Chapter 22: Alterations of Hormonal Regulation MULTIPLE CHOICE
1. The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include
solute: a. Retention and water retention . Retention and water loss
c. Dilution and water retention d. Dilution and water loss
A!S: "
The symptoms of SIADH secretion are a result of dilutional h yponatremia and water retention. This information supports the elimination of the other options. #TS: 1
R$%: #a&e '1
ele* ated le*els of antidiuretic hormone (ADH) secretion is: . The common cause of ele*ated a. $ctopically produced ADH c. #osterior pituitary tumor . Inflammation of the hypothalamus d. Inflammation of the nephrons A!S: A
A common cause of ele*ated le*els of ADH secretion is ectopically produced ADH+ which ma,es the other options incorrect. #TS: 1
R$%: #a&e '1-
. /hich laoratory *alue would the nurse nu rse e0pect to find if a person is e0periencin& e0p eriencin& syndrome
of inappropriate antidiuretic hormone (SIADH) a. Hypernatremia and urine hypoosmolality . Serum potassium (2 3) le*el of 4 m$567 and urine hyperosmolality c. Serum sodium (!a3) le*el of 18 m$567 and serum hypoosmolality d. Hypo,alemia and serum hyperosmolality A!S: "
A dia&nosis of SIADH re5uires a serum sodium le*el of less than 14 m$567+ serum hypoosmolality less than -8 m9sm6,&+ and urine hyperosmolarity h yperosmolarity.. #otassium le*els are not considered a factor. #TS: 1
R$%: #a&e '1
. Diaetes insipidus is a result of: a. Antidiuretic hormone hyposecretion . Antidiuretic hormone hypersecretion
c. Insulin hyposecretion d. Insulin hypersecretion
A!S: A
9f the a*ailale options+ diaetes insipidus is a result of insufficient antidiuretic hormone. #TS: 1
R$%: #a&e '1
4. A patient who is dia&nosed with a closed head in;ury has a urine output of < to - 76day.
$lectrolytes are within normal limits+ ut his antidiuretic hormone (ADH) le*el is low. Althou&h he has had no inta,e for hours+ no chan&e in his polyuria le*el has occurred. These symptoms support a dia&nosis of: a. !euro&enic diaetes insipidus . Syndrome of inappropriate antidiuretic hormone c. #sycho&enic polydipsia d. 9smotically induced diuresis A!S: A
The stated symptoms are reflecti*e of neuro&enic diaetes insipidus and not of the remainin& options. #TS: 1
R$%: #a&es '1='8
<. Diaetes insipidus+ diaetes mellitus+ and syndrome of inappropriate antidiuretic hormone all
e0hiit which symptom a. #olyuria . $dema
c. >omitin& d. Thirst
A!S: D
Thirst is the only symptom common to all these conditions. #TS: 1
R$%: #a&es '1='8 ? #a&es ''='-
'. The cause of neuro&enic diaetes insipidus (DI) is related to an or&anic lesion of the: a. Anterior pituitary c. #osterior pituitary . Thalamus d. Renal tuules A!S: "
!euro&enic DI is a result of dysfunctional antidiuretic hormone synthesis+ synthesis+ caused y a lesion of the posterior pituitary+ hypothalamus+ or pituitary stal,. #TS: 1
R$%: #a&e '1
-. /hich form of diaetic insipidus (DI) will result if the tar&et cells for antidiuretic hormone
(ADH) in the renal collectin& tuules demonstrate insensiti*ity a. !euro&enic c. #sycho&enic . !ephro&enic d. Ischemic A!S: @
9nly nephro&enic DI is associated with an insensiti*ity of the renal collectin& tuules to ADH. #TS: 1
R$%: #a&e '8
. /hich laoratory *alue is consistently low in a patient with diaetes insipidus (DI) a. rine=specific &ra*ity c. rine protein . Serum sodium d. Serum total protein A!S: A
The asic criteria for dia&nosin& DI include a low urine=specific &ra*ity while sodium le*els are hi&h. #rotein le*els are not considered.
