Ch 40 Endocrine function al
A nurse who works in the office of an endocrinologist is orienting a new staff member. Which teaching point should the nurse include in the orientation? A. "The regulation of homeostasis requires that hormones be absent from the body when their effect is not needed." B. "Sometimes hormones act locally on the area where they were produced, as in the case of endocrine actions." C. "It's uncommon for production of hormones to be far removed from the tissue where they ultimately exert their effect." D. "A single hormone can act on not only one process or organ but often on several different locations or processes."
"D. A single hormone can act on not only one process or organ but often on several different locations or processes." A single hormone can exert various effects in different tissues, or conversely, a single function can be regulated by several different hormones. Hormones act both distantly from their source and more locally, as in the case of autocrine and paracrine actions. Hormones are normally present at all times.
Select the category of hormones that include norepinephrine and epinephrine. Amines and amino acids Peptides Glycoproteins Steroids
Amines and amino acids Hormones can be divided into three categories: (1) amines and amino acids; (2) peptides, polypeptides, proteins, and glycoproteins; and (3) steroids. The amines include norepinephrine and epinephrine. The second category, the peptides, includes polypeptides, proteins, and glycoproteins. The third category consists of the steroid hormones, which are derivatives of cholesterol.
Thyroid and steroid hormones, which exert their effect on target cells by way of nuclear receptors, have which of the following characteristics? A) The selective use of a second messenger B) The ability to cross the cell membrane of target cells C) The ability to regulate surface receptor affinity D) Both lipid solubility and water solubility
B) The ability to cross the cell membrane of target cells
A nurse examines the laboratory values of a client in heart failure. Which value indicates a compensatory hormone mechanism? Elevated serum pH Decreased red blood cell count Decreased hematocrit Elevated atrial natriuretic hormone
Elevated atrial natriuretic hormone In heart failure, the client experiences fluid backlog in the heart as venous blood continues to return, but cardiac output is reduced. This stretches the atria, which secrete atrial natriuretic hormone (or peptide) to stimulate vasodilation and increased renal excretion of sodium and water. This reduces the volume and the strain in the heart.
An infant whose mother had myxedema during the pregnancy has failed to meet standards for growth and is developmentally delayed. Which hormonal imbalance is this child exhibiting? Hypoglycemia Dopamine insufficiency Hypothyroidism Calcium insufficiency
Hypothyroidism Thyroid hormone is necessary for metabolism at all ages, as well as growth and development during childhood. Uncorrected thyroid insufficiency in childhood leads to cretinism, a condition with marked physical and intellectual disability. Myxedema is the term used for thyroid insufficiency in adults.
The hormone levels in the body need to be kept within an appropriate range. How is this accomplished for many of the hormones in the body? Positive feedback loop Negative feedback loop Regulated feedback loop Sensory feedback loop
Negative feedback loop The level of many of the hormones in the body is regulated by negative feedback mechanisms.
As part of maintaining homeostasis, why are hormones, secreted by endocrine cells, continuously inactivated? Stimulate production Free receptor sites Absorb metabolic waste Prevent accumulation
Prevent accumulation Continuous inactivation of secreted hormones is necessary to prevent accumulation that could disrupt the feedback mechanism. Increased secretion stimulates production of more receptor sites. Metabolic waste absorption is not a function of the endocrine system.
Which hormones cross cell membranes to connect to nuclear receptors? Select all that apply. Parathyroid hormone Vitamin D Glucocorticoids Thyroid hormones Glucagon
Vitamin D Thyroid hormones Glucocorticoids Steroids, vitamin D, and thyroid hormone are fat soluble and they can cross the cell membrane, where they then connect to intracellular receptors that move to the nucleus and bind with receptors on the target gene.
