patho phys ch. 31 and 33
The nurse is discussing positive feedback mechanisms. Which example best explains this mechanism?
Increased estradiol production causes increased follicle-stimulating hormone (FSH) production.
Following a meal, a client's blood glucose level has increased. In addition, the client's pancreas has increased the amount of insulin produced and released. Which phenomenon has occurred?
Increased hormone level according to a negative feedback mechanism
A client with diabetes asks the nurse for advice in controlling between-meal blood glucose levels. Which of these might the nurse suggest as a long-acting insulin to provide a consistent basal level?
Insulin glargine
The diagnosis of type 1 diabetes would be confirmed by which principle?
Insulin is not available for use by the body.
The nurse knows that metabolic abnormalities that lead to type 2 diabetes include which physiologic problems? Select all that apply.
Insulin resistance Beta cell failure Hepatic glycogenolysis
Diabetics are at higher risk than are the majority of the population for injury to organ systems in the body. Which organs are most at risk?
Kidneys and eyes
Which gland is often referred to as the master gland because it secretes many hormones?
Pituitary
A client has been experiencing elevated blood glucose levels. The nurse anticipates that which assessment data correlates with hyperglycemia?
Polydipsia
What are the hallmark signs of diabetes mellitus?
Polyuria, polydipsia, and polyphagia
A client is diagnosed with diabetic ketoacidosis (DKA) in the emergency department. Which clinical manifestations will the client likely exhibit?
Polyuria, polydipsia, voming, and fatigue
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?
Cortisol, a glucocorticoid
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 single hormone can act on not only one process or organ but often on several different locations or processes."
A client diagnosed with type 2 diabetes has been instructed about managing his condition with diet. The nurse determines further teaching is necessary when the client states:
"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads."
A client diagnosed with type 2 diabetes has been instructed about managing his condition with diet. Which statements by the client indicate a need for additional education? Select all that apply.
"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads." "I need to carefully limit my protein consumption."
A nurse educator is conducting a course for newly diagnosed diabetes clients. Which statement by a participant should the nurse follow up first?
"I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal."
The nurse has just completed teaching a client, newly diagnosed with type 1 diabetes, about the treatment options. Which response by the client leads the nurse to conclude that addidtional teaching is needed?
"So I can stop my insulin if I start an exercise program."
A 3-year-old girl has just been diagnosed with type 1A diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain to the parents the etiology (cause) of their daughter's diabetes?
"The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin."
Following an oral glucose tolerance, a 36-year-old mother of 4 has been diagnosed with gestational diabetes mellitus (GDM), a problem that was not present in any of her previous pregnancies. What should her primary care provider tell her about this new health problem?
"Your baby could become too large or have low blood sugars if we're not vigilant about controlling your sugars."
Which manifestation indicates a client is at risk for developing diabetes mellitus?
2 hour oral GTT 175 mg/dL (9.7 mmol/L)
When explaining about structural classifications to a group of students, the instructor discusses the peptides and proteins. The instructor talks about small hormones and hormones as large and complex as growth hormone (GH), which has approximately how many amino acids involved?
200 amino acids
How long is the half-life of the hormone aldosterone, which is only 15% protein bound?
25 minutes
The nurse educates a client newly diagnosed with diabetes regarding diet and energy requirements. The nurse knows that 1 gram of fat will provide _____ kcal of energy.
9
The nurse is reviewing assessment data and determines which client is at highest risk for developing type 2 diabetes?
A 45-year-old obese female with a sedentary lifestyle
A client comes to a scheduled appointment in the endocrine clinic. The primary care physician referred the client, suspecting acromegaly. Knowing the usual testing involved, the nurse should educate the client about which lab/diagnostic procedure?
A suppression test
A 60 year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration, and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which action should be the wife's first choice?
Administration of 15 to 20 g of glucose in a concentrated carbohydrate source.
The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL (48.67 mmol/L). The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time?
Administration of intravenous fluids
Hypoglycemia has a sudden onset with a progression of symptoms. What are the signs and symptoms of hypoglycemia?
Altered cerebral function and headache
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
Diabetic ketoacidosis (DKA) is a condition that mostly occurs in type 1 diabetics. What are the definitive diagnostic criteria for DKA?
Blood glucose level greater than 250 mg/dL (13.88 mmol/L); bicarbonate less than 15 mEq/L (15 mmol/L) and pH less than 7.3
The diabetes nurse educator is teaching a community education class for new diabetics. Which of these does the nurse include in the discussion of signs and symptoms of hyperglycemia? Select all that apply.
Blurred vision Weight loss Thirst
The nurse is reviewing the test results of a client who was given thyrotropin-releasing hormone (TRH) to evaluate the function of the pituitary gland. The nurse would recognize pituitary dysfunction as:
Decreased TSH levels
A client experiences an increase in cortisol as a result of Cushing disease. Which hormonal responses demonstrate the negative feedback mechanism?
Decreased adrenocorticotropic hormone (ACTH)
A client experiences an increase in thyroid hormone as a result of a thyroid tumor. Which hormonal response demonstrates the negative feedback mechanism?
