unit 3

2. The common cause of elevated levels of antidiuretic hormone (ADH) secretion is: a. Ectopically produced ADH c. Posterior pituitary tumor b. Inflammation of the hypothalamus d. Inflammation of the nephrons

ANS: A A common cause of elevated levels of ADH secretion is ectopically produced ADH, which makes the other options incorrect. PTS: 1 REF: Page 718

33. 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. PTS: 1 REF: Page 711

11. Which hormone does the second messenger calcium (Ca++) bind to activate phospholipase C through a G protein? a. Angiotensin II c. Estrogen b. Thyroxine d. Testosterone

ANS: A Ca++ is considered an important second messenger that facilitates the binding of a hormone (e.g., norepinephrine, angiotensin II) to a surface receptor, activating the enzyme phospholipase C through a G protein inside the plasma membrane. None of the other options acts on its target cell via a second messenger. PTS: 1 REF: Page 694

5. Which of the following is a lipid-soluble hormone? a. Cortisol c. Epinephrine b. Oxytocin 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. PTS: 1 REF: Page 691

35. Hypoglycemia, followed by rebound hyperglycemia, is observed in those with: 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. PTS: 1 REF: Page 746

11. Which condition may result from pressure exerted by a pituitary tumor? a. Hypothyroidism c. Diabetes insipidus b. Hypercortisolism 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. PTS: 1 REF: Page 722

6. What is the function of the mucus secreted by the Bartholin glands? a. Enhancement of the motility of sperm b. Lubrication of the urinary meatus and vestibule c. Maintenance of an acid-base balance to discourage proliferation of pathogenic bacteria d. Enhancement of the size of the penis during intercourse

ANS: A In response to sexual stimulation, the Bartholin glands secrete mucus that serves only to lubricate the inner labial surfaces, as well as to enhance the viability and motility of sperm. PTS: 1 REF: Page 772

22. Insulin transports which electrolyte in the cell? a. Potassium c. Sodium b. Calcium d. Phosphorus

ANS: A Insulin facilitates the intracellular transport of potassium, phosphate, and magnesium. Insulin does not facilitate the transport of the other electrolytes. PTS: 1 REF: Pages 705-706

9. Lipid-soluble hormone receptors are located: a. Inside the plasma membrane in the cytoplasm b. On the outer surface of the plasma membrane c. Inside the mitochondria d. On the inner surface of the plasma membrane

ANS: A Lipid-soluble hormone receptors are located inside the plasma membrane and easily diffuse across the plasma membrane to bind to either cytosolic or nuclear receptors. The other options are not true statements. PTS: 1 REF: Pages 694-695

13. The mucosal secretions of the cervix secrete which immunoglobulin? a. IgA c. IgG b. IgE d. IgM

ANS: A Mucosal secretions from the cervix contain enzymes and antibodies—predominantly IgA. PTS: 1 REF: Page 775

10. Which form of diabetes insipidus (DI) is treatable with exogenous antidiuretic hormone (ADH)? a. Neurogenic c. Nephrogenic b. Psychogenic d. Ischemic

ANS: A Neurogenic DI is treated with ADH replacement therapy. The other options are incorrect. PTS: 1 REF: Page 720

4. Diabetes insipidus is a result of: a. Antidiuretic hormone hyposecretion c. Insulin hyposecretion b. Antidiuretic hormone hypersecretion d. Insulin hypersecretion

ANS: A Of the available options, diabetes insipidus is a result of insufficient antidiuretic hormone. PTS: 1 REF: Page 719

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

ANS: A Once synthesized in the hypothalamus, ADH acts on the vasopressin 2 (V2) receptors of the renal duct cells to increase their permeability. This information helps eliminate the other options. PTS: 1 REF: Pages 696-698

31. Type 2 diabetes mellitus is best described as a(an): a. Resistance to insulin by insulin-sensitive tissues b. Need for lispro instead of regular insulin c. Increase of glucagon secretion from α cells of the pancreas d. Presence of insulin autoantibodies that destroy β cells in the pancreas

