Pathophysiology - Endocrine

A 25-year-old male presents to his primary care provider reporting changes in facial features. CT scan reveals a mass on the anterior pituitary, and lab tests reveal severely elevated growth hormone (GH). Which of the following would the nurse also expect to find? a. Decreased IGF-1 b. Hypotension c. Sexual dysfunction d. Height increases

c. Sexual dysfunction

When a patient wants to know what most commonly causes hypoparathyroidism, how should the nurse reply? It is most commonly caused by: a. Pituitary hyposecretion b. Parathyroid adenoma c. Parathyroid gland injury d. Hypothalamic inactivity

c. Parathyroid gland injury

A nurse is assessing a patient with hypoparathyroidism. Clinical manifestations of hypoparathyroidism include (select all that apply): a. Tetany b. Chvostek sign c. Trousseau sign d. Oily skin e. Hair loss

A, B, C, E Rationale: Symptoms of hypoparathyroidism includes tetany, Chvostek and Trousseau signs, dry (not oily) skin, and loss of body and scalp hair.

A 12-year-old male is newly diagnosed with type 1 DM. Which of the following tests should the nurse prepare the patient to best confirm the diagnosis? a. Fasting plasma glucose levels b. Random serum glucose levels c. Genetic testing d. Glycosylated hemoglobin measurements

a. Fasting plasma glucose levels Rationale: Fasting blood glucose levels are most beneficial in confirming the diagnosis of diabetes. Random serum levels are not as accurate as fasting. Genetic testing may be important for future determination, but it does not confirm the diagnosis. Glycosylated testing measures glucose control over time.

A 15-year-old female presents with breast discharge, dysmenorrhea, and excessive excitability. Tests reveal that all her pituitary hormones are elevated. What does the nurse suspect as the most likely cause for these assessment findings? a. A pituitary adenoma b. Hypothalamic hyposecretion c. Hypothalamic inflammation d. Pheochromocytoma

a. A pituitary adenoma Rationale: Hormonal effects of pituitary adenomas include hypersecretion from the adenoma, itself, and hyposecretion from surrounding pituitary cells; in this case prolactin would be elevated with the manifestation of menstrual irregularities and secretion from the breast.

A nurse is discussing endocrine system dysfunction with a patient. Which statement indicates the patient understood? Endocrine system dysfunction can result from hyposecretion, hypersecretion, or from: a. Abnormal receptor activity b. Abnormal hormone levels c. Increased synthesis of second messengers d. Extracellular electrolyte alterations

a. Abnormal receptor activity Rationale: Dysfunction may result from abnormal cell receptor function or from altered intracellular response to the hormone-receptor complex.

A nurse is preparing to teach a patient about Addison disease. Which information should the nurse include? The most common cause of Addison disease is: a. An autoimmune reaction b. Dietary deficiency of sodium and potassium c. Cancer d. Viral infection of the pituitary gland

a. An autoimmune reaction Rationale: Addison disease is caused by autoimmune mechanisms that destroy adrenal cortical cells and is more common in women.

A 55-year-old female is admitted to the medical unit for complications of long-term, poorly controlled type 2 DM. Which of the following would the nurse expect to find in addition to elevated glucose? a. Atherosclerosis b. Metabolic alkalosis c. Elevated liver enzymes d. Anemia

a. Atherosclerosis Rationale: Macrovascular disease (lesions in large and medium sized arteries) increases morbidity and mortality and increases risk for accelerated atherosclerosis. Acidosis, rather than alkalosis, would occur in this patient.

A 30-year-old male presents to his primary care provider reporting visual disturbances. CT reveals a pituitary tumor and lab tests reveal elevated prolactin. He is diagnosed with prolactinoma. Which of the following treatments would the nurse help implement? Administering: a. Dopaminergic agonists b. Calcium c. Insulin d. Radiation

a. Dopaminergic agonists Rationale: Dopaminergic agonists (bromocriptine and cabergoline) are the treatment of choice for prolactinomas. Calcium is used to treat parathyroid disease. Insulin is used to treat diabetes. Radiation is used to treat GH.

A 35-year-old female with Graves disease is admitted to a medical-surgical unit. While the nurse is reviewing the lab tests, which results would the nurse expect to find? a. High levels of circulating thyroid-stimulating antibodies b. Ectopic secretion of thyroid-stimulating hormone (TSH) c. Low circulating levels of thyroid hormones d. Increased circulation of iodine

a. High levels of circulating thyroid-stimulating antibodies Rationale: Graves disease results from a form of Type II hypersensitivity in which there is stimulation of the thyroid by autoantibodies directed against the TSH receptor.

