Chapter 22: Alterations of Hormonal Regulation

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 a biopsy.

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.

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

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.

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.

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.

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.

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.