#TS: 1
R$%: #a&e '8
18. /hich form of diaetes insipidus (DI) is treatale with e0o&enous antidiuretic hormone
(ADH) a. !euro&enic . #sycho&enic
c. !ephro&enic d. Ischemic
A!S: A
!euro&enic DI is treated with ADH ADH replacement therapy. The other options are incorrect. #TS: 1
R$%: #a&e '8
11. /hich condition may result from pressure e0erted y a pituitary tumor a. Hypothyroidism c. Diaetes insipidus . Hypercortisolism d. Insulin hyposecretion A!S: A
If the tumor e0erts sufficient pressure+ then thyroid and adrenal hypofunction ma y occur ecause of lac, of thyroid=stimulatin& hormone (TSH) and adrenocorticotropic hormone (A"TH). These result in the symptoms of hypothyroidism and hypocortisolism. The remainin& options are not associated with the pressure e0erted y a pituitary tumor. #TS: 1
R$%: #a&e '
1. The term used to descrie a person who e0periences a lac, of all hormones associated with the
anterior pituitary is: a. #anhypopituitarism . Adrenocorticotropic hormone deficiency
c. Hypopituitarism d. Anterior pituitary failure
A!S: A
Panhypopituitarism is Panhypopituitarism is the only a*ailale term that is correctly associated with the lac, of all anterior pituitary hormones. #TS: 1
R$%: #a&e '1
1. >isual >isual disturances are a result of a pituitary adenoma ecause of the: a. 7ieration of anterior pituitary hormones into the optic chiasm . #ituitary hormones cloudin& the lens of the eyes c. #ressure of the tumor on the optic chiasm c hiasm d. #ressure of the tumor on the optic and a nd oculomotor cranial ner*es A!S: "
9f the a*ailale options+ pressure on the op tic chiasm is the only cause for *isual disturances resultin& from a pituitary adenoma. #TS: 1
R$%: #a&e '
1. /hich disorder is considered a co=morid condition of acrome&aly a. Hypotension c. @rain cancer . Diaetes d. Thyroid cancer
A!S: @
Symptoms of type diaetes mellitus+ such as polyuria and polydipsia+ may occur. Acrome&aly=associated hypertension is usually asymptomatic until symptoms of heart failure de*elop. !either thyroid nor rain cancer cance r has een associated with acrome&aly. #TS: 1
R$%: #a&e '
14. /hich disorder is caused y hypersecretion of the &rowth hormone (BH) in adults a. "ushin& syndrome c. Biantism . Acrome&aly d. Cy0edema A!S: @
Acromegaly is Acromegaly is a term for adults who ha*e een e0posed to continuously hi&h le*els of BH+ whereas the term giantism term giantism is is reser*ed for children and adolescents. The other options do not apply to hypersecretion of BH. #TS: 1
R$%: #a&e '
1<. Biantism occurs only in children and adolescents ado lescents ecause their: a. Browth hormones are still diminished. . $piphyseal plates ha*e not yet closed. c. S,eletal muscles are not yet fully de*eloped. d. Cetaolic rates are hi&her than in adulthood. A!S: @
Biantism is related to the effects of &rowth hormones on the &rowth of lon& ones at their epiphyseal plates. This information ma,es the other options incorrect. #TS: 1
R$%: #a&e '
1'. Amenorrhea+ &alactorrhea+ hirsutism+ and osteoporosis are each caused y a: a. #osterior pituitary adenoma c. #rolactinoma . Thymoma d. Browth hormone adenoma A!S: "
9f the options a*ailale+ the hallmar, of a prolactinoma is the sustained ele*ation of serum prolactin that is responsile for the symptoms symptoms listed in the 5uestion. #TS: 1
R$%: #a&e '
1-. Bra*es disease de*elops from a(n): a. >iral >iral infection of the thyroid &land that causes cau ses o*erproduction of thyroid hormone . Autoimmune process durin& which lymphocytes and firous tissue replace thyroid
tissue c. Thyroid=stimulatin& immuno&loulin that causes o*erproduction of thyroid hormones d. In&estion of &oitro&ens that inhiits the synthesis of the thyroid hormones+ causin& a &oiter A!S: "
The patholo&ic features of Bra*es disease indicates that normal re&ulatory mechanisms are o*erridden y anormal immunolo&ic mechanisms that result in the stimulation of e0cessi*e TH. The remainin& options are incorrect statements. #TS: 1
R$%: #a&e '<
1. The si&ns of thyroto0ic crisis include: a. "onstipation with &astric distention . @radycardia and radypnea