A 54-year-old patient with pulmonary tuberculosis (lung infection) is evaluated for syndrome of inappropriate ADH secretion (SIADH). Which of the following electrolyte imbalances would be expected in this patient? a. Hyponatremia b. Hyperkalemia c. Hypernatremia d. Hypokalemia

a. Hyponatremia Rationale: Hyponatremia occurs due to increased water reabsorption by kidneys.

A 3-year-old male was diagnosed with congenital hypothyroidism. The parents ask the nurse if left untreated what will happen. What is the nurse's best response? If left untreated, the child would have: a. Mental retardation and stunted growth b. Increased risk of childhood thyroid cancer c. Hyperactivity and attention deficit disorder d. Liver, kidney, and pancreas failure

a. Mental retardation and stunted growth Rationale: Cognitive disability varies with the severity of congenital hypothyroidism and the length of delay before treatment is initiated.

A 50-year-old male patient presents with polyuria and extreme thirst. He was given exogenous ADH. For which of the following conditions would this treatment be effective? a. Neurogenic diabetes insipidus b. Psychogenic diabetes insipidus c. Nephrogenic diabetes insipidus d. SIADH

a. Neurogenic diabetes insipidus Rationale: Neurogenic diabetes insipidus is caused by the insufficient secretion of ADH; thus, exogenous ADH would be useful in the treatment of this disorder.

An aide asks the nurse what is the most common cause of elevated levels of antidiuretic hormone (ADH) secretion. How should the nurse respond? a. Autoimmune disease b. Cancer c. Pregnancy d. Heart failure

b. Cancer

A 19-year-old female with type 1 DM was admitted to the hospital with altered consciousness and the following lab values: serum glucose 500 mg/dl (high) and serum K+ 2 (low). Her parents state that she has been sick with the "flu" for a week. The diagnosis is hyperosmolar hyperglycemia nonketotic syndrome (HHNKS). What relationship do these values have with her insulin deficiency? a. Increased glucose utilization causes the shift of fluid from the intravascular to the intracellular space. b. Decreased insulin causes hyperglycemia and osmotic diuresis. c. Increased glucose and fatty acid metabolism stimulates renal diuresis and electrolyte loss. d. Increased insulin use results in protein catabolism, tissue wasting, and electrolyte loss.

b. Decreased insulin causes hyperglycemia and osmotic diuresis. Rationale: Because the amount of insulin required to inhibit fat breakdown is less than that needed for effective glucose transport, insulin levels are sufficient to prevent excessive lipolysis and ketosis. Volume is depleted, not increased. Electrolyte loss does occur, but it is not due to fatty acids and glucose metabolism, it is due to insufficient insulin. Insulin is decreased, not increased.

A 22-year-old male is admitted to the intensive care unit with a closed head injury sustained in a motorcycle accident. The injury has caused severe damage to the posterior pituitary. Which of the following complications should the nurse anticipate? a. Dilutional hyponatremia b. Dehydration from polyuria c. Cardiac arrest from hyperkalemia d. Metabolic acidosis

b. Dehydration from polyuria Rationale: Diabetes insipidus is a well-recognized complication of closed head injury and is manifested by polyuria leading to dehydration.

While checking the lab results for a patient with Graves disease, the nurse would check the T3 level to be abnormally: a. Low b. High c. Variable d. Absent

b. High

When a staff member asks the nurse what causes the chronic complications of DM such as microvascular and macrovascular disease, how should the nurse respond? These complications are primarily related to: a. Pancreatic changes b. Hyperglycemia c. Ketone toxicity d. Hyperinsulinemia

b. Hyperglycemia

When a patient asks what causes hyperglycemia in type 2 DM, how should the nurse respond? Hyperglycemia is a result of: a. Insulin deficiency b. Hyperinsulinemia c. Glucagon deficiency d. Liver dysfunction

b. Hyperinsulinemia Rationale: Type 2 diabetes is due to hyperinsulinemia and insulin resistance.

