Patho exam 4 chapter 10
A client's primary care provider has ordered an oral glucose tolerance test (OGTT) as a screening measure for diabetes. Which of the following instructions should the client be given? A)"The lab tech will give you a sugar solution and then measure your blood sugar levels at specified intervals." B)"You'll have to refrain from eating after midnight and then go to the lab to have your blood taken first thing in the morning." C)"They'll take a blood sample and see how much sugar is attached to your red blood cells." D)"You can go to the lab at any time; just tell the technician when you last ate before they draw a blood sample."
A)"The lab tech will give you a sugar solution and then measure your blood sugar levels at specified intervals."
A young child develops type 1A diabetes. The parents ask, "They tell us this is genetic. Does that mean our other children will get diabetes?" The best response by the health care provider would be: A)"This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes." B)"probably not since genetically your other children have a different cellular makeup, they just might not become diabetic C)"If you put all your children on a low-carbohydrate diet, maybe they won't get diabetes." D)"We don't know what causes diabetes, so we will just have to wait and see
A)"This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes."
Which of the following individuals displays the precursors to acromegaly? A)An adult with an excess of growth hormone due to an adenoma B)A girl who has been diagnosed with precocious puberty C)An adult who has a diagnosis of crushing syndrome D)A client who has recently developed primary adrenal carcinoma
A)An adult with an excess of growth hormone due to an adenoma
A diabetic client presents to the clinic. He is concerned his lower legs are "feeling funny." Which of the following assessment findings lead the health care provider to suspect the client may have developed somatic neuropathy? Select all that apply. A)Both legs appear to be the same as far as numbness is involved. B)Bilateral cool ankles and feet. C)Right foot has a diminished perception of vibration; left foot is normal. D)With eyes closed, the client cannot identify where the HCP is touching his feet. E)One leg has a reddened area in the calf and has a positive Homan sign.
A)Both legs appear to be the same as far as numbness is involved. B)Bilateral cool ankles and feet. D)With eyes closed, the client cannot identify where the HCP is touching his feet.
Which of the following pathophysiologic phenomena may result in a diagnosis of Cushing disease? A)Excess ACTH production by a pituitary tumor B)Hypopituitarism C)Autoimmune destruction of the adrenal cortex D)Malfunction of the HPA system
A)Excess ACTH production by a pituitary tumor
Which of the following clinical manifestations would support the medical diagnosis of Cushing syndrome? Select all that apply. A)Excessive facial hair growth B)Muscle hypertrophy C)Blood glucose level in 200 mg/dl range D)"Buffalo hump" on back E)Blood pressure reading less than 90/70
A)Excessive facial hair growth C)Blood glucose level in 200 mg/dl range D)"Buffalo hump" on back
Loss of pituitary function can result in deficiencies/loss of which of the following hormones' secretions? Select all that apply. A)Growth hormone B)Luteinizing hormone C)Follicle stimulating hormone D) Prolactin E)Corticotropin-releasing hormone
A)Growth hormone B)Luteinizing hormone C)Follicle stimulating hormone D) Prolactin
A client with excessive production of growth hormone level will likely exhibit which clinical manifestations? Select all that apply ( 3 answers). A)Large hands and feet due to increased production of GH B)Excess thirst and urination due to decreased glucose uptake C)Difficulty chewing food D)Short stature with obesity E)Tendency to develop asthma
A)Large hands and feet due to increased production of GH B)Excess thirst and urination due to decreased glucose uptake C)Difficulty chewing food
The iatrogenic form of Cushing syndrome is caused by: A)Long-term cortisone therapy B)pituitary tumor secreting ACTH C)Benign or malignant adrenal tumor D)Ectopic ACTH- secreting lung tumor
A)Long-term cortisone therapy
One of the first signs that indicates an infant may have congenital hypothyroidism is: A)Prolonged period of physiologic jaundice B)Palpable mass in the neck region C)No passage of meconium within the first 72 hours after birth D)Full, bounding fontanels
A)Prolonged period of physiologic jaundice
When trying to explain hypothyroidism to a newly diagnosed client, the nurse stresses the fact that the thyroid hormone is transported in blood by specific: A)Proteins B)Target cells C)cholesterol molecules D)prohormones
A)Proteins
Primary adrenal insufficiency is manifested by: A)Serum sodium level of 120 mmol/L (low) and blood glucose level of 48 mg/dL (low) B)Truncal obesity and 3+ pitting edema in lower legs C)Potassium level of 2.8 mEq/L and weight gain of 3 pounds overnight D)Hypopigmentation over neck and BP greater that 150/90
A)Serum sodium level of 120 mmol/L (low) and blood glucose level of 48 mg/dL (low)
A client has developed the facial appearance that is characteristic of myxedema, along with an enlarged tongue, bradycardia, and voice changes. Which of the following treatment modalities is most likely to benefit this client? A)Synthetic preparations of T3 or T4 B)B-Adrenergic blocking drugs C)Corticosteroid replacement therapy D)Oral or parenteral cortisol replacement
