoporosis."
D)"Hormone replacement therapy should be initiated as soon as possible."

Question 53

What nursing intervention should be used to decrease pruritus in clients with liver disease?

A)Vigorously scrub the skin with soap to prevent infection.
B)Apply a lubricant on the skin to prevent dry skin.
C)Use hot water rather than cool water when bathing the client.
D)Administer an antihistamine as needed to reduce itching.

Question 54

A client with liver cirrhosis begins to drain bright red blood through the nasogastric tube.Which should the nurse prepare to administer to this client?

A)Vitamin K
B)Ferrous sulfate
C)Platelets
D)Folic acid

Question 55

A nurse is caring for a client with end-stage liver disease.Which alterations should the nurse anticipate with this client? Select all that apply.

A)Elevated serum albumin levels due to increased protein synthesis
B)Decreased clotting factor levels due to impaired clotting factor production
C)Hyperglycemia due to disrupted glucose metabolism
D)Increased serum vitamin K due to impaired clearance of fat-soluble vitamins
E)Increased plasma oncotic pressure due to impaired protein metabolism

Question 56

The nurse is assessing a school-age child who complains of severe itching,bruising easily,restlessness,and involuntary jerking of the hands.When considering these manifestations collectively,which organ or system should the nurse anticipate needing to assess further?

A)The liver
B)The nervous system
C)The gastrointestinal tract
D)The urinary system

Question 57

The nurse is assessing a postmenopausal client.Which question should the nurse ask to assess for signs of osteoporosis?

A)"Have you experienced any palpitations?"
B)"Are you having any low back pain?"
C)"Are you having problems with swelling in your feet?"
D)"Is constipation a problem for you?"

Question 58

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)Increasing the intake of alcoholic beverages
B)Isometric exercise for at least 30 minutes three times per week
C)Weight-bearing exercises such as walking
D)Having a yearly dual-energy x-ray absorptiometry (DEXA)test
E)A diet with adequate amounts of calcium and vitamin D

Question 59

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)"Smoking decreases nerve supply to the bones."
B)"Nicotine increases calcium absorption,leading to decreased bone density."
C)"Moderate alcohol consumption in postmenopausal women actually may increase bone mineral content."
D)"Alcohol has a direct toxic effect on osteoclast activity,suppressing bone formation."
E)"Heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis."

Question 60

A client with liver disease presents to the hospital with severe ascites.What pathophysiologic changes does the nurse recognize as contributing to the development of ascites? Select all that apply.

A)Presence of portal hypertension
B)Presence of hyperalbuminemia
C)Increased colloidal osmotic pressure
D)Sodium and water retention
E)Presence of hypoaldosteronism

Question 61

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)Thyroid hormone is often increased for older adult clients.
B)Symptoms of hypothyroidism in this group of clients are often confused with symptoms of aging.
C)Hypothyroidism is a congenital disease that manifests in older adult clients.
D)Hypothyroidism presents with pitting edema for this group of clients.

Question 62

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 hemoglobin (Hgb)level of 11.0 g/dL
B)A thyroid-stimulating hormone (TSH)level of 0.25 mU/mL
C)A TSH level of 18 mU/mL
D)A Hgb level of 13.8 g/dL

Question 63

What causes edema in adults with hypothyroidism?

A)Excess reabsorption of water and sodium in the kidneys
B)Decreased plasma oncotic pressure in the capillaries
C)Water retention in mucoprotein deposits in the interstitial spaces
D)Increased capillary permeability in the extremities

Question 64

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)Late closure of fontanels
B)Slow heart rate
C)Rapid weight gain
D)Breathing problems

Question 65

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)An increase in TSH levels
B)An increase in thyroid antibodies
C)A decrease in serum T₄
D)An increase in serum T₃
E)A decrease in T₃ uptake

Question 66

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)Increases stroke volume
B)Decreases cardiac rate
C)Lengthens the QRS interval
D)Decreases blood pressure

Question 67

Which client is at the greatest risk for developing hypothyroidism?

A)A 21-year-old woman who has a mother with Graves disease
B)A 32-year-old man who has an uncle with type 1 diabetes mellitus
C)A 57-year-old woman whose aunt had systemic lupus erythematosus
D)A 72-year-old man whose father had cardiovascular disease

Question 68

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)Provide client teaching related to using restraints to prevent falls.
B)Provide client teaching related to assistive devices to encourage walking.
C)Refer the client to a dietitian to increase calcium and vitamin D intake.
D)Refer the client to an occupational therapist to increase limb movement.

Question 69

The nurse is caring for a client with Graves disease.When observing the facial features of the client (pictured below),the nurse notes that the client is exhibiting which associated sign of the disease?

A)Conjunctivitis
B)Lacrimation
C)Periorbital edema
D)Exophthalmos

Question 70

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)"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."
B)"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."
C)"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."
D)"The baby won't require enough calcium during development to affect your bone mass or cause osteoporosis."

Question 71

The nurse suspects that a client is experiencing hypothyroidism.Which question should the nurse ask during the health history?

A)"Is your skin often clammy?"
B)"Do you have brown,shiny patches on your legs?"
C)"Are you intolerant to heat?"
D)"Have you had unexplained weight gain?"

Question 72

The nurse is providing care for a young adult client with exophthalmos.Which nursing diagnosis would be the most appropriate for this client?

A)Disturbed Body Image
B)Ineffective Coping
C)Risk for Injury
D)Activity Intolerance

Question 73

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)Hypothermia
B)Hot flashes
C)Nausea
D)Constipation
E)Tachycardia

Question 74

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)Nothing,because there is little effect on the quality of life in older adults.
B)Administration of antithyroid medications with propranolol
C)The ingestion of radioactive iodine,I-131
D)A combination treatment with levothyroxine (Synthroid)and amiodarone (Cordarone)