ANS: A One of the basic pathophysiologic characteristics of type 2 diabetes is the development of insulin-resistant tissue cells. None of the remaining options appropriately describes type 2 diabetes. PTS: 1 REF: Page 739

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

ANS: A Only biguanides decrease hepatic glucose production and increase insulin sensitivity and peripheral glucose uptake. PTS: 1 REF: Page 743 | Table 22-9

13. The portion of the pituitary that secretes oxytocin is: a. Posterior c. Anterior b. Inferior d. Superior

ANS: A Only the posterior pituitary secretes oxytocin. PTS: 1 REF: Page 698

12. The term used to describe a person who experiences a lack of all hormones associated with the anterior pituitary is: a. Panhypopituitarism c. Hypopituitarism b. Adrenocorticotropic hormone deficiency d. Anterior pituitary failure

ANS: A Panhypopituitarism is the only available term that is correctly associated with the lack of all anterior pituitary hormones. PTS: 1 REF: Page 721

27. Target cells for parathyroid hormone are located in the: a. Tubules of nephrons c. Glomeruli of nephrons b. Thyroid gland 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. PTS: 1 REF: Page 703

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

ANS: A Stress has been shown to increase adrenocorticotropic hormone secretion. The other options are not increased with stress. PTS: 1 REF: Page 708

9. Which laboratory value is consistently low in a patient with diabetes insipidus (DI)? a. Urine-specific gravity c. Urine protein b. Serum sodium d. 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. PTS: 1 REF: Page 720

20. Pathologic changes associated with Graves disease include: 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 The only option that correctly describes the changes associated with Graves disease identifies high levels of circulating thyroid-stimulating immunoglobulins that are found in more than 95% of individuals diagnosed with the disease. PTS: 1 REF: Page 726

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 The overall effect of parathyroid hormone (PTH)is to increase serum calcium and to decrease serum phosphate concentration. The other presented imbalances will not affect PTH in the described fashion. PTS: 1 REF: Pages 702-703

25. 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; therefore the other options are incorrect. PTS: 1 REF: Page 702

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 his antidiuretic hormone (ADH) level is low. Although he has had no intake for 4 hours, no change in his polyuria level has occurred. These symptoms support a diagnosis of: a. Neurogenic diabetes insipidus b. Syndrome of inappropriate antidiuretic hormone c. Psychogenic polydipsia d. Osmotically induced diuresis

ANS: A The stated symptoms are reflective of neurogenic diabetes insipidus and not of the remaining options. PTS: 1 REF: Pages 719-720

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

ANS: A With aging, the pancreatic cells are increasingly replaced with fat tissue. Dysfunction of the pancreas with decreased insulin secretion of the beta cells, insulin receptors, and insulin resistance have all been documented. PTS: 1 REF: Page 711

41. 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, hyperreflexia, tonic-clonic convulsions, laryngeal spasms, and, in severe cases, death from asphyxiation. PTS: 1 REF: Pages 733-734

42. 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. PTS: 1 REF: Page 747

34. 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. PTS: 1 REF: Pages 706-707

15. Which disorder is caused by hypersecretion of the growth hormone (GH) in adults? a. Cushing syndrome c. Giantism b. Acromegaly d. Myxedema

ANS: B Acromegaly is a term for adults who have been exposed to continuously high levels of GH, whereas the term giantism is reserved for children and adolescents. The other options do not apply to hypersecretion of GH. PTS: 1 REF: Page 722

30. Which human physiologic system is believed to be an integral factor in unhealthy aging? a. Cardiac c. Central nervous b. Endocrine d. Urinary

ANS: B Because the endocrine system is integral to health, changes in endocrine function have been used as biomarkers for unhealthy aging. The other systems, although contributing to the unhealthy aging, are not as integral. PTS: 1 REF: Page 711

8. What happens to the vagina's lining at puberty? a. It becomes thinner. c. It assumes a neutral pH. b. It becomes thicker. d. It undergoes atrophy.