A 30-year-old female with Graves disease is admitted to a hospital unit for the surgical removal of her thyroid gland. During the postoperative period, the nurse notes that the patient's serum calcium is low. The nurse should observe the patient for which of the following signs/symptoms? a. Muscle weakness and constipation b. Laryngeal spasms and hyperreflexia c. Abdominal pain and fever d. Anorexia, nausea, and vomiting

b. Laryngeal spasms and hyperreflexia Rationale: Symptoms of low calcium are associated with tetany, a condition characterized by muscle spasms, hyperreflexia, clonic-tonic convulsions, and laryngeal spasms.

While planning care for a patient with hypothyroidism, which principle should the nurse remember? The basal metabolic rate is unusually _____ with hypothyroidism. a. High b. Low c. Steady d. Variable

b. Low

A nurse is reviewing lab results for glycosylated hemoglobin (hemoglobin A1c) levels. A nurse recalls the purpose of this test is to: a. Measure fasting glucose levels. b. Monitor long-term serum glucose control. c. Detect acute complications of diabetes. d. Check for hyperlipidemia.

b. Monitor long-term serum glucose control. Rationale: Glycosylated hemoglobin refers to the permanent attachment of glucose to hemoglobin molecules and reflects the average plasma glucose exposure over the life of a red blood cell (approximately 120 days). Glycosylated hemoglobin does not measure fasting, but glucose control over time. Glycosylated hemoglobin does not identify complications, but could provide data if the patient is at risk. Glycosylated does not check for hyperlipidemia.

While planning care for a patient from general anesthesia, which principle should the nurse remember? A side effect of some general anesthetic agents is _____ diabetes insipidus. a. Neurogenic b. Nephrogenic c. Psychogenic d. Allogenic

b. Nephrogenic

Visual disturbances are a common occurrence in patients with untreated Graves disease. The endocrinologist explains to the patient that the main cause of these complications is: a. Decreased blood flow to the eye b. Orbital edema and protrusion of the eyeball c. TSH neurotoxicity to retinal cells d. Local lactic acidosis

b. Orbital edema and protrusion of the eyeball Rationale: Visual disturbances with Graves disease include orbital fat accumulation, inflammation, and edema of the orbital contents resulting in exophthalmos (protrusion of the eyeball), periorbital edema, and extraocular muscle weakness leading to diplopia (double vision).

An 11-year-old male is newly diagnosed with type 1 DM. Which classic symptoms should the nurse assess the patient for? a. Recurrent infections, visual changes, fatigue, and paresthesias b. Polydipsia, polyuria, polyphagia, and weight loss c. Vomiting; abdominal pain; sweet, fruity breath; dehydration; and Kussmaul breathing d. Weakness, vomiting, hypotension, and mental confusion

b. Polydipsia, polyuria, polyphagia, and weight loss

A 22-year-old female has a low level of TSH. What condition does the nurse expect the patient is experiencing? a. Primary hypothyroidism b. Secondary hypothyroidism c. Autoimmune hypothyroidism d. Atypical hypothyroidism

b. Secondary hypothyroidism Rationale: Causes of secondary hypothyroidism are related to either pituitary or hypothalamic failure, which would be evident by low levels of TSH. Primary hypothyroidism would be evident by elevated levels of TSH. Autoimmune hypothyroidism would be evident by elevated TSH. Atypical hypothyroidism would be evident by normal or elevated TSH.

When a nurse is assessing the physical features of individuals with Cushing syndrome, these findings will include: a. Weight loss and muscle wasting b. Truncal obesity and moon face c. Pallor and swollen tongue d. Depigmented skin and eyelid lag

b. Truncal obesity and moon face Rationale: Weight gain is the most common feature and results from the accumulation of adipose tissue in the trunk, facial, and cervical areas. These characteristic patterns of fat deposition have been described as "truncal obesity," "moon face," and "buffalo hump."

What common neurologic disturbances should the nurse assess for in a patient with a pituitary adenoma? a. Coma b. Visual disturbances c. Confused states d. Breathing abnormalities

b. Visual disturbances Rationale: The clinical manifestations of pituitary adenomas are visual changes including visual field impairments (often beginning in one eye and progressing to the other) and temporary blindness.

A nurse checks lab results as both Cushing syndrome and Addison disease can manifest with elevated levels of: a. ADH b. Cortisol c. Adrenocorticotropic hormone (ACTH) d. Aldosterone

c. Adrenocorticotropic hormone (ACTH)

Which of the following diseases should the nurse teach the patient to prevent as it is the ultimate cause of death in the patient with diabetes? a. Renal disease b. Stroke c. Cardiovascular disease d. Cancer

c. Cardiovascular disease

What is the cause of the hyperpigmentation seen in people with Cushing syndrome? a. Abnormal levels of cortisol b. Permissive effects of aldosterone when cortisol levels are altered c. Elevated levels of ACTH d. Hypersensitivity of melanocytes with sun exposure

c. Elevated levels of ACTH Rationale: Bronze or brownish hyperpigmentation of the skin, mucous membranes, and hair occurs when there are very high levels of ACTH.

