ATI LPN
Medical Surgical Endocrine ATI Questions
Question 1 of 5
A patient with hyperthyroidism is prescribed propylthiouracil (PTU). The nurse includes which formation about the mechanism of action of this medication in the teaching plan?
Correct Answer: A
Rationale: Propylthiouracil (PTU) inhibits the synthesis of thyroid hormone by diverting iodine pathways, reducing the production of T3 and T4.
Question 2 of 5
Mrs Jones is prescribed a GIK infusion that is commenced intraoperatively. As her postoperative nurse on the ward when will you cease her GIK infusion - GIK - Glucose, insulin and potassium
Correct Answer: A
Rationale: GIK maintains glucose levels perioperatively; it ceases when the patient resumes normal oral intake.
Question 3 of 5
A 48-year-old man has had increased swelling in the extremities for 2 months. Physical examination showed generalized edema. A 24-hour urine collection yielded 4.1 g of protein (albumin and globulins). He did not respond to a course of corticosteroid therapy. A renal biopsy was done, and microscopic examination showed diffuse thickening of the basement membrane. Immunofluorescence staining with antibody to the C3 component of complement was positive in a granular pattern in the glomerular capillary loops. Two years later, he experiences increasing malaise. Laboratory studies now show serum creatinine level of 4.5 mg/dL and urea nitrogen level of 44 mg/dL. Which of the following immunologic mechanisms was most likely responsible for the glomerular changes observed in the biopsy specimen?
Correct Answer: D
Rationale: Nephrotic syndrome may be produced by an idiopathic form of membranous nephropathy. Diffuse basement membrane thickening, in the absence of proliferative changes, and granular deposits of IgG and C3 are typical of this condition. It is caused by antibody targeting M-type phospholipase A 2 receptor antigen, the deposition of immune complexes on the basement membrane, and complement activation. In 75% of patients with membranous nephropathy, the cause of immune complex deposition is unknown. In the remaining cases an associated systemic disease (e.g. systemic lupus erythematosus) or some known cause of immune complex formation (e.g., drug reaction) exists. Antibodies that react with basement membrane give rise to a linear immunofluorescence pattern, as in Goodpasture syndrome. Membranous nephropathy has no association with streptococcal infections. There also is no evidence of cytokine-mediated or T cell-mediated damage in this disease.
Question 4 of 5
A 63-year-old man is in stable condition after an acute myocardial infarction when he became hypotensive for 3 hours before paramedical personnel arrived. Over the next week, the serum urea nitrogen level increases to 48 mg/dL, the serum creatinine level increases to 5 mg/dL, and the urine output decreases. He undergoes hemodialysis for the next 2 weeks and then develops marked polyuria, with urine output of 2 to 3 L/day. His renal function gradually returns to normal. Release of which of the following substances most likely participated in the elevation of BUN, creatinine, and reduced urinary output?
Correct Answer: B
Rationale: The most common cause of acute tubular necrosis is ischemic injury. The hypotension that develops after myocardial infarction causes decreased renal blood flow, with intrarenal vasoconstriction. Sublethal endothelial injury from reduced renal blood flow leads to the increased release of the vasoconstrictor endothelin and diminished amounts of the vasodilators nitric oxide and prostaglandin. The ischemic form of acute tubular injury is often accompanied by rupture of the basement membrane (tubulorrhexis). An initiating phase that lasts approximately 1 day is followed by a maintenance phase during which progressive oliguria and increasing blood urea nitrogen levels occur, with salt and water overload. This is followed by a recovery phase, during which there is a steady increase in urinary output and hypokalemia.
Question 5 of 5
A study of patients more than 25 years of age with body mass index above 30, dyslipidemia, hypertension, and fasting glucose averaging 115 mg/dL is performed. They have adipose tissue abnormalities including increased nonesterified fatty acid release, altered adipokines with decreased adiponectin, greater proinflammatory cytokine release, and diminished peroxisome proliferator-activated receptor gamma (PPARγ) function. Which of the following is the best initial therapeutic intervention for these patients?
Correct Answer: B
Rationale: The findings are those of insulin resistance from obesity with metabolic syndrome. Insulin resistance drives beta cell dysfunction, but other factors such as the TCF7L2 gene play a role in eventual development of overt type 2 diabetes mellitus. Excess free fatty acids may stimulate cytokine release from beta cells to promote inflammation and islet cell dysfunction. Lifestyle modification with dietary modification for weight reduction coupled with increased exercise will aid in reversing the insulin resistance so that no drug therapy is needed to control hyperglycemia.