Decreased thyroid-stimulating hormone (TSH)
Which manifestation would the nurse observe when assessing a client diagnosed with a benign secreting tumor of the adrenal medulla?
Elevated catecholamine levels and tachycardia
A 15-year-old child with type 1 diabetes asks nurse about the potential to "lose sight." Which response would be the most appropriate?
Explain that many people with diabetes experience some complications like retinopathy, but these are best prevented with tight control of glucose levels.
Which hormone is secreted based on a cyclic rather than a diurnal manner?
Follicle-stimulating hormone (FSH)
A 40-year-old man who is morbidly obese and leads a sedentary lifestyle has recently been diagnosed with type 2 diabetes. Which aspects of the man's obesity likely contributed to his new health problem?
Free fatty acids contribute to problems such as beta cell dysfunction and insulin resistance
Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur?
Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen
A client has been admitted with diabetic ketoacidosis. The emergency department starts an IV to improve circulatory volume. If there is a sudden change in extracellular fluid osmolality which results in a too rapid blood glucose lowering, the nurse will likely observe which clinical manifestations?
Headaches, dizziness, change in level of consciousness.
A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action?
Helping the client make meaningful changes to his diet and activity level.
Which laboratory values for a newly admitted client indicate a diagnosis of diabetes mellitus? Select all that apply.
Hemoglobin A1C 9.1% (.09) 2 hour oral GTT 245 mg/dL (13.6 mmol/L)
Which physiologic process allows hormones to exert influence upon some cells and not others?
Hormone receptors
Which statement best explains the function of hormone receptors?
Hormone receptors recognize a specific hormone and translate the hormonal signal into a cellular response
During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur?
Hyperglycemia
A client with hyperthyroidism took aspirin for a headache. Which complications could develop? Select all that apply.
Hyperthermia Tachycardia Agitation
The hypophysis is a unit formed by the pituitary and the hypothalamus. These two glands are connected by the blood flow in what system?
Hypophyseal portal system
A health care provider is assessing a client for a potential endocrine disorder. Assessment findings identify abnormalities with emotion, pain, and body temperature. Which mechanism of endocrine control will require further laboratory/diagnostic assessment?
Hypothalamus
Which gland acts as a signal relaying bridge between multiple body systems and the pituitary gland?
Hypothalamus
Which gland acts as a signal-relaying bridge between multiple body systems and the pituitary gland?
Hypothalamus
An adult client is scheduled for testing of a suspected growth hormone (GH)-secreting tumor. Which result from the glucose suppression test would confirm the condition?
Increased GH secretion
Neurotransmitters like catecholamines (e.g., dopamine and epinephrine) have a reaction time of:
Milliseconds
What is the most common mechanism of hormone control?
Negative feedback
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?
Negative feedback loop
A nurse is teaching a client with newly diagnosed type 1 diabetes about the importance of blood glucose control to decrease the risk of which potential chronic complications of diabetes? Select all that apply.
Nephropathy Neuropathy Retinopathy Gastroparesis
Which hormone will elicit a more rapid response than the others?
Norepinephrine
A woman with poorly controlled type 1 diabetes has been admitted to a hospital unit for the treatment of ketoacidosis. Place the following events in the pathophysiology of ketoacidosis in the correct chronological order. Use all the options.
Production of fatty acids and glycerol Low serum insulin levels Ketone production by the liver Breakdown of triglycerides Decrease in pH
While reviewing the concept of nuclear receptors with a group of pathophysiology students, the instructor uses the example of clients with type 2 diabetes mellitus taking pioglitazone, a thiazolidinedione medication. Because of the peroxisome proliferator-activated receptors (PPARs), the drug has which effect on the clients' diabetes?
Promotes glucose uptake and increase the synthesis of certain proteins involved in fat metabolism, which reduces levels of certain types of lipids.
The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary health care provider for further evaluation?
Random blood glucose 195 mg/dL (10.82 mmol/L)
The nurse is caring for a client who is receiving exogenous corticosteroids for rheumatoid arthritis. Recognizing that hormone levels are regulated by negative feedback, which laboratory test result does the nurse anticipate uncovering when reviewing the medical record?
Reduction in ACTH
A client with diabetes carries insulin with him at all times. At 11:35, he obtains a blood glucose reading of 218 mg/dL (12.1 mmol/L) and self-administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject?
Short acting
Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called?
Somogyi effect
A 21-year-old female is suspected of having inadequate function of her hypothalamic-pituitary-thyroid system. Her care provider is planning to inject thyrotropin-releasing hormone (TRH) and then measure her levels of TSH. Which diagnostic test is being performed?
Stimulation test
A client undergoing an evaluation of hormone levels asks, "What regulates the hormone levels?" Which response by the nurse would be considered most accurate?
The hypothalamic-pituitary-target cell system
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?
The thyroid gland is responsible for increasing the metabolic rate.
Which statement describes how water-soluble peptides, such as parathyroid hormone or glucagon, exert their effect on cells?
They bind to receptors.
A client with a history of an endocrine disorder exhibits signs and symptoms of hormone deficiency. Which process would the client's care team most likely rule out first as a contributing factor?
