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NURS 611 Pathophysiology Exam 3 - Maryville
University 2024: Comprehensive Practice
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Which form of diabetic insipidus (DI) will result if the target cells for antidiuretic hormone (ADH) in the renal collecting tubules demonstrate insensitivity? a. Neurogenic c. Psychogenic b. Nephrogenic d. Ischemic - CORRECT ANS--B Only nephrogenic DI is associated with an insensitivity of the renal collecting tubules to ADH. Which laboratory value is consistently low in a patient with diabetes insipidus (DI)? a. Urine-specific gravity c. Urine protein b. Serum sodium d. Serum total protein - CORRECT ANS--A
The basic criteria for diagnosing DI include a low urine-specific gravity while sodium levels are high. Protein levels are not considered. Which form of diabetes insipidus (DI) is treatable with exogenous antidiuretic hormone (ADH)? a. Neurogenic c. Nephrogenic b. Psychogenic d. Ischemic - CORRECT ANS--A Neurogenic DI is treated with ADH replacement therapy. The other options are incorrect. Which condition may result from pressure exerted by a pituitary tumor? a. Hypothyroidism c. Diabetes insipidus b. Hypercortisolism d. Insulin hyposecretion - CORRECT ANS--A If the tumor exerts sufficient pressure, then thyroid and adrenal hypofunction may occur because of lack of thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH). These result in the symptoms of hypothyroidism and hypocortisolism. The remaining options are not associated with the pressure exerted by a pituitary tumor.
c. Brain cancer b. Diabetes d. Thyroid cancer - CORRECT ANS--B Acromegaly is a term for adults who have been exposed to continuously high levels of GH, whereas the term giantism is reserved for children and adolescents. The other options do not apply to hypersecretion of GH. Giantism occurs only in children and adolescents because their: a. Growth hormones are still diminished. b. Epiphyseal plates have not yet closed. c. Skeletal muscles are not yet fully developed. d. Metabolic rates are higher than in adulthood. - CORRECT ANS--B Giantism is related to the effects of growth hormones on the growth of long bones at their epiphyseal plates. This information makes the other options incorrect. Amenorrhea, galactorrhea, hirsutism, and osteoporosis are each caused by a: a. Posterior pituitary adenoma c. Prolactinoma b.
Thymoma d. Growth hormone adenoma - CORRECT ANS--C Of the options available, the hallmark of a prolactinoma is the sustained elevation of serum prolactin that is responsible for the symptoms listed in the question. Graves disease develops from a(n): a. Viral infection of the thyroid gland that causes overproduction of thyroid hormone b. Autoimmune process during which lymphocytes and fibrous tissue replace thyroid tissue c. Thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones d. Ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing a goiter - CORRECT ANS--C The pathologic features of Graves disease indicates that normal regulatory mechanisms are overridden by abnormal immunologic mechanisms that result in the stimulation of excessive TH. The remaining options are incorrect statements. The signs of thyrotoxic crisis include: a. Constipation with gastric distention c. Hyperthermia and tachycardia b. Bradycardia and bradypnea d.
