Chapter 22: Alterations of Hormonal Regulation- McCance

Match the phrases with the corresponding terms: 43. Hypersecretion of thyroid hormone (TH) 44. Hypersecretion of adrenocorticotropic hormone (ACTH) 45. Hypersecretion of adrenal medulla hormones 46. Hyposecretion of thyroid hormone (TH) 47. Hyposecretion of adrenal cortex hormones 48. Hypersecretion of growth hormone (GH) ______ A. Acromegaly ______ B. Cushing disease ______ C. Addison disease ______ D. Graves disease ______ E. Myxedema ______ F. Pheochromocytoma

43. ANS: D Graves disease is caused by the hypersecretion of TH. 44. ANS: B Cushing disease is caused by the hypersecretion of ACTH. 45. ANS: F Pheochromocytoma is a tumor that causes hypersecretion of adrenal medulla hormones. 46. ANS: E Myxedema is the long-standing hyposecretion of TH. 47. ANS: C Addison disease is a result of hyposecretion of adrenal cortex hormones. 48. ANS: A Acromegaly is the condition associated with the exposure of adults to high levels of GH.

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

b. Low 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.

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.

b. Epiphyseal plates have not yet closed. 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.

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

b. Iodine ANS: B The only cause of hypothyroidism from among the provided options is a deficiency of endemic iodine.

33. 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

a. 28 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.

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

a. Antidiuretic hormone hyposecretion ANS: A Of the available options, diabetes insipidus is a result of insufficient antidiuretic hormone.

37. 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)

a. Biguanide (metformin) ANS: A Only biguanides decrease hepatic glucose production and increase insulin sensitivity and peripheral glucose uptake.

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

a. Ectopically produced ADH ANS: A A common cause of elevated levels of ADH secretion is ectopically produced ADH, which makes the other options incorrect.

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

a. High levels of circulating thyroid-stimulating immunoglobulins 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.

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

a. Hypothyroidism ANS: A If the tumor exerts sufficient pressure, then thyroid and adrenal hypofunction may occur because of a 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.

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

a. Neurogenic

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

a. Neurogenic diabetes insipidus ANS: A The stated symptoms are reflective of neurogenic diabetes insipidus and not of the remaining options.

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

a. Panhypopituitarism ANS: A Panhypopituitarism is the only available term that is correctly associated with the lack of all anterior pituitary hormones.

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

a. Resistance to insulin by insulin-sensitive tissues 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.

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

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

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

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

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

b. Acromegaly 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.

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.

b. Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis. 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.

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

b. Diabetes 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.

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

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

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

b. Secondary 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.

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

c. Dilution and water retention 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.

30. Polyuria occurs with diabetes mellitus because of the: a. Formation of ketones b. Chronic insulin resistance c. Elevation in serum glucose d. Increase in antidiuretic hormone

c. Elevation in serum glucose 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.

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

c. Hyperthermia and tachycardia ANS: C The systemic symptoms of thyrotoxic crisis include hyperthermia and tachycardia. The remaining options are not associated with this disorder.

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

c. Hypoglycemia caused by increased exercise 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.

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

c. Hypoparathyroidism caused by surgical injury 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.

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

c. Parathyroid gland damage ANS: C The most common cause of hypoparathyroidism is damage caused during thyroid surgery, thus eliminating the other options as being correct.

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

c. Posterior pituitary. ANS: C Neurogenic DI is a result of dysfunctional antidiuretic hormone synthesis, caused by a lesion of the posterior pituitary, hypothalamus, or pituitary stalk.

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

c. Pressure of the tumor on the optic chiasm ANS: C Of the available options, pressure on the optic chiasm is the only cause for visual disturbances resulting from a pituitary adenoma.

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

c. Prolactinoma 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.

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

c. Protein on 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.

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

c. Serum sodium (Na+) level of 120 mEq/L and serum hypoosmolality 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.

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

d. Kussmaul respirations ANS: D Kussmaul respirations are only observed in those with DKA.

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.

c. The capillary basement membranes thicken, and cell hyperplasia develops. 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.

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

c. Thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones 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.

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 heart rate, and lethargy

d. Constipation, decreased heart 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.

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

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.

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

d. Diffusely enlarged ANS: D The only option that characterizes Graves disease is a diffused enlargement of the thyroid gland.

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

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.

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.

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.

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

d. Thirst ANS: D Thirst is the only symptom common to all these conditions.