ATI LPN
Medical Surgical Endocrine Questions Questions
Question 1 of 5
The nurse monitors for which clinical manifestations in the patient diagnosed with hypoparathyroidism?
Correct Answer: D
Rationale: A hand spasm when measuring blood pressure indicates Trousseau's sign, a classic sign of hypocalcemia due to hypoparathyroidism.
Question 2 of 5
A 36-year-old woman has had increased malaise for 3 weeks and urine output <500 mL/day for the past 4 days. On examination, she has blood pressure 170/112 mm Hg and peripheral edema. Urinalysis shows protein 1+ and blood 3+, but no glucose or ketones. Urine microscopic analysis shows RBCs and RBC casts. Her serum urea nitrogen is 39 mg/dL, and creatinine is 4.3 mg/dL. Her serum complement C1q, C3, and C4 are decreased. A renal biopsy is performed, and immunofluorescence microscopy shows a granular pattern of staining with antibody to C3. Which of the following types of hypersensitivity reactions is most likely causing her renal disease?
Correct Answer: C
Rationale: The findings fit with immune-mediated glomerular injury with antigen-antibody complex deposition, typical of an underlying disease such as SLE, and nephritic picture. Type I hypersensitivity may play a role in drug-induced acute interstitial nephritis. Type II hypersensitivity is present with anti-glomerular basement membrane diseases, such as Goodpasture syndrome. Type IV hypersensitivity plays a role in renal transplant rejection and some cases of drug-induced interstitial nephritis.
Question 3 of 5
A 25-year-old man has a 5-year history of celiac sprue. Four days after a mild upper respiratory infection, he begins passing dark red-brown urine. The dark urine persists for the next 3 days and then becomes clear and yellow, only to become red-brown again 1 month later. There are no remarkable findings on physical examination. Urinalysis shows a pH of 6.5; specific gravity, 1.018; 3+ hematuria; 1+ proteinuria; and no glucose or ketones. Microscopic examination of the urine shows RBCs, but no WBCs, casts, or crystals. A 24-hour urine protein level is 200 mg. A renal biopsy specimen from the glomeruli of this patient is most likely to show which of the following alterations?
Correct Answer: C
Rationale: IgA nephropathy (also known as Berger disease) can explain this nephritic condition with the presence of recurrent hematuria in a young adult. Nephrotic syndrome is not present, and mesangial IgA deposition is characteristic. The initial episode of hematuria usually follows an upper respiratory infection. IgA nephropathy occurs with increased frequency in patients with celiac disease and liver disease. It proceeds to chronic renal failure within 20 years in up to half of cases. Diffuse proliferation and basement membrane thickening denote membranoproliferative glomerulonephritis (GN), with IgG and C3 deposited in the glomeruli. Granular staining of basement membrane with IgG antibodies denotes immune complex deposition, which may occur in postinfectious GN, along with subepithelial deposits seen on electron microscopy. Patients with these changes also have nephritic syndrome. Glomerular capillary thrombosis is typical of hemolytic uremic syndrome.
Question 4 of 5
A 63-year-old woman had frequent headaches for 1 month. She now suddenly experiences a generalized seizure and becomes obtunded. She is taken to the emergency department, where a physical examination reveals an irregular heart rate. Laboratory findings include serum calcium of 15.4 mg/dL, serum phosphorus of 1.9 mg/dL, and albumin of 4.2 g/dL. A chest radiograph shows multiple lung masses and lytic lesions of the vertebral column. Which of the following conditions best accounts for these findings?
Correct Answer: C
Rationale: A common cause of clinically significant hypercalcemia in adults is a malignancy. When a patient presents with hypercalcemia, a disorder of the parathyroid glands or a malignancy at a visceral location must be considered. Hypercalcemia from malignancy can be caused by osteolytic metastases or a paraneoplastic syndrome from secretion of parathyroid hormone-related protein by the tumor. Metastatic disease from common primary sites, such as the breast, lung, and kidney, is much more common than parathyroid carcinoma, which tends to be local but aggressive.
Question 5 of 5
A 45-year-old woman has had angina pectoris, polyuria, and polydipsia for the past 5 years. On physical examination, she has a body mass index of 32. Laboratory studies show her hemoglobin A1c is 10%. Urinalysis shows proteinuria, but no ketonuria. The representative microscopic appearance of her kidneys is shown in the figure. Which of the following is the most likely mechanism leading to the disease causing her findings?
Correct Answer: C
Rationale: Nodular glomerulosclerosis, as shown in the figure, is a characteristic feature of renal involvement in diabetes mellitus and explains her proteinuria (which may progress to nephrotic syndrome). Peripheral insulin resistance is strongly linked to type 2 diabetes mellitus. Her history is classic for type 2 diabetes, as is the elevated hemoglobin A1c.