ANS: B Before puberty, vaginal pH is approximately 7 (neutral) and the vaginal epithelium is thin. At puberty, the pH becomes more acidic (4 to 5) and the squamous epithelial lining thickens. Cell atrophy is not associated with puberty. PTS: 1 REF: Page 773

The initial reproductive structures of the male and female embryos appear the same until which week of gestation? a. Third c. Twentieth b. Eighth d. Thirtieth

ANS: B Between 6 and 7 weeks' gestation, the male embryo differentiates under the influence of testes-determining factor (TDF). In the absence of testosterone, a loss of the wolffian system occurs and the two gonads develop into ovaries at 6 to 8 weeks' gestation. PTS: 1 REF: Page 769

26. Renal failure is the most common cause of which type of hyperparathyroidism? a. Primary c. Exogenous b. Secondary 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. PTS: 1 REF: Page 732

29. 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. The relationship between the stated assessment values and insulin deficiency is not effectively described by any of the other options. PTS: 1 REF: Pages 744-745

8. Thyroid-stimulating hormone (TSH) is released to stimulate thyroid hormone (TH) and is inhibited when plasma levels of TH are adequate. This is an example of: a. Positive feedback c. Neural regulation b. Negative feedback 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. The described example is not accurately identified by any of the other options. PTS: 1 REF: Page 690

16. Giantism occurs only in children and adolescents because their: a. Growth hormones are still diminished. b. Epiphyseal plates have not yet closed. c. Skeletal muscles are not yet fully developed. d. Metabolic rates are higher than in adulthood.

ANS: B Giantism is related to the effects of growth hormones on the growth of long bones at their epiphyseal plates. This information makes the other options incorrect. PTS: 1 REF: Page 722

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

ANS: B Hyperphosphatemia leads to hypocalcemia; the other options are incorrect. PTS: 1 REF: Page 702

15. A surge of which hormone causes the corpus luteum to produce progesterone? a. Follicle stimulating hormone c. Gonadotropin-releasing hormone b. Luteinizing hormone d. Estrogen

ANS: B Luteinizing hormone from the anterior pituitary stimulates the corpus luteum to secrete progesterone, the second major female sex hormone. PTS: 1 REF: Page 778

16. What directly causes ovulation during the menstrual cycle? a. Gradual decrease in estrogen levels c. Sharp rise in progesterone levels b. Sudden increase of LH d. Gradual increase in estrogen levels

ANS: B Menstrual cyclicity and regular ovulation are dependent on (1) the activity of the gonadostat (GnRH pulse generator); (2) the pituitary secretion of gonadotropins; and (3) estrogen (estradiol)-positive feedback for the preovulatory LH and FSH surges, oocyte maturation, and corpus luteum formation. PTS: 1 REF: Pages 778-780

9. Which structure is lined with columnar epithelial cells? a. Perimetrium c. Myometrium b. Endocervical canal d. Vagina

ANS: B Of the available options, only the endocervical canal does not have an endometrial layer; rather, the layer is lined with columnar epithelial cells. PTS: 1 REF: Page 775

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

ANS: B Of the available options, the catecholamine epinephrine (adrenaline) is the only major product secreted. PTS: 1 REF: Page 710

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 c. Psychogenic b. Nephrogenic d. Ischemic

ANS: B Only nephrogenic DI is associated with an insensitivity of the renal collecting tubules to ADH. PTS: 1 REF: Page 720

20. Which hormone triggers uterine contractions? a. Thyroxine c. Growth hormone b. Oxytocin 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. The remaining options are not capable of triggering uterine contractions. PTS: 1 REF: Page 699

6. Most protein hormones are transported in the bloodstream and are: 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. The other options are not true statements related to the transport of protein hormones. PTS: 1 REF: Page 691

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

ANS: B Prolactin-releasing factor targets the anterior pituitary gland to stimulate the secretion of prolactin. The other remaining options are incorrect. PTS: 1 REF: Page 698 | Table 21-4

14. Which disorder is considered a co-morbid condition of acromegaly? a. Hypotension c. Brain cancer b. Diabetes d. Thyroid cancer

