Joey's Rendition of a Patho (Ch. 41) Quizlet
5. A woman with a diagnosis of type 2 diabetes has been ordered a hemoglobin A1C test for the first time by her primary care provider. The woman states, "I don't see why you want to test my blood cells when it's sugar that's the problem." What aspect of physiology will underlie the care provider's response to the client? A. The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell. B. Hemoglobin synthesis by the bone marrow is inversely proportionate to blood glucose levels, with low A1C indicating hyperglycemia. C. The high metabolic needs of red cells and their affinity for free glucose indicate the amount of glucose that has been available over 6 to 12 weeks. D. Insulin is a glucose receptor agonist on the hemoglobin molecule and high glucose suggests low insulin levels
Answer: A Rationale: Glucose entry into red blood cells is not insulin dependent, and the rate at which glucose becomes attached to the hemoglobin molecule depends on blood glucose levels. A1C levels thus indirectly indicate glucose levels. Hemoglobin synthesis, the metabolic needs of hemoglobin, and an agonist role of insulin do not underlie the A1C test. Question format: Multiple Choice Chapter 41: Disorders of Endocrine Control Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 1075
7. A 60 year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration, and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which action should be the wife's first choice? A. Administration of 15 to 20 g of glucose in a concentrated carbohydrate source. B. Administration of subcutaneous glucagon. C. IV infusion of 50% dextrose and water solution. D. Careful monitoring for level of consciousness and resolution of hypoglycemia.
Answer: A Rationale: An insulin reaction necessitates intervention in addition to careful observation. The ideal response to an insulin reaction in a still conscious client is the administration of 15 to 20 g of glucose in a concentrated carbohydrate source. Glucagon or D50 would be indicated if the client is unconscious or unable to swallow. Question format: Multiple Choice Chapter 41: Disorders of Endocrine Control Cognitive Level: Apply Client Needs: Physiolog
10. A female client presented to her primary care physician with classic signs/symptoms of Cushing syndrome. Upon testing, it was discovered that the client had vaginal small cell carcinoma. How can the health care providers explain the Cushing syndrome signs/symptoms to this client? A. "The tumor in your vagina is secreting a hormone called adrenocorticotropic hormone (ACTH), which is responsible for these signs/symptoms." B. "We are going to have to run some more tests. We think you might have a problem with your pituitary gland." C. "There is no connection between the Cushing syndrome and the vaginal carcinoma. You have two very distinct problems occurring at the same time." D. "We need to check your thyroid. Your Cushing syndrome may be caused by hypofunction of this gland."
Answer: A Rationale: Hyperfunction is usually associated with excessive hormone production. This can result from excessive stimulation and hyperplasia of the endocrine gland or from a hormone-producing tumor. A clinical example of this phenomenon is evidenced by the case of a woman with vaginal small cell carcinoma who also presented with Cushing syndrome. After testing, it was determined that the tumor was secreting ACTH. In this situation, the cause was not related to a pituitary problem. There is a connection between Cushing syndrome and the carcinoma. The thyroid gland is not responsible for Cushing syndrome.
6. A client with pancreatitis is admitted with weight loss, nausea, and vomiting. To maintain nutrition, the physician orders parenteral nutrition to be started. Knowing that a major side effect of parenteral nutrition is a hyperosmolar hyperglycemic state, the nurse should assess the client for which clinical manifestations? A. Dry lips, excess urine output, and seizures. B. Facial tics, shuffling gait, stiff joints. C. Fever, chills, elevated BP of 170/101. D. Irritability, bradycardia, wheezing noted on inspiration.
Answer: A Rationale: Hyperosmolar hyperglycemic state is characterized by high blood glucose (>600 mg/dL [33.3 mmol/L]), dehydration (dry lips), depression of sensorium, hemiparesis, seizures, and coma. The client may also experience weakness, polyuria, and excessive thirst. HHS may occur in various conditions, including type 2 diabetes, acute pancreatitis, severe infection, MI, and treatment with oral or parenteral nutrition solutions. Question format: Multiple Choice Chapter 41: Disorders of Endocrine Control Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 1080-1081
20. A nurse on a medical unit is providing care for a 37-year-old female client who has a diagnosis of Graves disease. Which treatment would the nurse most likely anticipate providing for the client? A. Beta-adrenergic blocking medications (beta-blockers) to reduce sympathetic nervous stimulation B. Administration of levothyroxine to supplement thyroid function C. Calcium channel blocking medications to reduce heart rate and cardiac risks D. Administration of somatostatin analogs to inhibit GH production
Answer: A Rationale: The hyperthyroidism that constitutes Graves disease can often be mitigated by the administration of beta-adrenergic blocking medications. Levothyroxine would be used to address hypothyroidism. Calcium channel blockers are not an identified treatment modality for Graves disease. Somatostatin analogs are used to treat GH excess.
