Patho Ch 40
a) Decreased TSH levels Pg. 1034 Structural Classification Stimulation tests are used when hypofunction of an endocrine organ is suspected. Failure to increase TSH levels after a TRH stimulation test suggests an inadequate capacity to produce TSH by the pituitary (i.e., the pituitary is dysfunctional in some way).
2. The nurse is reviewing the test results of a client who was given thyrotropin-releasing hormone (TRH) to evaluate the function of the pituitary gland. The nurse would recognize pituitary dysfunction as: a) Decreased TSH levels b) Increased TSH levels c) Increased TRH levels d) Decreased TRH levels
c) Provide a better measure of hormone levels during a designated period Pg. 1043 Urine Tests Measurements of urinary hormone or hormone metabolite excretion often are done on a 24-hour urine sample and provide a better measure of hormone levels during that period than hormones measured in an isolated blood sample. The advantages are relative ease of obtaining urine samples and blood sampling is not required. The disadvantages are that timed urine collections often are difficult to obtain and urine samples may be accidentally discarded or inaccurately preserved; drugs or disease states that alter hormone metabolism may interfere with the test results.
20. Select the most accurate statement regarding measurements of urinary hormone. a) Requires blood and urine sampling b) Drugs will not alter testing results c) Provide a better measure of hormone levels during a designated period d) Discarded samples will not alter results
a) Regulate body functions Pg. 1033 Hormones Hormones regulate and integrate body functions. Hormones act on specific target cells, but they cause a variety of effects on tissues. Hormones do not transport other substances; hormones are transported and present in body fluids at all times.
4. Hormones are chemical messengers that provide which function in the body? a) Regulate body functions b) Initiate immune reactions c) Cause one specific tissue effect d) Transport fatty acids and lipids
d) Negative feedback Pg. 1042 Negative Feedback With negative feedback, the most common mechanism of hormone control, some feature of hormone action directly or indirectly inhibits further hormone secretion so that the hormone level returns to an ideal level or set point.
6. What is the most common mechanism of hormone control? a) Hypothalamic-pituitary-adrenal axis b) Hypothalamic-pituitary-target cell feedback c) Positive feedback d) Negative feedback
d) The hypothalamic-pituitary-target cell system Pg. 1038 Hypothalamic Hormones The levels of many of the hormones are regulated by feedback mechanisms that involve the hypothalamic-pituitary-target cell system. Positive feedback control refers to rising levels of a hormone that causes another gland to release a hormone that is stimulating to the first. The hypophyseal portal system connects the supraoptic and paraventricular nuclei of the hypothalamus with the posterior pituitary gland. Exogenous forms of hormones (given as drug preparations) can influence the normal feedback control of hormone production and release.
1. A client undergoing an evaluation of hormone levels asks, "What regulates the hormone levels?" Which response by the nurse would be considered most accurate? a) The positive feedback loop b) Exogenous forms of hormones c) The hypophysial portal system d) The hypothalamic-pituitary-target cell system
b) Negative feedback loop Pg. 1042 Negative Feedback The level of many of the hormones in the body is regulated by negative feedback mechanisms.
10. The hormone levels in the body need to be kept within an appropriate range. How is this accomplished for many of the hormones in the body? a) Positive feedback loop b) Negative feedback loop c) Sensory feedback loop d) Regulated feedback loop
c) Antidiuretic hormone (ADH) and oxytocin Pg. 1034 Hormonal Actions The posterior pituitary secretes ADH and oxytocin/vasopressin, while the anterior pituitary secretes the hormones listed in the other choices.
11. A client has developed a tumor of the posterior pituitary gland. The client is at risk for problems with secretions of: a) Somatostatin and prolactin b) Growth hormone-releasing hormone (GHRH) and dopamine c) Antidiuretic hormone (ADH) and oxytocin d) Adrenocorticotropic hormone (ACTH) and vasopressin
c) Pituitary Pg. 1038 Pituitary Hormones The pituitary gland has been called the master gland because its hormones control the functions of many target glands and cells. That is not a term used to refer to the other options.
