Patho PrepU week 8
The nurse is teaching a client who has been newly diagnosed with hypothyroidism about the function of the thyroid. Which of these does the nurse explain to the client is the role of the thyroid gland? a) The thyroid gland promotes development of secondary sex characteristics. b) The thyroid gland is responsible for increasing the metabolic rate. c) The thyroid gland is responsible for regulating serum calcium levels. d) The thyroid gland releases neurotransmitters when the "flight or flight" mechanism is stimulated.
B) The thyroid gland is responsible for increasing the metabolic rate. 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.
The nurse explains to a client in labor who has demonstrated ineffective contractions impeding progression of labor that the health care provider has added oxytocin infusion to the orders. Which of these does the nurse teach the client is the purpose of oxytocin? a) To stimulate contraction of the uterus b) To reduce pain of uterine contractions c) To protect the fetus from effects of forceful contractions d) To contribute to maturation of fetal lungs
a
Which gland acts as a signal relaying bridge between multiple body systems and the pituitary gland? a) Thyroid b) Parathyroid c) Posterior pituitary d) Hypothalamus
d 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, ?-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.
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) "The regulation of homeostasis requires that hormones be absent from the body when their effect is not needed." d) "Sometimes hormones act locally on the area where they were produced, as in the case of endocrine actions."
A single hormone can act on not only one process or organ but often on several different locations or processes." Explanation: 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.
The nurse is caring for a client with a tentative diagnosis of Hashimoto thyroiditis. Which of these test results does the nurse anticipate will be present in autoimmune thyroiditis? a) Positive anti-thyroid peroxidase antibodies b) Elevated thyroid stimulating hormone (TSH) c) Decreased T4 d) Decreased T3
A) Positive anti-thyroid peroxidase antibodies Explanation: Blood tests that are routinely measured in endocrine disorders include various autoantibodies. For example, anti-thyroid peroxidase (anti-TPO) antibodies are measured during the initial diagnostic workup and subsequent followup of patients with Hashimoto thyroiditis. The other alterations may be present in all types of hypothyroidism.
The nurse is teaching a new diabetic about fingerstick blood glucose testing. When the client obtains a pre-meal fingerstick reading of 206 mg/dL, which teaching by the nurse is most appropriate? a) This is an elevated reading - let's talk about adherence to insulin and diet. b) This reading is within normal range - continue your regimen. c) This is a normal reading for after meals. d) Blood glucose levels of 206 are acceptable when you are ill.
A) This is an elevated reading - let's talk about adherence to insulin and diet. Normal fasting or pre-meal blood glucose levels are between 70 and 110 mg/dL. The nurse should ensure the client understands the diet and medication regimen, as diabetes is a self-managed disease; maintaining good glucose control can prevent complications of the disease.
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) When a female is thinking about getting pregnant, the body knows to release female sex hormones in greater proportion than usual. b) In children, the body knows to release growth hormones while they are sleeping instead of when they are awake and running around. 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. 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
The physician suspects a client may be experiencing hypofunction of an endocrine organ. Select the most appropriate test to determine organ function. a) Genetic testing b) Imaging studies c) Suppression tests d) Stimulation tests
D) Stimulation 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.
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) Increased TSH levels b) Decreased TRH levels c) Increased TRH levels d) Decreased TSH levels
Decreased TSH levels Explanation: 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). The other tests results would not increase.
Which of the following hormones is produced by the anterior pituitary gland? a) Corticotropin-releasing hormone (CRH) b) Growth hormone (GH) c) Oxytocin d) Norepinephrine
b
A nursing instructor is teaching a group of students about the action of hormones. The instructor determined that teaching was effective when the students' recognize the local action of hormones as: a) Autocrine b) Pancreatic c) Hormonal d) Paracrine
d
The physician is assessing a client with a preliminary diagnosis of endocrine disorder. Further assessment findings identify abnormalities with emotion, pain, body temperature, and neural input. The physician determines the need to further assess the: a) Anterior pituitary b) Cerebral cortex c) Hypothalamus d) Cerebellum
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 physiological 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. (
The nurse is planning to collect a 24-hour urine sample for hormone assay. In which of these situations 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) Client has anuria. Explanation: 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.
