Pathopharm Test 2 - review questions

Which of the following is not consistent with diabetic ketoacidosis? A. Blood glucose level of 600 mg/dL B. Blood glucose level of 60 mg/dL C. Acidosis D. Ketones in the urine

B. Blood glucose level of 60 mg/dL

Primary adrenal insufficiency is termed A. Addison's disease B. Cushing's disease C. Pheochromocytoma

A. Addison's disease

In addition to hyperglycemia, which of the following signs of long term complication of diabetes mellitus 2 could the patient present with? A. Atherosclerosis B. Metabolic alkalosis C. Elevated liver enzymes D. Anemia

A. Atherosclerosis

Which assessment finding should the nurse expect to observe in a woman diagnosed with prolactinoma? A. Galactorrhea B. Exophthalmos C. Heat intolerance D. Enlarged tongue

A. Galactorrhea Women with hyperprolactinemia from a prolactinoma generally present with galactorrhea (nonpuerperal milk production) and menstrual disturbances including amenorrhea. Heat intolerance occurs with thyrotoxicosis, not prolactinoma. Exophthalmos, large and protruding eyeballs, occurs in hyperthyroidism. Acromegaly is associated with enlarged tongue.

A client has an abnormality in endocrine functioning. Which factors may cause endocrine abnormalities? A. Gland dysfunction B. Faulty feedback system C. Altered metabolism of the hormones D. Adequate quantity of hormone precursors E. Hormone production by non endocrine tissues

A. Gland dysfunction B. Faulty feedback system C. Altered metabolism of the hormones E. Hormone production by non endocrine tissues

Syndrome of inappropriate ADH secretion (SIADH) is characterized by __________levels of ADH. A. High B. Low

A. High

A patient develops severe dehydration and hyperglycemia in the absence of ketosis. Which of the following conditions does this patient have? A. Hyperosmolar hyperglycemia nonketotic syndrome (HHNKS) B. DKA C. Hypoglycemia D. Somogyi effect

A. Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) HHNKS is different from DKA in the degree of insulin deficiency and fluid deficiency. It is also characterized by a lack of ketosis. Somogyi effect occurs when hypoglycemia stimulates glucose counterregulation of hormones, causing a rebound hyperglycemia.

Which laboratory result for thyroid-stimulating hormone (TSH) would the nurse expect to find in a client with Graves disease? A. Low level in the blood B. High level in the blood C. Normal level in the blood D. Increased level in the urine

A. Low level in the blood

Thyroid hormone is regulated through a ______feedback loop involving the hypothalamus and the pituitary gland. A. Negative B. Positive

A. Negative

Diabetic _____________is characterized by proteinuria, reduced glomerular filtration and increased blood pressure. A. Nephropathy B. Retinopathy C. Neuropathy

A. Nephropathy

Which hormone is secreted by the posterior pituitary? A. Oxytocin B. Calcitonin C. Thyroid-stimulating (TSH) D. Parathyroid (PTH)

A. Oxytocin Oxytocin is secreted by the posterior pituitary. Calcitonin is secreted by the thyroid gland. TSH is secreted by the anterior pituitary. PTH is secreted by the parathyroid glands.

If levothyroxine is added to a patient already on warfarin [Coumadin], the warfarin dose should be _________ . A. Reduced B. Increased C. Kept constant

A. Reduced

A patient experiences retinopathy due to diabetes. There is venous dilation, microaneurysm formation, and blot hemorrhages. Which stage of retinopathy is this patient experiencing? A. Stage I B. Stage II C. Stage III D. Stage IV

A. Stage I Stage I is characterized by increase in retinal permeability, vein dilation, microaneurysm formation, and superficial and deep blot hemorrhages. Stage II is progression to poor perfusion and infarcts. Stage III is fibrous tissue formation with the retina or optic disc. Stage IV is when new vessels on the vitreous humor have traction and may cause retinal detachment.

