Ch. 18: Mechanisms of Hormonal Regulation

16. A patient wants to know why ADH is important in the body. What is the nurses best response? ADH is important in: a. The bodys water balance and urine concentration b. Maintaining electrolyte levels and concentrations c. Follicular maturation d. Regulation of metabolic processes

ANS: A ADH is important in the bodys water balance and its ability to concentrate urine. ADH aids in water balance, not electrolyte levels. ADH aids in water balance, not follicular maturation. ADH aids in water balance, not metabolic processes.

22. A nurse is reviewing lab results. Which of the following lab results would slow down the rate of parathyroid hormone secretion? a. Increased serum calcium levels b. Decreased serum calcium levels c. Decreased levels of TSH d. Increased levels of TSH

ANS: A An increase in serum calcium inhibits parathyroid hormone (PTH) secretion. An increase, not a decrease, in serum calcium inhibits PTH secretion. Thyroid-stimulating hormone would not affect PTH secretion. Thyroid-stimulating hormone would not affect PTH secretion.

8. A patient has researched lipid-soluble hormones on the Internet. Which information indicates the patient has a good understanding? Lipid-soluble hormone receptors cross the plasma membrane by: a. Diffusion b. Osmosis c. Active transport d. Endocytosis

ANS: A Lipid-soluble hormones cross the plasma membrane by diffusion.

35. If the patient has a problem with the pineal gland, which substance would the nurse monitor? a. Melatonin b. Epinephrine c. Cortisol d. Somatostatin

ANS: A The pineal glands secrete melatonin. The adrenal medulla secretes epinephrine. The adrenal cortex secretes cortisol. The thyroid gland secretes somatostatin.

1. Elevated levels of glucocorticoids result in which of the following assessment findings? (Select all that apply.) a. Polycythemia b. Increased appetite c. Weight loss d. Decreased calcium e. Increased height

ANS: A, B, D Increased glucocorticoid secretion leads to polycythemia, increased appetite, fat deposition in the face and cervical areas, decreased serum calcium levels, and interference with the action of growth hormone so that somatic growth is inhibited. Weight gain and loss of height are expected.

15. Which principle should the nurse include while planning care for a patient with an ADH problem? ADH release from the posterior pituitary is stimulated by: a. Low blood pressure sensed by baroreceptors in the kidneys b. High serum osmolarity sensed by osmoreceptors in the hypothalamus c. Low osmolality sensed by osmoreceptors in the kidneys d. High concentration of potassium sensed by chemoreceptors in the carotid body

ANS: B As plasma osmolality increases, these osmoreceptors are stimulated, the rate of ADH secretion increases, more water is reabsorbed from the kidney, and the plasma is diluted back to its set-point osmolality. ADH release is stimulated by high serum osmolality, not lowered blood pressure. ADH release is stimulated by high serum osmolality, not low osmolality. ADH release is stimulated by high serum osmolality, not high concentrations of

25. A 30-year-old male is diagnosed with a hormone-secreting tumor of the pancreas alpha cells. Which of the following would the nurse expect to be most likely increased in this patient? a. Amylin b. Glucagon c. Insulin d. Somatostatin

ANS: B Glucagon is produced by the alpha cells of the pancreas. Amylin is secreted by the beta cells. Insulin is secreted by the beta cells. Somatostatin is produced by the delta cells.

24. A nurse is teaching a patient about insulin. Which information should the nurse include? Insulin is primarily regulated by: a. Metabolic rate b. Serum glucose levels c. Prostaglandins d. Enzyme activation

ANS: B Insulin secretion is promoted when blood levels of glucose rise. Insulin secretion is not based on metabolic rate but on blood levels of glucose. Insulin secretion is not based on prostaglandins but on blood levels of glucose. Insulin secretion is not based on enzyme activation but on blood levels of glucose.

12. A nurse recalls prolactin-inhibiting factors target tissue is the: a. Hypothalamus b. Anterior pituitary c. Mammary glands d. Posterior pituitary

ANS: B Prolactin-inhibiting factor (PIF) inhibits prolactin secretion by the anterior pituitary. PIF inhibits prolactin secretion by the anterior pituitary, not the hypothalamus. PIF inhibits prolactin secretion by the anterior pituitary, not the mammary glands. PIF inhibits prolactin secretion by the anterior pituitary, not the posterior pituitary.

