NURS 6501 Module 4 Knowledge Check Quiz

NURS 6501 Module 4 Knowledge Check Quiz

NURS 6501 Module 4 Knowledge Check Quiz

QUESTION 1

  1. A 67-year-old Caucasian woman was brought to the clinic by her son who stated that his mother had become slightly confused over the past several days. She had been stumbling at home and had fallen once but was able to

ambulate with some difficulty. She had no other obvious problems and had been eating and drinking. The son became concerned when she forgot her son’s name, so he thought he better bring her to the clinic.

PMH-Type II diabetes mellitus (DM) with peripheral neuropathy x 20 years. COPD. Depression after death of spouse several months ago

Social/family hx – non contributary except for 30 pack/year history tobacco use.

Meds: Metformin 500 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago

Labs-CBC WNL; Chem 7- Glucose-92 mg/dl, BUN 18 mg/dl, Creatinine 1.1 mg/dl, Na+120 mmol/L,

K+4.2 mmol/L, CO237 m mol/L, Cl–97 mmol/L.

The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic

hormone (SIADH).

Question:

Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH.

“SIADH secretion is characterized by high levels of ADH in the absence of normal physiologic stimuli for its release” (McCance et al., 2019, pg. 670). Enhanced water retention in the kidneys causes SIADH. ADH increases renal permeability to water by inducing the insertion of a water channel protein into the tubular luminal membrane, increasing water reabsorption by the kidneys (McCance et al.., 2019). This causes ECF volume to expand, causing diluting hyponatremia, hypoosmolarity, and improperly concentrated urine, as the water is being reabsorbed instead of being excreted (McCance et al., 2019).

The above patient has some signs that her BUN is elevated, such as the confusion. Her sodium level is decreased, along with her chloride level minimally below the normal range. This supports the above paragraph with water being reabsorbed instead of being excreted, causing hyponatremia.

NURS 6501 Module 4 Knowledge Check Quiz QUESTION2

PMH-significant for 20-year history of steroid dependent

rheumatoid arthritis (RA). GERD. No other significant illnesses or surgeries. Social-denies alcohol, illicit drugs, vaping, tobacco use

Physical exam

Thin, ill appearing woman who is sitting in exam room chair as she said she was too weak to climb on the exam table. VS Temp 101.2˚F, BP 98/64, pulse 110, Resp 16, PaO2 96% on room air.

ROS negative other than GI symptoms.

Based on the patient’s clinical presentation, the APRN diagnoses the patient

as having secondary hypocortisolism due to the lack of prednisone the patient was ta king for her RA secondary to vomiting.

Question:

Explain why the patient exhibited these symptoms?

Hypcortisolism has three different types, primary, secondary, or tertiary. Primary is Addison disease. It develops due to the inability of the adrenals to produce and secrete adrenocortical hormones. Secondary develops due to inadequate stimulation of the adrenal glands by ACTH. Tertiary is due to an abrupt witahdrawal of exogenous glucocorticoids or as a complication of treatment for Cushing syndrome (McCance et al., 2019). The patient was prescribed prednisone to help decrease her RA symptoms. The prednisone helps with flare-ups. When the patient started having n/v, she was not getting and keeping the prednisone in her body. Secondary hypocortisolism often results from prolonged administration of exogenous glucocorticoids, which causes suppression of ACTH secretion, causing adrenal atrophy, resulting in inadequate corticosteroidogenesis once the oral, extra glucocorticoids are removed (McCance et al., 2019). Symptoms of secondary hypocortisolism is similar to Addison’s disease, minus hyperpigmentation.

NURS 6501 Module 4 Knowledge Check Quiz QUESTION3

QUESTION 4                                                                                              

  1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without

trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.

QUESTION5

QUESTION 6                                                                                              

QUESTION7

Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan. NURS 6501 Module 4 Knowledge Check Quiz

Question 1 of 6:

The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polydipsia.”