Palpation of the neck of a person diagnosed with Graves disease would detect a thyroid that is: a. Left of midline c. Normal in size b. Small with discrete nodules d. Diffusely enlarged - CORRECT ANS--D The only option that characterizes Graves disease is a diffused enlargement of the thyroid gland. A deficiency of which chemical may result in hypothyroidism? a. Iron c. Zinc b. Iodine d. Magnesium - CORRECT ANS--B The only cause of hypothyroidism from among the provided options is a deficiency of endemic iodine. What are clinical manifestations of hypothyroidism? a. Intolerance to heat, tachycardia, and weight loss
b. Oligomenorrhea, fatigue, and warm skin c. Restlessness, increased appetite, and metrorrhagia d. Constipation, decreased heat rate, and lethargy - CORRECT ANS--D The lower levels of thyroid hormone result in decreased energy metabolism, resulting in constipation, bradycardia, and lethargy, thus eliminating the remaining options. Diagnosing a thyroid carcinoma is best performed with: a. Measurement of serum thyroid levels c. Ultrasonography b. Radioisotope scanning d. Fine-needle aspiration biopsy - CORRECT ANS--D Fine-needle aspiration of a thyroid nodule is generally performed to diagnose this condition; this method is best for early detection, thus eliminating the other options. Renal failure is the most common cause of which type of hyperparathyroidism? a. Primary c. Exogenous b. Secondary
The most common cause of hypoparathyroidism is damage caused during thyroid surgery, resulting in a lack of circulating PTH and causing a depressed level of serum calcium. This information supports the elimination of the other options. A patient diagnosed with diabetic ketoacidosis (DKA) has the following laboratory values: arterial pH 7.20; serum glucose 500 mg/dl; positive urine glucose and ketones; serum potassium (K+) 2 mEq/L; serum sodium (Na+) 130 mEq/L. The patient reports that he has been sick with the "flu" for 1 week. What relationship do these values have to his insulin deficiency? a. Increased glucose use causes the shift of fluid from the intravascular to the intracellular space. b. Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis. c. Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis. d. Decreased glucose use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss. - CORRECT ANS--B Decreased glucose causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis, which have resulted in the symptoms listed in the question. The relationship between the stated assessment values and insulin deficiency is not effectively described by any of the other options. Polyuria occurs with diabetes mellitus because of the: a. Formation of ketones c. Elevation in serum glucose b. Chronic insulin resistance
d. Increase in antidiuretic hormone - CORRECT ANS--C Glucose accumulates in the blood and appears in the urine as the renal threshold for glucose is exceeded, producing an osmotic diuresis and the symptoms of polyuria and thirst. None of the other options appropriately describes the pathologic features of diabetes mellitus-induced polyuria. Type 2 diabetes mellitus is best described as a(an): a. Resistance to insulin by insulin-sensitive tissues b. Need for lispro instead of regular insulin c. Increase of glucagon secretion from α cells of the pancreas d. Presence of insulin autoantibodies that destroy β cells in the pancreas - CORRECT ANS--A One of the basic pathophysiologic characteristics of type 2 diabetes is the development of insulin-resistant tissue cells. None of the remaining options appropriately describes type 2 diabetes. A person diagnosed with type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is: a. Hyperglycemia caused by incorrect insulin administration b. Dawn phenomenon from eating a snack before bedtime c. Hypoglycemia caused by increased exercise d.
Hypoglycemia, followed by rebound hyperglycemia, is observed in those with: a. The Somogyi effect b. The dawn phenomenon c. Diabetic ketoacidosis d. Hyperosmolar hyperglycemic nonketotic syndrome - CORRECT ANS--A Hypoglycemia, followed by rebound hyperglycemia, is observed only in the Somogyi effect. The first laboratory test that indicates type 1 diabetes is causing the development of diabetic nephropathy is: a. Dipstick test for urine ketones b. Increase in serum creatinine and blood urea nitrogen c. Protein on urinalysis d. Cloudy urine on the urinalysis - CORRECT ANS--C Microalbuminuria is the first manifestation of this form of renal failure. Although the other options may develop, they occur after protein is found in the urine. Which classification of oral hypoglycemic drugs decreases hepatic glucose production and increases insulin sensitivity and peripheral glucose uptake? a.
Biguanide (metformin) c. Meglitinides (glinides) b. Sulfonylureas (glyburide) d. α-Glycosidase inhibitor (miglitol) - CORRECT ANS--A Only biguanides decrease hepatic glucose production and increase insulin sensitivity and peripheral glucose uptake What causes the microvascular complications in patients with diabetes mellitus? a. The capillaries contain plaques of lipids that obstruct blood flow. b. Pressure in capillaries increase as a result of the elevated glucose attracting water. c. The capillary basement membranes thicken, and cell hyperplasia develops. d. Fibrous plaques form from the proliferation of subendothelial smooth muscle of arteries. - CORRECT ANS--C Microvascular complications are a result of capillary basement membranes thickening and endothelial cell hyperplasia. None of the remaining options appropriately describes the cause of microvascular complications in patients with diabetes mellitus. Retinopathy develops in patients with diabetes mellitus because: a. Plaques of lipids develop in the retinal vessels. b.