A client is diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNKS). Which clinical manifestations will the nurse expect? Select all that apply. A. Stupor B. Ketonuria C. Hypokalemia D. Severe dehydration E. Kussmaul respirations

A. Stupor C. Hypokalemia D. Severe dehydration

Diabetes insipidus (DI) is an insufficiency of ADH activity. A. True B. False

A. True

The posterior pituitary gland secretes: A. antidiuretic hormone (ADH) B. prolactin-releasing factor (PRF) C. thyrotropin-releasing hormone (TRH) D. gonadotropin-releasing hormone (GnRH)

A. antidiuretic hormone (ADH) ADH is secreted by the posterior pituitary gland. The hypothalamus secretes the remaining substances.

A patient is diagnosed with type 1 diabetes and is unable to produce insulin. The pancreatic cells that are most likely damaged are the: A. beta B. alpha C. C-peptide D. delta

A. beta The islets of Langerhans of the beta cells synthesize insulin. The alpha cells secrete glucagon. The delta cells secrete somatostatin and gastrin. C-peptide is the bond that connects the two peptides of proinsulin.

Syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH) may result from: (select all that apply) A. ectopic production of ADH by tumors B. pulmonary disorders like asthma C. central nervous system disorders such as encephalitis D. psychiatric disease treated with antidepressants or antipsychotics E. pancreatic disorders such as diabetes insidious (DI)

A. ectopic production of ADH by tumors B. pulmonary disorders like asthma C. central nervous system disorders such as encephalitis D. psychiatric disease treated with antidepressants or antipsychotics SIADH may result from tumor-produced ADH and is seen in conditions such as asthma and encephalitis and as a result of antidepressant or antipsychotic medication therapy. Diabetes insipidus (DI) is a disorder of insufficient activity of ADH and is not a cause of SIADH.

A symptom of a prolactinoma includes: A. galactorrhea B. alopecia C. excessive menses D. pregnancy

A. galactorrhea Galactorrhea is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing. Amenorrhea (absence of menses), hirsutism (excessive body hair), and osteopenia can all be caused by a prolactinoma. Pregnancy is a normal cause of galactorrhea.

Abnormalities in endocrine function may be caused by a(n): (select all that apply) A. glandular dysfunction B. altered metabolism of the hormones C. absence of antibodies against specific receptors D. faulty feedback systems E. hormone production by non endocrine tissues

A. glandular dysfunction B. altered metabolism of the hormones D. faulty feedback systems E. hormone production by non endocrine tissues Elevated or depressed hormone levels result from: (a) faulty feedback systems, (b) dysfunction of the gland, (c) altered metabolism of hormones, or (d) production of hormones from nonendocrine tissues. There is actually a presence of antibodies against specific receptors that either reduce available binding sites or mimic hormone action.

A symptom of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is: A. hyponatremia (dilutional) B. hypernatremia (concentration) C. hyperosmolality (serum) D. hypoosmolality (urine)

A. hyponatremia (dilutional) The cardinal features of SIADH are symptoms of water intoxication. These include hyponatremia (low serum sodium), serum hypoosmolality, and urine that is inappropriately concentrated (hyperosmolar) with respect to serum osmolality.

Medication used to treat thyrotocis crisis includes: A. iodine B. epinephrine C. thyroid hormone D. synthroid

A. iodine Beta blockers, PTU (propylthiouracil), iodine, and supportive care are used to treat thyrotoxic crisis. The remaining options would not be considered therapeutic for this condition.

Increased secretion of cortisol leads to A. Addison's disease B. Cushing's disease C. Pheochromocytoma

B. Cushing's disease

The effects of glucocorticoids includes: (select all that apply) A. metabolic B. hypertensive C. anti-inflammatory D. growth suppression E. tumor growth

A. metabolic C. anti-inflammatory D. growth suppression The hypertensive response and tumor growth are not a result of glucocorticoids. The other three answers are all effects of glucocorticoids.

Risk factors for insulin resistance include: (select all that apply) A. obesity B. inactivity C. low-fat diet D. age E. medications

A. obesity B. inactivity D. age E. medications Resistance of the receptors to insulin is heightened by obesity, inactivity, illnesses, medications, and age. A carbohydrate-rich diet, not low fat, puts an obese person at risk for insulin resistance.

