Josef Nachar
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Pathophysiology: The Biologic Basis for Disease in Adults and Children 8th Edition

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Emily Doyle
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Emily Doyle
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Josef Nachar
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Chapter 22: Alterations of Hormonal Regulation

Chapter 22: Alterations of Hormonal Regulation

Question 1 of 40

1

The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include
which solute?

Select one of the following:

  • Sodium and water retention

  • Sodium retention and water loss

  • c. Sodium dilution and water retention

  • Sodium dilution and water loss

Explanation

Question 2 of 40

1

Which patient would the healthcare professional assess for elevated levels of antidiuretic hormone (ADH) secretion?

Select one of the following:

  • Being treated for small cell carcinoma of the stomach

  • Taking high dose acetaminophen (Tylenol) for arthritis

  • Had a hip replacement operation 14 days ago

  • Has long-standing kidney disease from diabetes

Explanation

Question 3 of 40

1

Which laboratory value would the nurse expect to find if a person is experiencing syndrome
of inappropriate antidiuretic hormone (SIADH)?

Select one of the following:

  • Hypernatremia and urine hypoosmolality

  • . Serum potassium (K+) level of 5 mEq/L and urine hyperosmolality compared to
    serum

  • Serum sodium (Na+) level of 120 mEq/L and serum osmolality 260 mOsm/kg

  • Serum potassium (K+) of 2.8 mEq/L and serum hyperosmolality

Explanation

Question 4 of 40

1

What is diabetes insipidus a result of?

Select one of the following:

  • Antidiuretic hormone hyposecretion

  • Antidiuretic hormone hypersecretion

  • Insulin hyposecretion

  • Insulin hypersecretion

Explanation

Question 5 of 40

1

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?

Select one of the following:

  • Administration of desmopressin

  • Serum copeptin testing

  • Insulin administration

  • Renal angiogram

Explanation

Question 6 of 40

1

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?

Select one of the following:

  • Stop the water deprivation test.

  • Administer salt tablets.

  • Continue with the test as planned.

  • Take the patient’s blood glucose.

Explanation

Question 7 of 40

1

A healthcare professional is caring for four patients. Which patient does the professional assess for neurogenic diabetes insipidus (DI)?

Select one of the following:

  • Anterior pituitary tumor

  • Thalamus hypofunction

  • Posterior pituitary trauma

  • Renal tubule disease

Explanation

Question 8 of 40

1

Which form of diabetic insipidus (DI) will result if the target cells for antidiuretic hormone (ADH) in the renal collecting tubules demonstrate insensitivity?

Select one of the following:

  • Neurogenic

  • Nephrogenic

  • Psychogenic

  • Ischemic

Explanation

Question 9 of 40

1

Which laboratory value is consistent with diabetes insipidus (DI)?

Select one of the following:

  • Low urine-specific gravity

  • Low serum sodium

  • Low urine protein

  • High serum total protein

Explanation

Question 10 of 40

1

A patient has nephrogenic diabetes insipidus (DI). What treatment does the healthcare professional anticipate for this patient?

Select one of the following:

  • Exogenous ADH replacement

  • Intranasal desmopressin

  • Water and sodium restriction

  • Loop diuretic administration

Explanation

Question 11 of 40

1

Which condition may result from pressure exerted by a pituitary tumor?

Select one of the following:

  • Hypothyroidism

  • Hypercortisolism

  • Diabetes insipidus

  • Insulin hyposecretion

Explanation

Question 12 of 40

1

A healthcare professional reads a chart that notes the patient has panhypopituitarism. What does the professional understand that term to mean?

Select one of the following:

  • The patient has a lack of all hormones associated with the anterior pituitary gland.

  • The patient has a lack of all hormones associated with the lateral pituitary gland.

  • The patient has total adrenocorticoptropic hormone deficiency.

  • The patient has a dysfunction of the posterior pituitary gland due to a tumor.

Explanation

Question 13 of 40

1

Visual disturbances are a result of a pituitary adenoma because of what?