Type I DM, the most common pediatric condition has two distinct types: autoimmune (type IA) and idiopathic or nonimmune (type IB) (McCance et al., 2019). The 3rd type, type 3c DM is associated with chronic pancreatitis.

With autoimmune DM, there are environmental-genetic factors believed to trigger cell-mediated destruction of pancreatic beta cells (McCance et al., 2019). Type I usually leads to complete insulin deficiency, requiring the patient to take insulin in order to keep their blood sugars in a healthy range, otherwise it would spiral out of control.

With elevated blood glucose levels, water is osmotically attracted from body cells, resulting in intracellular dehydration and hypothalamic stimulation of thirst, causing polydipsia (McCance et al., 2019).

QUESTION 8

  1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent

urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.

PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child

Allergies-none know

Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends.

Labs in office: random glucose 220 mg/dl.

Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan. NURS 6501 Module 4 Knowledge Check Quiz

Question 2 of 6:

QUESTION 9

QUESTION 10                                                                                              

QUESTION 11

A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent

urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.

PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child

Allergies-none know

Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends.

Labs in office: random glucose 220 mg/dl.

Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.

Question 5 of 6:

The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “fatigue.”

The fatigue in Type I DM patients results from the manifestations of polydipsia, polyuria, polyphagia, and weight loss. The metabolic changes result in poor use of food products, causing lethargy and fatigue; furthermore, the loss of quality sleep from severe nocturia further causes fatigue (McCance et al., 2019).

NURS 6501 Module 4 Knowledge Check Quiz QUESTION 12

including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.

PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child

Allergies-none know

Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends.

Labs in office: random glucose 220 mg/dl.

Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.

Question 6 of 6:

How do genetics and environmental factors contribute to the development of Type 1 diabetes?

Type I DM, the most common pediatric condition has two distinct types: autoimmune (type IA) and idiopathic or nonimmune (type IB) (McCance et al., 2019). The 3rd type, type 3c DM is associated with chronic pancreatitis.

The genetic predisposition and environmental factors combined cause autoantigens to form on insulin-producing beta cells that circulate in the bloodstream and lymphatics. This leads to the processing and presentation of autoantigen by antigen- presenting cells, which leads to both the activation of T helper I lymphocytes and T helper 2 lymphocytes (McCance et al., 2019). The activation of the Th1 lymphocytes causes activation of macrophages with the release of IL-1 and TNF-alpha through interferon-gamma, as well as activation of autoantigen-specific T cytotoxic (CD8) cells through interleukin (McCance et al., 2019). The T helper 2 lymphocytes cause the activation of B lymphocytes to produce islet cell autoantibodies and anti-glutamic acid decarboxylase antibodies through interleukin (McCance et al., 2019). NURS 6501 Module 4 Knowledge Check Quiz

Collectively, the activation of the macrophages, autoantigen-specific T cytotoxic cells, and B lymphocytes cause the destruction of beta cells with decreased insulin secretion (McCance et al., 2019, pg. 687).

QUESTION 13

Cl- 95mmol/L; Ca++ 8.8mmol/L; AST (SGOT) 248U/L; ALT 198U/L; CK 34/35 IU/L; Chol

esterol 198mg/dl;

Phosphorus 6.8mg/dl; Acetone Moderate; LDH38U/L; Alkaline Phosphatase 132U/L.

Arterial blood gas values were as follows: pH 7.09; Paco220mm Hg; Po2100mm Hg; Sao2 98% (room air)

HCO3-7.5mmol/L; anion gap 19.4

A diagnosis of diabetic ketoacidosis was made, and the patient was transferred to the Intensive Care Unit (ICU) for close monitoring.

Question:

The hormones involved in intermediary metabolism, exclusive of insulin, that can participate in the development of diabetic ketoacidosis (DKA) are epinephrine, glucagon, cortisol, growth hormone. Describe how they participate in the development of DKA.