Which of the following hormones are synthesized by non-vesicle-mediated pathways? Select all that apply. A) Epinephrine B) Estrogen C) Insulin D) Aldosterone
B) Estrogen D) Aldosterone
A diabetic client is controlled on Avandia (rosiglitazone), a thiazolidinedione medication that acts at the level of nuclear peroxisome proliferator-activated receptors (PPARs) to promote: A) Glucose uptake B)Stimulation of the beta cells in the pancreas C) Increase in basal metabolic rate D) Weight loss by shrinking fat cells
A) Glucose uptake
A hormone has been synthesized in the rough endoplasmic reticulum of an endocrine cell after which it has moved into the Golgi complex, been packaged in a vesicle, and been released into circulation. From the following list, which hormone is synthesized and released in this manner? A) Insulin B) Cortisol C) Testosterone D) Estrogen
A) Insulin
When trying to explain hypothyroidism to a newly diagnosed client, the nurse stresses the fact that the thyroid hormone is transported in blood by specific: A) Proteins B) Target cells C) Cholesterol molecules D) Prohormones
A) Proteins
When hormones act locally rather than being secreted into the bloodstream, their actions are termed: Autocrine and paracrine Preventers and inhibitors Autocratic and paracratic Localized and influential
Autocrine and paracrine When hormones act locally on cells other than those that produced the hormone, the action is called paracrine. Hormones also can exert an autocrine action on the cells from which they were produced.
When sensors detect a change in a hormone level, the hormonal response is regulated by which of the following mechanisms that will return the level to within normal range. A) Metabolic B) Feedback C) Production D) Action potential
B) Feedback
17. When discussing luteinizing hormone and follicle-stimulating hormone with students, the instructor will emphasize that these hormones are under the control of: A)Thyroid gland B)Anterior pituitary gland C)Posterior adrenal cortex D)Pancreas
B) Anterior pituitary gland
The release of insulin from the pancreatic beta cells can inhibit its further release from the same cells. This is an example of which type of hormone action? A) Retinoid B) Autocrine C) Juxtaposed D) Arachidonic
B) Autocrine
While teaching a science class, the instructor mentions that both autocrine and paracrine hormonal actions occur without entering the blood stream. The instructor then asks the students, "What cells do paracrine actions affect?" The student with the correct answer is: A) Self B) Local C) Stored D) Target
B) Local
Hormones are usually divided into categories according to their structure. The release of epinephrine would be classified as: A) Proteins B) Steroids C) Amines and amino acids D) Peptides and polypeptides
C) Amines and amino acids
The nurse is planning to collect a 24-hour urine sample for hormone assay. In which situation does the nurse collaborate with the health care provider to find an alternate type of testing? Client has diabetes. Client has hypothyroidism. Client has anuria. Client has anemia.
Client has anuria. The advantages of a urine test include the relative ease of obtaining urine samples and the fact that blood sampling is not required. The disadvantage is that reliably timed urine collections often are difficult to obtain and rely on adequate renal function. Anuria refers to the absence of urine output.
Cyclic adenosine monophosphate (cAMP) performs which of the following roles in the functioning of the endocrine system? A Mediating hormone synthesis by non-vesicle-mediated pathways B) Acting as a high-affinity receptor on the surface of target cells C) Inactivating hormones to prevent excess accumulation D) Acting as a second messenger to mediate hormone action on target cells
D) Acting as a second messenger to mediate hormone action on target cells
The nurse is caring for a client who has hyperthyroidism. When evaluating the laboratory test results, which alteration does the nurse anticipate will be present? Decrease in TSH Increase in ACTH Increase in TSH Decrease in ACTH
Decrease in TSH When the sensors detect a decrease in hormone levels, they initiate changes that cause an increase in hormone production. When hormone levels rise above the set point of the system, the sensors cause hormone production and release to decrease. For example, sensors in the hypothalamus or anterior pituitary gland detect an increase in thyroid hormone, and this causes a reduction in the secretion of TSH, with a subsequent decrease in the output of thyroid hormone from the thyroid gland.
An adult client with a possible growth hormone (GH)-secreting tumor is undergoing testing. If a glucose load is given, which response by the body would confirm the client has a GH-secreting tumor? Suppresion of the GH level Elevated GH level after a glucose load No change in blood level after the glucose load Development of gigantism
Elevated GH level after a glucose load When a GH-secreting tumor is suspectred, the GH response to a glucose load is measured as part of the diagnostic workup. Normally, a glucose load would suppress GH levels. However, in adults with GH-secreting tumors (a condition known as acromegaly), GH levels are not suppressed.