Up-regulation has increased the sensitivity of the body to particular hormone levels.
The nurse is caring for a client with diabetes who has developed gastroparesis. Which symptom does the nurse expect the client to report?
Vomiting after eating
A client with a new diagnosis of an endocrine disorder is unclear how the body can control the levels of different hormones over time. Which statement most accurately underlies the dominant regulation process of hormone levels in the body?
With input from various sensors, hormone production and release are adjusted based on existing hormone levels.
The obstetrical nurse is caring for a client who has been treated for gestational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which risk factor in the teaching?
Woman with a family history of diabetes
When educating a client about glargine, the nurse should explain that this medication:
has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours.
A client with hyperthyroidism is being treated with medication that blocks the activity of thyroid-stimulating hormone. Her care team has determined that she has been overproducing TSH. This client will have lost her ability to:
have negative feedback regulation.
A middle-aged female client has been diagnosed with a thyroid condition. The nurse educates the client about the prescription and needed follow-up lab work, which will help regulate the dosage. The client asks, "Why do I not return to the clinic for weeks, since I am starting the medication tomorrow morning?" The nurse bases the answer on the knowledge that thyroid hormones:
may take days for the full effect to occur, based on the mechanism of action.
Which of the following best describes the half-life of a highly protein-bound drug such as thyroxine (99% protein bound)? The half-life would be:
much longer to reduce the concentration of the hormone by one half.
During a near-miss accident while cycling, a client marvels at how fast he was able to react. He attributes this to his "fight or flight" response but then wonders why it lasts for only a short period. The client had a short burst of catecholamine activity because catecholamines are:
rapidly degraded by enzymes in circulation and at the tissue.
While reviewing the major actions of follicle-stimulating hormone (FSH), the faculty points out that in males this hormone is responsible for the:
sperm production.
A client exhibiting problems with her thyroid has been scheduled for a radioactive scan. From the following list of clients, which would the nurse question as to whether this would be a safe procedure for this client?
A young female client who has been trying to get pregnant
The nurse is assessing a client with thyrotoxicosis and the nurse is explaining how the thyroid gland is stimulated to release thyroid hormones. The nurse should describe what process?
Action of releasing hormones from hypothalamus
Select the category of hormones that include norepinephrine and epinephrine.
Amines and amino acids
A nurse examines the laboratory values of a client in heart failure. Which value indicates a compensatory hormone mechanism?
Elevated atrial natriuretic hormone
What is an advantage of assessing hormone levels through collection of a 24-hour urine?
It does not require serum collection for an accurate reading.
A client asks the nurse what causes the secretion of growth hormone (GH) and adrenocorticotrophic hormone (ACTH) to fluctuate. The best response by the nurse would be:
Sleep-wake cycles
While reviewing the role of glucagon regarding the regulation of blood glucose, the nurse knows that which situation could lead to an inhibition of glucagon release?
An increase in glucose levels
A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first?
Check blood glucose
Which statements concerning endocrinology laboratory testing are true? Select all that apply.
Client education regarding endocrine testing must include specific test requirements. Endocrine tests are generally sensitive to storage requirements.
The nurse is caring for a client who received regular insulin at 7 am. Four hours later the nurse finds the client diaphoretic, cool, and clammy. Which of these interventions is the priority?
Give the client a concentrated carbohydrate.
The nurse and nursing student are performing medication reconciliation. Which medications taken by the client with diabetes does the nurse teach the student are implicated in causing hyperglycemia? Select all that apply.
Glucocorticoids Loop diuretics Oral contraceptives
A nurse assessing an 8-year-old child notes that the child is 6 feet tall. Which diagnostic test will be performed to evaluate the cause of the condition?
Glucose load
Which statement best describes an aspect of the normal process of glucose metabolism?
Glucose that exceeds metabolic needs is converted and stored by the liver.
A woman in her 28th week of pregnancy develops gestational diabetes mellitus and has persistent elevated blood glucose when using the diet plan. What medications are appropriate? Select all that apply.
Glyburide Insulin
A client is diagnosed with type 2 diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?
Glycosylated hemoglobin 5.2% (0.52)
A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes. The best diagnostic indicator that would support the client's response would be:
Glycosylated hemoglobin, hemoglobin A1C (HbA1C)
The nurse screening for diabetes mellitus at a health fair does not have enough supplies for all of the clients attending. Which client should be given screening priority?
Male age 45, BMI 37
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:
Paracrine
A client with diabetes mellitus is reporting burning pain of the feet and some numbness. These symptoms are likely due to which cause?
Somatic neuropathy
The kidney produces 1,25-dihydroxyvitamin D. This form of vitamin D is responsible for which action in the body?
Stimulates calcium absorption from the intestine
A woman with a diagnosis of type 2 diabetes has been ordered a hemoglobin A1C test for the first time by her primary care provider. The woman states, "I don't see why you want to test my blood cells when it's sugar that's the problem." What aspect of physiology will underlie the care provider's response to the client?
The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell.
A 30-year-old male who manages his type 1 diabetes with glyburide presents at the emergency room reporting headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half-marathon. Which of the following is likely to be the cause of his complaints?
Hypoglycemia