Laryngeal spasms d. Hyporeflexia e. Asphyxiation - CORRECT ANS--A, B, C, E Symptoms associated with hypoparathyroidism are related to hypocalcemia. Hypocalcemia causes a lowering of the threshold for nerve and muscle excitation so that a slight stimulus anywhere along the length of a nerve or muscle fiber may initiate a nerve impulse. This creates tetany manifested as muscle spasms, hyperreflexia, tonic-clonic convulsions, laryngeal spasms, and, in severe cases, death from asphyxiation. A chronic complication of diabetes mellitus is likely to result in microvascular complications in which areas? (Select all that apply.) a. Eyes b. Coronary arteries c. Renal system d. Peripheral vascular system e. Nerves - CORRECT ANS--A, C, E Of the options provided, the areas most often affected are the retina, kidneys, and nerves. Hypersecretion of adrenocorticotropic hormone (ACTH) A. Acromegaly B. Cushing disease
C. Addison disease D. Graves disease E. Myxedema F. Pheochromocytoma - CORRECT ANS--B Hypersecretion of adrenal medulla hormones A. Acromegaly B. Cushing disease C. Addison disease D. Graves disease E. Myxedema F. Pheochromocytoma - CORRECT ANS--F Hyposecretion of thyroid hormone (TH) A. Acromegaly B. Cushing disease C. Addison disease D. Graves disease E. Myxedema F. Pheochromocytoma - CORRECT ANS--E Hyposecretion of adrenal cortex hormones A. Acromegaly B. Cushing disease
Macrophages adhere to vessel walls. c. Injury to the endothelial cells that line the artery walls d. Release of the platelet-deprived growth factor - CORRECT ANS--C Atherosclerosis begins with an injury to the endothelial cells that line the arterial walls. Possible causes of endothelial injury include the common risk factors for atherosclerosis, such as smoking, hypertension, diabetes, increased levels of low-density lipoprotein (LDL), decreased levels of high-density lipoprotein (HDL), and autoimmunity. The remaining options occur only after the endothelial cells are injured. What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis? a. LDLs cause smooth muscle proliferation. b. LDLs cause regression of atherosclerotic plaques. c. LDLs increase levels of inflammatory cytokines. d. LDLs direct macrophages to the site in the endothelium. - CORRECT ANS--A Oxidized LDLs are toxic to endothelial cells, cause smooth muscle proliferation, and activate further immune and inflammatory responses. This selection is the only option that accurately identifies the effects of LDLs. Which inflammatory cytokines are released when endothelial cells are injured? a. Granulocyte-macrophage colony-stimulating factor (GM-CSF) b. Interferon-beta (IFN-β), interleukin 6 (IL-6), and granulocyte colony-stimulating factor (G-CSF)
c. Tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), and interleukin 1 (IL-1) d. Interferon-alpha (IFN-α), interleukin-12 (IL-12), and macrophage colony-stimulating factor (M- CSF) - CORRECT ANS--C Numerous inflammatory cytokines are released, including TNF-α, IFN-γ, IL-1, toxic oxygen radicals, and heat shock proteins. This selection is the only option that accurately identifies which inflammatory cytokines are associated with endothelial cell injury. Which factor is responsible for the hypertrophy of the myocardium associated with hypertension? a. Increased norepinephrine c. Angiotensin II b. Adducin d. Insulin resistance - CORRECT ANS--C Of the available options, only angiotensin II is responsible for the hypertrophy of the myocardium and much of the renal damage associated with hypertension This selection is the only option that accurately identifies the factor that contributes to atherosclerosis.When endothelia cells are injured, what alteration contributes to atherosclerosis? a. The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs). b. Cells are unable to make the normal amount of vasodilating cytokines.