The nurse is caring for a client who has hyperthyroidism. When evaluating the laboratory test results, which of these alterations does the nurse anticipate will be present? a) Decrease in TSH b) Increase in ACTH c) Increase in TSH d) Decrease in ACTH
a) Decrease in TSH Explanation: When the sensors detect a decrease in hormone levels, they initiate changes that cause an increase in hormone production. When hormone levels rise above the set point of the system, the sensors cause hormone production and release to decrease. For example, sensors in the hypothalamus or anterior pituitary gland detect an increase in thyroid hormone, and this causes a reduction in the secretion of TSH, with a subsequent decrease in the output of thyroid hormone from the thyroid gland
A nurse examines the laboratory values of a patient in heart failure. Which of the following values indicates a compensatory hormone mechanism? a) Elevated atrial natriuretic hormone b) Decreased red blood cell count c) Elevated serum pH d) Decreased hematocrit
a) Elevated atrial natriuretic hormone Explanation: In heart failure, the patient experiences fluid backlog in the heart as venous blood continues to return, but cardiac output is reduced. This stretches the atria, which secrete atrial natriuretic hormone (or peptide) to stimulate vasodilation and increased renal excretion of sodium and water. This reduces the volume and the strain in the heart. (
The nurse is caring for a client with diabetes. Which of these findings is cause for concern leading the nurse to initiate client education? a) Hemoglobin A1 C level is 8.7. b) The client is dependent on insulin. c) Glucose level is 80 mg/dL. d) The client states insulin is produced in the pancreas.
a) Hemoglobin A1 C level is 8.7. Explanation: Glycated hemoglobin test (hemoglobin A1c) should be 6% to 7% in clients with diabetes. Maintaining the desired level reduces complications of diabetes.
A client with many nonspecific complaints has been ordered a positron emission tomography (PET) scanning for evaluation of: a) Tumors located on the endocrine glands b) Radioactivity of the thyroid gland c) The pancreas response to an insulin injection d) Bone density
a) Tumors located on the endocrine glands Explanation: Positron emission tomography (PET) scanning is being used more widely for evaluation of endocrine tumors. PET scans do not calculate the pancreas response to insulin. A DEXA is used for diagnosis and monitoring of osteoporosis (bone density). Isotopic imaging includes radioactive scanning of the thyroid (using radioiodine) and parathyroids.
An instructor is teaching the class about positive feedback mechanism. The best example would be: a) Increased glucose levels in the blood decreases growth hormone (GH) levels. b) Increased estradiol production causes increased gonadotropin (FSH) production. c) Decreased thyroid hormone (TH) increases thyroid-stimulating hormone (TSH) levels. d) Decreased cortisone levels increase blood levels of adrenocorticotropic hormone (ACTH).
b
When discussing luteinizing hormone and follicle-stimulating hormone with students, the instructor will emphasize that these hormones are under the control of: a) Posterior adrenal cortex b) Anterior pituitary gland c) Pancreas d) Thyroid gland
b
Several hormones, including steroids and thyroid hormone, are bound to and carried by: a) cholesterol. b) proteins. c) prohormones. d) target cells.
b 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.
Select the most accurate statement regarding measurements of urinary hormone: a) Discarded samples will not alter results. b) Provide a better measure of hormone levels during a designated period. c) Drugs will not alter testing results. d) Requires blood and urine sampling.
b) 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.
Which gland is often referred to as the master gland because it secretes many hormones? a) Hypothalamus b) Pituitary c) Pancreas d) Thyroid
b) 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.
A patient experiences an increase in thyroid hormone as a result of a thyroid tumor. Which of the following hormonal responses demonstrates the negative feedback mechanism? a) Increased follicle-stimulating hormone b) Decreased thyroid-stimulating hormone (TSH) c) Increased thyrotropin-releasing hormone d) Decreased adrenocorticotropic hormone
b) Decreased thyroid-stimulating hormone (TSH) Explanation: 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
A client has developed a tumor of the posterior pituitary gland. The client is at risk for problems with secretions of: a) Growth hormone-releasing hormone (GHRH) and dopamine b) Adrenocorticotropic hormone (ACTH) and vasopressin c) Antidiuretic hormone (ADH) and oxytocin d) Somatostatin and prolactin
c
A patient develops hypocalcemia after thyroid surgery. Which of the following hormonal imbalances caused this complication? a) Lack of thyroid-stimulating hormone b) Lack of thyroid hormone c) Lack of parathyroid hormone d) Lack of thyrotropic-releasing hormone
c
As part of maintaining homeostasis, hormones secreted by endocrine cells are inactivated continuously to: a) Absorb metabolic waste b) Free receptor sites c) Prevent accumulation d) Stimulate production
c
Select the process that allows hormones to exert influence upon some cells and not others. a) Protein binding b) Pituitary-hypothalamic feedback c) Receptor binding d) Positive feedback
c
Which of the following manifestations would a nurse expect when assessing a child with insufficient growth hormone (GH) secretion? a) Mental sluggishness b) Lower blood calcium levels c) Rank below 10% on the growth chart d) Increased susceptibility to infection
c
Which of the following structures controls the functions of the greatest number of target glands and cells? a) Thyroid gland b) Pancreas c) Pituitary gland d) Adrenal cortex
c
A client has received an injection containing thyrotropin-releasing hormone (TRH) and is now being assessed for levels of thyroid-stimulating hormone (TSH). This client has undergone which of the following diagnostic tests? a) Suppression testing b) Autoantibody testing c) Stimulation testing d) Radioimmunoassay (RIA)
c) 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.