18. Which gland is often referred to as the master gland because it secretes many hormones? a) Pancreas b) Hypothalamus c) Pituitary d) Thyroid
a) The thyroid gland is responsible for increasing the metabolic rate Pg. 1035 Table 40-1: Major Action and Source of Selected Hormones The thyroid gland produces thyroid hormones, T3 and T4. These hormones increase the metabolic rate; increase protein and bone turnover; increase responsiveness to catecholamines; are necessary for fetal and infant growth and development. The parathyroid gland regulates calcium metabolism. The adrenal glands regulate "flight or fight" and the testes or ovaries regulate development of secondary sex characteristics.
8. The nurse is teaching a client who has been newly diagnosed with hypothyroidism about the function of the thyroid. Which statement about the role of the thyroid gland is most accurate? a) The thyroid gland is responsible for increasing the metabolic rate b) The thyroid gland is responsible for regulating serum calcium levels c) The thyroid gland promotes development of secondary sex characteristics d) The thyroid gland releases neurotransmitters when the "flight or flight" mechanism is stimulated
a) Proteins Pg. 1034 Structural Classification Some hormones, such as steroids and thyroid hormone, are bound to protein carriers for transportation to the target cell destination. Cholesterol is a precursor for steroid hormone. Prohormones have an extra amino acid and convert to hormones in the Golgi complex.
12. Several hormones, including growth hormone (GH) and thyrotropin-releasing hormone (TRH), are bound to and carried by which substance? a) Proteins b) Prohormones c) Target cells d) Cholesterol
a) Stimulation testing Pg. 1043 Hormone Stimulation and Suppression Tests Introduction of TRH tests the pituitary gland's ability to produce TSH, and is an example of a stimulation test. Suppression testing examines a gland's response to a stimulus that would normally result in decreased hormone production. RIA and autoantibody testing are examples of direct and indirect measurement of serum levels of a hormone.
13. A client has received an injection containing thyrotropin-releasing hormone (TRH) and is now being assessed for serum levels of thyroid-stimulating hormone (TSH). Which type of diagnostic testing is this client undergoing? a) Stimulation testing b) Suppression testing c) Radioimmunoassay (RIA) d) Autoantibody testing
d) Hypothyroidism Pg. 1034 Structural Classification Thyroid hormone is necessary for metabolism at all ages, as well as growth and development during childhood. Uncorrected thyroid insufficiency in childhood leads to cretinism, a condition with marked physical and intellectual disability. Myxedema is the term used for thyroid insufficiency in adults.
14. 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) Hypoglycemia b) Calcium insufficiency c) Dopamine insufficiency d) Hypothyroidism
b) Insulin and glucagon c) Calcitonin and parathyroid hormone (PTH) Pg. 1034 Hormones Insulin lowers blood glucose, whereas glucagon raises blood glucose. Calcitonin stimulates calcium to enter the bones, whereas PTH removes calcium from the bones. Cortisol and aldosterone both come from the adrenal cortex, but they perform similar tasks. ADH and oxytocin both come from the pituitary gland but do not perform opposite tasks. Epinephrine and norepinephrine perform similar tasks as neurotransmitters.
15. Which options contain a pair of hormones that act to balance each other? Select all that apply. a) Epinephrine and norepinephrine b) Insulin and glucagon c) Calcitonin and parathyroid hormone (PTH) d) Cortisol and aldosterone e) Antidiuretic hormone (ADH) and oxytocin
d) Client has anuria Pg. 1043 Urine Tests The advantages of a urine test include the relative ease of obtaining urine samples and the fact that blood sampling is not required. The disadvantage is that reliably timed urine collections often are difficult to obtain and rely on adequate renal function. Anuria refers to the absence of urine output.
