Basicsofinternalmedicine(Diseasesofuninary, Blood and Endocrine System, Allergic Diseases

Module 2

BasicsofinternalMedicine(diseasesofuninary, blood and endocrine system, allergic diseases, writing and defense of case history)

Text test

For the diabetic patient with microalbuminuria, what dietary modification should the doctor suggest?
Decreased percentage of total calories derived from carbohydrates
* Decreased percentage of total calories derived from proteins
Decreased percentage of total calories derived from fats
Decreased total caloric intake
No any answer is correct
For which situation should the doctor suggest the pen-type injector insulin delivery system?
The patient who is confused and must rely on another person for insulin injections
* The patient using intensive therapy who must use insulin frequently in small doses
The patient who is visually impaired and cannot accurately draw up insulin
The patient who has frequent episodes of hypoglycemia
No any answer is correct
How does glucagon assist in maintaining blood glucose levels?
Glucagon enhances the activity of insulin, restoring blood glucose levels to normal more quickly after a high-calorie meal.
Glucagon is a storage form of glucose and can be broken down for energy when blood glucose levels are low.
Glucagon converts the excess glucose into glycogen, lowering blood glucose levels in times of excess.
* Glucagon prevents hypoglycemia by promoting glucose release from liver storage sites.
All above mentioned
How does intravenous infusion of a glucose and insulin solution reduce serum potassium levels?
The glucose stimulates an osmotic diarrhea, which results in an actual loss of total body potassium.
* The insulin activates membrane-bound sodium-potassium pumps, which results in a relative decrease in serum potassium.
Each glucose molecule substitutes one potassium ion for one carbon atom, resulting in a relative decrease in serum potassium.
Insulin stimulates the release of aldosterone, increasing renal excretion of potassium and resulting in an actual loss of total body potassium.
No any answer is correct
How does the syndrome of inappropriate antidiuretic hormone (SIADH) cause hyponatremia?
ADH increases the renal excretion of water.
ADH increases the renal excretion of sodium.
* ADH increases the renal reabsorption of water.
ADH increases the renal reabsorption of sodium.
All above mentioned
Interpret GTT.Glycemia: I trial – 5,3 mMol/l, II trial – 8,2 mMol/l, III trial – 4,8 mMol/l
* Normal
Impairment of carbohydrate tolerance
Diabetes mellitus
Necessary to repeat test
Necessary to order additional laboratory tests.
Macroangiopathy, as a symptom of diabetes mellitus, most often destroy vessels of:
* Brain
Lung
Kidneys
Retina
Intestine
The 45-year-old diabetic patient has proliferative retinopathy, nephropathy, and peripheral neuropathy. What should the doctor teach this patient about exercise?
“The type of exercise that would most efficiently help you to lose weight, decrease insulin requirements, and maintain cardiovascular health would be jogging for 20 minutes 4 to 7 days each week.”
“Considering the complications you already have, vigorous exercise for an hour each day is needed to prevent progression of disease.”
“Considering the complications you already have, you should avoid engaging in any form of exercise.”
* “Swimming or water aerobics 30 minutes each day would be the safest exercise routine for you.”
No any answer is correct
The patient diabetic patient asks the doctor why it is necessary to maintain blood glucose levels no lower than about 74 mg/dL. What is the doctor’s best response?
“Glucose is the only fuel form used by body cells to produce energy needed for physiologic activity.”
* “The central nervous system, which cannot store glucose, requires a continuous supply of glucose for fuel.”
“Without a minimum level of glucose circulating in the blood, erythrocytes cannot produce ATP.”
“The presence of glucose in the blood counteracts the formation of lactic acid and prevents acidosis.”
No any answer is correct
The patient who has used insulin for diabetes control for 20 years has a spongy swelling at the site used most frequently for insulin injection. What is the doctor’s best action?
Apply ice to this area.
Document the finding as the only action.
Assess the patient for other signs of cellulitis.
* Instruct the patient to use a different site for insulin injection.
No any answer is correct
The patient with diabetes is visually impaired and wants to know if syringes can be prefilled and stored for use later. What is the doctor’s best response?
* “Yes, prefilled syringes can be stored for up to 3 weeks in the refrigerator in a vertical position with the needle pointing up.”
“Yes, prefilled syringes can be stored for up to 3 weeks in the refrigerator, placed in a horizontal position.”
“Insulin reacts with plastic, so prefilled syringes must be made of glass.”
“No, insulin cannot be stored for any length of time outside of the container.”
No any answer is correct
The patient with diabetes who is just starting on insulin therapy wants to know why more than one injection of insulin each day will be required. What is the doctor’s best response?
