NURS 317 Unit 3 Chapter 41 Path Point Questions Flashcards
The health care provider is teaching a client about the metabolic effect of cortisol. The most appropriate information to provide would be:
A) Regulation of anti-inflammatory reactions
B) Breakdown of proteins and fats
C) Regulation of behavior and emotion
D) Suppression of the immune response to invasive pathogens
B) Breakdown of proteins and fats
Rationale: The best-known metabolic effect of cortisol and other glucocorticoids is their ability to stimulate gluconeogenesis (glucose production) by the liver. Metabolic effects of cortisol involve the metabolism of proteins, carbohydrates, and fats. Behavior and emotion regulation is a psychological effect of cortisol. The other two options are immunologic and inflammatory effects of cortisol.
A client diagnosed with type 2 diabetes has been instructed about managing his condition with diet. Which statements by the client indicate a need for additional education? Select all that apply.
A) “I need to limit the amount of foods that I eat that contain trans fats.”
B) “I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads.”
C) “I need to avoid adding salt to my foods.”
D) “I need to carefully limit my protein consumption.”
E) “I can drink 8 to 10 glasses of water daily without concern for calories.”
B) “I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads.”
D) “I need to carefully limit my protein consumption.”
Rationale: The client needs more education regarding all carbohydrate sources. Protein consumption should remain normal for optimal nutrition. All the other statements are correctly stated and demonstrate good understanding of dietary needs for type 2 diabetes.
The health care provider is reviewing diurnal variation pattern in adrenocorticotropic (ACTH) levels. Select the typical diurnal variation pattern in adrenocorticotropic (ACTH) levels.
A) ACTH peaks in correspondence with food intake.
B) ACTH peaks in the morning and declines throughout the day.
C) ACTH increases in the morning and peaks again in the evening hours.
D) ACTH maintains a consistent level regardless of the time of day.
B) ACTH peaks in the morning and declines throughout the day.
Rationale: ACTH levels have diurnal variation in which they reach their peak in the early morning (around 6 to 8 AM) and decline as the day progresses related to rhythmic activity of the CNS. The diurnal pattern is reversed in people who work during the night and sleep during the day. The rhythm also may be changed by physical and psychological stresses, endogenous depression, and liver disease or other conditions that affect cortisol metabolism.
A client is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level (FBS) of 80 mg/dL (4.44 mmol/L) and a hemoglobin A1C of 5% (.05). Based on these findings, which of the following can the nurse assume?
A) The client is at risk for an insulin reaction.
B) The client is achieving normal glycemic control.
C) The client needs to modify his diet related to the low readings.
D) The client is at risk for developing hyperglycemia.
B) The client is achieving normal glycemic control.
Rationale: The reading for the FBS is appropriate (<100 mg/dL [5.55 mmol/L] is normal) and the hemoglobin A1C level (<6.5) shows good control of glucose levels over a 6- to 12-week period. This client should continue his current exercise and diet routine, which is working well for him.
The diagnosis of type 1 diabetes would be confirmed by which principle?
A) Insulin is produced but unavailable for use in the body.
B) Small amounts of insulin are produced daily.
C) Insulin is not available for use by the body.
D) Insulin is present in large amounts for use by the body.
C) Insulin is not available for use by the body.
Rationale: Type 1 diabetes is a catabolic disorder characterized by an absolute lack of insulin. In type 2 diabetes, some insulin is produced.
A client with a suspected diagnosis of primary hypothyroidism would most likely demonstrate which serum laboratory value?
A) Elevated thyroid-stimulating hormone (TSH) and decreased thyroxine (T4)
B) Decreased thyroid-stimulating hormone (TSH) related to poor thyroid function
C) Elevated thyroid-stimulating hormone (TSH), thyroxine (T4), and T3
D) Decreased thyroid-stimulating hormone (TSH) and thyroxine (T4), and low T3
A) Elevated thyroid-stimulating hormone (TSH) and decreased thyroxine (T4)
Rationale: A low serum T4 and elevated TSH levels are characteristic of primary hypothyroidism. Elevated TSH, T4, and T3 may indicate hyperthyroidism. Decreased levels may be due to suppression by medication.
The nurse is assessing a female client with a diagnosis of primary adrenal cortical insufficiency. Which manifestation should the nurse anticipate?
A) Anorexia and increased excitability
B) Sparse axillary and pubic hair
C) Weight gain and fluid retention
D) Pale skin and increased hunger
B) Sparse axillary and pubic hair
Rationale: A common finding would be sparse axillary and pubic hair. Other signs/symptoms would include dehydration, weakness, fatigue, anorexia, nausea, and weight loss. Skin would have increased pigmentation. Weight gain and fluid retention may be the result of Cushing syndrome.
Select the most appropriate intervention for the nurse to teach a client diagnosed with distal symmetric neuropathy related to diabetes.
