Pathophysiology Unit 6 (Ch21-23) Endocrinology

2. Which patient would the healthcare professional assess for elevated levels of antidiuretic hormone (ADH) secretion? a. Being treated for small cell carcinoma of the stomach b. Taking high dose acetaminophen (Tylenol) for arthritis c. Had a hip replacement operation 14 days ago d. Has long-standing kidney disease from diabetes

ANS: A A common cause of elevated levels of ADH secretion is ectopically produced ADH by tumors, such as small cell carcinoma of the duodenum, stomach, and pancreas; cancers of the bladder, prostate, and endometrium; lymphomas; and sarcomas. High doses of antiinflammatory medications are a risk factor, but acetaminophen is not an antiinflammatory medication. Surgery within the last 5 to 7 leads to increased ADH secretion. Kidney disease does not lead to excess levels of ADH.

30. Which is an expected hormonal change in an older patient? a. Thyroid-stimulating hormone secretion below normal b. Triiodothyronine level below normal c. Cortisol level below normal d. Adrenocorticotropic hormone level above normal

ANS: A Aging causes overall thyroid-stimulating hormone secretion to diminish but does not bring about the other changes.

5. Which of these is a lipid-soluble hormone? a. Cortisol b. Oxytocin c. Epinephrine d. Growth hormone

ANS: A Cortisol and adrenal androgens are lipid-soluble hormones and are primarily bound to a carrier or transport protein in circulation. The other options are water-soluble hormones.

4. What is diabetes insipidus a result of? a. Antidiuretic hormone hyposecretion b. Antidiuretic hormone hypersecretion c. Insulin hyposecretion d. Insulin hypersecretion

ANS: A Diabetes insipidus is a result of insufficient antidiuretic hormone (hyposecretion). It is not related to insulin secretion.

20. Which pathologic changes are associated with Graves' disease? a. High levels of circulating thyroid-stimulating immunoglobulins b. Diminished levels of thyrotropin-releasing hormone c. High levels of thyroid-stimulating hormone d. Diminished levels of thyroid-binding globulin

ANS: A High levels of circulating thyroid-stimulating immunoglobulins are found in more than 95% of individuals diagnosed with this disease.

32. Hypoglycemia, followed by rebound hyperglycemia, is observed in those with what? a. The Somogyi effect b. The dawn phenomenon c. Diabetic ketoacidosis d. Hyperosmolar hyperglycemic nonketotic syndrome

ANS: A Hypoglycemia, followed by rebound hyperglycemia, is observed only in the Somogyi effect.

11. Which condition may result from pressure exerted by a pituitary tumor? a. Hypothyroidism b. Hypercortisolism c. Diabetes insipidus d. Insulin hyposecretion

ANS: A If the tumor exerts sufficient pressure, then thyroid and adrenal hypofunction may occur because of lack of thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH). These result in the symptoms of hypothyroidism and hypocortisolism. The remaining options are not associated with the pressure exerted by a pituitary tumor.

6. A patient is having a water deprivation test. The patient's initial weight was 220 pounds (100 kg). The next weight is 209 pounds (95 kg). What action by the healthcare professional is most appropriate? a. Stop the water deprivation test. b. Administer salt tablets. c. Continue with the test as planned. d. Take the patient's blood glucose.

ANS: A In patients with severe diabetes insipidus the water deprivation test can be diagnostic. However, it can also be risky; if the patient loses more than 3% of body weight, cardiovascular collapse and shock can occur. This patient has lost 5% of initial body weight, so the professional should stop the test. Administering salt tablets does not take priority over stopping the test. Glucose measurement is not relevant.

21. A diabetic patient has not taken insulin in several days and has an extremely high blood sugar. What electrolyte would the health care professional assess as the priority? a. Potassium b. Calcium c. Sodium d. Chloride

ANS: A Insulin facilitates the intracellular transport of potassium, phosphate, and magnesium. Without insulin, potassium does not get transported to the intracellular environment and the serum potassium will rise. The health care professional would assess the patient's potassium level as the priority.

10. A patient has nephrogenic diabetes insipidus (DI). What treatment does the healthcare professional anticipate for this patient? a. Exogenous ADH replacement b. Intranasal desmopressin c. Water and sodium restriction d. Loop diuretic administration

ANS: A Nephrogenic DI is usually treated with administration of fluids, or intranasal (or oral) desmopressin. Neurogenic DI is treated with ADH replacement therapy. Water restriction would not be helpful. Thiazide (not loop) diuretics can improve moderate nephrogenic DI.

15. Where is antidiuretic hormone (ADH) synthesized, and where does it act? a. Hypothalamus; renal tubular cells b. Renal tubules; renal collecting ducts c. Anterior pituitary; posterior pituitary d. Posterior pituitary; loop of Henle

ANS: A Once synthesized in the hypothalamus, ADH is stored and secreted by the posterior pituitary and acts on the vasopressin 2 (V2) receptors of the renal duct cells to increase their permeability.