DKA is a severe complication of DM, related to a deficiency of insulin and an increase in the insulin counter-regulatory hormones of epinephrine, glucagon, cortisol, and growth hormone (McCance et al., 2019).  DKA affects those with Type 1 DM more than type 2. These hormones normally increase glucose production as well as decreasing the body’s use of glucose. This results in insulin deficiency and decreased glucose uptake, increased fat mobilization with the release of fatty acids, accelerated gluconeogenesis, glycogenesis, and ketogenesis (McCance et al., 2019, pg. 693). NURS 6501 Module 4 Knowledge Check Quiz

With the absence of insulin, the free fatty acids release increases the production of ketone bodies in the liver mitochondria. This causes a drop in pH, triggering buffering system with metabolic acidosis. Increased glucagon levels activates gluconeogenic and ketogenic pathways in the liver (McCance et al., 2019).  Ketones are normally used as energy to regenerate bicarbonate, as bicarbonate is lost when the ketone is formed. Hyperketonemia results from impaired ketone use of peripheral tissue.

Further bicarbonate buffering does not occur, resulting in metabolic acidosis (McCance et al., 2019).

QUESTION 14

QUESTION 15                                                                                              

QUESTION 16

QUESTION 17     

Question18

QUESTION 19                                                                                              

QUESTION 20

NURS 6501 Module 4 Knowledge Check Quiz QUESTION 21                                                                                              

  1. A 44-year-old woman presents to the clinic with complaints of extreme

fatigue, weight gain, decreased appetite, cold intolerance, dry skin, hair loss, and sleepiness. She also admits that she often bursts into tears without any reason

and has been exceptionally forgetful. Her vision is occasionally blurry, and she admits to being depressed without any social or occupational triggers. Past medical

history noncontributory. Physical exam Temp 96.2˚F, pulse 62 and regular, BP 108/90, respirations. Dull facial expression with coarse facial

features. Periorbital puffiness noted. Based on the clinical history and physical exam, and pending laboratory data, the ARNP diagnoses the patient with hypothyroidism.

Question:

What causes hypothyroidism?

Hypothyroidism is caused from inappropriate production of TH by the thyroid gland. Loss of thyroid function in primary hypothyroidism causes decreased production of TH and increased secretion of TSH and TRH (McCance et al., 2019). For adults, the most common causes are autoimmune thyroiditis (Hashimoto disease), iatrogenic loss of thyroid tissue after surgery or radioactive treatment, hand and neck radiation therapy, medications, and endemic iodine deficiency (McCance et al., 2019). For infants and children there may be congenital defects in the pituitary or thyroid glands. NURS 6501 Module 4 Knowledge Check Quiz

Secondary hypothyroidism is caused by the pituitary’s failure to synthesize adequate amounts of TSH, or a lack of TRH. Pituitary tumors that compress surrounding pituitary cells as well as possible consequences of treatment are the most common causes. TBI, subarachnoid hemorrhage, or pituitary infarction are other less common causes (McCance et al., 2019).

Subclinical hypothyroidism- mild thyroid failure is caused from an elevation of TSH level with normal levels of TH.

QUESTION 22

NURS 6501 Module 4 Knowledge Check Quiz QUESTION 23                                                                                              

  1. A 53-year-old woman presents to the primary care clinic with complaints of

severe headaches, palpitations, high blood pressure and diaphoresis. She relates that these symptoms come in clusters and when she has these “spells”, she also experiences, tremor, nausea, weakness, anxiety, and a sense of doom and dread, epigastric pain, and flank pain. She had one of these spells when she was at the pharmacy and the pharmacist took her blood pressure which was recorded as 200/118. The pharmacist recommended that she immediately be evaluated for these symptoms. Past medical history significant for a family history of neurofibromatosis type 1 (NF1). Based on the presenting symptoms and family history of NF1, the

APRN suspects the patient has a pheochromocytoma. Laboratory data and computerized tomography of the abdomen confirms the diagnosis.

QUESTION24