A) Inspect the feet for blisters daily
B) Wear comfortable, open-toed shoes
C) Decrease daily walking activity
D) Rotate insulin injection sites once a week
A) Inspect the feet for blisters daily
Rationale: A client with neuropathy is at risk for damage to his or her feet, such as blisters or ulcers, as the clients are unable to feel this damage. Clients need to inspect their feet daily, wear foot coverings (such as closed-toe shoes) to prevent injuries, and continue the exercise patterns to promote improved circulation.
The nurse is working in a pediatric clinic. Which child would the nurse recognize as having isosexual precocious puberty?
A) A 14-year old white female who has not yet developed secondary sex characteristics
B) A 9-year-old white female who has small breast buds
C) A 10-year-old black female who has begun menstruating
D) A 5-year-old black female with developing breasts and pubic hair
D) A 5-year-old black female with developing breasts and pubic hair
Rationale: Precocious puberty is now defined as the appearance of secondary sexual development before the age of 7 years in white girls and 6 years in black girls. In boys of both races, the lower age limit remains 9 years. However, it is recognized that puberty can develop earlier in boys with obesity.
The mother of a 2-year-old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. The best response by the nurse is:
A) “When your child gets old enough, you will not have to administer injections.”
B) “Insulin is destroyed by the stomach contents and has to be administered by injection.”
C) “Your child is not old enough to swallow the pills needed to treat her diabetes.”
D) “Insulin needs to go directly into the vein to work best.”
B) “Insulin is destroyed by the stomach contents and has to be administered by injection.”
Rationale: Insulin is destroyed by the gastrointestinal tract and needs to be administered via injection or inhalation. Type 1 diabetes is not treated with oral medications at this time. Insulin is administered subcutaneously rather than in the vein. The statement about the mother not having to give injections once the child is older does not address the mother’s concerns.
Which statement best describes a secondary disorder of endocrine function?
A) The disorder occurs when the target organ becomes dysfunctional.
B) The disorder occurs when the target organ is normal, but stimulating hormones alter its function.
C) The disorder occurs from hypothalamic dysfunction resulting in under stimulation of the target organ.
D) The disorder occurs in the target gland responsible for producing the hormone.
B) The disorder occurs when the target organ is normal, but stimulating hormones alter its function.
Rationale: In secondary disorders of endocrine function, the target gland is essentially normal, but its function is altered by defective levels of stimulating hormones or releasing factors from the pituitary system. The disorder occurring in the target gland responsible for producing the hormone describes a primary defect. The disorder occurring from hypothalamic dysfunction resulting in under stimulation of the target organ describes a tertiary disorder.
Which interventions would be included in the plan of care for a client experiencing myxedema coma? Select all that apply.
A) Initiation of thyroid replacement therapy
B) Rewarming to manage hypothermia
C) Reversal of hypoglycemia
D) Frequent monitoring of cardiac functions
E) Oxygen therapy to support ineffective respirations
A) Initiation of thyroid replacement therapy
C) Reversal of hypoglycemia
D) Frequent monitoring of cardiac functions
E) Oxygen therapy to support ineffective respiration
Rationale: Treatment includes aggressive management of precipitating factors; supportive therapy such as management of cardiorespiratory status, hyponatremia, and hypoglycemia; and thyroid replacement therapy. If hypothermia is present, active rewarming of the body is contraindicated because it may induce vasodilation and vascular collapse.
A 48-year-old male client diagnosed with type 2 diabetes presents with the following: * Blood glucose level of 46 mg/dL (2.55 mmol/L) * Very lethargic * Has cool, clammy skin. Select the most appropriate intervention.
A) Encourage the client to sit up and drink 12 ounces of orange juice
B) Place sugared breath mints in the client’s mouth
C) Administer scheduled dose of insulin
D) Administer injectable glucagon
D) Administer injectable glucagon
Rationale: The best course of action for this client who is experiencing hypoglycemia and is lethargic is to administer injectable glucagon. Insulin would be used to treat hyperglycemia. Encouraging fluids and placing breath mints could result in aspiration for this lethargic client and would not be recommended.
Which complication of acromegaly can be life threatening?
A) Cardiac structures increase in size
B) Bone overgrowth causes arthralgias
C) Vertebral changes result in kyphosis
D) Splayed teeth result in impaired chewing
A) Cardiac structures increase in size
Rationale: While all the complications can exist, it is the enlargement of the heart and accelerated atherosclerosis that may lead to an early death. The teeth become splayed, causing a disturbed bite and difficulty in chewing. Vertebral changes often lead to kyphosis, or hunchback. Bone overgrowth often leads to arthralgias and degenerative arthritis of the spine, hips, and knees. Virtually every organ of the body is increased in size.
A 25-year-old female client exhibits exophthalmos of both eyes. The health care provider recognizes this as a manifestation of:
A) Hashimoto thyroiditis
B) Acquired hypothyroidism
C) Graves disease
D) Myxedema
C) Graves disease
Rationale: Graves disease is a state of hyperthyroidism in which ophthalmopathies, such as exophthalmos, typically occur. The other conditions are states of hypothyroidism and are not associated with this abnormality