28. A student asks the professor to differentiate Type 2 diabetes mellitus from Type 1. The professors' response would be that Type 2 is best described as what? a. Resistance to insulin by insulin-sensitive tissues b. Need for lifelong insulin injections c. Increase of glucagon secretion from beta cells of the pancreas d. Presence of insulin autoantibodies that destroy beta cells in the pancreas

ANS: A One of the basic pathophysiologic characteristics of type 2 diabetes is the development of insulin-resistant tissue cells. Type 1 diabetes always must be treated with insulin. Type 2 diabetes can be treated with insulin but there are other options. Pancreatic beta cells are destroyed in Type 1 diabetes. Increased glucagon is not secreted from pancreatic beta cells in Type 2 diabetes.

34. Which classification of oral hypoglycemic drugs decreases hepatic glucose production and increases insulin sensitivity and peripheral glucose uptake? a. Biguanide metformin) b. Sulfonylureas (glyburide) c. Meglitinides (glinides) d. α-Glycosidase inhibitor (miglitol)

ANS: A Only biguanides decrease hepatic glucose production and increase insulin sensitivity and peripheral glucose uptake. The sulfonylureas and meglitinides stimulate insulin release from pancreatic beta cells. The α-glycosidase inhibitors delay carbohydrate absorption in the gut.

12. What is the portion of the pituitary that secretes oxytocin? a. Posterior b. Inferior c. Anterior d. Superior

ANS: A Only the posterior pituitary secretes oxytocin and antidiuretic hormone (ADH). The anterior pituitary secretes adrenocorticotropic hormone (ACTH), follicle-stimulating hormone, growth hormone, luteinizing hormone, prolactin, and thyroid-stimulating hormone (TSH). There is no inferior or superior portion of the pituitary gland.

3. The student asks the professor for a definition of "orexigenic neurons." What description by the professor is most accurate? a. Promote appetite and stimulate eating b. Suppress appetite and inhibit eating c. Increase overall metabolism d. Promote satiety after eating

ANS: A Orexigenic neurons promote appetite, stimulate eating, and decrease metabolism. The anorexigenic neurons suppress appetite, inhibit eating, increase metabolism, and promote satiety after eating.

16. Where is oxytocin synthesized? a. Hypothalamus b. Paraventricular nuclei c. Anterior pituitary d. Posterior pituitary

ANS: A Oxytocin is synthesized in hypothalamic neurons and is stored and secreted by the posterior pituitary. The paraventricular nuclei and anterior pituitary are not involved in oxytocin synthesis.

1. What imbalance lessens the rate of secretion of parathyroid hormone (PTH)? a. Increased serum calcium levels b. Decreased serum magnesium levels c. Decreased levels of thyroid-stimulating hormone d. Increased levels of thyroid-stimulating hormone

ANS: A PTH is the single most important regulator of serum calcium. When serum calcium levels are low, PTH secretion is stimulated; when calcium levels are high, PTH secretion is inhibited. PTH secretion is not inhibited by magnesium or thyroid-stimulating hormone levels.

12. A healthcare professional reads a chart that notes the patient has panhypopituitarism. What does the professional understand that term to mean? a. The patient has a lack of all hormones associated with the anterior pituitary gland. b. The patient has a lack of all hormones associated with the lateral pituitary gland. c. The patient has total adrenocorticoptropic hormone deficiency. d. The patient has a dysfunction of the posterior pituitary gland due to a tumor.

ANS: A Panhypopituitarism is the term denoting the lack of all anterior pituitary hormones.

26. Where are target cells for parathyroid hormone located? a. Tubules of nephrons b. Thyroid gland c. Glomeruli of nephrons d. Smooth and skeletal muscles

ANS: A Parathyroid hormone acts on its plasma membrane receptor only in the distal and proximal tubules of the kidney's nephron.

6. A health care professional is caring for a patient admitted to the hospital with severe anorexia. What action by the health care professional would be most important? a. Ensuring the patient is on a cardiac monitor b. Facilitating laboratory testing of electrolytes c. Arranging a psychiatry consultation d. Assessing the patient's favorite foods

ANS: A Patients with severe anorexia can have cardiac dysrhythmias, so this patient should be placed on a cardiac monitor as the priority. The other actions are appropriate; they just do not take priority.

30. Which serum glucose level would indicate hypoglycemia in a newborn? a. 28 mg/dL b. 40 mg/dL c. 60 mg/dL d. 80 mg/dL

ANS: A Serum glucose <30 mg/dL in newborn (first 2 to 3 days) and <55 to 60 mg/dL in adults is associated with hypoglycemia.

22. A person who has experienced physiologic stresses will have increased levels of which hormone? a. Cortisol b. Thyroid hormone c. Somatostatin d. Alpha endorphin

ANS: A Stress has been shown to increase adrenocorticotropic hormone secretion. Thyroid hormone, somatostatin, and alpha endorphin are not increased with stress.

9. Which laboratory value is consistent with diabetes insipidus (DI)? a. Low urine-specific gravity b. Low serum sodium c. Low urine protein d. High serum total protein

ANS: A The basic criteria for diagnosing DI include a low urine-specific gravity while sodium levels are high. Protein levels are not considered.