Select one of the following:

  • Liberation of anterior pituitary hormones into the optic chiasm

  • Pituitary hormones clouding the lens of the eyes

  • Pressure of the tumor on the optic chiasm

  • Pressure of the tumor on the optic and oculomotor cranial nerves

Explanation

Question 14 of 40

1

A patient has an enlarged tongue, body odor, rough skin, and coarse hair. Which laboratory result does the healthcare professional associate with this presentation?

Select one of the following:

  • Decreased blood glucose

  • Increased growth hormone

  • Decreased ACTH

  • Increased TSH

Explanation

Question 15 of 40

1

A patient has acromegaly. What assessment by the healthcare professional would be most important?

Select one of the following:

  • Skin condition

  • Sleep patterns

  • Bowel function

  • Range of motion

Explanation

Question 16 of 40

1

Why does giantism occur only in children and adolescents?

Select one of the following:

  • Their growth hormones are still diminished.

  • Their epiphyseal plates have not yet closed.

  • Their skeletal muscles are not yet fully developed.

  • Their metabolic rates are higher than in adulthood.

Explanation

Question 17 of 40

1

A patient chart notes the patient has amenorrhea, galactorrhea, hirsutism, and osteoporosis.
What diagnostic test would the healthcare professional prepare the patient for?

Select one of the following:

  • Water deprivation test

  • Hemoglobin A1C

  • CT scan of the head

  • Ovarian biopsy

Explanation

Question 18 of 40

1

What does Graves’ disease develop from?

Select one of the following:

  • A viral infection of the thyroid gland that causes overproduction of thyroid hormone

  • An autoimmune process during which lymphocytes and fibrous tissue replace
    thyroid tissue

  • A thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones

  • An ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing a goiter

Explanation

Question 19 of 40

1

Which patient would the healthcare professional assess for other signs of thyrotoxic crisis?

Select one of the following:

  • Constipation with gastric distention

  • Bradycardia and bradypnea

  • Hyperthermia and tachycardia

  • Constipation and lethargy

Explanation

Question 20 of 40

1

Which pathologic changes are associated with Graves’ disease?

Select one of the following:

  • High levels of circulating thyroid-stimulating immunoglobulins

  • Diminished levels of thyrotropin-releasing hormone

  • High levels of thyroid-stimulating hormone

  • Diminished levels of thyroid-binding globulin

Explanation

Question 21 of 40

1

A healthcare professional is palpating the neck of a person diagnosed with Graves’ disease.
What finding would the professional associate with this disorder?

Select one of the following:

  • Parathyroids left of midline

  • Thyroid small with discrete nodules

  • Parathyroids normal in size

  • Thyroid diffusely enlarged

Explanation

Question 22 of 40

1

A person has hypothyroidism. What chemical does the healthcare professional advise the
person to include in the diet?

Select one of the following:

  • Iron

  • Iodine

  • Zinc

  • Magnesium

Explanation

Question 23 of 40

1

A patient has a suspected thyroid carcinoma. What diagnostic test does the healthcare
professional prepare the patient for?

Select one of the following:

  • Measurement of serum thyroid levels

  • Radioisotope scanning

  • Ultrasonography

  • Fine-needle aspiration biopsy

Explanation

Question 24 of 40

1

Renal failure is the most common cause of which type of hyperparathyroidism?

Select one of the following:

  • Primary

  • Secondary

  • Exogenous

  • Inflammatory

Explanation

Question 25 of 40

1

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?

Select one of the following:

  • TSH and T4

  • Serum sodium

  • Serum calcium

  • Urine osmolality

Explanation

Question 26 of 40

1

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?

Select one of the following:

  • Increased glucose use causes the shift of fluid from the intravascular to the intracellular space.

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

  • Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis.

  • Decreased glucose use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss

Explanation

Question 27 of 40

1

Why does polyuria occur with diabetes mellitus?