14. If a patients posterior pituitary is removed, which hormone would the nurse expect to decrease? a. PRF b. ADH c. ACTH d. GH

ANS: B The hormones ADH and oxytocin are released from the posterior pituitary gland. PRF is released by the hypothalamus. ACTH is released by the anterior pituitary. GH is released by the hypothalamus.

17. If a patient had a problem with the hypothalamus, which of the following hormones would be affected? a. ACTH b. Oxytocin c. ADH d. TSH

ANS: B The hypothalamus secretes oxytocin. The anterior pituitary secretes ACTH. The posterior pituitary secretes ADH. The anterior pituitary secretes TSH.

33. If a patient had a problem with the adrenal medulla, which of the following hormones should the nurse monitor? a. Cortisol b. Epinephrine c. Androgens d. Estrogens

ANS: B The major products stored and secreted by the adrenal medulla are the catecholamines epinephrine (adrenaline) and norepinephrine. The adrenal cortex secretes cortisol. The adrenal cortex secretes androgens. The pituitary secretes estrogens.

13. When a staff member asks the nurse which gland secretes ADH and oxytocin, how should the nurse respond? a. Anterior pituitary b. Posterior pituitary c. Hypothalamus d. Pineal gland

ANS: B The posterior pituitary secretes ADH, which also is called vasopressin, and oxytocin. The anterior pituitary secretes ACTH, melanocyte-stimulating hormone (MSH), somatotropic hormones (GH, prolactin), and glycoprotein hormonesfollicle-stimulating hormone (FSH), LH, and TSH. The hypothalamus secretes PRF, which stimulates secretion of prolactin; PIF (dopamine), which inhibits prolactin secretion; TRH, which affects release of thyroid hormones; GH-releasing hormone (GHRH), which stimulates the release of GH; somatostatin, which inhibits the release of GH; gonadotropin-releasing hormone (GnRH), which facilitates release FSH and LH; corticotropin-releasing hormone (CRH), which facilitates the release of ACTH and endorphins; and substance P, which inhibits ACTH release and stimulates release of a variety of other hormones.

31. A 50-year-old male with one kidney had to undergo surgery for an adrenal tumor. His zona glomerulosa was largely removed during the surgery. The nurse would expect the removal of this tumor to result in a decrease in: a. Sodium b. Aldosterone c. Potassium d. Acid

ANS: B The zona glomerulosa, the outer layer, constitutes about 15% of the cortex and primarily produces the mineralocorticoid aldosterone.

9. When a patient asks about target cell receptors, which is the nurses best response? Target cell receptors for most water-soluble hormones are located in the: a. Cytosol b. Cell membrane c. Endoplasmic reticulum d. Nucleus

ANS: B Water-soluble hormones bind to cell surface receptors.

32. An endocrinologist is teaching about aldosterone secretion. Which information should the endocrinologist include? Aldosterone secretion is regulated by: a. The sympathetic nervous system b. ACTH feedback c. The renin-angiotension system d. Positive feedback

ANS: C Aldosterone synthesis and secretion are regulated primarily by the renin-angiotensin system.

20. A 70-year-old female has brittle bones secondary to osteoporosis. Her primary care provider prescribes calcitonin to: a. Activate vitamin D b. Stimulate osteoclastic activity c. Inhibit calcium resorption from bones d. Promote thyroid hormone release

ANS: C Calcitonin lowers serum calcium levels by inhibition of bone-resorbing osteoclasts. Calcitonin inhibits bone-resorbing osteoclasts; it does not activate vitamin D. Calcitonin inhibits bone-resorbing osteoclasts; not stimulate it. Calcitonin inhibits bone-resorbing osteoclasts; it does not promote thyroid hormone release.