A client has developed a tumor of the anterior pituitary gland. The nurse is aware that the client is at risk for alterations in which body function? Select all that apply. A. Growth and metabolism B. Function of the thyroid gland C. Glucocorticoid hormone levels D. Function of the gonads E. Storage and release of ADH F. Oxytocin secretion
GFTAP Growth and metabolism Function of the gonads Function of the thyroid gland Glucocorticoid hormone levels Hormones produced by the anterior pituitary control body growth and metabolism (GH), function of the thyroid gland (TSH), glucocorticoid hormone levels (ACTH), function of the gonads (FSH and LH), and breast growth and milk production (prolactin). The posterior pituitary gland stores and releases antidiuretic hormone (ADH) and oxytocin.
Which hormone is produced by the anterior pituitary gland? Growth hormone (GH) Oxytocin Corticotropin-releasing hormone (CRH) Norepinephrine
Growth hormone (GH) GH is among the hormones produced and released by the anterior pituitary. Oxytocin is a posterior pituitary hormone, whereas CRH is produced by the hypothalamus. Norepinephrine and epinephrine are produced by the adrenal medulla.
When hypofunction of an endocrine organ is suspected, which type of diagnostic test can be administered to measure and assess target gland response? 24-hour urine Antibody binding Hormone stimulation Agglutination
Hormone stimulation Stimulating hormone can be given to identify (determine hypofunction) if the target gland is able to increase hormone response to increased stimulation. Agglutination with enzymes is a way of measuring hormone antigen levels. The 24-hour urine sample measures hormone metabolite excretion. Radioactive hormone-antibody binding levels provide a method of measuring plasma levels.
Release and synthesis of anterior pituitary hormones are mainly regulated by which part of the body? Hypothalamus Cell receptors Adrenal gland Thymus gland
Hypothalamus The hypophysis (pituitary plus hypothalamus) and hypothalamus stimulatory hormones regulate the release and synthesis of anterior pituitary hormones. The adrenal gland and thymus gland hormones are regulated by the hypothalamus. Cell receptors are involved with the target cell response to the hormones.
The nurse is discussing positive feedback mechanisms. Which example best explains this mechanism? A. Decreased thyroid hormone (TH) increases thyroid-stimulating hormone (TSH) levels. B. Decreased cortisone levels increase blood levels of adrenocorticotropic hormone (ACTH). C. Increased estradiol production causes increased follicle-stimulating hormone (FSH) production. D. Increased glucose levels in the blood decreases growth hormone (GH) levels.
Increased estradiol production causes increased follicle-stimulating hormone (FSH) production. The positive feedback mechanism regulates hormones as follows: a rising level of a hormone causes another gland to release a hormone that is stimulating to the first. The other choices represent negative feedback mechanisms of control.
An adult client with suspected hypothyroidism is scheduled for a thyrotropin-releasing hormone (TRH) stimulation test to evaluate pituitary response. Which test results would confirm secondary hypothyroidism? No increase in TSH Increased thyroid-stimulating hormone (TSH) Increased calcitonin No increase in calcitonin
No increase in TSH A stimulation test is intended to determine if an organ that is undersecreting will produce an increased response. A normal response to the TRH stimulation test would be for the pituitary to produce an increased amount of TSH. If the pituitary gland responds with increased production, then hypothalamic undersecretion may be the cause of the condition. If the pituitary does not increase secretion, it can indicate secondary hypothyroidism. Calcitonin is not secreted by the pituitary.
Which of the following are examples of amines? Select all that apply. Norepinephrine Epinephrine Growth hormone (GH) Follicle stimulating hormone (FSH) Thyrotropin-releasing hormone (TRH)
Norepinephrine Epinephrine The amines include only norepinephrine and epinephrine. The remaining options are classified as peptides.
A nursing instructor is teaching a group of students about the action of hormones. The instructor determined that teaching was effective when the students recognize the local action of hormones as: Autocrine Pancreatic Hormonal Paracrine
Paracrine : When hormones act locally on cells other than those that produced the hormone, the action is called paracrine. Hormones can also exert an autocrine action on the cells in which they were produced. Pancreatic and hormonal are not actions.
