Chapter 13: Altered Hormonal and Metabolic Regulation
Place the hormonal response to stress from the hypothalamus in the correct order. Pituitary secretes adrenocorticotropic hormone (ACTH) Adrenal glands secrete cortisol Increased metabolism, blood glucose regulation Release of corticotropin-releasing hormone (CRH) Decreased inflammation
Release of corticotropin-releasing hormone (CRH) Pituitary secretes adrenocorticotropic hormone (ACTH) Adrenal glands secrete cortisol Increased metabolism, blood glucose regulation Decreased inflammation
The nurse is teaching a client how to collect a 24-hour urine sample for cortisol levels. The client asks why a blood sample cannot just be taken since collecting urine for 24-hours is inconvenient. How should the nurse respond? a) "Because cortisol levels fluctuate, collecting a sample over time will be more accurate." b) "Cortisol cannot be measured using blood samples, because it is produced by your kidneys." c) "The results from urine tests are less likely to be affected by any medications you take." d) "Urine tests are safer to collect, because they are noninvasive compared to a blood test."
a) "Because cortisol levels fluctuate, collecting a sample over time will be more accurate."
The health care provider is reviewing diurnal variation pattern in adrenocorticotropic (ACTH) levels. Select the typical diurnal variation pattern in adrenocorticotropic (ACTH) levels. a) ACTH peaks in the morning and declines throughout the day. b) ACTH increases in the morning and peaks again in the evening hours. c) ACTH maintains a consistent level regardless of the time of day. d) ACTH peaks in correspondence with food intake.
a) ACTH peaks in the morning and declines throughout the day.
The signs and symptoms of abrupt cessation of pharmacologic glucocorticoids closely resemble those of which disease process? a) Addison disease b) Cushing disease c) Cushing syndrome d) Graves disease
a) Addison disease
The nurse is caring for a client with impairment of the adrenal gland. The nurse notes abnormal sodium and potassium levels. Which hormone is the most likely to be impaired? a) Aldosterone b) Cortisol c) Estrogen d) Testosterone
a) Aldosterone
Select the category of hormones that include norepinephrine and epinephrine. a) Amines and amino acids b) Peptides c) Glycoproteins d) Steroids
a) Amines and amino acids
A client diagnosed with metabolic syndrome and growth hormone (GH) deficiency will likely display which physical assessment finding? a) Increased visceral fat b) Enhanced insulin uptake c) Increase in lean body mass d) Increased bone mineral density
a) Increased visceral fat
When the nurse is performing a health history for a client who is being admitted for hyperthyroidism, what symptom does the client report that the nurse would find associated with this disorder? a) Constipation b) Increase in appetite c) Weight gain d) Fatigue
b) Increase in appetite
A client comes to the clinic with fatigue and muscle weakness. The client also states she has been having diarrhea. The nurse observes the skin of the client has a bronze tone and when asked, the client says she has not had any sun exposure. The mucous membranes of the gums are bluish-black. When reviewing laboratory results from this client, what does the nurse anticipate seeing? a) Elevated WBC count b) Increased levels of ACTH c) Increase in sedimentation rate d) Positive C-reactive protein
b) Increased levels of ACTH
While teaching a science class, the instructor mentions that both autocrine and paracrine hormonal actions occur without entering the bloodstream. A student asks, "What cells do paracrine actions affect?" Which response is correct? a) Self b) Local c) Stored d) Target
b) Local
Which individual displays the precursors to acromegaly? a) An adult with an excess of growth hormone due to an adenoma b) A girl who has been diagnosed with precocious puberty c) An adult who has a diagnosis of Cushing syndrome d) A client who has recently developed primary adrenal carcinoma
a) An adult with an excess of growth hormone due to an adenoma
Which effect of thyroid hormone deficit alters the function of all major organs in the body? a) Decreases metabolism b) Increases protein synthesis c) Causes vitamin deficiencies d) Enhances absorption of glucose
a) Decreases metabolism
A nurse on a medical unit is providing care for a 37-year-old female client who has a diagnosis of Graves disease. Which assessments should the nurse prioritize? a) Eye health and visual acuity b) Cognition and judgment c) Signs and symptoms of decreased bone density d) Skin integrity and distribution of adipose tissue
a) Eye health and visual acuity
Which hormone is produced by the anterior pituitary gland? a) Growth hormone (GH) b) Oxytocin c) Corticotropin-releasing hormone (CRH) d) Norepinephrine
a) Growth hormone (GH)
The nurse is teaching a client diagnosed with Addison disease about the importance of lifetime oral replacement therapy. Which pharmacologic agent would be the drug of choice and included in this teaching plan? a) Hydrocortisone b) Insulin c) Potassium supplements d) Ketoconazole
a) Hydrocortisone
Which gland acts as a signal relaying bridge between multiple body systems and the pituitary gland? a) Hypothalamus b) Posterior pituitary c) Thyroid d) Parathyroid
a) Hypothalamus
An infant whose mother had myxedema during the pregnancy has failed to meet standards for growth and is developmentally delayed. Which hormonal imbalance is this child exhibiting? a) Hypothyroidism b) Calcium insufficiency c) Hypoglycemia d) Dopamine insufficiency
a) Hypothyroidism
The nurse is discussing positive feedback mechanisms. Which example best explains this mechanism? a) Increased estradiol production causes increased follicle-stimulating hormone (FSH) production. b) Decreased thyroid hormone (TH) increases thyroid-stimulating hormone (TSH) levels. c) Increased glucose levels in the blood decreases growth hormone (GH) levels. d) Decreased cortisone levels increase blood levels of adrenocorticotropic hormone (ACTH).
