Deck 12: Metabolism

Question 1

While performing an endocrine assessment on a client suspected of having Cushing disease,the nurse asks if the client has experienced recent weight changes.Which portions of the endocrine systems is the nurse assessing? Select all that apply.

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

Answer 1

Pituitary gland
Thyroid gland
Adrenal gland

Question 2

An adult client who is newly diagnosed with type 2 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 arteriosclerotic changes in blood vessels.
D) Smoking promotes weight gain.

Answer 2

Smoking accelerates arteriosclerotic changes in blood vessels.

Question 3

The nurse is planning care for a young school-age client 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) Knowledge Deficit
C) Ineffective Coping (Family)
D) Risk for Unstable Blood Glucose
E) Risk for Injury

Answer 3

Knowledge Deficit
Ineffective Coping (Family)
Risk for Unstable Blood Glucose

Question 4

The nurse is concerned that a school-age client has undiagnosed type 1 diabetes mellitus and is experiencing diabetic ketoacidosis (DKA).What did the nurse assess in the client to come to this conclusion? Select all that apply.

A) Blurred vision
B) Irregular heartbeat
C) Sunken eye sockets
D) Sluggish bowel sounds
E) Dry mucous membranes

Question 5

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's sign
D) Cullen's sign

Question 6

The nurse is completing an assessment interview with a 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 7

An older client is diagnosed with disorders of fat metabolism,reduced absorption of fat-soluble vitamins,and slightly elevated blood glucose level.When caring for this client,on which endocrine organ should the nurse focus interventions?

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

Question 8

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 9

A client is experiencing health problems related to alterations in adrenal medulla function.On which areas should the nurse focus when assessing this client? Select all that apply.

A) Heart rate
B) Weight
C) Respiratory rate
D) Skin integrity
E) Blood pressure

Question 10

During a home visit,the nurse evaluates teaching provide to a client with type 1 diabetes mellitus on the ability to prepare an insulin injection.List the order in which the client prepared the injection that indicates teaching has been effective.

A) Wipe the selected skin site with alcohol and wait for it to dry.
B) Fill the syringe with an amount of air equal to the number of units of insulin, and insert the needle into the vial.
C) Insert the insulin.
D) Push air into the vial, invert the vial, and withdraw the prescribed units of insulin.
E) Pinch up a fold of skin, and insert the needle into the tissue.

F) Withdraw the needle and apply firm pressure to the site for a few seconds.

Question 11

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 12

The nurse is preparing to admit a school-age client for treatment of diabetic ketoacidosis (DKA).On what should the nurse focus for this client's care? Select all that apply.

A) Peripheral perfusion
B) Fluid volume overload
C) Frequent blood glucose monitoring
D) Intravenous fluid infusions
E) Insulin infusion

Question 13

After reviewing the population demographics for an urban community,the community health nurse determines that community members would benefit from teaching on types 1 and 2 diabetes mellitus in children.Which information caused the nurse to come to this 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 14

The nurse is providing care to a client who is receiving treatment for diabetic ketoacidosis (DKA)who is experiencing an acid-base imbalance.Which is the reason for the associated altered metabolism that the client is experiencing?

A) Insulin deficiency
B) Hypothyroidism
C) Ascites
D) Hyperparathyroidism

Question 15

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) Take 2 hours before meals or 1 hour after meals.
B) Alternate nostrils used daily.
C) Take on an empty stomach in the morning with water.
D) Remain in an upright position for 30 minutes after taking.

Question 16

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 upon insulin absorption rates?

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

Question 17

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 18

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

A) Risk for Falls
B) Risk for Infection
C) Ineffective Tissue Perfusion: Cardiac
D) Impaired Tissue Integrity

Question 19

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 them, 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 20

The nurse is reviewing the laboratory test results for a client with an endocrine disorder.For which tests should the nurse expect to have current values on the medical record? Select all that apply.

A) Prothrombin time
B) Albumin
C) Ammonia level
D) Liver functions studies
E) Hemoglobin and hematocrit

Question 21

A nurse working in a community health center is counseling an adolescent regarding a suspected eating disorder.The adolescent is of normal weight but admits to periods of overeating,especially when experiencing stress.Based on this data,for which potential health problem should the nurse counsel the adolescent?

A) Obesity
B) An emaciated body
C) Hunger pangs
D) Anorexia

Question 22

A nurse is caring for a client who was recently admitted for treatment of cirrhosis.The client is currently experiencing BP of 200/100 mmHg,+3 pitting edema,and shortness of breath.Which nursing diagnosis should the nurse select as a priority for this client?

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

Question 23

The nurse is caring for a client with cirrhosis of the liver.Which information in the client's health history supports the current medical diagnosis?