“You need to start with multiple injections until you become more proficient at self-injection.”
* “A single dose of insulin each day would not match your blood insulin levels and your food intake patterns closely enough.”
“A regimen of a single dose of insulin injected each day would require that you could eat no more than one meal each day.”
“A single dose of insulin would be too large to be absorbed predictably, so you would be in danger of unexpected insulin shock.”
No any answer is correct
The patient with hypokalemia requires a diuretic for another health problem. Which agent should the doctor be prepared to administer?
Furosemide (Lasix)
Bumetanide (Bumex)
Chlorothiazide (Diuril)
* Spironolactone (Aldactone)
No any answer is correct
The patient with type 1 diabetes has a blood glucose level of 160 mg/dL on arrival at the operating room. What is the doctor’s best action?
* Document the finding as the only action.
Administer regular insulin.
Cancel the surgery.
Notify the physician.
No any answer is correct
Three hours after surgery, the doctor note that the breath of the patient who is a type 1 diabetic has a “fruity” odor. What is the doctor’s best first action?
Document the finding as the only action.
Increase the IV fluid flow rate.
* Test the urine for ketone bodies.
Perform oral care.
All above mentioned
What effect can moderate to severe hypokalemia have on digoxin therapy?
Hypokalemia increases the excretion rate of digoxin; therefore, digoxin must be given twice each day.
Hypokalemia increases the half-life of digoxin; therefore, digoxin must be given every other day.
* Hypokalemia increases the sensitivity of excitable membranes to digoxin; therefore, toxic effects may occur with normal doses.
Hypokalemia decreases the sensitivity of excitable membranes to digoxin; therefore, higher doses of digoxin are required to achieve a therapeutic effect.
All above mentioned
What intervention is most important to teach the patient at risk for hypercalcemia?
“Avoid drinking coffee and other caffeinated beverages.”
* “Be sure to drink at least 3 liters of fluids each day.”
“Do not eat or drink any dairy products.”
“Take at least one 2-hour nap per day.”
No any answer is correct
What intervention should the doctor suggest to the diabetic patient who self-injects insulin to prevent or limit local irritation at the injection site?
“Do not reuse needles.”
“Massage the site for 1 full minute after injection.”
“Try to make the injection deep enough to enter muscle.”
* “Allow the insulin to warm to room temperature before injection.”
No any answer is correct
What intervention should the doctor teach the patient with diabetes who uses an insulin infusion pump to prevent the complication of infection?
“Test your urine daily for the presence of ketone bodies.”
“Use buffered insulin to prevent crystal formation.”
“Keep the insulin frozen until you fill the pump.”
* “Change the needle every 3 days.”
All above mentioned
What is the basic underlying pathology of diabetes mellitus?
A disruption of the cellular glycolytic pathway
* An inability of the liver to catabolize glycogen
A failure to synthesize and/or utilize insulin
An inhibition of the conversion of protein to amino acids
No any answer is correct
What is the basic underlying pathology of diabetes mellitus?
A disruption of the cellular glycolytic pathway
An inability of the liver to catabolize glycogen
* A failure to synthesize and/or utilize insulin
An inhibition of the conversion of protein to amino acids
No any answer is correct
What is the physiologic basis for the polyuria manifested by individuals with untreated diabetes mellitus?
Inadequate secretion of antidiuretic hormone (ADH)
Early-stage renal failure causing a loss of urine concentrating capacity
Chronic stimulation of the detrusor muscle by the ketone bodies in the urine
* Hyperosmolarity of the extracellular fluids secondary to hyperglycemia
No any answer is correct
What is the priority intervention for the patient having Kussmaul respirations as a result of diabetic ketoacidosis?
Administration of oxygen by mask or nasal cannula
Intravenous administration of 10% glucose
Implementation of seizure precautions
* Administration of intravenous insulin
All above mentioned
What is the priority nursing diagnosis for a patient with long-standing hypocalcemia?
Ineffective Breathing Pattern related to muscle weakness
Risk for Infection related to immunosuppression
* Risk for Injury related to bone demineralization
Fatigue related to malnutrition and anemia
No any answer is correct
What is the priority nursing intervention for a patient with moderate to severe hypernatremia?
Restricting fluid intake
* Initiating seizure precautions
Weighing the patient daily at the same time of day
Assessing pulse oximetry and respiratory status every hour
No any answer is correct
What is the priority teaching intervention for the patient with chronic hypophosphatemia?
Where to find the radial pulse and what qualities to note
How to intersperse daily activities with periods of rest
* How to select foods high in phosphorus and avoid foods with high concentrations of calcium.