Complications experienced by patients with chronic uncontrolled type 2 diabetes are: (select all that apply) A. peripheral vascular disease B. orthostatic hypotension C. thickened capillary membranes D. increased GFR E. visual difficulties

A. peripheral vascular disease B. orthostatic hypotension C. thickened capillary membrances E. visual difficulties GFR decreases due to destruction of the nephrons and thickening of the filtration barrier. All other options occur with uncontrolled hyperglycemia.

A newly diagnosed diabetic patient will exhibit symptoms of: (select all that apply) A. polydipsia B. anuria C. polyphagia D. weight loss E. loss of muscle mass

A. polydipsia C. polyphagia D. weight loss Excessive thirst and hunger as well as weight loss will likely be seen in a diabetic patient. Polyuria, not anuria, is seen. Loss of muscle mass is not a symptom of diabetes mellitus.

It is true that neurogenic diabetes insipidus (DI): (select all that apply) A. results from low levels of antidiuretic hormone (ADH) B. occurs with organic lesion of the hypothalamus or pituitary C. may be demonstrated by excessively concentrated urine D. is caused by low levels of antidiuretic hormone (ADH) E. caused by inadequate response of the renal tubules to available antidiuretic hormone (ADH)

A. results from low levels of ADH B. occurs with organic lesion of the hypothalamus or pituitary D. is caused by low levels of ADH The neurogenic form of DI occurs when a lesion of the hypothalamus, pituitary stalk, or posterior pituitary interferes with ADH synthesis, transport, or release. While the neurogenic form is caused by low levels of ADH, the nephrogenic form is caused by inadequate response of the renal tubules to available ADH. Urine is usually very diluted.

When a patient is diagnosed with thyroid carcinoma, patient education concerning the disease should include the information that: A. thyroid carcinoma is the most common endocrine malignancy B. Americans frequently have thyroid carcinoma as a diagnosis C. heredity is the most common risk factor for thyroid carcinoma D. most thyroid carcinoma tumors are undifferentiated

A. thyroid carcinoma is the most common endocrine malignancy Thyroid carcinoma is relatively rare, but is the most common type of endocrine malignancy. The most common risk factor is exposure to ionizing radiation, not heredity or American birth. Most tumors are differentiated.

Clinical manifestation(s) of hypoparathyroidism is/are A. Tetany B. Chvostek sign C. Trousseau sign D. All of the above

D. All of the above

Which client meets the diagnostic criteria for diabetes mellitus? A. A client with a glycosylated hemoglobin of 5.5% B. A client with a fasting blood glucose of 128 mg/dL C. A client with a random serum glucose of 197 mg/dL D. A client with a serum glucose of 185 mg/dL two hours after taking 75 grams of glucose

B. A client with a fasting blood glucose of 128 mg/dL A fasting blood glucose of 128 mg/dl meets the criteria for diabetes mellitus. A fasting plasma glucose greater than or equal to 126 mg/dl meets the criteria for a diagnosis of diabetes mellitus. A glycosylated hemoglobin of 5.5% does not meet the criteria of 6.5%; a two-hour oral glucose tolerance test result of 185 mg/dl does not meet the criteria of 200 mg/dl; or a random serum glucose of 197 mg/dl does not meet criteria for 200 mg/dl with classic symptoms of hyperglycemia.

A patient experiences nausea, vomiting, loss of body hair, fatigue, weakness, and hypoglycemia. The hormone deficiency the patient is most likely experiencing is that of: A. TSH (thyroid-stimulating hormone) B. ACTH (adrenocorticotropic hormone) C. FSH (follicle-stimulating hormone) D. LH (luteinizing hormone)

B. ACTH (adrenocorticotropic hormone) Within 2 weeks of complete absence of ACTH, symptoms of nausea, vomiting, anorexia, fatigue, and weakness develop. With absence of TSH, there is cold intolerance, dry skin, mild myxedema, lethargy, and decreased metabolic rate. FSH and LH deficiencies are associated with amenorrhea, atrophic vagina, uterus, breasts, decrease in body hair, and diminished libido.