24. A client with severe dermatitis from poison ivy has been prescribed prednisone, a corticosteroid, for the treatment of his skin condition. The client has been informed to gradually taper off rather than abruptly stop the prednisone. What is the most accurate rationale for this dosing protocol? A. The client's hypothalamic-pituitary-adrenal (HPA) system will require recovery time before normal adrenal function is restored. B. Steroids can induce a dependency that is best addressed with a gradual withdrawal. C. HPA function is heightened during steroid administration and must return to normal levels before the drug is completely stopped. D. Abrupt cessation of the drug can contribute to symptoms similar to Cushing syndrome.
Answer: A Rationale: The suppression of the HPA system that accompanies steroid therapy requires time for a return to normal function. Dependency on the drug itself is not the rationale for tapering, and HPA function is suppressed, not heightened, during therapy. Abrupt cessation can contribute to an Addison-like response, not Cushing syndrome.
3. A 3-year-old girl has just been diagnosed with type 1A diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain to the parents the etiology (cause) of their daughter's diabetes? A. "The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin." B. "It's not known exactly why your daughter has completely stopped making insulin, and treatment will consist of your rigidly controlling her diet." C. "This tendency to produce insufficient amounts of insulin is likely something that she inherited." D. "Environmental and lifestyle factors are known to play a part in the fact that her pancreas secretes and withholds insulin at the wrong times."
Answer: A Rationale: Type 1A, or immune-mediated, diabetes involves the autoimmune destruction of pancreatic beta cells and a consequent absolute lack of insulin. Exogenous insulin is required as dietary control alone is insufficient. The central problem is an absolute lack of insulin production rather than deranged release. Question format: Multiple Choice Chapter 41: Disorders of Endocrine Control Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 1075-1076
19. Which nursing interventions would be considered priority when managing a client with life-threatening myxedema coma? Select all that apply. A. Administer 3% sodium IV solution to increase sodium levels. B. Administer 50% dextrose to raise glucose levels. C. Place on oxygen therapy to encourage deep breathing. D. Place on a warming bed to raise body temperature. E. Administer sedatives frequently to prevent seizures.
Answer: A, B, C Rationale: Myxedema coma is a life-threatening, end-stage expression of hypothyroidism. It is characterized by coma, hypothermia, CV collapse, hypoventilation, and severe metabolic disorders that include low sodium, low glucose and lactic acidosis. Treatment includes aggressive management of precipitating factors; supportive therapy such as management of CV status, hyponatremia, and hypoglycemia; and thyroid replacement therapy. If hypothermia is present, active rewarming is contraindicated because it may induce vasodilation and vascular collapse. Administering sedatives frequently could be harmful since the person is unable to metabolize sedatives, analgesics, and anesthetic drugs.
9. The nurse knows that a client with diabetes admitted for a lower limb infection likely is experiencing which pathophysiologic principle listed below? Select all that apply. A. Many clients with diabetes have sensory deficits and ignore minor trauma just because they can't feel it in their feet. B. Clients with chronic diabetes may have vascular problems that impair circulation and therefore cells needed for adequate inflammatory response can't reach the site. C. Hyperglycemia may provide an environment that enhances the growth of microorganisms. D. Infections happen to all age-groups and people and the client with diabetes has the same risk for developing an infection as other clients without diabetes. E. Any exercise that creates diaphoresis in their feet can cause a fungal infection in clients with diabetes.
Answer: A, B, C Rationale: Suboptimal response to infection in a person with diabetes is caused by the presence of chronic complications, such as vascular disease and neuropathies, and by the presence of hyperglycemia and altered neutrophil function. Certain types of infections occur with increased frequency in people with diabetes: soft tissue infections of the extremities, osteomyelitis, UTIs and pyelonephritis, Candida infections of the skin/mucous surfaces, dental caries, and periodontal disease. Question format: Multiple Select Chapter 41: Disorders of Endocrine Control Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 1083
16. Which scenario would put a client at risk for experiencing a thyroid problem due to a decrease in thyroxine-binding globulin (TBG)? Select all that apply. A. 55-year-old male with cirrhosis due to alcohol abuse B. 47-year-old female experiencing hot flashes and excess diaphoresis related to menopause C. 75-year-old man receiving chronic glucocorticoid therapy to treat his severe chronic obstructive pulmonary disease (COPD) D. 18-year-old female client with anorexia nervosa weighing 78 pounds who has consumed no protein for the past 3 years.