a) Increased estradiol production causes increased follicle-stimulating hormone (FSH) production.
The nurse is caring for a neonate with congenital hypothyroidism. Which alterations does the nurse expect? Select all that apply. a) Lack of thyroid gland development b) Absence of thyroid gland c) Impaired thyroid hormone synthesis d) Impaired serum iodine levels e) Alterations in TSH secretion
a) Lack of thyroid gland development c) Impaired thyroid hormone synthesis e) Alterations in TSH secretion
What is the most common mechanism of hormone control? a) Negative feedback b) Positive feedback c) Hypothalamic-pituitary-target cell feedback d) Hypothalamic-pituitary-adrenal axis
a) Negative feedback
The nurse is caring for a client diagnosed with excessive aldosterone levels. Which laboratory finding(s) does the nurse expect to find? Select all that apply. a) Potassium 3.0 mEq/L (3 mmol/L) b) Sodium 148 mEq/L (148 mmol/L) c) Bicarbonate 14 mEq/L (14 mmol/L) d) Blood pH 7.25 e) Blood glucose 50 mg/dL (2.77 mmol/L)
a) Potassium 3.0 mEq/L (3 mmol/L) b) Sodium 148 mEq/L (148 mmol/L)
Several hormones, including growth hormone (GH) and thyrotropin-releasing hormone (TRH), are bound to and carried by which substance? a) Proteins b) Target cells c) Cholesterol d) Prohormones
a) Proteins
An adolescent boy asks the nurse what increases the secretion of growth hormone (GH). Which response by the nurse is best? a) Starvation b) Elevated glucose levels c) Increased levels of cortisol d) Obesity
a) Starvation
The physician suspects a client may be experiencing hypofunction of an endocrine organ. Select the most appropriate test to determine organ function. a) Stimulation tests b) Suppression tests c) Genetic testing d) Imaging studies
a) Stimulation tests
The nurse cares for a client with severe chronic obstructive pulmonary disease who has been taking oral steroids for several years. Which response in the client's endocrine control will the nurse expect? a) Suppression of the client's hypothalamic-pituitary-target cell system b) Increased levels of adrenocorticotropic hormone (ACTH) c) Increased levels of epinephrine and norepinephrine d) Suppression of the body's positive feedback mechanisms
a) Suppression of the client's hypothalamic-pituitary-target cell system
A client has developed the facial appearance that is characteristic of myxedema, along with an enlarged tongue, bradycardia, and voice changes. Which treatment modality is most likely to benefit this client? a) Synthetic preparations of T3 or T4 b) beta-adrenergic blocking drugs (beta-blockers) c) Corticosteroid replacement therapy d) Oral or parenteral cortisol replacement
a) Synthetic preparations of T3 or T4
Hyperthyroidism that is inadequately treated can cause a life-threatening condition known as a thyroid storm. What are the manifestations of a thyroid storm? Select all that apply. a) Tachycardia b) Very low fever c) Delirium d) Bradycardia e) Very high fever
a) Tachycardia c) Delirium e) Very high fever
Which clinical manifestations following thyroidectomy would alert the nurse that the client is going into a life-threatening thyroid storm? Select all that apply. a) Temperature of 104.2°F (40.1°C) b) Telemetry showing heart rate of 184 c) Unable to close eyelids completely together d) Extremely agitated e) Bruising on knees and feet
a) Temperature of 104.2°F (40.1°C) b) Telemetry showing heart rate of 184 d) Extremely agitated
The nurse is educating a newly diagnosed client with Hashimoto thyroiditis who is to be discharged from the acute care facility. What should the nurse be sure to include in the education to prevent complications? a) The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention. b) The client should be informed that if he observes an increase in fatigue, an extra dose of his thyroid medication should be taken. c) The client should not participate in any exercise activity that could utilize more thyroid hormone. d) The client should skip a dose of the thyroid supplement if he has symptoms of fever or restlessness.
a) The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention.