c. Hyperthermia and tachycardia d. "onstipation and lethar&y
A!S: "
The systemic symptoms of thyroto0ic crisis include hyperthermia and tachycardia. The remainin& options are not associated with this disorder. #TS: 1
R$%: #a&e '-
8. #atholo&ic chan&es associated with Bra*es disease include: a. Hi&h le*els of circulatin& thyroid=stimulatin& immuno&loulins . Diminished le*els of thyrotropin=releasin& hormone c. Hi&h le*els of thyroid=stimulatin& hormone d. Diminished le*els of thyroid=indin& &loulin A!S: A
The only option that correctly descries the chan&es associated with Bra*es disease identifies hi&h le*els of circulatin& thyroid=stimulatin& immuno&loulins that are found in more than 4 of indi*iduals dia&nosed with the disease. #TS: 1
R$%: #a&e '<
1. The le*el of thyroid=stimulatin& hormone (TSH) in indi*iduals with Bra*es disease is usually: a. Hi&h c. !ormal . 7ow d. In constant flu0 A!S: @
The hyperfunction of the thyroid &land leads to suppression of TSH ecause of the normal ne&ati*e feedac, mechanism+ thus eliminatin& the o ther options as ein& correct. #TS: 1
R$%: #a&e '<
. #alpation of the nec, of a person dia&nosed with Bra*es disease would detect a thyroid that
is: a. 7eft of midline . Small with discrete nodules
c. !ormal in siEe d. Diffusely enlar&ed
A!S: D
The only option that characteriEes Bra*es disease is a diffused enlar&ement of the thyroid &land. #TS: 1
R$%: #a&e '<8
. A deficiency of which chemical may result in hypothyroidism a. Iron c. Finc
. Iodine
d. Ca&nesium
A!S: @
The only cause of hypothyroidism h ypothyroidism from amon& the pro*ided options is a deficiency of endemic iodine. #TS: 1
R$%: #a&e '-
. /hat are clinical manifestations of hypothyroidism a. Intolerance to heat+ tachycardia+ and wei&ht loss . 9li&omenorrhea+ fati&ue+ and warm s,in c. Restlessness+ increased appetite+ and metrorrha&ia d. "onstipation+ decreased heat rate+ and lethar&y A!S: D
The lower le*els of thyroid hormone result in decreased ener&y metaolism+ resultin& in constipation+ radycardia+ and lethar&y+ thus thus eliminatin& the remainin& options. #TS: 1
R$%: #a&es '-='8 ? Tale =
4. Dia&nosin& a thyroid carcinoma is est performed with: a. Ceasurement of serum thyroid le*els c. ltrasono&raphy . Radioisotope scannin& d. %ine=needle aspiration iopsy A!S: D
%ine=needle aspiration of a thyroid nodule is &enerally performed to dia&nose this conditionG this method is est for early detection+ thus eliminatin& the other o ptions. #TS: 1
R$%: #a&e '1
<. Renal failure is the most common cause of which type of hyperparathyroidism a. #rimary c. $0o&enous . Secondary d. Inflammatory A!S: @
"hronic renal failure is the most common cause of secondary hyperparathyroidism ecause of the resultin& hyperphosphatemia that stimulates parathyroid hormone secretion. Althou&h the other options may occur+ they are not the most common types of the disorder. #TS: 1
R$%: #a&e '
'. The most common cause of h ypoparathyroidism is: a. #ituitary hyposecretion c. #arathyroid &land dama&e . #arathyroid adenoma d. Autoimmune parathyroid disease A!S: "
The most common cause of h ypoparathyroidism is dama&e caused durin& thyroid sur&ery+ thus eliminatin& the other options as ein& correct. #TS: 1
R$%: #a&e '
-. The most proale cause of low serum calcium after a thyroidectomy is: a. Hyperparathyroidism+ secondary to Bra*es disease
. Cy0edema+ secondary to sur&ery c. Hypoparathyroidism caused y sur&ical in;ury d. Hypothyroidism caused y the lac, of thyroid replacement A!S: "
The most common cause of h ypoparathyroidism is dama&e caused durin& thyroid sur&ery+ resultin& in a lac, of circulatin& #TH and causin& a depressed le*el of serum calcium. This information supports the elimination of the other options. #TS: 1
R$%: #a&e '
. A patient dia&nosed with diaetic ,etoacidosis (D2A) has the followin& laoratory *alues:
arterial pH '.8G serum &lucose 488 m&6dlG positi*e urine &lucose and ,etonesG serum potassium (2 3) m$567G serum sodium (!a3) 18 m$567. The patient reports that he has een sic, with the flu for 1 wee,. /hat relationship do these *alues ha*e to his insulin deficiency a. Increased &lucose use causes the shift of fluid from the intra*ascular to the intracellular space. . Decreased &lucose use causes fatty acid use+ ,eto&enesis+ metaolic acidosis+ and osmotic diuresis. c. Increased &lucose and fatty acids stimulate renal diuresis+ electrolyte loss+ and metaolic al,alosis. d. Decreased &lucose use results in protein cataolism+ tissue wastin&+ respiratory acidosis+ and electrolyte loss. A!S: @
Decreased &lucose causes fatty acid use+ ,eto&enesis+ , eto&enesis+ metaolic acidosis+ and osmotic diuresis+ which ha*e resulted in the symptoms listed in the 5uestion. The relationship etween the stated assessment *alues and insulin deficiency is not effecti*ely descried y any of the other options. #TS: 1
R$%: #a&es '='4
8. #olyuria occurs with diaetes mellitus ecause of the: a. %ormation of ,etones c. $le*ation in serum &lucose . "hronic insulin resistance d. Increase in antidiuretic hormone A!S: "
Blucose accumulates in the lood and an d appears in the urine as the renal threshold for &lucose is e0ceeded+ producin& an osmotic diuresis and the symptoms of polyuria and thirst. !one of the other options appropriately descries the patholo&ic features of diaetes mellitusJinduced polyuria. #TS: 1
R$%: #a&e '-
1. Type Type diaetes mellitus is est descried as a(an): a. Resistance to insulin y insulin=sensiti*e tissues . !eed for lispro instead of re&ular insulin c. Increase of &luca&on secretion from α cells of the pancreas d. #resence of insulin autoantiodies that destroy β cells in the pancreas A!S: A
9ne of the asic pathophysiolo&ic pathoph ysiolo&ic characteristics of type diaetes is the de*elopment of insulin=resistant tissue cells. !one of the remainin& options appropriately descries type diaetes. #TS: 1
R$%: #a&e '
. A person dia&nosed with type 1 diaetes e0periences hun&er+ li&htheadedness+ tachycardia+
pallor+ headache+ and confusion. The most proale cause of these symptoms is: is: a. Hyper&lycemia caused y incorrect insulin administration . Dawn phenomenon from eatin& a snac, efore edtime c. Hypo&lycemia caused y increased e0ercise d. Somo&yi effect from insulin sensiti*ity A!S: "
The most li,ely cause of these symptoms is hypo&lycemia+ which is often caused y a lac, of systemic &lucose as a result of muscular acti*ity. !one of the remainin& options appropriately descries why a person dia&nosed with type t ype 1 diaetes e0periences the descried symptoms. #TS: 1
R$%: #a&e ' ? Tale =18
. /hich serum &lucose le*el would indicate hypo&lycemia in a neworn a. - m&6dl c. <8 m&6dl . 8 m&6dl d. -8 m&6dl A!S: A
Serum &lucose K8 m&6dl in neworn (first to days) and K44 to <8 m&6dl in adults is associated with hypo&lycemia. #TS: 1
R$%: #a&e ' ? Tale =18
. /hen comparin& the clinical manifestations of oth diaetic ,etoacidosis (D2A) and
hyper&lycemic hyperosmolar non,etotic syndrome (HH!2S)+ which condition is associated with only D2A a. %luid loss c. Increased serum &lucose . /ei&ht loss d. 2ussmaul respirations A!S: D
2ussmaul respirations are only oser*ed in those with D2A. #TS: 1
R$%: #a&es '4='<
4. Hypo&lycemia+ followed y reound hyper&lycemia+ is oser*ed in those with: a. The Somo&yi effect . The dawn phenomenon c. Diaetic ,etoacidosis d. Hyperosmolar hyper&lycemic non,etotic syndrome A!S: A
Hypo&lycemia+ followed y reound hyper&lycemia+ is oser*ed only in the Somo&yi effect. #TS: 1
R$%: #a&e '<
<. The first laoratory test that indicates type 1 diaetes is causin& the de*elopment of diaetic
nephropathy is: a. Dipstic, test for urine ,etones . Increase in serum creatinine and lood urea nitro&en c. #rotein on urinalysis d. "loudy urine on the urinalysis A!S: "
Cicroaluminuria is the first manifestation of this form of renal failure. Althou&h the other options may de*elop+ they occur after protein is found in the urine. #TS: 1
R$%: #a&es '-='
'. /hich classification of oral hypo&lycemic dru&s decreases hepatic &lucose production and
increases insulin sensiti*ity and peripheral &lucose upta,e c. Ce&litinides (&linides) d. α=Blycosidase inhiitor (mi&litol)
a. @i&uanide (metformin) . Sulfonylureas (&lyuride) A!S: A
