ATI LPN
PN Learning System Medical Surgical Endocrine Practice Quiz Questions
Question 1 of 5
A patient with thyroid cancer is receiving high-dose radiation to the thyroid gland. In assessing the patient, which clinical manifestations would be consistent with hypoparathyroidism?
Correct Answer: B
Rationale: Clinical manifestations of hypoparathyroidism are related to hypocalcemia and include tetany, muscle cramps, positive Chvostek's sign, positive Trousseau's sign, paresthesias of the hands and feet, and circumoral tingling.
Question 2 of 5
You are caring for a patient who has unstable diabetes. As a nurse, it is important to recognise the early signs and symptoms of diabetic ketoacidosis These are:
Correct Answer: D
Rationale: Early DKA signs include the 3 P's (polydipsia, polyuria, polyphagia) due to hyperglycemia, before progressing to dehydration and fruity breath.
Question 3 of 5
A study of renal disease identifies patients with greater than 3.5 g of protein in a 24-hour urine collection, but no RBCs or WBCs. Dysfunction involving which of the following cells is most likely to be responsible for proteinuria?
Correct Answer: D
Rationale: The podocytes (visceral epithelial cells) of the glomerulus form a filtration barrier that depends upon both the anionic charge as well as slit diaphragms. Injuries that cause effacement, retraction, detachment, and vacuolization allow protein, principally albumin, to escape into Bowman space. Podocytes have limited capacity for regeneration and repair. The loss of 3.5 g/day of protein defines nephrotic syndrome. About a sixth of filtration occurs through the mesangium. The remaining listed options do not participate in this epithelial protein filtration barrier.
Question 4 of 5
A 15-year-old boy has been passing dark-colored urine for the past month. On physical examination, he has bilateral sensorineural hearing loss and corneal erosions. Urinalysis shows a pH of 6.5; specific gravity, 1.015; 1+ hematuria; 1+ proteinuria; and no ketones, glucose, or leukocytes. The serum creatinine level is 2.5 mg/dL, and the urea nitrogen level is 24 mg/dL. A renal biopsy specimen shows tubular epithelial foam cells by light microscopy. By electron microscopy, the glomerular basement membrane shows areas of attenuation, with splitting and lamination of lamina densa in other thickened areas. What is the most likely diagnosis?
Correct Answer: A
Rationale: Alport syndrome is a form of hereditary nephritis. Hematuria is the most common presenting feature, but proteinuria is often present and may be in the nephrotic range. Patients progress to chronic renal failure in adulthood. An X-linked pattern of inheritance is present in 85% of cases, but autosomal dominant and autosomal recessive pedigrees also exist. The foamy change in the tubular epithelial cells and ultrastructural alterations of the basement membrane are characteristic features. The genetic defect results from mutation in the gene for the a5 chain of type IV collagen. IgA nephropathy is a form of glomerulonephritis that does not produce tubular epithelial changes. TTP is often associated with inherited or acquired deficiencies of ADAMTS13, leading to thrombotic microangiopathy, similar to hemolytic uremic syndrome from Escherichia coli Shiga toxin damaging vascular endothelium. Nodular and diffuse glomerulosclerosis are typical changes in diabetic nephropathy that can occur following loss of pancreatic islet beta cells. Toxic injuries are most likely to damage tubular cells, leading to acute tubular necrosis.
Question 5 of 5
A 47-year-old woman noticed a lump in her neck 1 week ago. On physical examination, there is a 2-cm nodule in the right lobe of the thyroid gland. A fine-needle aspiration biopsy is performed, and microscopic examination of the specimen shows cells consistent with a follicular neoplasm. She undergoes a subtotal thyroidectomy. Which of the following laboratory tests should be performed on this patient in the immediate postoperative period?
Correct Answer: C
Rationale: Inadvertent removal of or damage to the parathyroid glands during thyroid surgery can cause hypocalcemia secondary to hypoparathyroidism. This is the most common cause of hypoparathyroidism. Individuals with hypocalcemia exhibit neuromuscular irritability, carpopedal spasm, and sometimes seizures. Antithyroglobulin antibody levels are of no use in diagnosing surgical diseases of the thyroid. Calcitonin quantitative is not a useful measure to determine the status of calcium metabolism.