Which hormone deficiency causes serum hyperosmolarity? A. Prolactin B. ADH C. TSH D. TRH

B. ADH

Two siblings are diagnosed with a thyroid disorder due to destruction of thyroid tissue by lymphocytes and circulating thyroid autoantibodies. This pathology is likely the result of: A. subacute thyroiditis B. Hashimoto disease C. painless thyroiditis D. postpartum thyroiditis

B. Hashimoto disease Hashimoto disease is also called autoimmune thyroiditis. It results in the gradual destruction of thyroid tissue by infiltration or lymphocytes and circulating thyroid autoantibodies. This disorder is linked with several genetic risk factors. Painless thyroiditis has a similar course to subacute thyroiditis, but is pathologically identical to Hashimoto disease. Subacute thyroiditis is a nonbacterial inflammation of thyroid often preceded by a viral infection. Postpartum thyroiditis generally occurs within 6 months of delivery and occurs in up to 7% of all women.

A client has syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Upon assessment of the laboratory results, which finding is typical? A. Hypokalemia B. Hyponatremia C. Urine hyposmolarity D. Serum hyperosmolality

B. Hyponatremia SIADH leads to hyponatremia when free water is inappropriately retained and dilutes the serum to a sodium concentration below the normal range. Hypokalemia is not a defining assessment finding in SIADH. Serum hyposmolality, not hyperosmolality, and urine hyperosmolarity, not hyposmolarity, occur with SIADH.

In hypothyroidism, the basal metabolic rate is A. High B. Low C. Steady D. Variable

B. Low

Hemoglobin A1c test is used for monitoring A. Measuring fasting glucose levels B. Monitoring long-term serum glucose control C. Detecting acute complications of diabetes D. Checking for hyperlipidemia

B. Monitoring long-term serum glucose control

A nurse is teaching the client about causes of hyperglycemia in type 2 diabetes mellitus. Which information from the client indicates teaching was successful? A. One cause is glycogen excess B. One cause is insulin resistance C. One cause is increased ghrelin D. One cause is glucagon deficiency

B. One cause is insulin resistance Hyperglycemia in type 2 diabetes mellitus is due primarily to cellular resistance to the physiologic effects of insulin (i.e., insulin resistance). Glucagon, not glycogen, is increased. Ghrelin is decreased.

A client has visual changes that began in one eye and then progressed to the second eye. These assessment findings support which condition? A. Acromegaly B. Pituitary adenoma C. ACTH insufficiency D. Growth hormone insufficiency

B. Pituitary adenoma

ADH and oxytocin is secreted by which of the following glands? A. Anterior pituitary B. Posterior pituitary C. Hypothalamus D. Pineal

B. Posterior pituitary

Which hormone is secreted by the anterior pituitary? A. Androgen B. Prolactin C. Thyroid D. Oxytocin

B. Prolactin Prolactin is secreted by the anterior pituitary. Androgen is secreted by the adrenal glands and gonads. Thyroid hormone is secreted by the thyroid gland. Oxytocin is secreted by the posterior pituitary.

What is the nurse's best response to a client who is asking about autoantibodies and Graves disease? A. That is why your thyroid has shut down - because the autoantibodies attacked the gland. B. The autoantibodies bind to the thyroid cells & stimulate them to secrete thyroid hormones. C. The autoimmune process acts on the anterior pituitary, which normally secretes a hormone. D. That is why you take the thyroid hormone replacement - because your thyroid gland is damaged.