Answer: A, C, D Rationale: A number of disease conditions and pharmacologic agents can decrease the amount of binding protein in the plasma or influence the binding of hormone. Glucocorticoid medications and systemic disease conditions such as protein malnutrition, nephritic syndrome, and cirrhosis decrease TBG concentrations.
What is Joey's favorite color? Select all that apply. A. Keeney Blue B. Sage Forest Green C. Fuschia D. Rubber Ducky Yellow E. Orange F. Blood Diamond Red
Answer: A, C, E, sometimes B Rationale: A. Having gone to URI for undergrad, Keeney blue is what runs thru the veins of the Ocean State, mirroring not only the blue skies above, but the lapping waves hitting 'gansett beach daily. C. Not only is it fun to say, but Fuschia is a color that screams passion and pazazz, something Joey aspires to have in each and every breath. E. Need we say more? The color Orange says alot about someone, its not a common favorite color, but if Joey's bedroom, blankets, towels, and teeth could speak for themselves, they'd agree, this man likes to POP. Sometimes B. What? You're allowed to be in a certain mood for a certain food but I cant sometimes like and not like a color? Ridiculous.
4. A 40-year-old man who is morbidly obese and leads a sedentary lifestyle has recently been diagnosed with type 2 diabetes. Which aspects of the man's obesity likely contributed to his new health problem? A. The low metabolic needs of adipose tissue mimic a hypoglycemic state and suppress insulin secretion. B. Free fatty acids contribute to problems such as beta cell dysfunction and insulin resistance. C. Fat tissue initiates glycogenolysis and reliance on glycogen release rather than metabolism of free glucose. D. Triglyceride deposits in the pancreas result in damage to beta cells.
Answer: B Rationale: Type 2 diabetes in obese people is thought to link to the actions of free fatty acids, which include beta cell dysfunction (lipotoxicity), insulin resistance, glucose underutilization, and the accumulation of FFAs and triglycerides to reduce hepatic insulin sensitivity. Question format: Multiple Choice Chapter 41: Disorders of Endocrine Control Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 1076
23. Which statement best captures an aspect of the function of the hypothalamic- pituitary-adrenal (HPA) system? A. Adrenocorticotropic hormone (ACTH) released by the hypothalamus controls the release of cortisol. B. The pituitary gland communicates with the adrenal cortex through the release of ACTH. C. The adrenal cortex receives corticotropin-releasing hormone (CRH) and in turn releases cortisol. D. The pituitary gland causes a release of CRH from the hypothalamus which promotes hormone release from the adrenal cortex.
Answer: B Rationale: ACTH mediates between the anterior pituitary gland and the adrenal cortex in the HPA system. ACTH is released by the pituitary, not the hypothalamus, and CRH acts on the pituitary, not the adrenal cortex. CRH flows from the hypothalamus to the pituitary, not vice versa
14. An adult male who is 6'11" tall has a diagnosis of acromegaly. The man is explaining to a curious but sympathetic coworker exactly what accounts for his extraordinary height. Which explanation demonstrates a sound understanding of his health problem? A. "My pituitary gland produced a much higher than normal amount of growth hormone when I was a child." B. "A tumor in my brain threw off my hormone levels after I finished adolescence." C. "My liver is malfunctioning and produces too many of the hormones that ultimately cause growth." D. "The high sugar levels that go along with my diabetes made my pituitary gland overproduce the hormones that cause you to grow."
Answer: B Rationale: Acromegaly is associated with adult onset, and is nearly always involves an adenoma. Increased GH as a child and liver dysfunction are not noted contributors to acromegaly. High levels of GH can cause overproduction of insulin and eventual diabetes, but diabetes does not itself lead to acromegaly.
22. Following the identification of low blood levels of cortisol and low 24-hour urinary free cortisol, a 51-year-old female client has been diagnosed with a primary adrenal cortical insufficiency. Which health consequence would be attributable to her low levels of cortisol? A. Visible exophthalmos B. Impaired immunologic and inflammatory response C. Diminished secondary sex characteristics D. Insufficient regulation of serum potassium and sodium levels
Answer: B Rationale: Cortisol plays a central role in the normal functioning of the immune response and inflammation. Exophthalmos is associated with Graves disease and secondary sex characteristics are a function of adrenal androgens. Potassium and sodium are regulated by mineralocorticoids.