24. Which hormone is involved in the regulation of serum calcium levels? a. Parathyroid hormone (PTH) b. Thyroxine (T4) c. Adrenocorticotropic hormone (ACTH) d. Triiodothyronine (T3)

ANS: A The parathyroid glands produce PTH, a regulator of serum calcium. Thyroxine (T4) and triiodothyronine (T3) are thyroid hormones. ACTH is the main regulator of cortisol secretion and adrenocortical growth.

5. A patient who is diagnosed with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits, but the antidiuretic hormone (ADH) level is low. Although the patient has had no intake for 4 hours, no change in the polyuria level has occurred. What treatment or diagnostic testing does the healthcare professional prepare the patient for? a. Administration of desmopressin b. Serum copeptin testing c. Insulin administration d. Renal angiogram

ANS: A The stated symptoms are reflective of neurogenic diabetes insipidus (DI) which can be treated with desmopressin. Desmopressin will cause an increased ability to concentrate urine. Copeptin is a precursor of ADH and obtaining a serum level is useful in diagnosing dipsogenic DI. The patient does not need insulin or a renal angiogram.

25. Which hormone inhibits the secretion of growth hormone (GH)? a. Somatostatin b. Thyroxine c. Thyroid-stimulating hormone d. Calcitonin

ANS: A Two hormones from the hypothalamus control GH secretion: (1) GH-releasing hormone (GHRH), which increases GH secretion; and (2) somatostatin, which inhibits it. Thyroxine and thyroid-stimulating hormone are related to thyroid function. Calcitonin helps regulate serum calcium levels.

1. A person may experience which complications as a result of a reduction in parathyroid hormone (PTH)? (Select all that apply.) a. Muscle spasms b. Tonic-clonic seizures c. Laryngeal spasms d. Hyporeflexia e. Asphyxiation

ANS: A, B, C, E Symptoms associated with hypoparathyroidism are related to hypocalcemia. Hypocalcemia causes a lowering of the threshold for nerve and muscle excitation so that a slight stimulus anywhere along the length of a nerve or muscle fiber may initiate a nerve impulse. This creates tetany manifested as muscle spasms, hyporeflexia, tonic-clonic convulsions, laryngeal spasms, and, in severe cases, death from asphyxiation.

2. A health care professional is speaking to a weight-loss support group and encourages the participants to have regular screening for medical conditions that are related to obesity. Which conditions does the professional include in this list? (Select all that apply.) a. Cancer b. Cardiovascular disease c. Cirrhosis d. Diabetes e. Dementias

ANS: A, B, D The three leading causes of death in the US related to obesity are cancer, cardiovascular disease, and diabetes. The professional would encourage the participants to be screened for these conditions. Obesity is not linked to cirrhosis of the liver or dementias.

1. A student asks the professor about the functions of adipose tissue. What responses by the professor are accurate? (Select all that apply.) a. Provides insulation b. Helps with mechanical support c. Dysregulates thyroid function d. Secretes adipokines e. Helps generate heat

ANS: A, B, D, E Adipose tissue has multiple functions including providing insulation and mechanical support, secreting adipokines, and heat generation. They do not specifically cause thyroid dysregulation.

6. A student learning about the effects of obesogens discovers what information about them? (Select all that apply.) a. Can be found in personal care products b. Cannot cross the placental barrier c. Can be transmitted through breast milk d. Are limited to a single genetic defect e. Have been associated with pesticide exposure

ANS: A, C, E Obesogens are exogenous chemicals related to the development of obesity. They can be found in a variety of items such as person care products, plastics, pesticides, food products, and other household and consumer products. Some of them can cross the placental barrier and be transmitted through breast milk. They produce epigenetic changes in gene regulation and expression.

2. A chronic complication of diabetes mellitus is likely to result in microvascular complications in which areas? (Select all that apply.) a. Eyes b. Coronary arteries c. Renal system d. Peripheral vascular system e. Nerves

ANS: A, C, E Of the options provided, the areas most often affected are the retina, kidneys, and nerves. Coronary artery disease and peripheral vascular disease are macrovascular complications.

3. What role does leptin resistance have in promoting obesity? (Select all that apply.) a. Promotes overeating b. Promotes early satiety c. Inhibits orexigenic outcomes d. Increases oxidative stress e. Leads to hyperglycemia

ANS: A, D, E Leptin resistance has a major role in obesity. Some of the effects of leptin resistance include: promotion of overeating, failure to inhibit orexigenic hypothalamic satiety signaling, increased oxidative stress, and hyperglycemia.

1. What are actions of glucocorticoids? (Select all that apply.) a. Decreasing muscle cell reuptake of glucose b. Fat storage c. Decreased blood glucose d. Carbohydrate metabolism e. Liver gluconeogenesis

ANS: A, D, E The term glucocorticoid refers to those steroidal hormones that have direct effects on carbohydrate metabolism. These hormones increase blood glucose concentration by promoting gluconeogenesis in the liver and by decreasing uptake of glucose into muscle cells, adipose cells, and lymphatic cells. Glucocorticoids are not capable of fat storage.

22. A person has hypothyroidism. What chemical does the healthcare professional advise the person to include in the diet? a. Iron b. Iodine c. Zinc d. Magnesium

ANS: B A lack of iodine can lead to hypothyroidism.