B. The autoantibodies bind to the thyroid cells & stimulate them to secrete thyroid hormones.

Clinical manifestations of Cushing syndrome are? A. Weight loss & muscle wasting B. Truncal obesity & moon face C. Pallor & swollen tongue D. Depigmented skin & eyelid lag

B. Truncal obesity & moon face

A client has Addison disease. Which pathophysiologic process should the nurse remember when assessing the symptoms of this disease? A. An insufficient amount of T4 & T3 B. Increased serum levels of aldosterone C. An insufficient amount of circulating cortisol D. Increased activity of the renin-angiotensin system

C. An insufficient amount of circulating cortisol The symptoms of Addison disease are primarily a result of hypocortisolism and hypoaldosteronism. Addison disease is not related to amounts of T 4 and T 3 or to the renin-angiotensin system. Hypoaldosteronism, not increased serum levels of aldosterone, causes symptoms of Addison disease.

Which is true regarding acromegaly? It: A. occurs due to excessive levels of ACTH B. is the result of a GH-secreting pituitary adenoma C. occurs more frequently in men D. is a relatively common condition

B. is the result of a GH-secreting pituitary adenoma Acromegaly is a condition caused by excess of GH, not ACTH, as a result of a GH-secreting pituitary adenoma. It occurs more commonly in women and is a relatively uncommon condition occurring in about 40 per 1 million individuals.

A nurse is preparing to administer an oral hypoglycemic agent to a client. The nurse is caring for which client? A. A client with ketoacidosis B. A client with hypoglycemia C. A client with type 2 diabetes D. A client with type 1 diabetes

C. A client with type 2 diabetes

Which information indicates the nurse has a correct understanding of the cause for acromegaly in adult clients and giantism in children? A. Hyperparathyroidism B. Asymptomatic hypercalcemia C. Adenoma in the pituitary gland D. Pituitary response to excessive calcium intake

C. Adenoma in the pituitary gland

A nurse is teaching the staff about the cause of primary Addison disease. Which information should the nurse include in the teaching session? A. A secreting adrenal cancer B. Viral infection of the posterior pituitary C. Autoimmune injury to the adrenal cortex D. Bacterial infection of the adrenal medulla

C. Autoimmune injury to the adrenal cortex

Which term describes "obvious changes in cell function that result from stimulation by a particular hormone"? A. Upregulation B. Downregulation C. Direct effects D. Permissive effects

C. Direct effects Direct effects are obvious changes in cell function that specifically result from stimulation by a particular hormone. Permissive effects are less obvious and facilitate the maximal response or functioning of a cell. Upregulation is when low concentrations of a hormone increase the number of receptors per cell. Downregulation occurs when high concentrations of a hormone decrease the number of receptors.

Which symptom would a patient diagnosed with pheochromocytoma also experience? A. Hypotension B. Bradycardia C. Headaches D. Hyperglycemia

C. Headaches Pheochromocytoma causes excessive release of epinephrine and norepinephrine resulting in hypertension, tachycardia, decreased insulin secretion, and headaches due to changes in cerebral blood flow.

Which of the following is a cause of type 1 diabetes mellitus? A. A familial, autosomal dominant gene defect B. Obesity & lack of exercise C. Immune destruction of pancreas D. Hyperglycemia from eating candy

C. Immune destruction of pancreas

Which of the following nutrient is important for thyroid hormone synthesis? A. Zinc B. Sodium C. Iodine D. Calcium

C. Iodine

Some of the symptoms with Graves disease are as follows: A. Weight gain, cold intolerance B. Slow heart rate, rash C. Skin hot and moist, rapid heart rate D. Constipation, confusion

C. Skin hot and moist, rapid heart rate

What alteration should the nurse expect to find in a person who has untreated Cushing syndrome? A. Pale skin B. Weight loss C. Truncal obesity D. Pulmonary edema

C. Truncal obesity Truncal obesity due to central fat deposition is a common physical manifestation of untreated Cushing syndrome. Pale skin is not a common manifestation of Cushing syndrome. Elevated cortisol generally leads to weight gain, not weight loss. Pulmonary edema is not a common manifestation of Cushing syndrome.

A characteristic of pituitary adenomas would include that they: A. will experience rapid growth B. are generally metastatic C. arise from the anterior pituitary D. have a pathogenesis due to infarction

C. arise from the anterior pituitary They arise from the anterior pituitary, are benign, and are usually slow growing in nature. The pathogenesis is not a result of infarction.