A) Smokes two packs of cigarettes per day.
B) Drinks a six-pack of beer each evening.
C) Eats salads for lunch every day.
D) Plays on an adult softball team several times a week.

Question 24

The nurse is discussing postoperative care with a client scheduled for Roux-en-Y gastric bypass surgery.Which client statement indicates that learning goals for this client have been met?

A) "Maintaining protein intake will be a priority in my recovery diet."
B) "I will need to take daily vitamin and mineral supplements."
C) "I will initially take in only liquids, such as low-sugar juices."
D) "The foods I am allowed to eat gradually will be increased."

Question 25

The nurse is planning a teaching seminar for a group of young adult clients who are at risk for obesity.What statement should the nurse include in the program for this group?

A) There are drugs that are good to use to reduce weight.
B) Obesity puts the client at risk for anorexia nervosa.
C) Proper diet and exercise programs
D) The obese client will eventually be bulimic.

Question 26

The community health nurse is planning education for a group of individuals from Alcoholics Anonymous on the risk factors for liver disease.The group has a high number of Native Americans in attendance.What should the nurse explain as the reasons for the high incidence of cirrhosis in this ethnic group? 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 27

The nurse is caring for an adult client who is admitted to the hospital with a possible hip fracture.Following the admission assessment,nurse determines that the client is obese.About which disorders should the nurse teach the client that are often associated with obesity? Select all that apply.

A) Stroke
B) Degenerative joint disease
C) Urinary retention
D) Mobility problems
E) Chronic cough

Question 28

The nurse is discussing a new diet prescription with a client who is seeking help to lose weight.The client asks the nurse how to best balance the new diet.Which response by the nurse is most appropriate?

A) "Your diet should consist of 1,250-1,500 calories per day, with 15% of the calories being sources of protein."
B) "Your diet should be consist of 750-1,000 calories per day, with less than 15% of the total calories coming from fat."
C) "Your diet should simply cut 500 calories per day from your normal intake."
D) "Your diet should consist of 1,000-1,200 calories per day, with less than 15% of the total calories coming from fat."

Question 29

The nurse is planning care for a client with upper body obesity.What teaching should the nurse include in this client's care? Select all that apply.

A) Oxygen consumption
B) Exercise
C) Injury prevention
D) Diet
E) Behavior modification

Question 30

The nurse determines that a client is at risk for contracting hepatitis B because of intravenous drug use.What should the nurse teach to reduce the client's risk for this health problem?

A) Avoid contaminated food and water.
B) Avoid sharing needles.
C) Avoid alcohol consumption.
D) Wash hands frequently, as the disease is transmitted via the fecal-oral route.

Question 31

The nurse is caring for 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 32

A multidisciplinary conference has concluded that focused on the care needs of an older school-age client diagnosed with type 2 diabetes mellitus.On which areas should the team focus care to improve this client's long-term prognosis? 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 30-60 minutes per day most days of the week
E) Family participation in the lifestyle change

Question 33

The family of a client with cirrhosis of the liver asks what symptoms they need to look for while the client is being cared for in their home.Which manifestation should the nurse teach the family that indicates that the client is experiencing portal hypertension?

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

Question 34

A client with liver disease presents to the hospital with severe ascites.When providing care for this client,which pathophysiologic principles regarding this diagnosis will the nurse take into account? 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 35

A nurse is caring for a client with end-stage liver disease.Which hematological alterations might 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 mechanisms
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 36

The nurse is finalizing a plan of care for a school-age client newly diagnosed with type 1 diabetes mellitus.On which areas should the plan focus 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 37

The nurse is evaluating care provided to a school-age client recently discharged from the hospital with a new diagnosis of type 1 diabetes mellitus.Which observations indicate that care outcomes have been achieved? Select all that apply.

A) The client is documenting blood glucose readings and associated insulin dosages in a notebook next to the glucometer.
B) The client spends attends school and completes homework before bedtime.
C) The client correctly demonstrates drawing up and administering daily insulin dose.
D) The client has a glucagon kit in school backpack and explains how it should be used.
E) The client watches brothers play Little League baseball on the weekends.

Question 38

The nurse is concerned that a client with potential hepatic failure is at risk for developing ascites.Which assessment finding supports the nurse's concern?

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

Question 39

The nurse is working with a morbidly obese client who is seeking help to lose weight at a bariatric clinic.When planning this client's care,which nursing diagnosis is the priority?

A) Activity Intolerance
B) Disturbed Body Image
C) Defensive Coping
D) Constipation

Question 40

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 41

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 500-750 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 42

The nurse identifies the nursing diagnosis of Imbalanced Nutrition as appropriate for a client with osteoporosis.Which client statement supports the use of this diagnosis when planning care?