Select the statement that best explains the function of hormone receptors. a) Hormone receptors produce antibodies to block certain hormones from entering the cell. b) Hormone receptors are located within the red blood cells and carry hormones to the target cells. c) Hormone receptors recognize a specific hormone and translate the signal into a cellular response. d) Hormone receptors respond to decreasing hormone levels by producing a decrease in receptor numbers.
c) Hormone receptors are complex molecular structures that are located either on the surface of or inside target cells. The function of these receptors is to recognize a specific hormone and translate the hormonal signal into a cellular response.
While reviewing the concept of nuclear receptors with a group of pathophysiology students, the instructor uses the example of clients with type 2 diabetes mellitus taking pioglitazone, a thiazolidinedione medication. Because of the peroxisome proliferator-activated receptors (PPARs), the drug has which effect on the clients' diabetes? Select the best answer. a) Increases the clients' metabolic rate, thereby giving them more energy, which results in weight loss. b) Help the body burn fats more effectively thereby preventing any cardiovascular problems like myocardial infarction. c) Promote glucose uptake and increase the synthesis of certain proteins involved in fat metabolism, which reduces levels of certain types of lipids. d) This medicines increases insulin resistance in muscle and fat and increases the amount of glucose produced by the liver.
c) Promote glucose uptake and increase the synthesis of certain proteins involved in fat metabolism, which reduces levels of certain types of lipids. Explanation: The peroxisome proliferator-activated receptors (PPARs) bind intracellular lipid metabolites and regulate the transcription of genes involved in lipid metabolism and adipose tissue metabolism. Pioglitazone is not given solely to increase metabolic rate or to just burn fats, even though this may occur. Thiazolidimedione medications lower insulin resistance in muscle and fat. They also reduce glucose produced by the liver.
Which of the following types of imaging is preferred to evaluate a patient with a thyroid nodule? a) Magnetic resonance imaging (MRI) b) Computed tomography (CT) scan c) Dual energy x-Ray rbsorptiometry (DEXA) scan d) Ultrasound
d
When caring for a client with anemia and a decrease in red blood cells (RBCs), the nurse recognizes which of these hormones will stimulate the bone marrow to produce additional RBCs? a) Atrial natriuretic peptide b) Somatostatin c) Cortisol d) Erythropoietin
d) Erythropoietin is made in the kidney and stimulates erythropoiesis, production of RBCs in the bone marrow.
Cyclic adenosine monophosphate (cAMP) performs which of the following roles in the functioning of the endocrine system? a) Acting as a high-affinity receptor on the surface of target cells b) Mediating hormone synthesis by nonvesicle-mediated pathways 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 Explanation: cAMP is one of the most common second messengers, whose role is to generate an intracellular signal in response to cell surface receptor activation by a hormone. cAMP does not mediate hormone synthesis, act as a receptor itself, or inactivate hormones
Which of the following hormones exert paracrine action? a) Adrenocorticotropic hormone (ACTH) b) Progesterone c) Insulin d) Epinephrine e) Estrogen f) Calcitoni
• Estrogen • Progesterone Explanation: Hormones can exert four types of effects. Endocrine effects occur when the hormone is secreted into the blood and it travels to a distant site of action. Hormones that do this are epinephrine, calcitonin, and ACTH. Parecrine effects occur when the hormone acts locally on surrounding cells other than those that produced the hormone. Autocrine action is when the hormone produces a biologic effect on the cell that produced it. Insulin has that effect on pancreatic beta cells blocking further release. Intracrine action is when the hormone is produced and acts within the same cell.
