1. Parents have just been told that genetic testing has shown that their unborn baby has Turner’s syndrome. The mother asks the nurse if the child will grow in a normal fashion. The nurse responds that:
a. The child will have no abnormal growth features
b. Height will be affected, but no systemic problems will result
c. There will be uncommon physical features and a risk of cardiovascular problems
d. There will be no overt physical abnormalities, but there will probably be significant cardiac problems
2. A diabetic patient has a serum glucose level of 824 mg/dl and is somnolent and unresponsive. After assessing the patient, the nurse suspects diabetic ketoacidosis rather than hyperglycemic hyperosmolar nonketotic syndrome based on the finding of
a. polyuria
b. severe dehydration
c. decreased serum potassium
d. rapid, deep respirations
Answers:
1. c
Rationale: Turner’s syndrome is the absence of a second sex chromosome from a homologous pair which reduces the total number of chromosomes to 45. Phenotypically affected individuals are female but do not develop sexually. They tend to be short of stature and have characteristic abnormalities, including a short, webbed neck, low posterior hairline, wide-spaced nipples, and poorly developed ovaries. Cardiovascular abnormalities occur in up to half of the patients, with coarctation of the aorta being the classic cardiac issue.
2. d
Rationale: Polyuria and high blood glucose are the major defining symptoms of HHNS and often result in dehydration. Other symptoms include lethargy and postural hypotension. In ketoacidosis, patients can also have hypotension, tachycardia, and lethargy and decreased levels of consciousness; however the defining indicator is rapid, deep respirations (Kussmaul’s breathing). Acidic blood has a low pH; very deep and rapid respirations are the body’s attempt to raise this pH and make the blood more alkaline. Decreased serum potassium is not a major defining symptom of HHNS or ketoacidosis.
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