Practice Test Flashcards
The nurse would instruct a patient with diabetes mellitus to notify the health care provider immediately for which event?
A. When dental work needs to be done.
B. Signs of infection develop
C. If injury does not begin to heal within 72 hours.
D. When a new cut or scrape occurs.
B. Signs of infection develop
Which statement illustrates the concept of the negative feedback system for control of serum cortisol?
A. A decreased serum cortisol when ACTH secretion is increased.
B. An increased serum cortisol when ACTH secretion is decreased.
C. A decreased secretion of ACTH when serum cortisol is increased.
D. An increased secretion of ACTH when serum cortisol is increased.
C. A decreased secretion of ACTH when serum cortisol is increased.
Understanding Negative Feedback in Cortisol Regulation
Negative feedback is a self-regulating system where the body reduces or stops the production of a hormone when its levels get too high. This helps maintain balance (homeostasis).
How Does Cortisol Regulation Work?
1. The Hypothalamus Releases CRH (Corticotropin-Releasing Hormone):
• This stimulates the pituitary gland to release ACTH (Adrenocorticotropic Hormone).
2. The Pituitary Gland Releases ACTH:
• ACTH stimulates the adrenal glands to release cortisol into the bloodstream.
3. When Cortisol Levels Rise Too High:
• The body detects the increase and signals the pituitary gland to stop producing ACTH.
• This means less ACTH → less stimulation of the adrenal glands → less cortisol is produced.
• This is negative feedback because high cortisol levels suppress ACTH secretion to prevent excessive cortisol production.
Why Is Option C Correct?
✔ “A decreased secretion of ACTH when serum cortisol is increased.”
• This correctly describes negative feedback because high cortisol levels tell the pituitary gland to stop producing ACTH.
Why Are the Other Options Incorrect?
• (A) “Decreased serum cortisol when ACTH secretion is increased.”
❌ This would be positive feedback (not how cortisol is controlled).
• (B) “Increased serum cortisol when ACTH secretion is decreased.”
❌ Less ACTH should mean less cortisol, not more.
• (D) “Increased secretion of ACTH when serum cortisol is increased.”
❌ This would be opposite to negative feedback (the body wouldn’t keep producing ACTH when cortisol is already high).
Summary:
• The body regulates cortisol through negative feedback.
• More cortisol = Less ACTH.
• Less ACTH = Less cortisol production.
• This prevents excessive cortisol levels and maintains balance.
Does this explanation make sense? Would you like a simplified diagram?
Which patient action indicates a good understanding of dietary restrictions when a nurse is providing dietary teaching to a patient with diabetes?
A. Using nutritive or non-nutritive sweeteners for beverages
B. Consuming 5 carbohydrate servings per day.
C. Preparing meals that consist of 50% protein
D. Drinking one or two glasses of wine before going to bed.
A. Using nutritive or non-nutritive sweeteners for beverages
A patients CBC shows a hgb of 200 g/L and a hematocrit if 54%. Which of the following questions should the nurse ask to determine possible causes of this finding?
A. “What is your intake of fruits and vegetables?”
B. “Have you noticed any dark or glossy stools?”
C. Do you have any problem with your vision?”
D. “Has their been any recent weight loss”
D. “Has their been any recent weight loss”
Understanding the Question
The CBC (Complete Blood Count) results show:
• Hemoglobin (Hgb): 200 g/L (very high)
• Hematocrit (Hct): 54% (also high)
These findings suggest polycythemia, which is an abnormal increase in red blood cells.
Why Is Option D Correct?
✔ “Has there been any recent weight loss?”
• Unintentional weight loss is a red flag for polycythemia vera (PV), a bone marrow disorder where the body produces too many red blood cells.
• Polycythemia can be primary (due to bone marrow overproduction) or secondary (due to other conditions like chronic hypoxia or tumors).
• Recent weight loss could suggest an underlying malignancy (e.g., kidney or lung cancer, which can produce erythropoietin and cause secondary polycythemia).
Why Are the Other Options Incorrect?
1. (A) “What is your intake of fruits and vegetables?”
❌ This relates more to vitamin deficiencies (e.g., iron, folate, B12) but does not explain high hemoglobin and hematocrit.
2. (B) “Have you noticed any dark or glossy stools?”
❌ Dark stools (melena) suggest GI bleeding, which causes low hemoglobin (anemia), not high.
3. (C) “Do you have any problem with your vision?”
❌ High RBC counts can cause blood thickening and vision changes, but asking about weight loss is more diagnostic in finding the cause.
Key Takeaways:
• High hemoglobin + hematocrit = possible polycythemia.
• Ask about weight loss to assess for serious conditions like polycythemia vera or cancer.
• Follow-up tests: JAK2 mutation (for PV), oxygen levels (for chronic hypoxia), and erythropoietin levels.
Would you like a breakdown of polycythemia types and causes?