ANS: B Symptoms of type 2 diabetes mellitus, such as polyuria and polydipsia, may occur. Acromegaly-associated hypertension is usually asymptomatic until symptoms of heart failure develop. Neither thyroid nor brain cancer has been associated with acromegaly. PTS: 1 REF: Page 724

5. The Skene glands are located on either side of which structure? a. Introitus c. Clitoris b. Urinary meatus d. Vestibule

ANS: B The ducts of the Skene glands (also called the lesser vestibular or paraurethral glands) are related only to the urinary meatus. PTS: 1 REF: Page 772

21. The level of thyroid-stimulating hormone (TSH) in individuals with Graves disease is usually: a. High c. Normal b. Low d. In constant flux

ANS: B The hyperfunction of the thyroid gland leads to suppression of TSH because of the normal negative feedback mechanism, thus eliminating the other options as being correct. PTS: 1 REF: Page 726

23. A deficiency of which chemical may result in hypothyroidism? a. Iron c. Zinc b. Iodine d. Magnesium

ANS: B The only cause of hypothyroidism from among the provided options is a deficiency of endemic iodine. PTS: 1 REF: Page 728

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 c. Serum sodium (Na+) level of 120 mEq/L and serum hypoosmolality d. Hypokalemia 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. PTS: 1 REF: Page 719

7. Which change is a result of puberty and defends the vagina from infection? a. The pH stabilizes between 7 and 8. b. A thin squamous epithelial lining develops. c. Vaginal pH becomes more acidic. d. Estrogen levels are low.

ANS: C At puberty, the pH becomes more acidic (4 to 5) and the squamous epithelial lining thickens. These changes are maintained until menopause (cessation of menstruation), at which time the pH rises again to more alkaline levels and the epithelium thins out. Therefore protection from infection is greatest during the years when a woman is most likely to be sexually active. Estrogen does not play a role in infection protection. PTS: 1 REF: Page 773

30. Polyuria occurs with diabetes mellitus because of the: a. Formation of ketones c. Elevation in serum glucose b. Chronic insulin resistance 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. None of the other options appropriately describes the pathologic features of diabetes mellitus-induced polyuria. PTS: 1 REF: Page 738

12. The control of calcium in cells is important because it: a. Is controlled by the calcium negative-feedback loop. b. Is continuously synthesized. c. Acts as a second messenger. d. 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. The other options are not true statements related to the control of calcium within the cells. PTS: 1 REF: Page 694

3. Which gland produces the associated hormones that are found in high levels in a female fetus? a. Posterior pituitary excretes gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH). b. Hypothalamus excretes luteinizing hormone (LH) and gonadotropin-releasing hormone (GnRH). c. Anterior pituitaryfollicle-stimulating hormone (FSH) and luteinizing hormone (LH). d. Hypothalamus excretes gonadotropin-releasing hormone (GnRH) and follicle-stimulating hormone (FSH).

ANS: C In the female fetus, the anterior pituitary excretes high levels of two gonadotropins—FSH and LH. The other sequences are not correct. PTS: 1 REF: Pages 769-770 4. Which hormone is linked to an increase in appetite during puberty? a. Inhibin c. Activin b. Leptin d. Follistatin ANS: B Sensitivity to leptin, which regulates appetite and energy metabolism, increases during puberty; in theory, the adolescent consumes more calories to meet the caloric needs of the pubertal growth spurt. The percent of body fat and leptin levels in girls continue to increase, whereas muscle mass increases in boys. No apparent link exists between increased appetite during puberty and any of the other options. PTS: 1 REF: Page 778

32. Aldosterone directly increases the reabsorption of: a. Magnesium c. Sodium b. Calcium d. Water

ANS: C In the kidney, aldosterone primarily acts on the epithelial cells of the nephron-collecting duct to increase sodium ion reabsorption. This action cannot be said of the other options. PTS: 1 REF: Page 709

36. The first laboratory test that indicates type 1 diabetes is causing the development of diabetic nephropathy is: a. Dipstick test for urine ketones b. Increase in serum creatinine and blood urea nitrogen c. Protein on urinalysis d. Cloudy urine on the urinalysis

