ATI LPN
PN Learning System Medical Surgical Endocrine Practice Quiz Questions
Question 1 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 2 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 3 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.
Question 4 of 5
A 39-year-old man has had headache, weakness, and a 5-kg weight gain over the past 3 months. He has experienced mental depression during the same period. On physical examination, his face is puffy. His temperature is 36.9°C and blood pressure is 160/75 mm Hg. He has cutaneous striae over the lower abdomen and ecchymoses scattered over the extremities. A radiograph of the spine shows a compressed fracture of T11. Laboratory findings show fasting plasma glucose level of 200 mg/dL, serum Na+ of 150 mmol/L, and serum K+ of 3.1 mmol/L. The plasma cortisol level is 38 μg/dL at 8:00 am and 37 μg/dL at 6:00 pm. Administration of low and high doses of dexamethasone fails to suppress the plasma cortisol level and excretion of urinary 17-hydroxycorticosteroids. The plasma corticotropin level is 0.8 pg/mL. Which of the following lesions is most likely to be present in this man?
Correct Answer: B
Rationale: The clinical and laboratory features of this case point to Cushing syndrome. The dexamethasone suppression test is used to localize the source of excess cortisol. When low-dose and high-dose dexamethasone trials fail to suppress cortisol secretion, a pituitary corticotropin-secreting adenoma as the source of excess glucocorticoids is unlikely. The choice is an ectopic source of corticotropin, such as a lung cancer, or a tumor of the adrenal cortex that is secreting glucocorticoids. The plasma corticotropin level distinguishes between these two possibilities. Corticotropin levels are high if there is an ectopic source, whereas glucocorticoid secretion from an adrenal neoplasm suppresses corticotropin production by the pituitary, leading to atrophy of the contralateral adrenal cortex.
Question 5 of 5
Which of the following statements regarding hormones is incorrect?
Correct Answer: A
Rationale: Hormones act via bloodstream, not synapses (neurotransmitters do); others are true: receptor specificity, gene expression, second messengers.