A patient with Addison disease has weakness and easy fatigability. A nurse recalls this is due to: a. Hyperkalemia b. Hypoglycemia c. Hypocortisolism d. Metabolic acidosis

c. Hypocortisolism

A 13-year-old male who uses insulin to control his type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion during gym class. The most probable cause of these symptoms is: a. Hyperglycemia resulting from incorrect insulin administration b. Dawn phenomenon caused by eating a snack before gym class c. Hypoglycemia caused by increased exercise d. Somogyi effect caused by insulin sensitivity

c. Hypoglycemia caused by increased exercise

A 50-year-old female presents with lightheadedness and overall abnormal feelings. Hyperaldosteronism is diagnosed. Which of the following symptoms would the nurse expect? a. Hypovolemia b. Hypotension c. Hypokalemia d. Hyponatremia

c. Hypokalemia Rationale: Hypokalemia occurs due to increased renal secretion of potassium. Hypervolemia, not hypovolemia, occurs. Hypertension, not hypotension, occurs. Hypernatremia, not hyponatremia, occurs

A 45-year-old female with Graves disease underwent surgical removal of her thyroid gland. During the postoperative period, her serum calcium was low. The most probable reason for her low serum calcium is: a. Hyperparathyroidism secondary to Graves disease b. Myxedema secondary to surgery c. Hypoparathyroidism caused by surgical injury to the parathyroid glands d. Hypothyroidism resulting from lack of thyroid replacement

c. Hypoparathyroidism caused by surgical injury to the parathyroid glands

A 12-year-old female is newly diagnosed with type 1 DM. When the parents ask what causes this, what is the nurse's best response? a. A familial, autosomal dominant gene defect b. Obesity and lack of exercise c. Immune destruction of the pancreas d. Hyperglycemia from eating too many sweets

c. Immune destruction of the pancreas Rationale: The most common cause of type 1 DM is a slowly progressive autoimmune T cell-mediated disease that destroys the beta cells of the pancreas.

A nurse wants to determine if there is kidney dysfunction in a patient with diabetes. Which of the following is the earliest manifestation? a. Polyuria b. Glycosuria c. Microalbuminuria d. Decreased glomerular filtration

c. Microalbuminuria

A nurse is caring for a patient with SIADH. What severe complication should the nurse assess for? a. Stroke b. Diabetes insipidus c. Neurologic damage d. Renal failure

c. Neurologic damage Rationale: When the hyponatremia of SIADH becomes severe, 110 mEq/L to 115 mEq/L, confusion, lethargy, muscle twitching, convulsions, and severe and sometimes irreversible neurologic damage may occur.

A 30-year-old male was diagnosed with thyroid carcinoma. The lab tests the nurse would most likely find are _____ T3 and T4 levels. a. High b. Low c. Normal d. Variable

c. Normal Rationale: Most individuals with thyroid carcinoma have normal T3 and T4 levels and are therefore euthyroid.

A 35-year-old female with Graves disease is admitted to a medical-surgical unit. Which of the following symptoms would the nurse expect to find before treatment? a. Weight gain, cold intolerance b. Slow heart rate, rash c. Skin hot and moist, rapid heart rate d. Constipation, confusion

c. Skin hot and moist, rapid heart rate Rationale: Symptoms of Graves disease include heat intolerance and increased tissue sensitivity to stimulation by the sympathetic division of the autonomic nervous system. Weight loss, rather than weight gain, and heat intolerance would result. Tachycardia, not slow heart rate, would occur. Diarrhea would occur as opposed to constipation.

The body's inability to conserve water and sodium when affected by Addison disease is explained by which of the following conditions? a. Elevated levels of cortisol b. Decreased levels of ACTH c. Hypersecretion of ADH d. Aldosterone deficiency

d. Aldosterone deficiency Rationale: The symptoms of Addison disease are primarily a result of hypocortisolism and hypoaldosteronism.