9nly i&uanides decrease hepatic &lucose production and increase insulin sensiti*ity and peripheral &lucose upta,e. #TS: 1
R$%: #a&e ' ? Tale =
-. /hat causes the micro*ascular complications in patients with diaetes mellitus a. The capillaries contain pla5ues of lipids that ostruct lood flow. . #ressure in capillaries increase as a result of the ele*ated &lucose attractin& water. c. The capillary asement memranes thic,en+ and cell hyperplasia de*elops. d. %irous pla5ues form from the proliferation of suendothelial smooth muscle of
arteries. A!S: "
Cicro*ascular complications are a result of capillary asement memranes thic,enin& and endothelial cell hyperplasia. !one of the re mainin& options appropriately descries the cause of micro*ascular complications in patients with diaetes mellitus. #TS: 1
R$%: #a&e ''
. Retinopathy de*elops in patients with diaetes mellitus ecause: a. #la5ues of lipids de*elop in the retinal *essels. . #ressure in the retinal *essels increase as a result of increased osmotic pressure. c. 2etones cause microaneurysms in the retinal *essels. d. Retinal ischemia and red lood cell a&&re&ation a& &re&ation occur. A!S: D
Retinopathy appears to e a response to retinal ischemia and red lood cell a&&re&ation. !one of the remainin& options appropriately descries the relationship etween retinopathy and diaetes mellitus. #TS: 1
R$%: #a&e ''
8. A person has acne+ easy ruisin&+ thin e0tremities+ and truncal oesity. These These clinical
manifestations are indicati*e of which endocrine disorder a. Hyperthyroidism c. Diaetes insipidus . Hypoaldosteronism d. "ushin& disease A!S: D
These symptoms are characteristic of "ushin& disease and are cau sed y e0cessi*e A"TH secretion. The symptoms descried are not characteristic of any of the other options. #TS: 1
R$%: #a&es '4='44
MULTIPLE RESPOSE
1. A person may e0perience which complications as a result of a reduction in parathyroid
hormone (#TH) (Select all that apply.) a. Cuscle spasms . Tonic=clonic Tonic=clonic seiEures c. 7aryn&eal spasms d. Hyporefle0ia e. Asphy0iation A!S: A!S: A+ @+ @+ "+ "+ $
Symptoms associated with hypoparathyroidism are related to hypocalcemia. Hypocalcemia causes a lowerin& of the threshold for ner*e and muscle e0citation so that a sli&ht stimulus anywhere alon& the len&th of a ner*e or muscle fier may initiate a ner*e impulse. This creates tetany manifested as muscle spasms+ hyperrefle0ia+ tonic=clonic con*ulsions+ laryn&eal spasms+ and+ in se*ere cases+ death from asphy0iation. #TS: 1
R$%: #a&es '='
co mplications . A chronic complication of diaetes mellitus is li,ely to result in micro*ascular complications in which areas (Select all that apply.) a. $yes . "oronary arteries c. Renal system d. #eripheral *ascular system e. !er*es A!S: A+ "+ "+ $
9f the options pro*ided+ the areas most often o ften affected are the retina+ ,idneys+ and ner*es. #TS: 1
R$%: #a&e ''
MATCHI!
Match the phrases with the corresponding corresponding terms. LLLLLL A. Acrome&aly LLLLLL @. "ushin& disease LLLLLL ". Addison disease LLLLLL D. Bra*es disease
LLLLLL $. Cy0edema LLLLLL %. #heochromocytoma . Hypersecretion of thyroid hormone (TH) . Hypersecretion of adrenocorticotropic hormone (A"TH) 4. Hypersecretion of adrenal medulla hormones <. Hyposecretion of thyroid hormone (TH) '. Hyposecretion of adrenal corte0 hormones -. Hypersecretion of &rowth hormone (BH) . A!S: CS": . A!S: CS": 4. A!S: CS": <. A!S: CS": '. A!S: CS": -. A!S: CS":
D #TS: 1 R$%: #a&e '< Bra*es Bra*es disease disease is caused y the the hypersecret hypersecretion ion of TH. @ #TS: 1 R$%: #a&e '4 "ushin& disease disease is caused caused y the hypersecretion hypersecretion of A"TH. % #TS: 1 R$%: #a&e '4#heochromocytoma is a tumor tumor that causes causes hypersecretion hypersecretion of adrenal adrenal medulla hormones. $ #TS: 1 R$%: #a&e ' Cy0edema is is the lon&=standin& hyposecretion of TH. TH. " #TS: 1 R$%: #a&e '4' Addison disease disease is a result of hyposecretion hyposecretion of adrenal corte0 hormones. A #TS: 1 R$%: #a&es '=' Acrome&aly is the the condition associated with with the e0posure e0posure of adults to to hi&h le*els of BH.