The importance of weighing himself or herself daily at the same time each day and wearing the same amount of clothing.
All above mentioned
What pathologic process is most likely occurring in a patient who has a serum sodium level of 122 mEq/L and a serum potassium level of 6.6 mEq/L?
* Adrenal insufficiency
Chronic renal failure
Cushing’s syndrome
SIADH
No any answer is correct
When taking the blood pressure of a very ill patient, the doctor observes that the patient's hand undergoes flexion contractions. What is the doctor’s best first action?
Place the patient in the high-Fowler's position and increase the IV flow rate.
* Deflate the blood pressure cuff and give the patient oxygen.
Document the finding as the only action.
Notify the emergency team.
No any answer is correct
Which action should the doctor suggest to reduce insulin needs in the patient with diabetes mellitus?
Reducing intake of water and other liquids to no more than 2 L/day
Eating animal organ meats high in insulin
Taking two 1-hour naps daily
* Walking 1 mile each day
No any answer is correct
Which action should the doctor suggest to the patient who has been having difficulty with hypoglycemia to decrease the rate of insulin absorption from the injection site?
Massaging the injection site
Exercising within 1 hour of insulin injection
Injecting into muscle rather than subcutaneous tissue
* Using refrigerated insulin without warming it to room temperature
All above mentioned
Which action should the doctor teach the diabetic patient as being most beneficial in delaying the onset of microvascular and macrovascular complications?
* Controlling hyperglycemia
Preventing hypoglycemia
Restricting fluid intake
Preventing ketosis
No any answer is correct
Which alteration in psychosocial functioning should alert the doctor to the possibility of hypokalemia?
Anxiety
Insomnia
* Confusion
Combative behavior
All above mentioned
Which assessment finding in the patient with diabetes mellitus indicates that the disease is damaging the kidneys?
The presence of ketone bodies in the urine during acidosis
The presence of glucose in the urine during hyperglycemia
* The presence of protein in the urine during a random urinalysis
The presence of white blood cells in the urine during a random urinalysis
No any answer is correct
Which change in clinical manifestations in a patient with long-standing diabetes mellitus alerts the doctor to the possibility of renal dysfunction?
Loss of tactile perception
The presence of glucose in the urine
The presence of ketone bodies in the urine
* A sustained increase in blood pressure from 130/84 to 150/100
No any answer is correct
Which patient is at greatest risk for developing hypercalcemia?
The patient taking digoxin and a high-ceiling diuretic (Lasix) for heart failure
The patient with long-standing osteoarthritis
The patient who is pregnant with twins
* The patient with hyperparathyroidism
No any answer is correct
Which patient is at greatest risk for hypokalemia?
65-year-old with diabetes mellitus
55-year-old with Addison’s disease
* 45- year-old with Cushing’s disease
35-year-old with diabetes insipidus
No any answer is correct
Which patient is at greatest risk for the development of hyperphosphatemia?
* 27-year-old man undergoing chemotherapy for lymphoma
45- year-old man taking Tums for chronic acid indigestion
21-year-old man recovering from a fractured tibia that has been pinned
36-year-old woman taking thyroid hormone replacement after a thyroidectomy
No any answer is correct
Which clinical manifestation in a patient with uncontrolled diabetes mellitus should the doctor expect as a result of the presence of ketoacid in the blood?
* Increased rate and depth of respiration
Extremity tremors followed by seizure activity
Oral temperature of 102° F (38.9° C)
Severe orthostatic hypotension
All above mentioned
Which clinical manifestation indicates to the doctor that the therapy for the patient with hyperglycemic, hyperosmolar, nonketotic syndrome (HHNS) needs to be adjusted?
The patient's serum potassium level increased from 2.8 mEq/L to 3.2 mEq/L.
The patient's blood osmolarity has decreased from 350 mOsm to 330 mOsm.
* The patient's score on the Glasgow Coma Scale is unchanged from 3 hours ago.
The patient's urine has remained negative for ketone bodies for the past 3 hours.
No any answer is correct
Which intervention for self-monitoring of blood glucose levels should the doctor teach the patient with diabetes to prevent bloodborne infections?
“Wash your hands before beginning the test.”
* “Do not share your monitoring equipment.”
“Blot excess blood from the strip.”
“Use gloves during monitoring.”
All above mentioned
Which intravenous solution should the doctor be prepared to administer to a patient with a serum sodium level of 120 mEq/L and a serum potassium level of 4.3 mEq/L?