1. A researcher is moving to an area with a year-round cold climate. The researcher asks the health care professional how people in these areas are able to adjust to the temperature. What response by the professional is most accurate? a. They have less adipose tissue. b. They have more beige (bAT) adipose tissue. c. Their bone marrow produces more adipose tissue. d. They gain weight which insulates them.

ANS: B Chronic exposure to cold climates causes the conversion of white adipose tissue (WAT) to beige adipose tissue, which is thermogenic. Changing the amount of adipose tissue overall does not help with acclimation to cold climates.

24. Renal failure is the most common cause of which type of hyperparathyroidism? a. Primary b. Secondary c. Exogenous d. Inflammatory

ANS: B Chronic renal failure is the most common cause of secondary hyperparathyroidism because of the resulting hyperphosphatemia that stimulates parathyroid hormone secretion. Although the other options may occur, they are not the most common types of the disorder.

26. A patient diagnosed with diabetic ketoacidosis (DKA) has the following laboratory values: arterial pH 7.20; serum glucose 500 mg/dL; positive urine glucose and ketones; serum potassium (K+) 2 mEq/L; serum sodium (Na+) 130 mEq/L. The patient reports that he has been sick with the "flu" for 1 week. What relationship do these values have to his insulin deficiency? a. Increased glucose use causes the shift of fluid from the intravascular to the intracellular space. b. Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis. c. Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis. d. Decreased glucose use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss.

ANS: B Decreased glucose causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis, which have resulted in the symptoms listed in the question. Glucose is not being used which accounts for the high serum glucose. The pH indicates acidosis, not alkalosis. DKA is a metabolic, not respiratory, process.

27. Which compound or hormone is secreted by the adrenal medulla? a. Cortisol b. Epinephrine c. Androgens d. Aldosterone

ANS: B Epinephrine is secreted by the adrenal medulla. Cortisol, androgens, and aldosterone are secreted by adrenal cortex.

8. Thyroid-stimulating hormone (TSH) is released to stimulate thyroid hormone (TH) and is inhibited when plasma levels of TH are adequate. What is this an example of? a. Positive feedback b. Negative feedback c. Neural regulation d. Physiologic regulation

ANS: B Feedback systems provide precise monitoring and control of the cellular environment. Negative feedback occurs because the changing chemical, neural, or endocrine response to a stimulus negates the initiating change that triggered the release of the hormone. Thyrotropin-releasing hormone (TRH) from the hypothalamus stimulates TSH secretion from the anterior pituitary. Secretion of TSH stimulates the synthesis and secretion of THs. Increasing levels of T4 and triiodothyronine (T3) then generate negative feedback on the pituitary and hypothalamus to inhibit TRH and TSH synthesis. A positive feedback loop would have the opposite effect. Neural regulation is a type of hormonal control that involves the nervous system. Physiologic is not a specific type of hormone regulation.

16. Why does giantism occur only in children and adolescents? a. Their growth hormones are still diminished. b. Their epiphyseal plates have not yet closed. c. Their skeletal muscles are not yet fully developed. d. Their metabolic rates are higher than in adulthood.

ANS: B Giantism is related to the effects of excess growth hormones on the growth of long bones at their epiphyseal plates in acromegaly. It is not related to skeletal muscle development of metabolic rate.

20. What effect does hyperphosphatemia have on other electrolytes? a. Increases serum calcium b. Decreases serum calcium c. Decreases serum magnesium d. Increases serum magnesium

ANS: B Hyperphosphatemia leads to hypocalcemia.

b. 745 c. 936 d. 1200

ANS: B In order to prevent refeeding syndrome, feedings should start slowly at about 20 kcal/kg/day. This 82-pound person weighs 37.2727 kg, so that would be 745 calories a day.

2. A health care professional wishes to provide community screening for obesity. Which population should the professional focus on as the priority? a. Caucasians b. Non-Hispanic blacks c. Hispanics d. Asians

ANS: B Non-Hispanic blacks have the highest age-adjusted rate of obesity at 48.1% followed by Hispanics (42.5%), non-Hispanic whites (34.5%), and non-Hispanic Asians (11.7%). The professional's priority should be on the group with the highest prevalence rate, which is non-Hispanic blacks.

8. Which form of diabetic insipidus (DI) will result if the target cells for antidiuretic hormone (ADH) in the renal collecting tubules demonstrate insensitivity? a. Neurogenic b. Nephrogenic c. Psychogenic d. Ischemic

ANS: B Only nephrogenic DI is associated with an insensitivity of the renal collecting tubules to ADH.

19. Which hormone triggers uterine contractions? a. Thyroxine b. Oxytocin c. Growth hormone d. Insulin

ANS: B Oxytocin is responsible for the contraction of the uterus and milk ejection in lactating women and may affect sperm motility in men. Thyroxine is the major hormone secreted by the thyroid gland helps regulate metabolic activity in the body. Growth hormone is essential to normal growth and maturation. Insulin helps cells utilize glucose.