16. The nurse is planning to collect a 24-hour urine sample for hormone assay. In which situation does the nurse collaborate with the health care provider to find an alternate type of testing? a) Client has anemia b) Client has diabetes c) Client has hypothyroidism d) Client has anuria
a) Anterior pituitary gland Pg. 1038 Hypothalamic-Pituitary Regulation The pituitary gland has been called the master gland because its hormones control the functions of many target glands and cells. The anterior pituitary gland or adenohypophysis contains five cell types: (1) thyrotrophs, which produce thyrotropin, also called TSH; (2) corticotrophs, which produce corticotropin, also called ACTH; (3) gonadotrophs, which produce the gonadotropins, LH, and FSH; (4) somatotrophs, which produce GH; and (5) lactotrophs, which produce prolactin.
17. When discussing luteinizing hormone and follicle-stimulating hormone with students, the instructor will emphasize that these hormones are under the control of: a) Anterior pituitary gland b) Thyroid gland c) Pancreas d) Posterior adrenal cortex
d) Rank below 10% on the growth chart Pg. 1035 Table 40-1: Major Action and Source of Selected Hormones GH stimulates growth of bone and muscle and promotes protein synthesis and fat metabolism and decreased carbohydrate metabolism. A child lacking sufficient GH would demonstrate lack of growth but not the mental delays seen in childhood hypothyroidism.
19. Which manifestation would a nurse expect when assessing a child with insufficient growth hormone (GH) secretion? a) Increased susceptibility to infection b) Lower blood calcium levels c) Mental sluggishness d) Rank below 10% on the growth chart
a) Following a meal that was high in carbohydrates, a person's blood glucose elevates, which stimulates the release of insulin from the pancreas Pg. 1038 Control of Hormone Levels The levels of hormones such as insulin and antidiuretic hormone (ADH) are regulated by feedback mechanisms that monitor substances such as glucose (insulin) and water (ADH) in the body. None of the other examples are accurate examples of this feedback mechanism.
21. 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) Following a meal that was high in carbohydrates, a person's blood glucose elevates, which stimulates the release of insulin from the pancreas 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) In children, the body knows to release growth hormones while they are sleeping instead of when they are awake and running around
a) "A single hormone can act on not only one process or organ but often on several different locations or processes" Pg. 1034 Hormones A single hormone can exert various effects in different tissues, or conversely, a single function can be regulated by several different hormones. Hormones act both distantly from their source and more locally, as in the case of autocrine and paracrine actions. Hormones are normally present at all times.
22. A nurse who works in the office of an endocrinologist is orienting a new staff member. Which teaching point should the nurse include in the orientation? a) "A single hormone can act on not only one process or organ but often on several different locations or processes" b) "It's uncommon for production of hormones to be far removed from the tissue where they ultimately exert their effect" c) "Sometimes hormones act locally on the area where they were produced, as in the case of endocrine actions" d) "The regulation of homeostasis requires that hormones be absent from the body when their effect is not needed"
d) Stimulation tests Pg. 1043 Hormone Stimulation and Suppression Tests Stimulation tests are used when hypofunction of an endocrine organ is suspected. Suppression tests are used when hyperfunction of an endocrine organ is suspected. Genetic testing is used for DNA analysis, and imaging may be used as a follow-up after the diagnosis.
23. The physician suspects a client may be experiencing hypofunction of an endocrine organ. Select the most appropriate test to determine organ function. a) Suppression tests b) Genetic testing c) Imaging studies d) Stimulation tests
b) Positron emission tomography/CT (PET/CT) Pg. 1029 Types of Obesity PET/CT imaging is advantageous in that the CT component allows a good examination of the tissue structure, whereas the PET component provides information about tissue function. PET/CT has been demonstrated to be useful in managing thyroid cancers. DEXA scan is routinely used for the diagnosis and monitoring of osteoporosis and metabolic bone imagining. Ultrasonography scanning provides good structural imaging and is used frequently to aid in visualization of a lesion for biopsy. MRI provides information about structural changes within solid tissue.
