NSG 210 Physiological Health Alterations and Reproduction Exam 3 Practice Set, Exams of Human Physiology

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NSG 210

Physiological Health

Alterations and

Reproduction Exam 3

Practice Set

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 - ANS-A, B, C, E

The adrenal medulla secretes the catecholamines epinephrine and norepinephrine. These hormones stimulate the heart, increase metabolism, increase respiration, and constrict blood vessels. The nurse should focus the assessment on heart rate, weight, respiratory rate, and blood pressure. Dry and cracked heels are not caused by changes in adrenal medulla function.

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 - ANS-B,C,D

In adrenal, thyroid, and pituitary disease, the client's weight changes might provide information as to the endocrine disorder the client is experiencing. The client might gain weight with an adrenal or pituitary disorder such as Cushing disease or with thyroid disease such as hypothyroidism or hyperthyroidism. The pituitary gland controls antidiuretic hormone (ADH), which influences water absorption by the renal tubules. The parathyroid gland regulates calcium and phosphorus. The gonads influence estrogen and androgens.

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

Explanation: When administering calcitonin-human nasal spray, the nurse should teach the client to alternate nostrils each day. The nasal spray should not be administered in only the left nostril, only the right nostril, or both nostrils at each dose.

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 - ANS-C

Clients who have a hormone deficiency require client teaching related to the importance of regularly taking their hormone supplements. Depending on the hormone deficiency, clients may need education related to either increasing or decreasing fluid intake or increasing or decreasing body weight. Client teaching related to regulating sugar intake is specific for clients with insulin deficiency or insulin resistance, not for any client with a hormone deficiency.

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. - ANS-B

Many clients with an alteration in metabolism will have special dietary needs, so the nurse can refer the client to a nutritionist or dietitian as an independent nursing intervention. Administering hormone therapies is a collaborative intervention. Ordering blood tests is outside the scope of nursing practice. Nurses should not refer the client to an acupuncturist without consulting with a provider who understands the effects of acupuncture on the client's specific metabolic disorder.

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 - ANS-D

Mobility and the risk for bone fracture is related to calcium regulation, which is controlled by parathyroid hormone and calcitonin. Acid—base balance, reproduction, and perfusion are not directly related to calcium regulation and parathyroid hormone levels.

B) Mobility and the risk for bone fracture is related to calcium regulation, which is controlled by parathyroid hormone and calcitonin. Acid—base balance, reproduction, and perfusion are not directly related to calcium regulation and parathyroid hormone levels.

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 - ANS-A

The pituitary gland is responsible for the secretion of growth hormone. Excess growth hormone secretion can result in gigantism in children, which causes an increase in the growth of the bones, organs, and muscles. The thyroid gland, parathyroid glands, and adrenal glands do not secrete growth hormone.

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. - ANS-A

Pregnant women with preexisting endocrine disorders such as hypothyroidism may need to change their dosage of hormone replacement therapy during the pregnancy. The nurse should consult with the

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 - ANS-C, E

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 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." - ANS-D

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.

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 - ANS-C

A standard intervention for those attempting to prevent osteoporosis is beginning an exercise plan that includes weight-bearing activities. Strict bedrest, decreasing calcium intake, and assisted range of motion exercises may make the osteoporosis worse.

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 - ANS-B

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 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. - ANS-C

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.

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."

E) "Heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis." - ANS-C, E

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.

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. - ANS-D

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.

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

D) Cervical lordosis - ANS-A

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.

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. - ANS-B

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 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." - ANS-C

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

A) "Is your skin often clammy?"

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 - ANS-A

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.

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 - ANS-C

Explanation: A) 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.

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-

D) A combination treatment with levothyroxine (Synthroid) and amiodarone (Cordarone) - ANS-B

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 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 - ANS-D

Exophthalmos is a condition associated with Graves disease, caused by hyperthyroidism. Lacrimation is a sign of Graves disease, but it is not depicted in this photo. Conjunctivitis is not associated with Graves disease. Periorbital edema is a sign of hypothyroidism, not hyperthyroidism.

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 T

D) An increase in serum T

E) A decrease in T3 uptake - ANS-B, D

Explanation: A) 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 causes edema in adults with hypothyroidism?

A) Excess reabsorption of water and sodium in the kidneys

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 - ANS-D

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.

An adult client is diagnosed with a degenerative bone disease that is impairing mobility. Based on this information alone, which of the following actions should be the nurse's first priority?

A) Implementing a low-level exercise program for the client

B) Assessing the client's pain management

C) Teaching the client relaxation techniques

D) Referring the client to a dietitian - ANS-B

When caring for a client with a degenerative bone disease that is impairing mobility, the nurse should assess pain management prior to implementing an exercise program, teaching relaxation exercises, or referring to a dietitian.

A preadolescent client who fell from a balance beam in physical education class injured her ankle. Given this information, which action by the nurse is appropriate?