Myxedema coma is generally associated with: A. hyperthyroidism B. hyperthermia C. lactic acidosis D. hyperglycemia

C. lactic acidosis Myxedema coma is a medical emergency involving lactic acidosis. It is associated with a diminished level of consciousness due to severe hypothyroidism. Signs and symptoms include hypothermia, hypoventilation, hypotension, hypoglycemia, and lactic acidosis.

Which client is most likely to develop hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)? A. Pregnant woman with type 1 diabetes mellitus B. Child with type 1 diabetes mellitus & an infection C. Young adult with type 2 diabetes mellitus & a fracture D. Older adult with type 2 diabetes mellitus & renal disease

D. Older adult with type 2 diabetes mellitus & renal disease HHNKS is an uncommon but significant complication of type 2 diabetes mellitus, with a high overall mortality. It occurs more often in elderly individuals who have other comorbidities, including infections or cardiovascular or renal disease. People with type 1 diabetes mellitus are more predisposed to diabetic ketoacidosis.

A nurse is caring for a young adult who has Graves disease. Which assessment finding alerts the nurse to notify the primary healthcare provider immediately? A. Goiter present B. Exophthalmos C. "I sometimes have double vision." D. Pulse: 130 beats per minute, irregular rhythm

D. Pulse: 130 beats per minute, irregular rhythm Irregular pulse indicates thyroid storm. Thyrotoxic crisis (thyroid storm) is a rare but dangerous worsening of the thyrotoxic state in which death can occur within 48 hours without treatment. Goiter, exophthalmos, and double vision (diplopia) are expected clinical manifestations of Graves disease; the primary healthcare provider should not be notified for normal, expected clinical manifestations.

A patient who is receiving Vasopressin (anti-diuretic hormone) should be educated to A. Avoid grapefruit juice B. Increase sodium intake C. Monitor blood pressure D. Reduce fluid intake

D. Reduce fluid intake

Which pathophysiologic process should the nurse consider when caring for a client with the syndrome of inappropriate antidiuretic hormone (SIADH)? A. Renal retention of sodium & water B. Renal excretion of water & sodium C. Renal retention of sodium without water D. Renal retention of water without sodium

D. Renal retention of water without sodium

Diabetic ketoacidosis (DKA) is a result of: A. an increase in insulin production B. a decrease in catecholamine secretion C. impaired metabolism seen in the elderly D. increased fat mobilization

D. increased fat mobilization DKA develops when there is an absolute or relative deficiency of insulin or increase in insulin counterregulatory hormones and fat is burned for fuel. This includes an increase in catecholamines, cortisol, glucagon, and GH. Emotional factors and stress, especially in children, can contribute to the development of DKA, and there is increased glucose production, decreased peripheral glucose usage, and increased fat mobilization.

Which is a characteristic of the hypothalamus? It is: A. divided into two nuclei B. connected to the anterior pituitary by a single membrane C. connected to the posterior pituitary by blood vessels D. made up of neurosecretory neurons that secrete releasing hormones

D. made up of neurosecretory neurons that secrete releasing hormones It is true that the hypothalamus comprises neurosecretory neurons that secrete releasing hormones. The hypothalamus is divided into numerous nuclei, while being connected to the anterior pituitary by blood vessels and to the posterior pituitary by a nerve tract.

A patient with visual changes beginning in one eye and then progress to the second eye could be experiencing: A. pituitary infarct B. ACTH insufficiency C. Growth hormone (GH) insufficiency D. pituitary adenoma

D. pituitary adenoma With a pituitary adenoma, there can be increased pressure on the optic chiasm, and growth of the tumor can cause visual changes in both eyes. The other conditions do not present with optic nerve involvement.

Hydrocortisone is a glucocorticoid that has mineralocorticoid actions as well. True False

True

NPH insulin is appropriate for mixing with short acting insulins. True False

True