0.45% saline
0.9% saline
* 2% saline
Ringer's lactate
No any answer is correct
Which nutritional group should the doctor teach the diabetic patient with normal renal function to rigidly control to reduce the complications of diabetes?
* Fats
Fiber
Proteins
Carbohydrates
No any answer is correct
Which nutritional problem should the doctor be more alert for in older adult patients with diabetes mellitus?
Obesity
* Malnutrition
Alcoholism
Hyperglycemia
No any answer is correct
Which protein source should the doctor recommend for a patient who needs to restrict dietary potassium intake?
Raw broccoli
Grilled salmon
* Poached eggs
Baked chicken
All above mentioned
Which question is most important for the doctor to ask the patient who has been diagnosed with hypokalemia to identify a possible cause for the imbalance?
“Do you use sugar substitutes?”
* “Do you use diuretics or laxatives?”
“Have you or any member of your family been diagnosed with kidney disease?”
“Have you noticed any changes in your pattern of bowel elimination during the last month?”
No any answer is correct
Which statement made by the diabetic patient who has a urinary tract infection indicates correct understanding regarding antibiotic therapy?
“If my temperature is normal for 3 days in a row, the infection is gone and I can stop taking my medicine.”
“If my temperature goes above 100° F (37.8° C) for 2 days, I should take twice as much medicine.”
* “Even if I feel completely well, I should take the medication until it is gone.”
“When my urine no longer burns, I will no longer need to take the antibiotics.”
No any answer is correct
Which statement regarding diabetes mellitus is true?
Diabetes increases the risk for development of epilepsy.
The cure for diabetes is the administration of insulin.
* Diabetes increases the risk for development of cardiovascular disease.
Carbohydrate metabolism is disturbed in diabetes, but protein and lipid metabolism are normal.
All above mentioned
Which subjective symptom reported by the patient should alert the doctor to the possibility of hypocalcemia?
“I have a bowel movement only every 2 to 3 days.”
* “Usually I wake up several times a night with painful cramps in my legs or feet.”
“My rings and shoes are much tighter fitting at night than they are in the morning.”
“I notice that my heart seems to pound whenever I climb steps or drink a cup of coffee.”
No any answer is correct
While assessing the patient who has had diabetes for 15 years, the doctor notes that the patient has decreased tactile sensation in both feet. What is the doctor’s best first action?
Document the finding as the only action.
Test sensory perception in the patient's hands.
* Examine the patient's feet for signs of injury.
Notify the physician.
No any answer is correct
Why is ketosis rare in patients with type 2 diabetes, even when blood glucose levels are very high (higher than 900 mg/dL)?
Ketosis is less prevalent among obese adults.
People with type 2 diabetes have normal lipid metabolism.
* There is enough insulin produced by type 2 diabetes to prevent fat catabolism but not enough to prevent hyperglycemia.
Oral antidiabetic agents do not promote the breakdown of fat for fuel (lipolysis), and exogenous insulin spares carbohydrates at the expense of fats.
No any answer is correct
With which therapy for diabetes mellitus is the patient not at risk for hypoglycemia?
Regular insulin
Lente insulin
* Biguanides
Sulfonylureas
No any answer is correct
Excretion of which metabolites causes hypercreatininemia?
* Proteins metabolites
Carbohydrates metabolites
Fats metabolites
All mentioned
Uric acid salts
What is the purpose of Nechyporenko’s test execution?
to reveal which part of urinary system is the source of hematuria or leukocyturia,
estimation of kidney concentration function
* for calculation of formed elements (red cells, leukocytes, casts) in urine with the method of Kakovsky-Addis
for determination of diuresis
for determination of the amount of albumen in urine.
Which is main drug for treatment of acute glomerulonephritis?
Antibiotics
* Glucocoricoids
Immunodepressants
Diuretics
Calcium channel antagonists
Which is main drug for treatment of acute pyelonephritis?
* Antibiotics
Glucocortecoids
Immunodepressants
Diuretics
Calcium channel antagonists
Which laboratory test is useful for assessment kidney concentration function?
Complete blood count;
ECG;
Nechiporenko’s test;
* Zimnicki’s test
determination of daily proteinuria.
According to location of pathological process chronic pyelonephritis may be:
Unilateral
Bilateral
Pyelonephritis of a single kidney
No correct answer
* All enumerated
Anticoagulants are prescribed in the following curse of glomerulonephritis:
With uric syndrome
With uric syndrome and hematuria
In resistant hypertension
* With nephrotic syndrome
With acute nephritic syndrome
For patient A., who sufers of chronic glomerulonephritis, it was found out violation of kidneys concentration function.