1. A nurse recalls direct stimulation of the insulin-secreting cells of the pancreas by the autonomic nervous system is an example of _____ control. a. Negative feedback b. Positive feedback c. Neural d. Substrate-level dependent

ANS: C Direct stimulation of the insulin-secreting cells of the pancreas by the autonomic nervous system is a form of neural control. Stimulation of the insulin cells of the pancreas by the autonomic nervous system is a form of neural control and is not regulated as a form of negative feedback. Negative feedback works like a thermostat. Stimulation of the insulin cells of the pancreas by the autonomic nervous system is a form of neural control and is not regulated as a form of positive feedback. Stimulation of the insulin cells of the pancreas by the autonomic nervous system is a form of neural control and is not substrate-level dependent

7. A patient has high levels of hormones. To adapt to the high hormone concentrations, the patients target cells have the capacity for: a. Negative feedback b. Positive feedback c. Down-regulation d. Up-regulation

ANS: C High concentrations of hormone decrease the number of receptors; this is called down-regulation; thus, the cell can adjust its sensitivity to the concentration of the signaling hormone. Adaptation to high hormone concentration is the process of down-regulation. Negative feedback regulates hormone release. Adaptation to high hormone concentration is the process of down-regulation. Positive feedback regulates some forms of hormone release. Up-regulation is a response to low concentrations of hormone, thus increasing the number of receptors per cell.

11. An aide asks the nurse what activates tyrosine. What is the nurses best response? a. GH b. PRL c. Insulin d. Estrogen

ANS: C Insulin receptor binding activates tyrosine kinase autophosphorylation and sends a cascade of signals to activate glucose transporters. Insulin binding, not growth hormone, activates tyrosine. Insulin, not PRL, activates tyrosine. Insulin, not estrogen, activates tyrosine.

21. Which nutrient would the nurse encourage the patient to consume for thyroid hormone synthesis? a. Zinc b. Sodium c. Iodine d. Calcium

ANS: C Iodine is necessary for the synthesis of thyroid hormone. Iodine, not zinc, is necessary for synthesis of thyroid hormone. Iodine, not sodium, is necessary for synthesis of thyroid hormone. Iodine, not calcium, is necessary for synthesis of thyroid hormone.

23. A 40-year-old male undergoes surgery for a PTH-secreting tumor in which the parathyroid is removed. Which of the following would the nurse expect following surgery? a. Increased serum calcium b. Decreased bone formation c. Decreased calcium reabsorption in the kidney d. Increased calcitonin

ANS: C PTH also acts on the kidney to increase calcium reabsorption and to decrease phosphate reabsorption. Removal of the PTH-secreting tumor would result in decreased calcium reabsorption in the kidney, not increased serum calcium. Removal of the PTH-secreting tumor would result in decreased calcium reabsorption in the kidney, not decreased bone formation. Removal of the PTH-secreting tumor would result in decreased calcium reabsorption in the kidney, not increased calcitonin.

6. A 30-year-old male was diagnosed with hypothyroidism. Synthesis of which of the following would decrease in this patient? a. Corticosteroid B globulin b. Sex hormone-binding globulin c. Thyroid-binding globulin d. Albumin

ANS: C TH is transported in the blood in bound and free forms. Most of the TH is transported bound to thyroxine-binding globulin (TBG); thus, if TH is low, the patient would also be low in TBG. Thyroid-binding globulin is decreased with hypothyroidism, not corticosteroid B globulin. Thyroid-binding globulin is decreased with hypothyroidism, not sex hormone-binding globulin. Thyroid-binding globulin is decreased with hypothyroidism, not albumin.

30. The nurse is teaching the staff about aldosterone. Which information should the nurse include? The main site of aldosterone synthesis is the: a. Liver b. Kidneys c. Adrenal cortex d. Hypothalamus

ANS: C The adrenal cortex synthesizes aldosterone. The adrenal cortex, not the liver, synthesizes aldosterone. The adrenal cortex, not the kidneys, synthesizes aldosterone. The adrenal cortex, not the hypothalamus, synthesizes aldosterone.

27. A student asks the instructor which of the following is the most potent naturally occurring glucocorticoid. How should the instructor respond? a. Aldosterone b. Testosterone c. Cortisol d. Prolactin

ANS: C The most potent naturally occurring glucocorticoid is cortisol.

19. A 50-year-old male patient is deficient in ADH production. Which of the following assessment findings would the nurse expect to find? a. Increased blood volume b. Increased urine osmolality c. Increased urine volume d. Increased arterial vasoconstriction

ANS: C With deficient ADH, the kidneys would not concentrate urine leading to increased urine output. Blood volume would decrease with increased renal excretion of fluid. Urine osmolality would decrease. Arteries would dilate with deficient ADH production.