ANS: C Microalbuminuria is the first manifestation of this form of renal failure. Although the other options may develop, they occur after protein is found in the urine. PTS: 1 REF: Pages 748-749

38. 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 increase 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. None of the remaining options appropriately describes the cause of microvascular complications in patients with diabetes mellitus. PTS: 1 REF: Page 747

7. The cause of neurogenic diabetes insipidus (DI) is related to an organic lesion of the: a. Anterior pituitary c. Posterior pituitary b. Thalamus d. Renal tubules

ANS: C Neurogenic DI is a result of dysfunctional antidiuretic hormone synthesis, caused by a lesion of the posterior pituitary, hypothalamus, or pituitary stalk. PTS: 1 REF: Page 719

13. Visual disturbances are a result of a pituitary adenoma because of the: 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 Of the available options, pressure on the optic chiasm is the only cause for visual disturbances resulting from a pituitary adenoma. PTS: 1 REF: Page 722

17. Amenorrhea, galactorrhea, hirsutism, and osteoporosis are each caused by a: a. Posterior pituitary adenoma c. Prolactinoma b. Thymoma d. Growth hormone adenoma

ANS: C Of the options available, the hallmark of a prolactinoma is the sustained elevation of serum prolactin that is responsible for the symptoms listed in the question. PTS: 1 REF: Page 724

29. The secretion of adrenocorticotropic-stimulating hormone (ACTH) will result in the increased level of which hormone? a. Thyroxine c. Cortisol. b. Insulin d. Antidiuretic hormone

ANS: C Psychologic and physiologic stress (e.g., hypoxia, hypoglycemia, hyperthermia, exercise) increases ACTH secretion, leading to increased cortisol levels. Only cortisol describes the appropriate feedback loop. PTS: 1 REF: Page 708

19. Which mineral is needed for thyroid-stimulating hormone (TSH) to stimulate the secretion of thyroid hormone (TH)? a. Iron c. Iodide b. Zinc d. Copper

ANS: C TSH, which is synthesized and stored in the anterior pituitary, stimulates secretion of TH by activating intracellular processes, including the uptake of iodine necessary for the synthesis of TH. This supports the elimination of the other options. PTS: 1 REF: Page 713

10. Where is the usual site of fertilization of an ovum? a. Trumpet end of the fallopian tubes c. Ampulla of the fallopian tubes b. Fimbriae of the fallopian tubes d. Os of the fallopian tubes

ANS: C The ampulla, or distal third, of the fallopian tube is the usual site of fertilization (see Figure 23-7). PTS: 1 REF: Page 775

17. Which anatomic structure secretes follicle stimulating hormone (FSH) and luteinizing hormone (LH)? a. Hypothalamus c. Anterior pituitary b. Ovaries d. Adrenal cortex

ANS: C The anterior pituitary is the gland that secretes FSH and LH. PTS: 1 REF: Pages 780-781

28. The most probable cause of low serum calcium after a thyroidectomy is: a. Hyperparathyroidism, secondary to Graves disease b. Myxedema, secondary to surgery c. Hypoparathyroidism caused by surgical injury d. Hypothyroidism caused by the lack of thyroid replacement

ANS: C The most common cause of hypoparathyroidism is damage caused during thyroid surgery, resulting in a lack of circulating PTH and causing a depressed level of serum calcium. This information supports the elimination of the other options. PTS: 1 REF: Page 733

27. The most common cause of hypoparathyroidism is: a. Pituitary hyposecretion c. Parathyroid gland damage b. Parathyroid adenoma d. Autoimmune parathyroid disease

ANS: C The most common cause of hypoparathyroidism is damage caused during thyroid surgery, thus eliminating the other options as being correct. PTS: 1 REF: Page 733

32. A person diagnosed with type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is: 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. None of the remaining options appropriately describes why a person diagnosed with type 1 diabetes experiences the described symptoms. PTS: 1 REF: Page 744 | Table 22-10