11. Following destruction of the pituitary gland, ACTH stimulation stops. Without ACTH to stimulate the adrenal glands, the adrenal glands' production of cortisol drops. This is an example of which type of endocrine disorder? A. Primary B. Secondary C. Tertiary D. Somatic
Answer: B Rationale: In secondary disorders of endocrine function, the target gland is essentially normal, but defective levels of stimulating hormones or releasing factors from the pituitary system alter its function.
17. An infant born with congenital hypothyroidism who does not receive care from any health care provider is likely to develop which complications? Select all that apply. A. Deformed joints and bone spurs B. Impaired physical growth C. Intellectual disability D. Loss of fine motor control and arthritis E. Down's syndrome
Answer: B, C Rationale: Thyroid hormone is essential for normal growth and brain development, almost half of which occurs during the first 6 months of life. If untreated, congenital hypothyroidism causes intellectual disability and impairs physical growth. Down syndrome is a congenital birth defect and not caused by hypothyroidism.
21. Which statement best captures the role of the adrenal cortex in maintaining homeostasis? A. The adrenal cortex is responsible for the production of epinephrine and norepinephrine that are part of the sympathetic nervous system. B. The adrenal cortical hormones are primarily steroids and sex hormones. C. Redundant, secondary production of adrenal cortical hormones can compensate for the loss of the adrenal glands. D. Normal sexual function is dependent on adequate adrenal cortical function.
Answer: B. Rationale: The adrenal cortex is responsible for secreting three types of hormones: the glucocorticoids, the mineralocorticoids, and the adrenal androgens. The adrenal medulla produces epinephrine and norepinephrine. There are no alternate production sites for adrenal cortical hormones. The adrenal androgens are not responsible for normal sexual function.
13. The mother of 6-year-old male and female fraternal twins has brought her son to see a pediatrician because he is nearly 4 inches shorter than his sister. Which phenomenon would the physician most likely suspect as contributing factor to the boy's short stature? A. Genetic short stature B. Lack of IGF receptors in epiphyseal long bones C. A shortage of hypothalamic GHRH production D. Excess insulin production resulting in chronically low blood glucose levels
Answer: C Rationale: Inadequate levels of hypothalamic GHRH will result in adequate production but inadequate release of GH by the pituitary. Genetic short stature is less likely given the disparity between his height and his twin's, and a shortage of IGF receptors is not a noted pathology. While poorly controlled diabetes can contribute to short stature, excess insulin production is not a likely factor.
8. An adolescent male with type 1 diabetes is exasperated by his regimen of blood sugar monitoring and insulin administration, and has told his mother that he wants to scale both back. Which response by his mother is most accurate? A. "I know it's not fun, but you're even more susceptible to complications when you're young if you don't stay on top of your diabetes." \ B. "Even though you might save some time and energy by doing this, remember that high blood sugars cause a lot of pain and will cause you to gain weight." C. "Even though it's hard to do, you need to continue so you don't go blind or need a kidney transplant down the road." D. "You need to be vigilant now if you want to be free of diabetes when you grow up."
Answer: C Rationale: Nephropathies and retinopathies are common complications of poor glycemic control. Complications of diabetes are not noted to be more acute in younger individuals. Hyperglycemia is not normally associated with pain or weight gain. Conscientious diabetes control does not result in a resolution of the disease. Question format: Multiple Choice Chapter 41: Disorders of Endocrine Control Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential
2. An adult diagnosed with type 1 diabetes is aware of the multiple effects that insulin has on his metabolism. Which physiologic processes are actions of insulin? Select all that apply. A. Increasing the metabolic needs of body cells B. Promoting the breakdown of stored triglycerides C. Facilitating triglyceride synthesis by the liver D. Inhibiting protein breakdown E. Promoting glucose uptake by target cells.