4. An endocrinologist isolated a new hormone and found it to be a water-soluble amine. Which of the following is most like this new hormone? a. Growth hormone (GH) b. Luteinizing hormone (LH) c. Antidiuretic hormone (ADH) d. Epinephrine

ANS: D An example of a water-soluble amine is epinephrine. GH is a water-soluble hormone but is a peptide. LH is water-soluble hormone but is a polypeptide. ADH is water-soluble hormone but is a polypeptide.

34. When catecholamines are released in a patient, what should the nurse assess for? a. Nutrient absorption b. Fluid retention c. Hypotension d. Hyperglycemia

ANS: D Catecholamines cause hyperglycemia and immune suppression.

5. When insulin binds to its receptors on muscle cells, an increase in glucose uptake by the muscle cells occurs. This is an example of a _____ effect by a hormone. a. Pharmacologic b. Permissive c. Biphasic d. Direct

ANS: D Direct effects are the obvious changes in cell function that result specifically from stimulation by a particular hormone as is true with insulin. Pharmacologic effects are the result of high doses of a drug. Permissive effects are less obvious hormone-induced changes that facilitate the maximal response or functioning of a cell. Biphasic effects are twofold effects.

26. A nurse recalls insulin has an effect on which of the following groups of electrolytes? a. Sodium, chloride, phosphate b. Calcium, magnesium, potassium c. Hydrogen, bicarbonate, chloride d. Potassium, magnesium, phosphate

ANS: D Insulin facilitates the intracellular transport of potassium (K+), phosphate, and magnesium.

10. When the endocrinologist asks the staff how the releasing hormones that are made in the hypothalamus travel to the anterior pituitary, how should the staff reply? Via the: a. Vessels of the zona fasciculata b. Chromophils c. Median eminence d. Hypophysial portal system

ANS: D Neurons in the hypothalamus secrete releasing hormones into veins that carry the releasing hormones directly to the vessels of the adenohypophysis via the hypophysial portal system, thus bypassing the normal circulatory route. Zona fasciculata secretes abundant amounts of cortisol from the adrenal gland. Chromophils are the secretory cells of the adenohypophysis. The median eminence is a part of the posterior pituitary, not the anterior.

18. A nurse is teaching the staff about oxytocin. Which information should the nurse include? Target cells for oxytocin are located in the: a. Renal tubules b. Thymus c. Liver d. Uterus

ANS: D Oxytocin causes uterine contraction and lactation in women and may have a role in sperm motility in men. Oxytocin does not stimulate the renal tubules; it stimulates the uterus. Oxytocin does not stimulate the thymus; it stimulates the uterus. Oxytocin does not stimulate the liver; it stimulates the uterus.

29. A 39-year-old female is recovering from the birth of her third child. Which hormone would help prevent uterine bleeding? a. Aldosterone b. Cortisol c. Prolactin d. Oxytocin

ANS: D Oxytocin functions near the end of labor to enhance effectiveness of contractions, promote delivery of the placenta, and stimulate postpartum uterine contractions, thereby preventing excessive bleeding. Aldosterone regulates water balance. Cortisol helps protect from stress. Prolactin assists with milk production.

2. A nurse is teaching staff about protein hormones. Which information should the nurse include? One of the protein hormones is: a. Thyroxine (T4) b. Aldosterone c. Testosterone d.Insulin

ANS: D Protein hormones are also water-soluble hormones, and insulin is a part of this group. Thyroxine is a lipid soluble hormone and is not a protein hormone. Aldosterone is a lipid soluble hormone and is not a protein hormone. Testosterone is a lipid soluble hormone and is not a protein hormone.

3. A 45-year-old female has elevated thyroxine production. Which of the following would accompany this condition? a. Increased thyroid-releasing hormone (TRH) b. Increased anterior pituitary stimulation c. Decreased T4 d. Decreased thyroid-stimulating hormone (TSH)

ANS: D Secretion of TSH stimulates the synthesis and secretion of thyroid hormones. Increasing levels of T4 and T3 then feed back negatively on the pituitary and hypothalamus to inhibit TRH and TSH synthesis. With increased thyroxine production, TRH will be decreased. Increased thyroxine would lead to decreased anterior pituitary stimulation. Thyroxine is T4; its level will be elevated.

28. A patient wants to know what can cause ACTH to be released. How should the nurse respond? a. High serum levels of cortisol b. Hypotension c. Hypoglycemia d. Stress

ANS: D Stress increases ACTH secretion. ACTH regulates the release of cortisol from the adrenal cortex. It is not stimulated by high serum levels.