18. Graves disease develops from a(n): a. Viral infection of the thyroid gland that causes overproduction of thyroid hormone b. Autoimmune process during which lymphocytes and fibrous tissue replace thyroid tissue c. Thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones d. Ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing a goiter

ANS: C The pathologic features of Graves disease indicates that normal regulatory mechanisms are overridden by abnormal immunologic mechanisms that result in the stimulation of excessive TH. The remaining options are incorrect statements. PTS: 1 REF: Page 726

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

ANS: C The release of hormones occurs either in response to an alteration in the cellular environment or in the process of maintaining a regulated level of certain hormones or certain substances. Several different mechanisms, one of which is neural control (e.g., stress-induced release of catecholamines from the adrenal medulla), regulate the release of hormones. The remaining options do not accurately describe the example given. PTS: 1 REF: Page 690

1. The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include solute: a. Retention and water retention c. Dilution and water retention b. Retention and water loss d. Dilution and water loss

ANS: C The symptoms of SIADH secretion are a result of dilutional hyponatremia and water retention. This information supports the elimination of the other options. PTS: 1 REF: Page 719

19. The signs of thyrotoxic crisis include: a. Constipation with gastric distention c. Hyperthermia and tachycardia b. Bradycardia and bradypnea d. Constipation and lethargy

ANS: C The systemic symptoms of thyrotoxic crisis include hyperthermia and tachycardia. The remaining options are not associated with this disorder. PTS: 1 REF: Page 728

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

ANS: C Two hormones from the hypothalamus control GH secretion: (1) GH-releasing hormone (GHRH), which increases GH secretion; and (2) somatostatin, which inhibits it. The other options would not produce the necessary effect. PTS: 1 REF: Page 700

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

ANS: D ADH and oxytocin are synthesized in hypothalamic neurons but are stored and secreted by the posterior pituitary. The other options do not synthesize oxytocin. PTS: 1 REF: Page 713

14. Antidiuretic hormone acts to cause vasoconstriction when: a. Urine output is less than 20 ml/hr. b. Serum osmolality is increased. c. Osmotic and oncotic pressures are increased. d. Vasopressin is pharmacologically administered.

ANS: D ADH was originally named vasopressin because, in extremely high doses, it causes vasoconstriction and a resulting increase in arterial blood pressure. However, significant vasoconstriction may only be achieved pharmacologically. Antidiuretic hormone induced vasoconstriction is not a result of the other options. PTS: 1 REF: Pages 698-699

14. The equivalent to the female gonad is the male: a. Epididymis c. Vas deferens b. Spermatic cord d. Testes

ANS: D Between 6 to 7 weeks' gestation, the male embryo will differentiate under the influence of TDF. TDF stimulates the male gonads to develop into the two testes. The ovaries, the female gonads, are the primary female reproductive organs. PTS: 1 REF: Page 769

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

ANS: D Calcitonin, also called thyrocalcitonin, acts to lower serum calcium levels by inhibiting bone-resorbing osteoclasts, making the other options incorrect. PTS: 1 REF: Page 702

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 c. Synergistic b. Permissive d. Direct

ANS: D Direct effects are the obvious changes in cell function that specifically result from the stimulation by a particular hormone. The other options are not used to identify the described effect. PTS: 1 REF: Page 696

25. Diagnosing a thyroid carcinoma is best performed with: a. Measurement of serum thyroid levels c. Ultrasonography b. Radioisotope scanning d. Fine-needle aspiration biopsy

ANS: D Fine-needle aspiration of a thyroid nodule is generally performed to diagnose this condition; this method is best for early detection, thus eliminating the other options. PTS: 1 REF: Page 731

2. The absence of which major hormone is a determinant of sexual differentiation (wolffian system) in utero? a. Estrogen c. Growth hormone b. Progesterone d. Testosterone

ANS: D In the absence of testosterone, a loss of the wolffian system occurs and the two gonads develop into ovaries at 6 to 8 weeks' gestation. Between 6 and 7 weeks' gestation, the male embryo differentiates under the influence of TDF. The presence of estrogen is a determinating factor. None of the other options function as a major determinant to sexual differentiation in utero. PTS: 1 REF: Page 769