Answer: C, D, E Rationale: The actions of insulin are threefold: (1) it promotes glucose uptake by target cells and provides for glucose storage as glycogen, (2) it prevents fat and glycogen breakdown, and (3) it inhibits gluconeogenesis and increases protein synthesis. Insulin acts to promote fat storage by increasing the transport of glucose into fat cells. It also facilitates triglyceride synthesis from glucose in fat cells and inhibits the intracellular breakdown of stored triglycerides. Insulin also inhibits protein breakdown. It does not directly influence the metabolic needs of body cells. Question format: Multiple Select Chapter 41: Disorders of Endocrine Control Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 1071
25. A client is admitted to the hospital in Addisonian crisis 1 month after a diagnosis of Addison disease. The nurse knows which clinical manifestation would support this diagnosis? A. Hyperactive deep tendon reflexes and slow, shallow breathing B. Cerebral spinal fluid leakage and impaired swallowing C. Irregular heart rate and decreased temperature D. Change in level of consciousness and profound hypotension
Answer: D Rationale: Acute adrenal crisis is a life-threatening situation. Exposure to even a minor illness or stress can cause a client with Addison disease to develop nausea, vomiting, muscular weakness, hypotension, dehydration, and vascular collapse (which causes a change in LOC). Hemorrhage (low BP) can be caused by septicemia, adrenal trauma, anticoagulant therapy, adrenal vein thrombosis, or adrenal metastases. A hyperactive reflex may indicate disease of the pyramidal tract above the level of the reflex arc being tested. Generalized hyperactivity of DTRs may be caused by hyperthyroidism. Any tear or hole in the membrane that surrounds the brain and spinal cord (dura) can allow the fluid that surrounds those organs to leak. This fluid is called the cerebrospinal fluid (CSF). When it leaks out, the pressure around the brain and spinal cord drops. Causes of leakage through the dura include certain head, brain, or spinal surgeries; head injury; placement of tubes for epidural anesthesia or pain medications; or lumbar puncture. Irregular heart rates (dysrhythmias) may be caused by many different factors, including coronary artery disease, electrolyte imbalances in the blood (such as sodium or potassium), changes in the heart muscle, or injury from a heart attack.
18. Following the identification of low levels of T3 and T4 coupled with the presence of a goiter, a 28-year-old female has been diagnosed with Hashimoto thyroiditis. In light of this diagnosis, which assessment result would constitute an unexpected finding? A. The presence of myxedema in the woman's face and extremities. B. Recent weight gain despite a loss of appetite and chronic fatigue. C. Coarse, dry skin and hair with decreased sweat production. D. Increased white cell count and audible crackles on chest auscultation.
Answer: D Rationale: An increased white cell count and the presence of adventitious fluid in the lungs are not classic findings associated with hypothyroidism. Myxedema, weight gain, lethargy, and dry skin and nails are commonly associated with low levels of thyroid hormones.
1. Which statement best describes an aspect of the normal process of glucose metabolism? A. Blood glucose levels are primarily a result of the timing, quantity, and character of food intake. B. Ingested glucose that is not needed for cellular metabolism circulates in the blood until it is taken up to meet cellular needs. C. Blood glucose levels are kept in a steady state by selective excretion and reuptake by the kidneys. D. Glucose that exceeds metabolic needs is converted and stored by the liver.
Answer: D Rationale: Approximately two-thirds of the glucose that is ingested with a meal is removed from the blood and stored in the liver as glycogen. Between meals, the liver releases glucose as a means of maintaining blood glucose within its normal range. Normal glucose metabolism does not involve large variations in blood glucose levels in response to food intake, and excess glucose does not normally remain in circulation. Glucose levels are not primarily maintained by the kidneys. Question format: Multiple Choice Chapter 41: Disorders of Endocrine Control Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 1069
15. An endocrinologist is providing care for a 30-year-old male who has lived with the effects of increased levels of growth hormone (GH). Which teaching point about the client's future health risks is most accurate? A. "It's not unusual for high GH levels to cause damage to your hypothalamus." B. "GH excess inhibits your pancreas from producing enough insulin." C. "The high levels of GH that circulate in your body can result in damage to your liver." D. "When your pituitary gland is enlarged, there's a real risk that you'll develop some sight deficiencies."
Answer: D Rationale: GH excess is associated with tumor formation and consequent compression of cranial nerves is responsible for vision. Damage to the hypothalamus and liver are not common sequelae. While the beta cells of the pancreas can "burn out," the primary effect of excess GH is to increase insulin secretion.
12. Which of these activities or conditions will inhibit growth hormone (GH)? A. Hypoglycemia B. Starvation C. Heavy exercise D. Obesity
Answer: D Rationale: GH is inhibited by increased glucose levels, free fatty acid release, cortisol, and obesity. It is stimulated by hypoglycemia, fasting starvation, increased blood levels of amino acids, and stress conditions such as trauma, excitement, emotional stress, and heavy exercise.