6. Most protein hormones are transported in the bloodstream and are what? a. Bound to a lipid-soluble carrier b. Free in an unbound, water-soluble form c. Bound to a water soluble-binding protein d. Free because of their lipid-soluble chemistry

ANS: B Peptide or protein hormones, such as insulin, pituitary, hypothalamic, and parathyroid, are water soluble and circulate in free (unbound) forms. They are not bound to carriers or lipid soluble.

14. What is the target tissue for prolactin-releasing factor? a. Hypothalamus b. Anterior pituitary c. Mammary glands d. Posterior pituitary

ANS: B Prolactin-releasing factor targets the anterior pituitary gland to stimulate the secretion of prolactin.

9. A severely malnourished patient is in the hospital to improve nutrition. On the second day, the patient reports palpitations and difficulty breathing. After placing the patient on a cardiac monitor, what action does the health care professional take next? a. Take the patient's temperature. b. Have lab drawn for electrolyte levels. c. Cancel the patient's next meal. d. Facilitate a chest x-ray.

ANS: B Refeeding syndrome occurs when patients are fed too quickly, causing rapid shifts of fluids and electrolytes, often leading to dysrhythmias. After placing the patient on a cardiac monitor, the professional should next ensure that serum electrolytes are measured. The patient's temperature is not relevant to this situation. The patient should continue to eat although calories should be decreased. There may or may not be a need for a chest x-ray.

15. A patient has acromegaly. What assessment by the healthcare professional would be most important? a. Skin condition b. Sleep patterns c. Bowel function d. Range of motion

ANS: B Sleep patterns are important to assess for in patients with acromegaly because sleep-disordered breathing such as obstructive sleep apnea is common. The skin in patients with acromegaly will be coarse. Bowel function may or may not be altered. Range of motion is decreased as an expected consequence of the disease.

14. A patient has an enlarged tongue, body odor, rough skin, and coarse hair. Which laboratory result does the healthcare professional associate with this presentation? a. Decreased blood glucose b. Increased growth hormone c. Decreased ACTH d. Increased TSH

ANS: B This patient has clinical findings suggestive of acromegaly which is caused by high levels of growth hormone (GH), often from a pituitary adenoma. It would result in high blood glucose and no effect on ACTH or TSH.

3. Which laboratory value would the nurse expect to find if a person is experiencing syndrome of inappropriate antidiuretic hormone (SIADH)? a. Hypernatremia and urine hypoosmolality b. Serum potassium (K+) level of 5 mEq/L and urine hyperosmolality compared to serum c. Serum sodium (Na+) level of 120 mEq/L and serum osmolality 260 mOsm/kg d. Serum potassium (K+) of 2.8 mEq/L and serum hyperosmolality

ANS: C A diagnosis of SIADH requires a serum sodium level of less than 135 mEq/L, serum hypoosmolality less than 280 mOsm/kg, and urine hyperosmolarity. Potassium levels are not considered a factor.

9. A person wants to know if eating only plant-based foods is advisable as a way to cut cholesterol to near-zero levels. What response by the health care professional is best? a. "No, you will become extremely malnourished." b. "Yes, that is an effective way to eliminate cholesterol." c. "No, many hormones are made from cholesterol." d. "Yes, that will increase the action of insulin."

ANS: C All the lipid-soluble hormones except thyroid hormone are synthesized from cholesterol, so it is a needed substance in the body. Vegetarian and vegan diets can be healthy so malnutrition is not the issue. Insulin is water soluble.

4. A student asks the health care professional why obese people are at higher risk for hypertension than non-obese individuals. What response by the professional is best? a. They produce more ghrelin in the stomach. b. Their thyroid gland secretes less hormone. c. They produce more angiotensinogen. d. They secrete fewer endocannabinoids.

ANS: C Angiotensinogen is a precursor of angiotensin I, which, converted to angiotensin II, is a potent vasoconstrictor. Angiotensinogen is produced both by the liver and by adipocytes; therefore obese individuals have more, leading to increased vasoconstriction and increased systemic vascular resistance which leads to high blood pressure. Ghrelin, produced in the stomach, increases food intake. The thyroid gland function is not directly linked to obesity. Endocannabinoids are associated with increase in appetite and nutrient absorption.

7. A person has abnormally severe tooth decay and erosion of the tooth enamel. What problem should the health care professional assess the person for? a. Anorexia nervosa b. Binge eating c. Bulimia d. Refeeding syndrome

ANS: C Chronic vomiting and exposure to gastric acids leads to loss of tooth enamel and decay. These are not signs of anorexia, binge eating, or refeeding syndrome.

2. Regulation of the release of insulin is an example of which type of regulation? a. Negative feedback b. Positive feedback c. Neural d. Physiologic

ANS: C Hormone release is governed by three factors: chemical factors, endocrine factors, and neural control. An example of neural control is when insulin is secreted in response to increased glucose in the blood. Negative feedback is seen when changes occur in chemical, endocrine, or neural control that lead to decreased synthesis or secretion of a hormone. Positive feedback occurs when changes in one of the factors lead to increased synthesis or secretion of a hormone. "Physiologic" is not a specific type of regulation.