34. 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 c. Increased serum glucose b. Weight loss d. Kussmaul respirations

ANS: D Kussmaul respirations are only observed in those with DKA. PTS: 1 REF: Pages 745-746

3. How does a faulty negative-feedback mechanism result in a hormonal imbalance? 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, can cause various hormonal imbalances and related conditions. The correct option is the only accurate description of this hormonal function. PTS: 1 REF: Pages 690-691

4. Which substance is a water-soluble protein hormone? a. Thyroxine c. Follicle-stimulating hormone b. Aldosterone 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. PTS: 1 REF: Page 691

18. The releasing hormones that are made in the hypothalamus travel to the anterior pituitary via the: a. Vessels of the zona fasciculata c. Hypophyseal stalk b. Infundibular stem 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 releasing hormones do not enter the anterior pituitary gland via any of the other options. PTS: 1 REF: Pages 696-697

39. Retinopathy develops in patients with diabetes mellitus because: 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 options appropriately describes the relationship between retinopathy and diabetes mellitus. PTS: 1 REF: Page 747

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 (see Table 21-3). 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. PTS: 1 REF: Page 694

24. What are clinical manifestations of hypothyroidism? a. Intolerance to heat, tachycardia, and weight loss b. Oligomenorrhea, fatigue, and warm skin c. Restlessness, increased appetite, and metrorrhagia d. Constipation, decreased heat rate, and lethargy

ANS: D The lower levels of thyroid hormone result in decreased energy metabolism, resulting in constipation, bradycardia, and lethargy, thus eliminating the remaining options. PTS: 1 REF: Pages 728-730 | Table 22-3

22. Palpation of the neck of a person diagnosed with Graves disease would detect a thyroid that is: a. Left of midline c. Normal in size b. Small with discrete nodules d. Diffusely enlarged

ANS: D The only option that characterizes Graves disease is a diffused enlargement of the thyroid gland. PTS: 1 REF: Page 760

11. Where is the usual site of cervical dysplasia or cancer in situ? a. Squamous epithelium of the cervix meets the cuboidal epithelium of the vagina. b. Columnar epithelium of the cervix meets the squamous epithelium of the uterus. c. Squamous epithelium of the cervix meets the columnar epithelium of the uterus. d. Columnar epithelium of the cervix meets the squamous epithelium of the vagina.

ANS: D The point at which the columnar epithelium of the cervix meets the squamous epithelium of the vagina is called the transformation zone or the squamous-columnar junction. The transformation zone is especially susceptible to the oncogenic human papillomavirus (HPV), which leads to cervical dysplasia and, ultimately, cervical cancer; these are the cells sampled during a Papanicolaou (Pap) test. PTS: 1 REF: Page 775[ 12. Having ejected a mature ovum, the ovarian follicle develops into a(n): a. Atretic follicle c. Corpus luteum b. Thecal follicle d. Functional scar[ ANS: C Having ejected a mature ovum, the only resulting structure is the corpus luteum. PTS: 1 REF: Page 776

40. A person has acne, easy bruising, thin extremities, and truncal obesity. These clinical manifestations are indicative of which endocrine disorder? a. Hyperthyroidism c. Diabetes insipidus b. Hypoaldosteronism d. Cushing disease

ANS: D These symptoms are characteristic of Cushing disease and are caused by excessive ACTH secretion. The symptoms described are not characteristic of any of the other options. PTS: 1 REF: Pages 753-755

6. Diabetes insipidus, diabetes mellitus, and syndrome of inappropriate antidiuretic hormone all exhibit which symptom? a. Polyuria c. Vomiting b. Edema d. Thirst

ANS: D Thirst is the only symptom common to all these conditions. PTS: 1 REF: Pages 719-720 | Pages 737-738

Cortisol

Adrenal cortex

Glycoproteins

Anterior pituitary

Calcitonin

C. Thyroid

Adrenal medulla

Epinephrine

__Oxytocin

__ Posterior pituitary

Erections begin

in utero and continue throughout life, but ejaculation does not occur until sperm production begins at puberty.