Select one of the following:

  • Formation of ketones

  • Chronic insulin resistance

  • Elevation in serum glucose

  • Increase in antidiuretic hormone

Explanation

Question 28 of 40

1

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?

Select one of the following:

  • Resistance to insulin by insulin-sensitive tissues

  • Need for lifelong insulin injections

  • Increase of glucagon secretion from beta cells of the pancreas

  • Presence of insulin autoantibodies that destroy beta cells in the pancreas

Explanation

Question 29 of 40

1

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?

Select one of the following:

  • Hyperglycemia caused by incorrect insulin administration

  • Dawn phenomenon from eating a snack before bedtime

  • Hypoglycemia caused by increased exercise

  • Somogyi effect from insulin sensitivity

Explanation

Question 30 of 40

1

Which serum glucose level would indicate hypoglycemia in a newborn?

Select one of the following:

  • 28 mg/dL

  • 40 mg/dL

  • 60 mg/dL

  • 80 mg/dL

Explanation

Question 31 of 40

1

When comparing the clinical manifestations of both diabetic ketoacidosis (DKA) and
hyperglycemic hyperosmolar nonketotic syndrome (HHNKS), which condition is associated with only DKA?

Select one of the following:

  • Fluid loss

  • Weight loss

  • Increased serum glucose

  • Kussmaul respirations

Explanation

Question 32 of 40

1

Hypoglycemia, followed by rebound hyperglycemia, is observed in those with what?

Select one of the following:

  • The Somogyi effect

  • The dawn phenomenon

  • Diabetic ketoacidosis

  • Hyperosmolar hyperglycemic nonketotic syndrome

Explanation

Question 33 of 40

1

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?

Select one of the following:

  • More frequent blood glucose monitoring

  • Moderate dietary sodium restriction

  • Treatment with an ACE inhibitor

  • Home blood pressure monitoring

Explanation

Question 34 of 40

1

Which classification of oral hypoglycemic drugs decreases hepatic glucose production and
increases insulin sensitivity and peripheral glucose uptake?

Select one of the following:

  • Biguanide (metformin)

  • Sulfonylureas (glyburide)

  • Meglitinides (glinides)

  • α-Glycosidase inhibitor (miglitol)

Explanation

Question 35 of 40

1

What causes the microvascular complications in patients with diabetes mellitus?

Select one of the following:

  • The capillaries contain plaques of lipids that obstruct blood flow.

  • Pressure in capillaries increases as a result of the elevated glucose attracting water.

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

  • Fibrous plaques form from the proliferation of subendothelial smooth muscle of arteries.

Explanation

Question 36 of 40

1

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?

Select one of the following:

  • Plaques of lipids develop in the retinal vessels.

  • Pressure in the retinal vessels increase as a result of increased osmotic pressure.

  • Ketones cause microaneurysms in the retinal vessels.

  • Retinal ischemia and red blood cell aggregation occur.

Explanation

Question 37 of 40

1

A person has acne, easy bruising, thin extremities, and truncal obesity. The healthcare professional assesses the person for which of these?

Select one of the following:

  • Previous thyroid surgery

  • Urine osmolality

  • Serum electrolytes

  • Use of glucocorticoids

Explanation

Question 38 of 40

1

A person may experience which complications as a result of a reduction in parathyroid hormone (PTH)? (Select all that apply.)

Select one or more of the following:

  • Muscle spasms

  • Tonic-clonic seizures

  • Laryngeal spasms

  • Hyporeflexia

  • Asphyxiation

Explanation

Question 39 of 40

1

A chronic complication of diabetes mellitus is likely to result in microvascular complications
in which areas? (Select all that apply.)

Select one or more of the following:

  • Eyes

  • Coronary arteries

  • Renal system

  • Peripheral vascular system

  • Nerves

Explanation

Question 40 of 40

1

What are clinical manifestations of hypothyroidism? (Select all that apply.)

Select one or more of the following:

  • Intolerance to heat

  • Restlessness

  • Constipation

  • Bradycardia

  • Lethargy

Explanation

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