Which gland is often referred to as the master gland because it secretes many hormones? Thyroid Hypothalamus Pancreas Pituitary
Pituitary The pituitary gland has been called the master gland because its hormones control the functions of many target glands and cells. That is not a term used to refer to the other options.
Which structure controls the functions of the greatest number of target glands and cells? Pancreas Thyroid gland Pituitary gland Adrenal cortex
Pituitary gland The pituitary gland has been called the master gland because its hormones control the functions of many target glands and cells. It supersedes the importance of the thyroid, adrenal cortex, or pancreas in this regulatory role.
Hormones are chemical messengers that provide which function in the body? Cause one specific tissue effect Regulate body functions Initiate immune reactions Transport fatty acids and lipids
Regulate body functions Hormones regulate and integrate body functions. Hormones act on specific target cells, but they cause a variety of effects on tissues. Hormones do not transport other substances; hormones are transported and present in body fluids at all times.
Which manifestation would a nurse expect when assessing a child with insufficient growth hormone (GH) secretion? Lower blood calcium levels Mental sluggishness Increased susceptibility to infection Rank below 10% on the growth chart
Rank below 10% on the growth chart GH stimulates growth of bone and muscle and promotes protein synthesis and fat metabolism and decreased carbohydrate metabolism. A child lacking sufficient GH would demonstrate lack of growth but not the mental delays seen in childhood hypothyroidism.
A client has received an injection containing thyrotropin-releasing hormone (TRH) and is now being assessed for serum levels of thyroid-stimulating hormone (TSH). Which type of diagnostic testing is this client undergoing? Stimulation testing Autoantibody testing Radioimmunoassay (RIA) Suppression testing
Stimulation testing Introduction of TRH tests the pituitary gland's ability to produce TSH, and is an example of a stimulation test. Suppression testing examines a gland's response to a stimulus that would normally result in decreased hormone production. RIA and autoantibody testing are examples of direct and indirect measurement of serum levels of a hormone.
The nurse is teaching a client who has been newly diagnosed with hypothyroidism about the function of the thyroid. Which statement about the role of the thyroid gland is most accurate? A. The thyroid gland is responsible for regulating serum calcium levels. B. The thyroid gland promotes development of secondary sex characteristics. C. The thyroid gland releases neurotransmitters when the "flight or flight" mechanism is stimulated. D. The thyroid gland is responsible for increasing the metabolic rate.
The thyroid gland is responsible for increasing the metabolic rate. The thyroid gland produces thyroid hormones, T3 and T4. These hormones increase the metabolic rate; increase protein and bone turnover; increase responsiveness to catecholamines; are necessary for fetal and infant growth and development. The parathyroid gland regulates calcium metabolism. The adrenal glands regulate "flight or fight" and the testes or ovaries regulate development of secondary sex characteristics.
While reviewing the major actions of follicle-stimulating hormone (FSH), the faculty points out that in males this hormone is responsible for the: size of gonads. sperm production. testosterone levels. size of muscles.
sperm production. FSH in males stimulates sperm production. GH stimulates growth of bone and muscle. LH stimulates secretions of testosterone. Androgens affect the development of male sex organs.
When hypofunction of an endocrine organ is suspected, which hormone test can be administered to measure and assess target gland response? A) Stimulation B) 24-hour urine C) Agglutination D) Antibody binding
A) Stimulation
Which of the following physiologic processes best exemplifies a positive feedback mechanism? A) The increase in prolactin secretion that occurs with more frequent breast-feeding B) The regulation of blood glucose levels by insulin C) The release of parathyroid hormone in response to decreased serum calcium levels D) The release of antidiuretic hormone when sodium levels are higher than normal
A) The increase in prolactin secretion that occurs with more frequent breast-feeding
When explaining factors that influence the number of receptors present on target cells, the instructor will likely mention: Select all that apply. A) The role antibodies may have on receptor proteins. B) A decreased hormone level may produce increased receptor numbers. C)A sustained excess hormone level brings about a decrease in receptor numbers. D) How any given hormone can change its affinity to supply a need to all cells. E) It may take days to weeks before a hormone can react to target cells.