A) "I have removed all scatter rugs from my home."
B) "I frequently take long walks in the sun."
C) "My pain is relieved by Tylenol."
D) "I am allergic to dairy products."

Question 43

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) Fatigue
E) Tachycardia

Question 44

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 45

A client with new-onset atrial fibrillation appears very anxious.After reviewing the client's recent laboratory results,the nurse concludes that which might be causing the client's symptoms?

A) A Hgb of 11.0 g/dL
B) A TSH of 0.25 mU/mL
C) A TSH of 18 mU/mL
D) A Hgb of 13.8 g/dL

Question 46

A post-menopausal 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 47

A nurse is working with a client who is attempting to lose weight.The client admits having difficulty being compliant with the diet prescribed by the healthcare provider.Which suggestion by the nurse might assist the client in being compliant with the prescribed diet?

A) "Record your food intake so that you can see what and how much you are eating."
B) "Set aside small food reward when you meet a weight loss goal."
C) "Eat alone to reduce outside distractions that may cause you to stray from your diet."
D) "Allow at least 45 minutes to 1 hour to promote full enjoyment of your meal."

Question 48

An older adult client with hyperthyroidism is not a candidate for surgery.Which treatment could be used to quickly reduce the clinical manifestations that the client is experiencing as a result of the disorder?

A) Nothing, because there is little effect on the quality of life in older adults.
B) A partial thyroidectomy
C) The ingestion of radioactive sodium iodine, I131
D) A combination treatment with levothyroid (Synthroid) and amiodarone (Cordarone)

Question 49

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

A) Having a BMI that indicates obesity
B) Using corticosteroids for ten years due to a chronic lung disorder
C) Eating 3-5 servings of shrimp and liver per week
D) Drinking three glasses of skim milk daily

Question 50

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 room
D) The use of wrist restraints

Question 51

A nurse is caring for a client who weighs 209 pounds and is 1.67 meters tall.The nurse calculates the body mass index (BMI)of this client as ________.Round the answer to the nearest whole number.

Question 52

The nurse is preparing an education session for nurses who work in an endocrinology clinic caring for older adult clients.Which characteristic of hypothyroidism should the nurse include for this client group?

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 53

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) "Is your skin smooth?"
D) "Is your skin rough and dry?"

Question 54

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 55

The nurse is assessing an older adult 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 56

The home health nurse is visiting a 3-month-old infant diagnosed with congenital hypothyroidism who has been prescribed a daily dose of thyroxine.Due to digestive issues,the infant consumes soy formula and is at the 50th percentile for height and weight.Based on this data,which statement by the nurse to the mother is appropriate?

A) "You can stop the thyroxine as long as your baby remains in the 50th percentile for height and weight."
B) "The soy formula can interfere with the absorption of thyroxine."
C) "A dairy-based formula is contraindicated because your baby is prescribed thyroxine."
D) "As long as your baby is growing along the same growth curve, no interventions are necessary."

Question 57

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 bone mineral density (BMD) test
E) A diet with adequate amounts of calcium and vitamin D

Question 58

A client with exophthalmos is pictured below.Which conclusion by the nurse is appropriate?

A) This condition is caused by hypothyroidism.
B) Treatment for this condition reverses the symptoms of exophthalmos.
C) This condition is caused by Hashimoto thyroiditis.
D) Women with this condition may have fertility problems.

Question 59

A community health nurse is educating a group of adults about obesity and weight management.Which statements will the nurse include regarding upper body obesity? Select all that apply.

A) "This is also called peripheral obesity."
B) "It is when the waist-to-hip ratio in men is greater than 0.8 in men or greater than 1 in women."
C) "It is associated with a greater risk of hypertension."
D) "Young women tend to have more intra-abdominal fat than men."
E) "Postmenopausal women tend to have this."

Question 60

A young adult client is concerned because the healthcare provider states that the client is demonstrating signs consistent with early onset of osteoporosis.Which health promotion activities are appropriate for this client?

A) Suggest stopping all physical activity.
B) Recommend reducing the intake of diary in the diet.
C) Instruct on increasing intake of calcium and vitamin D.
D) Discuss the use of estrogen replacement therapy.

Question 61

A client with Graves disease requests that the nurse discuss the results of laboratory tests with the client.Which statements would the nurse include? Select all that apply.

A) "Your TSH level is increased."
B) "Your thyroid antibodies test is increased."
C) "Your serum T4 is decreased."
D) "Your serum T3 is increased."
E) "Your T3 uptake is decreased."