A 44-year-old patient with pulmonary tuberculosis (lung infection) is evaluated for SIADH. Which of the following assessment findings would be expected in this patient? a. Peripheral edema b. Tachycardia c. Low blood pressure d. Concentrated urine

d. Concentrated urine Rationale: Clinical manifestations of SIADH include urine that is inappropriately concentrated with respect to serum osmolarity.

A 25-year-old female with Graves disease is admitted to a medical-surgical unit. Palpation of her neck would most likely reveal: a. A normal-sized thyroid b. A small discrete thyroid nodule c. Multiple discrete thyroid nodules d. Diffuse thyroid enlargement

d. Diffuse thyroid enlargement Rationale: A patient with Graves disease would reveal stimulation of the gland causing diffuse thyroid enlargement. In Graves disease, the thyroid will be enlarged, not normal sized.

Which of the following alterations would the nurse expect to find in a patient with untreated Cushing disease or syndrome? a. Bradycardia b. Tachypnea c. Hyperkalemia d. Hypertension

d. Hypertension Rationale: With elevated cortisol levels, vascular sensitivity to catecholamines increases significantly, leading to vasoconstriction and hypertension. Tachycardia is more likely than bradycardia due to increased sensitivity to catecholamines. Tachypnea does not occur; the patient experiences hypertension. Hypokalemia, not hyperkalemia, occurs.

A 19-year-old female with type 1 DM was admitted to the hospital with the following lab values: serum glucose 500 mg/dl (high), urine glucose and ketones 4+ (high), and arterial pH 7.20 (low). Her parents state that she has been sick with the "flu" for a week. Which of the following statements best explains her acidotic state? a. Increased insulin levels promote protein breakdown and ketone formation. b. Her uncontrolled diabetes has led to renal failure. c. Low serum insulin promotes lipid storage and a corresponding release of ketones. d. Insulin deficiency promotes lipid metabolism and ketone formation.

d. Insulin deficiency promotes lipid metabolism and ketone formation. Rationale: With insulin deficiency, lipolysis is enhanced, and there is an increase in the amount of nonesterified fatty acids delivered to the liver. The consequence is increased glyconeogenesis contributing to hyperglycemia and production of ketone bodies (acetoacetate, hydroxybutyrate, and acetone) by the mitochondria of the liver at a rate that exceeds peripheral use.

A 49-year-old female is diagnosed with hypercortisolism. Which of the following would the nurse expect? a. Weight loss b. Hypoglycemia c. Decreased urination d. Osteoporosis

d. Osteoporosis Rationale: The effects of hypercortisolism in bone cause loss of the protein matrix leading to osteoporosis, with pathologic fractures, vertebral compression fractures, bone and back pain, kyphosis, and reduced height.

What problem should the nurse assess for in a patient with chronic hyperparathyroidism? a. Seizure disorders b. Vitamin D malabsorption c. Hyponatremia d. Osteoporosis and pathologic fractures

d. Osteoporosis and pathologic fractures Rationale: Excessive osteoclastic and osteocytic activity resulting in bone resorption may cause pathologic fractures, kyphosis of the dorsal spine, and compression fractures of the vertebral bodies.

A 30-year-old female presents with hypertension, headache, tachycardia, impaired glucose tolerance, and weight loss. Which of the following diagnosis will the nurse see documented on the chart? a. Addison disease b. Conn disease c. Cushing disease d. Pheochromocytoma

d. Pheochromocytoma

A 25-year-old male presents with fatigue, constipation, and sexual dysfunction. Tests reveal all pituitary hormones are normal and no masses are present. The nurse suspects the most likely cause of his symptoms is a dysfunction in the: a. Anterior pituitary b. Posterior pituitary c. Pars intermedia d. Pituitary stalk

d. Pituitary stalk Rationale: When pituitary hormones are normal, dysfunction in the action of hypothalamic hormones are most commonly related to interruption of the connection between the hypothalamus and pituitary, the pituitary stalk.

Diabetes insipidus, diabetes mellitus (DM), and SIADH share which of the following assessment manifestations? a. Polyuria b. Edema c. Vomiting and abdominal cramping d. Thirst

d. Thirst

A 35-year-old female took corticosteroid therapy for several months. Which of the following would the nurse expect to find? a. Renal toxicity b. Episodes of hypoglycemia c. Hypotension d. Type 2 DM

d. Type 2 DM Rationale: Overt DM develops in approximately 20% of individuals with hypercortisolism. Hypertension, not hypotension, occurs; hypotension occurs with Addison.