A) Referring the client to physical therapy

B) Placing an ice pack on the client's ankle

C) Planning for a corticosteroid injection

D) Ordering an x-ray of the ankle - ANS-B

An appropriate intervention for a client who experiences an ankle injury is placing ice on the ankle to limit swelling. If physical therapy is needed, the referral would be given after the ankle has had time to heal. A corticosteroid injection would be more appropriate for a client with osteoarthritis, not an acute ankle injury. Ordering an x-ray of the ankle is outside the nurse's scope of practice.

The nurse is conducting a gait and posture assessment for a client who is experiencing mobility issues. Which action by the nurse is appropriate during this assessment?

A) Assessing the client's muscle mass and strength

B) Measuring the length and circumference of the client's extremities

C) Inspecting the client's spine for curvature

D) Palpating the client for tenderness and pain - ANS-C

When assessing a client's gait and posture, the nurse should be sure to inspect the client's spine for curvature. Assessing muscle mass and strength, measuring the length and circumference of the extremities, and palpating for tenderness and pain are part of the physical assessment performed by the nurse for clients who are experiencing mobility issues.

The nurse is caring for a client who is experiencing limited mobility related to a musculoskeletal alteration. Which laboratory tests would be useful to diagnose the client appropriately? Select all that apply.

A) Magnetic resonance imaging (MRI)

B) Alkaline phosphatase (ALP)

C) Human leukocyte antigen-B27 (HLA-B27)

D) Rheumatoid factor (RF)

E) Electromyography (EMG) - ANS-B, C, D

ALP, HLA-B27, and RF are all laboratory tests that are used to diagnose clients with musculoskeletal disorders that can cause alterations in mobility. ALP is produced by bone and other organs. Increased ALP may indicate bone disease, bone fracture, bone tumors, osteomalacia, Paget disease, or rickets. Decreased ALP may indicate Wilson disease. The presence of HLA-B27 indicates an increased risk for ankylosing spondylitis and arthritis. Elevated levels of RF may indicate rheumatoid arthritis, scleroderma, lupus erythematosus, and adult Still disease. MRI and EMG are both diagnostic, not laboratory, tests use to diagnose the cause of alterations in mobility.

A) Instructing on the importance of proper nutrition and an active lifestyle

B) Administering a prescribed nonsteroidal anti-inflammatory drug (NSAID)

C) Identifying necessary modifications to the home environment

D) Prescribing a skeletal muscle relaxant - ANS-A

An appropriate independent nursing intervention for a client who is experiencing an alteration in mobility is providing instruction on the importance of proper nutrition and an active lifestyle. Administering a prescribed NSAID is an example of a collaborative intervention that the nurse can implement. Identifying necessary modifications for the home environment is a collaborative intervention often implemented by the occupational therapist. Although it is appropriate for the nurse to administer a skeletal muscle relaxant, it is outside the scope of nursing practice to prescribe this medication.

The nurse is caring for an adult client who sustained a right distal radial fracture and a left tibia fracture. Which mobility aid does the nurse anticipate being used for this client?

A) Lofstrand crutches

B) Platform crutches

C) Walker

D) Axillary crutches - ANS-B

This client has fractures in both the leg and wrist. Platform crutches are used for clients who are unable to bear weight on their wrists. A walker, axillary crutches, and Lofstrand crutches all require use of the wrists.

The nurse is providing care for several clients. For which client should the nurse anticipate an order for administering 1000 mg of aspirin?

A) A 68-year-old client with rheumatoid arthritis who is experiencing hand pain

B) A 5-year-old client who is experiencing ankle pain after a fall from a horse

C) A 38-year-old client who is experiencing headache pain after a skiing accident

D) A 70-year-old client who is experiencing back pain after laminectomy - ANS-A

Aspirin is appropriate for the client with rheumatoid arthritis who is experiencing hand pain, assuming there are no other contraindications. This medication is not appropriate for the other clients, however.

Aspirin therapy is not recommended for children because it is associated with an increased risk of Reye syndrome, and it may contribute to bleeding in adult clients who have sustained physical injury.

The cells that produce the matrix for bone formation are known as

A) osteoclasts.

B) sarcomeres.

C) osteoblasts.

D) epiphyseal plates. - ANS-C

Osteoblasts are the cells that produce the matrix for bone formation, whereas osteoclasts are cells that break down bone tissue. Sarcomeres are filaments made of actin or myosin that are found within muscle. Epiphyseal plates are areas of cartilage located between the epiphysis and diaphysis of a child's long bones.

Within the human body, which type of connective tissue connects bones to other bones to form a joint?

A) Tendon

B) Ligament

C) Cartilage

D) Myelin - ANS-B

Ligaments, tendons, and cartilage are all connective tissues. Ligaments connect bones to other bones to form a joint. Tendons connect bones to muscles and carry the contractile forces from the muscle to the bone to cause movement. Cartilage is a type of flexible connective tissue found in many locations throughout the body. Myelin is not a type of connective tissue but rather a fatty substance that insulates neuronal axons and promotes faster signal transmission.

A client presents with an alteration in mobility. Which finding would suggest damage to the muscle?

A) Increased PTH levels

B) Decreased PTH levels

C) Decreased CK levels

D) Increased CK levels - ANS-D