A)Synthetic preparations of T3 or T4
Which of the following clinical manifestations following thyroidectomy would alert the nurse that the client is going into a life-threatening thyroid storm? Select all that apply. A)Temperature of 104.2 F B)Telemetry showing heart rate of 184 C)unable to close eyelids completely togther D)Extremely agitated E) Bruising on knees and feet
A)Temperature of 104.2 F B)Telemetry showing heart rate of 184 D)Extremely agitated
A student nurse is taking a test on the endocrine system. From the following list of clinical manifestations, she needs to select the ones she would see in hypothyroidism. Which answers should she select? Select all that apply ( 3 answers). A)Weight gain despite loss of appetite B)Coarse brittle hair C)Puffy face with swollen eyelids D)Nervousness with fine muscle tremors E)Heat intolerance
A)Weight gain despite loss of appetite B)Coarse brittle hair C)Puffy face with swollen eyelids
Thyroid and steroid hormones, which exert their effect on target cells by way of nuclear receptors, have which of the following characteristics? A) The selective use of a second messenger B) The ability to cross the cell membrane of target cells C)The ability to regulate surface receptor affinity D)Both lipid solubility and water solubility
B) The ability to cross the cell membrane of target cells
when discussing luteinizing hormone and follicle stimulating hormone with students the instructor will emphasize that these hormones are under the control of A)Thyroid gland B)Anterior pituitary gland C)Posterior adrenal cortex D)Pancreas
B)Anterior pituitary gland
A client with a history of diabetes presents to the emergency department following several days of polyuria and polydipsia with nausea/vomiting. On admission, the client labs show a blood glucose level of 480 mg/dL and bicarbonate level of 7.8 mEq/dL. The nurse suspects the client has diabetic ketoacidosis (DKA). The priority intervention should include: A)Limit fluid intake to only 250 mL/4 hours. B)Begin a loading dose of IV regular insulin followed by a continuous insulin infusion. C)Give at least 50 units of regular insulin IV stat and recheck blood glucose in 2 hours. D)Push a stat dose of bicarbonate followed by a double-dose (loading) of metformin.
B)Begin a loading dose of IV regular insulin followed by a continuous insulin infusion.
While working on the med-surg floor, the nurse has a client who is experiencing an insulin reaction. The client is conscious and can follow directions. The most appropriate intervention would be: A)Call the physician and wait for him or her to respond to give you orders of what he or she prefers you do for this client. B)Immediately administer 15 g of glucose (preferably via oral route if the client is alert enough to swallow) and wait for 15 minutes. Then repeat this if necessary. C)Start pushing 50% glucose solution slowly and do not stop pushing until the client's repeat blood glucose level is above 100 mg/dL. D)Skip the oral glucose tablets and go directly to giving intramuscular glucagon. Repeat the glucagon in 15 minutes if the blood glucose level is not within a normal range.
B)Immediately administer 15 g of glucose (preferably via oral route if the client is alert enough to swallow) and wait for 15 minutes. Then repeat this if necessary.
Which of the following insulin administration regimens is most likely to result in stable blood glucose levels for a client with a diagnosis of type 1 diabetes? A)One large dose of long-acting insulin each day before breakfast B)Intermediate-acting insulin at 8:00 AM and 8:00 PM with rapid-acting insulin before each meal C)Six to eight small doses of rapid-acting insulin each day, with capillary monitoring before each D)Long-acting insulin twice daily (breakfast and bedtime), with intermediate-acting insulin in the afternoon
B)Intermediate-acting insulin at 8:00 AM and 8:00 PM with rapid-acting insulin before each meal
When describing to a newly diagnosed diabetic client how insulin is regulated, the nurse will draw upon her knowledge of which hormonal regulation mechanism? A)Basal metabolic rate B)The hypothalamic-pituitary target cell system C)The cytokine-interleukin regulatory mechanism D)the angiotensin l to angiotensin ll to aldosterone system
B)The hypothalamic-pituitary target cell system
A client with many nonspecific complaints has been ordered a positron emission tomography (PET) scanning for evaluation of: A)The pancreas response to an insulin injection B)Tumors located on the endocrine glands C)Bone density D)Radioactive and thyroid gland
B)Tumors located on the endocrine glands
When sensors detect a change in a hormone level, the hormonal response is regulated by _________ mechanisms that will return the level to within normal range. A)metabolic B)feedback C)production D)action potential
B)feedback
While trying to explain the physiology behind type 2 diabetes to a group of nursing students, the instructor will mention which of the following accurate information? A)The destruction of beta cells and absolute lack of insulin in people with type 2 diabetes means that they are particularly prone to the development of diabetic complication. B)Because of the loss of insulin response, all people with type 2 diabetes require exogenous insulin replacement to control blood glucose levels. C)In skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance. D)They have increased predisposition to other autoimmune disorders such as Graves disease, rheumatoid arthritis, and Addison disease.