A client who has just undergone a thyroidectomy is experiencing high fever, tachycardia, and extreme restlessness. The nurse would interpret these findings as manifestations of which complication? a) Thyroid storm b) Myxedema coma c) Hypothyroidism d) Addisonian crisis
a) Thyroid storm
When discussing luteinizing hormone and follicle-stimulating hormone with students, the instructor will emphasize that these hormones are under the control of: a) Thyroid gland b) Anterior pituitary gland c) Posterior adrenal cortex d) Pancreas
b) Anterior pituitary gland
Which pathophysiologic phenomenon may result in a diagnosis of Cushing disease? a) Hypopituitarism b) Excess ACTH production by a pituitary tumor c) Autoimmune destruction of the adrenal cortex d) Malfunction of the HPA system
b) Excess ACTH production by a pituitary tumor
Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of: a) Cushing syndrome b) Graves disease c) Addison disease d) Cushing disease
b) Graves disease
The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding? a) Blood pressure 180/110 mm Hg b) Heart rate 110 and bounding c) Temperature 96°F (35.5°C) d) Respiratory rate 14
b) Heart rate 110 and bounding
The nurse is caring for a client with a hormonal imbalance. The client has increased abdominal fat, hyperglycemia, and a moon face appearance. Which additional condition(s) does the nurse expect? Select all that apply. a) Short stature b) Osteoporosis c) Delayed puberty d) Delayed wound healing e) Infection
b) Osteoporosis d) Delayed wound healing e) Infection
A client is diagnosed with Addison disease. What statement by the client indicates an understanding of the discharge instructions by the nurse? a) "Once the symptoms go away, I will be able to stop taking my medication." b) "If I have surgery, it will cure me." c) "I will have to take my medication for the rest of my life." d) "I should be able to control my condition with diet and exercise."
c) "I will have to take my medication for the rest of my life."
A client is diagnosed with hyperthyroidism and is exhibiting weight loss, diarrhea, and tachycardia. What does the nurse understand that these clinical manifestations are related to? a) A decrease in oxygen consumption b) A decrease in the level of glucose c) A hypermetabolic state d) A decrease in sympathetic nervous system activity
c) A hypermetabolic state
The nurse administers a glucocorticoid medication to a client with pneumonia. Which of these does the nurse teach the client is the purpose of the medication? a) To regulate glucose metabolism b) To decrease appetite c) To decrease airway inflammation d) To decrease stress of illness
c) To decrease airway inflammation
A client with small cell carcinoma lung cancer may secrete an excess of which hormone, causing an ectopic form of Cushing syndrome due to a nonpituitary tumor? a) GH b) TSH c) DHEA d) ACTH
d) ACTH
Cyclic adenosine monophosphate (cAMP) performs which role in the functioning of the endocrine system? a) Mediating hormone synthesis by non-vesicle-mediated pathways b) Acting as a high-affinity receptor on the surface of target cells c) Inactivating hormones to prevent excess accumulation d) Acting as a second messenger to mediate hormone action on target cells
d) Acting as a second messenger to mediate hormone action on target cells
While discussing the regulation of hormone levels, the instructor gives an example of hormones regulated by feedback mechanisms. Which example of this regulation is best? a) In children, the body knows to release growth hormones while they are sleeping instead of when they are awake and running around. b) When a female is thinking about getting pregnant, the body knows to release female sex hormones in greater proportion than usual. c) When a person's body pH is decreasing, the stomach lining becomes more acidic to offset this. d) Following a meal that was high in carbohydrates, a person's blood glucose elevates, which stimulates the release of insulin from the pancreas.
d) Following a meal that was high in carbohydrates, a person's blood glucose elevates, which stimulates the release of insulin from the pancreas.
A client who has been taking 80 mg of prednisone, a glucocorticoid, each day has been warned by his primary care provider to carefully follow a plan for the gradual reduction of the dose rather than stopping the drug suddenly. What is the rationale for this directive? a) Sudden changes in glucocorticoid dosing may reverse the therapeutic effects of the drug. b) Stopping the drug suddenly may "shock" the HPA axis into overactivity. c) Sudden cessation of a glucocorticoid can result in adrenal gland necrosis. d) Stopping the drug suddenly may cause acute adrenal insufficiency.
d) Stopping the drug suddenly may cause acute adrenal insufficiency.
The nurse is providing discharge instructions for a client with Graves disease who has ophthalmopathy. What should the nurse be sure to include in the instructions to decrease exacerbation of this clinical manifestation? a) The client should be informed that he should not be in contact with other people during the acute phase. b) The client should be informed that if he begins to feel symptoms getting worse, he should take an extra dose of medication. c) The client should be strongly encouraged not to drink any alcohol. d) The client should be strongly urged not to smoke.
d) The client should be strongly urged not to smoke.