11. Why is the control of calcium in cells important? a. It is controlled by the calcium negative-feedback loop. b. It is continuously synthesized. c. It acts as a second messenger. d. It carries lipid-soluble hormones in the bloodstream.

ANS: C In addition to being an important ion that participates in a multitude of cellular actions, Ca++ is considered an important second messenger. Serum calcium levels are mainly controlled by parathyroid hormone. Timing of synthesis is not related to the control of calcium levels. Calcium does not carry lipid-soluble hormones in the bloodstream.

29. What does aldosterone directly increase the reabsorption of? a. Magnesium b. Calcium c. Sodium d. Water

ANS: C In the kidney, aldosterone primarily acts on the epithelial cells of the nephron-collecting duct to increase sodium ion reabsorption. Aldosterone does not directly increase the reabsorption of magnesium, calcium, or water.

18. To ensure optimal thyroid health and function, which mineral does the health care professional advise a nutrition class to include in the daily diet? a. Iron b. Zinc c. Iodide d. Copper

ANS: C Iodine is needed for thyroid stimulating hormone (TSH) to stimulate the secretion of thyroid hormone (TH). The other minerals are important for good health, but not related to the health and function of the thyroid gland.

33. A patient has diabetes mellitus. A recent urinalysis showed increased amounts of protein. What therapy does the healthcare provider educate the patient that is specific to this disorder? a. More frequent blood glucose monitoring b. Moderate dietary sodium restriction c. Treatment with an ACE inhibitor d. Home blood pressure monitoring

ANS: C Microalbuminuria is the first manifestation of diabetic nephropathy. Treatment with an ACE inhibitor or angiotensin receptor blocker is the treatment of choice. Depending on the patient, more frequent blood glucose and blood pressure monitoring may be in order, but is not specific to this disorder and does not treat it. The patient may benefit from a moderate or even severe sodium restriction for several reasons (nephropathy, hypertension, etc.) but that is not as specific to nephropathy treatment as the medications are.

35. What causes the microvascular complications in patients with diabetes mellitus? a. The capillaries contain plaques of lipids that obstruct blood flow. b. Pressure in capillaries increases as a result of the elevated glucose attracting water. c. The capillary basement membranes thicken, and cell hyperplasia develops. d. Fibrous plaques form from the proliferation of subendothelial smooth muscle of arteries.

ANS: C Microvascular complications are a result of capillary basement membranes thickening and endothelial cell hyperplasia. They do not occur due to plaque accumulation, increased capillary pressure, or from proliferation of subendothelial smooth muscle.

7. A healthcare professional is caring for four patients. Which patient does the professional assess for neurogenic diabetes insipidus (DI)? a. Anterior pituitary tumor b. Thalamus hypofunction c. Posterior pituitary trauma d. Renal tubule disease

ANS: C Neurogenic DI is a result of dysfunctional antidiuretic hormone synthesis, caused by a lesion of the posterior pituitary, hypothalamus, or pituitary stalk. Injury of dysfunction of the anterior pituitary, the thalamus, or the renal tubules does not cause neurogenic DI.

13. Visual disturbances are a result of a pituitary adenoma because of what? a. Liberation of anterior pituitary hormones into the optic chiasm b. Pituitary hormones clouding the lens of the eyes c. Pressure of the tumor on the optic chiasm d. Pressure of the tumor on the optic and oculomotor cranial nerves

ANS: C Pressure on the optic chiasm is the only cause for visual disturbances resulting from a pituitary adenoma.

29. A person diagnosed with type 1 diabetes experienced an episode of hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The healthcare professional teaches the person that what is the most probable cause of these symptoms? a. Hyperglycemia caused by incorrect insulin administration b. Dawn phenomenon from eating a snack before bedtime c. Hypoglycemia caused by increased exercise d. Somogyi effect from insulin sensitivity

ANS: C The most likely cause of these symptoms is hypoglycemia, which is often caused by a lack of systemic glucose as a result of muscular activity or decreased food intake. Hyperglycemia is not characterized by these symptoms. The Dawn phenomenon is manifested by an early morning elevation in blood glucose. The Somogyi effect is distinguished by early morning (i.e., 4 AM) hypoglycemia followed by hyperglycemia upon arising.

18. What does Graves' disease develop from? a. A viral infection of the thyroid gland that causes overproduction of thyroid hormone b. An autoimmune process during which lymphocytes and fibrous tissue replace thyroid tissue c. A thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones d. An ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing a goiter

ANS: C The pathologic features of Graves' disease indicate that normal regulatory mechanisms are overridden by abnormal immunologic mechanisms resulting in the stimulation of excessive TH. Graves' disease is not caused by a viral infection, lymphocyte and fibrous tissue infiltration, or ingestion of goitrogens.

25. A patient had a thyroidectomy and now reports tingling around the mouth and has a positive Chvostek sign. What laboratory finding would be most helpful to the healthcare professional? a. TSH and T4 b. Serum sodium c. Serum calcium d. Urine osmolality

ANS: C The patient is displaying signs of hypocalcemia, which can be caused by hypoparathyroidism. The most common cause of hypoparathyroidism is damage caused during thyroid surgery. The healthcare professional would be more informed by a serum calcium test. Thyroid hormones, serum sodium, and urine osmolality will not provide information related to this condition.