A) The role antibodies may have on receptor proteins. B) A decreased hormone level may produce increased receptor numbers. C) A sustained excess hormone level brings about a decrease in receptor numbers.
Which physiologic process best exemplifies a positive feedback mechanism? A. increase in prolactin secretion that occurs with more frequent breastfeeding B. regulation of blood glucose levels by insulin C. release of parathyroid hormone in response to decreased serum calcium levels D. release of antidiuretic hormone when sodium levels are higher than normal
A. increase in prolactin secretion that occurs with more frequent breastfeeding A positive feedback mechanism occurs when one hormonal or physiologic factor stimulates further hormonal release, creating a cascade that will increase until the stimulus is reduced. Because the stimulation of breastfeeding releases prolactin that enhances milk production, this is a positive feedback mechanism. Correction of alterations in homeostasis is normally achieved using negative feedback mechanisms, such as those accomplished by insulin, parathyroid hormone, and antidiuretic hormone. In each of these cases, the stimulus results in an response that causes an opposite physiologic effect. For example, high blood glucose levels stimulate the release of insulin which then results in a lowering of the blood glucose level.
When describing to a newly diagnosed diabetic client how insulin is regulated, the nurse will draw upon her knowledge of which hormonal regulation mechanism? A) Basal metabolic rate B) The hypothalamic-pituitary-target cell system C) The cytokine-interleukin regulatory mechanism D) The angiotensin I to angiotensin II to aldosterone system
B) The hypothalamic-pituitary-target cell system
A client with many nonspecific complaints has been ordered a positron emission tomography (PET) scanning for evaluation of: A) The pancreas response to an insulin injection B) Tumors located on the endocrine glands C) Bone density D) Radioactivity of the thyroid gland
B) Tumors located on the endocrine glands
While discussing the elimination of hormones from the body to prevent overaccumulation, which of the following hormones are eliminated in bile? Select all that apply. A) Catecholamines B) Unbound adrenal hormones C) Gonadal steroid hormones D) Thyroid hormones E) Peptide hormones
B) Unbound adrenal hormones C) Gonadal steroid hormones D) Thyroid hormones
To prevent the accumulation of hormones in our bodies, the hormones are constantly being metabolized and excreted. Where are adrenal and gonadal steroid hormones excreted? Bile and urine Feces and urine Cell metabolites and lungs Bile and lungs
Bile and urine Unbound adrenal and gonadal steroid hormones are conjugated in the liver, which renders them inactive, and then excreted in the bile or urine. Adrenal and gonadal steroid hormones are not excreted in the feces, cell metabolites, or the lungs.
Paracrine action involves which of the following characteristics? A) Action on a distant target cell B) Autoregulation C) Act locally on cells other than those that produce the hormone D) Action on nearby target cells
C) Act locally on cells other than those that produce the hormone
Which of the following statements best describes the relationship between the hypothalamus and the posterior pituitary in the normal functioning of the endocrine system? A) Posterior pituitary hormones are constituted from components of both the hypothalamus and the pituitary gland itself. B) The posterior pituitary gland regulates the release of hypothalamic hormones. C) Posterior pituitary hormones are produced in the hypothalamus but released from the pituitary gland. D) The hypothalamus regulates the production and release of posterior pituitary hormones by the pituitary gland.
C) Posterior pituitary hormones are produced in the hypothalamus but released from the pituitary gland.
As part of maintaining homeostasis, hormones secreted by endocrine cells are inactivated continuously to: A) Free receptor sites B) Stimulate production C) Prevent accumulation D) Absorb metabolic waste
C) Prevent accumulation
When comparing the endocrine and nervous system functions, the nurse knows that the endocrine system: Select all that apply. A) Sends signals to neurons over a short distance to muscles B) Responds to neurotransmitter molecules within milliseconds C) Releases hormones into the blood that is transported throughout the body D) Glands are widely scattered throughout the body E)Takes longer to respond to innervations but has prolonged actions when they arrive
C) Releases hormones into the blood that is transported throughout the body D) Glands are widely scattered throughout the body E) Takes longer to respond to innervations but has prolonged actions when they arrive
After having a very stressful day in pathophysiology class, the student knows that which hormone (secreted by the adrenal cortex) will help decrease the effects of stress? Dehydroepiandrosterone, an adrenal androgen Aldosterone, a mineralocorticosteroid Androstenedione, an adrenal androgen Cortisol, a glucocorticoid
Cortisol, a glucocorticoid Glucocorticoids, mainly cortisol, affect metabolism of all nutrients; regulate blood glucose levels; affect growth; have anti-inflammatory action; and decrease effects of stress. The other hormones do not affect stress levels.