C)In skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance.
A client with long-standing type 2 diabetes is surprised at his high blood sugar readings while recovering from an emergency surgery. Which of the following factors may have contributed to the client's inordinately elevated blood glucose levels? A)The tissue trauma of surgery resulted in gluconeogenesis. B)Illness inhibited the release and uptake of glucagon. C)The stress of the event caused the release of cortisol. D)Sleep disruption in the hospital precipitated the dawn effect.
C)The stress of the event caused the release of cortisol.
As part of maintaining homeostasis, hormones secreted by endocrine cells are inactivated continuously to: A)free receptor sites. B)stimulate production. C)prevent accumulation. D)absorb metabolic waste.
C)prevent accumulation.
A hospital client has been complaining of increasing fatigue for several hours, and his nurse has entered his room to find him unarousable. The nurse immediately checked the client's blood glucose level (and reverified with a second blood glucose meter), which is 22 mg/dL (1.2 mmol/L). The nurse should prepare to administer which of the following? A. A snack that combines simple sugars, protein, and complex carbohydrates B. Infusion of rapid-acting insulin C. A 50% glucose solution intravenously D. An oral solution containing glucagon and simple sugars
C. A 50% glucose solution intravenously
A diabetic client presents to a clinic for routine visit. Blood work reveals a HbA1C of 11.0% (high)? Which response by the patient may account for this abnormal lab result? A)"I've had more periods of hypoglycemia than usual over the past few months." B)"I've been doing great. I haven't needed much insulin coverage before meals." C)"To tell you the truth, my blood glucose levels have been pretty normal for me." D)"My meter broke so I have not been checking my blood glucose levels for a while."
D)"My meter broke so I have not been checking my blood glucose levels for a while."
A lung cancer client with small cell carcinoma may secrete an excess of which hormone causing an ectopic form of Cushing syndrome due to a nonpituitary tumor? A)GH B)TSH C)DHEA D)ACTH
D)ACTH
A client with type 1 diabetes has started a new exercise routine. Knowing there may be some increase risks associated with exercise, the health care provider should encourage the client to: A)Watch for too rapid weight loss B)Monitor for respiratory disorders C)Be careful that you're not experiencing a rebound hyperglycemia D)Carry a snack with carbs to prevent profound hypoglycemia
D)Carry a snack with carbs to prevent profound hypoglycemia
Impaired and delayed healing in a person with diabetes is caused by long-term complications that include: A)Ketoacidosis B)Somogyi effect C)Fluid imbalances D)Chronic neuropathies
D)Chronic neuropathies
A client tells his health care provider that his body is changing. It used to be normal for his blood glucose to be higher during the latter part of the morning. However, now his fasting blood glucose level is elevated in the early AM (07:00). The health care provider recognizes the client may be experiencing: A)Possible stress-related hypoglycemia B)Somogyi effect C)Hyperglycemic hyperosmolar state (HHS) D)Dawn phenomenon
D)Dawn phenomenon
The immune suppressive and anti-inflammatory effects of cortisol cause: A)Moderate insulin resistance B)Increased capillary permeability C)Increased cell-mediated immunity D)Inhibition of prostaglandin synthesis
D)Inhibition of prostaglandin synthesis
Which of the following pregnant women likely faces the greatest risk of developing gestational diabetes? A client who: A)Was diagnosed with placenta previa early in her pregnancy B)Is gravida five (in her fifth pregnancy) C)Has BP of 130/85 mm Hg and pulse rate of 90 beats/minute D)Is morbidly obese defined as greater than 100 pounds over ideal weight
D)Is morbidly obese defined as greater than 100 pounds over ideal weight
A client has received an injection containing thyrotropin-releasing hormone (TRH) and is now being assessed for levels of thyroid-stimulating hormone (TSH). This client has undergone which of the following diagnostic tests? A)Supression testing B)Radioimmunoassay (RIA) C)Autoantibody testing D)Stimulation testing
D)Stimulation testing
A client who has been taking 80 mg of prednisone, a glucocorticoid, each day has been warned by his primary care provider to carefully follow a plan for the gradual reduction of the dose rather than stopping the drug suddenly. What is the rationale for this directive? A. Sudden changes in glucocorticoid dosing may reverse the therapeutic effects of the drug. B. Stopping the drug suddenly may "shock" the HPA axis into overactivity. C. Sudden cessation of a glucocorticoid can result in adrenal gland necrosis D. Stopping the drug suddenly may cause acute adrenal insufficiency.
D. Stopping the drug suddenly may cause acute adrenal insufficiency.