17. A patient chart notes the patient has amenorrhea, galactorrhea, hirsutism, and osteoporosis. What diagnostic test would the healthcare professional prepare the patient for? a. Water deprivation test b. Hemoglobin A1C c. CT scan of the head d. Ovarian biopsy

ANS: C The patient presents with characteristics of a prolactinoma: a pituitary tumor that secretes prolactin. The professional would prepare the patient for a CT scan of the head. A water deprivation test is used to diagnose diabetes insipidus. The hemoglobin A1C is used to measure blood glucose over time. Polycystic ovary disease can lead to increased level of prolactin, but this is not diagnosed with

1. The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include which solute? a. Sodium and water retention b. Sodium retention and water loss c. Sodium dilution and water retention d. Sodium dilution and water loss

ANS: C The symptoms of SIADH secretion are a result of dilutional hyponatremia and water retention. SIADH does not lead to sodium retention or water loss.

19. Which patient would the healthcare professional assess for other signs of thyrotoxic crisis? a. Constipation with gastric distention b. Bradycardia and bradypnea c. Hyperthermia and tachycardia d. Constipation and lethargy

ANS: C The systemic symptoms of thyrotoxic crisis include hyperthermia, tachycardia, diarrhea, and agitation or delirium, heart failure, dysrhythmias, nausea, and vomiting.

28. What are the effects of aging on pancreatic cells? a. Pancreatic cells are replaced by fibrotic cells. b. Increased insulin production is typical. c. Beta cell function decreases. d. No appreciable change occurs on pancreatic cells.

ANS: C With aging, there is an associated decline in the functioning of pancreatic beta cells. There is no evidence to suggest that pancreatic cells are replaced with fibrotic tissue, or that insulin production increases.

27. Why does polyuria occur with diabetes mellitus? a. Formation of ketones b. Chronic insulin resistance c. Elevation in serum glucose d. Increase in antidiuretic hormone

ANS: C glucose accumulates in the blood and appears in the urine as the renal threshold for glucose is exceeded, producing an osmotic diuresis and the symptoms of polyuria and thirst. Ketone formation would lead to acidosis. Insulin resistance will promote hyperglycemia. And increase in antidiuretic hormone leads to water retention.

4. What does the student learn about the effects of long-term starvation? (Select all that apply.) a. Energy is supplied through glycogenolysis. b. Gluconeogenesis begins for energy requirements. c. Increase in inflammatory mediators. d. Use of ketone bodies for energy needs. e. Proteolysis begins in adipose tissue.

ANS: C, D Glycogenolysis and gluconeogenesis supply energy needs in short-term starvation, or fasting states. During long-term starvation the body produces more inflammatory mediators and begins using ketones for energy. Proteolysis begins once adipose tissue has been depleted.

5. A family is concerned that their most elderly member is not eating. What information about the anorexia of aging does the health care professional provide the family? (Select all that apply.) a. Usually there is a direct cause that can be treated successfully. b. Is not related to age-related changes and signifies illness c. Decreases in saliva and the sense of taste are contributing factors. d. Age-related loss of appetite is common finding. e. Social stimulation at meals might promote better eating habits.

ANS: C, D, E Anorexia of aging has multiple causes that include normal age-related changes, physiologic alterations, and social/psychological factors. Decreases in saliva and the senses of smell and taste are contributory. Aging is marked by a decrease in orexigenic signals and an increase in anorexigenic signals, leading to decreased appetite. Social isolation has also been implicated in this phenomenon.

13. A patient is in severe shock and is receiving vasopressin. A student asks the health care professional to explain the rationale for this treatment. What response by the professional is most accurate? a. "Antidiuretic hormone conserves fluid when urine output is less than 20 mL/hr." b. "Antidiuretic hormone causes serum osmolality to be increased." c. "Antidiuretic hormone leads to better insulin utilization." d. "Antidiuretic hormone causes vasoconstriction to help increase blood pressure."

ANS: D ADH in high doses causes vasoconstriction and a resulting increase in arterial blood pressure which would be important to the patient in shock. It does not cause fluid conservation, changes in serum osmolality, or better insulin utilization.

23. What is the action of calcitonin? a. Increases metabolism b. Decreases metabolism c. Increases serum calcium d. Decreases serum calcium

ANS: D Calcitonin, also called thyrocalcitonin, acts to lower serum calcium levels by inhibiting bone-resorbing osteoclasts. Calcitonin does not alter metabolism.

7. When insulin binds its receptors on muscle cells, an increase in glucose uptake by the muscle cells is the result. This is an example of what type of effect by a hormone? a. Pharmacologic b. Permissive c. Synergistic d. Direct

ANS: D Direct effects are the obvious changes in cell function that specifically result from the stimulation by a particular hormone. The term pharmacologic could be used to describe the effect of a medication on a hormone. Permissive effects encourage maximum response of functioning of a cell. Synergistic means that two separate entities work together to create a bigger result than either one would have alone; this is not a type of hormone effect.

