ATI LPN
Medical Surgical Endocrine ATI Questions
Question 1 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 2 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 3 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.
Question 4 of 5
A 19-year-old, previously healthy woman collapsed after complaining of a mild sore throat the previous day. On examination she is hypotensive and febrile with purpuric skin lesions. Her peripheral blood smear shows schistocytes. Imaging studies show her adrenal glands are enlarged, and there are extensive bilateral cortical hemorrhages. Infection with which of the following organisms best accounts for these findings?
Correct Answer: D
Rationale: This is the typical adrenal finding in Waterhouse-Friderichsen syndrome, and meningococcemia is the most likely cause of such a rapid course. Chronic adrenocortical insufficiency can result from disseminated tuberculosis and from fungal infections, such as histoplasmosis, that involve the adrenal glands.
Question 5 of 5
Which of the following is not an effect of a hormone secreted by the adrenal gland?
Correct Answer: D
Rationale: Adrenal hormones (cortisol, epinephrine) raise glucose, mimic SNS, reduce inflammation; thirst is regulated by hypothalamus/ADH, not adrenal.