A nursing student who has a history of brain tumors that resulted in partial removal of her pituitary gland years ago is asking her OB/GYN doctor about her ability to breast-feed her infant. This is based on which physiological function of the pituitary gland that facilitates breast milk production? A) Growth hormone (GH) B) Oxytocin C) Corticotropin-releasing hormone (CRH) D) Prolactin
D) Prolactin GLFTAP = GH LH/FSH TSH ACTH PRL The anterior pituitary gland or adenohypophysis contains five cell types: (1) thyrotrophs, which produce thyrotropin, also called TSH; (2) corticotrophs, which produce corticotropin, also called ACTH; (3) gonadotrophs, which produce the gonadotropins, LH and FSH; (4) somatotrophs, which produce GH; and (5) lactotrophs, which produce prolactin that is involved with breast growth and milk production.
Which of the following statements about immunoradiometric assay (IRMA) testing for measuring plasma hormone levels is most accurate? A) This bioassay test uses an intact animal or a portion of tissue from an animal to calculate specificity and sensitivity. B) This testing procedure uses antibody-coated plates to produce colored reaction. C) A 24-hour urine test will be required along with blood tests to calculate specific results. D) These tests are very specific since they utilize two antibodies instead of one.
D) These tests are very specific since they utilize two antibodies instead of one.
. In major athletic competition, athletes are required to submit to liquid chromatography testing looking for: A) Blood doping to increase RBC levels B) Low serum sodium levels indicating dehydration C) Use of opioids to minimize pain during competition D) Use of performance-enhancing agents to increase the chances of winning
D) Use of performance-enhancing agents to increase the chances of winning
A client has developed a tumor of the posterior pituitary gland. A. The client is at risk for problems with secretions of: Somatostatin and prolactin B. Adrenocorticotropic hormone (ACTH) and vasopressin C. Growth hormone-releasing hormone (GHRH) and dopamine D. Antidiuretic hormone (ADH) and oxytocin
D. Antidiuretic hormone (ADH) and oxytocin The posterior pituitary secretes ADH and oxytocin/vasopressin, while the anterior pituitary secretes the hormones listed in the other choices.
Which gland acts as a signal relaying bridge between multiple body systems and the pituitary gland? Hypothalamus Thyroid Posterior pituitary Parathyroid
Hypothalamus The activity of the hypothalamus is regulated by both hormonally mediated signals (e.g., negative feedback signals) and by neuronal input from a number of sources. Neuronal signals are mediated by neurotransmitters such as acetylcholine, dopamine, norepinephrine, serotonin, gamma-aminobutyric acid (GABA), and opioids. Cytokines that are involved in immune and inflammatory responses, such as the interleukins, also are involved in the regulation of hypothalamic function. This is particularly true of the hormones involved in the hypothalamic-pituitary-adrenal axis. Thus, the hypothalamus can be viewed as a bridge by which signals from multiple systems are relayed to the pituitary gland. This cannot be said of the other options.
Which are examples of a negative feedback system? Select all that apply. Insulin and glucagon Somatostatin and thyroid-stimulating hormone (TSH) Cortisol and adrenocorticotropic hormone Estradiol and follicle-stimulating hormone (FSH) Calcium and parathyroid hormone
Insulin and glucagon Cortisol and adrenocorticotropic hormone Somatostatin and thyroid-stimulating hormone (TSH) Calcium and parathyroid hormone : In negative feedback, sensors detect a change in hormone levels and adjust hormone secretion to maintain optimal levels. In positive feedback control, rising levels of a hormone cause another gland to release a hormone that stimulates the first. Release of the female hormone estradiol during the follicular stage of the menstrual cycle causes increased release of gonadotropin (FSH), which further increases release of estradiol until the follicle dies and ceases production.