24. The nurse is educating a client with a newly diagnosed thyroid cancer. Which testing procedure should be reviewed because it allows good examination of the tissue structure and provides information about the tissue function as well? a) Dual-electron x-ray absorptiometry (DEXA) scan b) Positron emission tomography/CT (PET/CT) c) Magnetic-resonance imaging (MRI) d) Ultrasonography
b) Hypothalamus Pg. 1038 Hypothalamic Hormones The hypothalamus is the coordinating center of the brain for endocrine, behavioral, and autonomic nervous system function. It is at the level of the hypothalamus that emotion, pain, body temperature, and other neural input are communicated to the endocrine system. The anterior pituitary regulates several physiologic processes, including stress, growth, reproduction, and lactation. The cerebellum is involved in motor control, and the cerebral cortex is associated with sensory, motor, and association.
3. A health care provider is assessing a client for a potential endocrine disorder. Assessment findings identify abnormalities with emotion, pain, and body temperature. Which mechanism of endocrine control will require further laboratory/diagnostic assessment? a) Cerebral cortex b) Hypothalamus c) Cerebellum d) Anterior pituitary
c) Hypothalamus Pg. 1038 Hypothalamic Hormones The activity of the hypothalamus is regulated by both hormonally mediated signals (e.g., negative feedback signals) and by neuronal input from a number of sources. Neuronal signals are mediated by neurotransmitters such as acetylcholine, dopamine, norepinephrine, serotonin, gamma-aminobutyric acid (GABA), and opioids. Cytokines that are involved in immune and inflammatory responses, such as the interleukins, also are involved in the regulation of hypothalamic function. This is particularly true of the hormones involved in the hypothalamic-pituitary-adrenal axis. Thus, the hypothalamus can be viewed as a bridge by which signals from multiple systems are relayed to the pituitary gland. This cannot be said of the other options.
5. Which gland acts as a signal relaying bridge between multiple body systems and the pituitary gland? a) Posterior pituitary b) Thyroid c) Hypothalamus d) Parathyroid
a) Decreased thyroid-stimulating hormone (TSH) Pg. 1042 Negative Feedback Negative feedback occurs when secretion of one hormone causes a reduction in the secretion of the hormone that stimulates production of the first hormone. In this case, TSH, which is manufactured by the anterior pituitary gland, would normally stimulate release of thyroid hormones, but with the increase of those hormones by the secreting tumor, enough thyroid hormones flood the system that there should be a reduction in TSH levels.
7. A client experiences an increase in thyroid hormone as a result of a thyroid tumor. Which hormonal response demonstrates the negative feedback mechanism? a) Decreased thyroid-stimulating hormone (TSH) b) Decreased adrenocorticotropic hormone (ACTH) c) Increased follicle-stimulating hormone (FSH) d) Increased thyrotropin-releasing hormone (TRH)
c) These tests are very specific since they utilize two antibodies instead of one Pg. 1043 Blood Tests Immunoradiometric assay (IRMA) testing is very specific since it utilizes two antibodies instead of one. These two antibodies are directed against two different parts of the molecule, and therefore IRMA assays are more specific. Hormones circulating in the plasma were first detected by bioassay test, which used an intact animal or a portion of tissue from an animal to calculate specificity and sensitivity. ELISA testing procedure utilizes antibody-coated plates to produce colored reaction. The IRMA is a blood test, not a urine test.
9. Which statement about immunoradiometric assay (IRMA) testing for measuring plasma hormone levels is most accurate? a) This testing procedure uses antibody-coated plates to produce colored reaction b) A 24-hour urine test will be required along with blood tests to calculate specific results c) These tests are very specific since they utilize two antibodies instead of one d) This bioassay test uses an intact animal or a portion of tissue from an animal to calculate specificity and sensitivity