23. A patient has a suspected thyroid carcinoma. What diagnostic test does the healthcare professional prepare the patient for? a. Measurement of serum thyroid levels b. Radioisotope scanning c. Ultrasonography d. Fine-needle aspiration biopsy

ANS: D Fine-needle aspiration of a thyroid nodule is generally performed to diagnose thyroid carcinoma. Serum thyroid levels probably will not be abnormal early in disease. Radioisotope scanning is not used and ultrasound is not specific enough for diagnosis.

21. A healthcare professional is palpating the neck of a person diagnosed with Graves' disease. What finding would the professional associate with this disorder? a. Parathyroids left of midline b. Thyroid small with discrete nodules c. Parathyroids normal in size d. Thyroid diffusely enlarged

ANS: D Graves' disease is characterized by a diffusely enlarged thyroid gland. The parathyroid glands are not involved.

31. When comparing the clinical manifestations of both diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNKS), which condition is associated with only DKA? a. Fluid loss b. Weight loss c. Increased serum glucose d. Kussmaul respirations

ANS: D Kussmaul respirations are only observed in those with DKA. This is due to compensation by the lungs for the metabolic acidosis. Both DKA and HHNKS show fluid loss, weight loss, and hyperglycemia.

3. A student asks the professor how a faulty negative-feedback mechanism results in a hormonal imbalance. What response by the professor is best? a. Hormones are not synthesized in response to cellular and tissue activities. b. Decreased hormonal secretion is a response to rising hormone levels. c. Too little hormone production is initiated. d. Excessive hormone production results from a failure to turn off the system.

ANS: D Negative-feedback systems are important in maintaining hormones within physiologic ranges. The lack of negative-feedback inhibition on hormonal release often results in pathologic conditions. Excessive hormone production, which is the result of the failure to turn off the system in response to changes in chemical, endocrine, or neurologic factors, can cause various hormonal imbalances and related conditions. Hormones are synthesized in response to cellular and tissue activities, but not appropriately.

5. Which individual does the health care professional determine is obese? a. Body mass index 23 kg/m2 b. Body mass index 25 kg/m2 c. Body mass index 29 kg/m2 d. Body mass index 32 kg/m2

ANS: D Overweight is defined as a body mass index (BMI) of >25 kg/m2, while a BMI of >30 kg/m2 is considered obese. The individual with the BMI of 23 kg/m2 would be considered of normal weight, those with BMIs of 25 and 29 kg/m2 would be considered overweight, and the person with the BMI of 32 kg/m2 is obese.

4. Which substance is a water-soluble protein hormone? a. Thyroxine b. Aldosterone c. Follicle-stimulating hormone d. Insulin

ANS: D Peptide or protein hormones, such as insulin, pituitary, hypothalamic, and parathyroid, are water soluble and circulate in free (unbound) forms. All the remaining options are fat-soluble hormones.

17. How do the releasing hormones that are made in the hypothalamus travel to the anterior pituitary? a. Vessels of the zona fasciculata b. Infundibular process c. Pituitary stalk d. Portal hypophyseal blood vessels

ANS: D Releasing and inhibitory hormones are synthesized in the hypothalamus and are secreted into the portal blood vessels through which they travel to the anterior pituitary hormones. The initial stages of aldosterone synthesis occur in the adrenal zona fasciculata and zona reticularis. The infundibular process is part of the posterior pituitary. The pituitary stalk contains the axons of neurons that originate in the supraoptic and paraventricular nuclei of the hypothalamus.

36. A healthcare professional advises a person with diabetes mellitus to have an annual eye exam. When the person asks why this is necessary, the professional states that retinopathy develops in patients with diabetes mellitus because of what reason? a. Plaques of lipids develop in the retinal vessels. b. Pressure in the retinal vessels increase as a result of increased osmotic pressure. c. Ketones cause microaneurysms in the retinal vessels. d. Retinal ischemia and red blood cell aggregation occur.

ANS: D Retinopathy appears to be a response to retinal ischemia and red blood cell aggregation. None of the remaining explanations appropriately describe the relationship between retinopathy and diabetes mellitus.

10. Which second messenger is stimulated by epinephrine binding to a β-adrenergic receptor? a. Calcium b. Inositol triphosphate (IP3) c. Diacylglycerol (DAG) d. Cyclic adenosine monophosphate (cAMP)

ANS: D Second-messenger molecules are the initial link between the first signal (hormone) and the inside of the cell. For example, the binding of epinephrine to a β-adrenergic-receptor subtype activates (through a stimulatory G protein) the enzyme, adenylyl cyclase. Adenylyl cyclase catalyzes the conversion of adenosine triphosphate (ATP) to the second messenger, 3′, and 5′-cAMP. The remaining messengers are not stimulated by epinephrine to bind as described.

37. A person has acne, easy bruising, thin extremities, and truncal obesity. The healthcare professional assesses the person for which of these? a. Previous thyroid surgery b. Urine osmolality c. Serum electrolytes d. Use of glucocorticoids

ANS: D These symptoms are characteristic of Cushing disease (or Cushing-like syndrome) which can be caused by long-term use of glucocorticoids to treat other medical conditions. Thyroid surgery, urine osmolality, and serum electrolytes would not give information about the disorder.