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Chapter 22: Alterations of Hormonal Regulation

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Pathophysiology: The Biologic Basis for Disease in Adults and Children 8th Edition
Josef Nachar
Quiz by Josef Nachar, updated more than 1 year ago More Less
Emily Doyle
Created by Emily Doyle almost 5 years ago
Emily Doyle
Copied by Emily Doyle almost 5 years ago
Josef Nachar
Copied by Josef Nachar almost 5 years ago
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Resource summary

Question 1

Question
The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include which solute?
Answer
  • Sodium and water retention
  • Sodium retention and water loss
  • c. Sodium dilution and water retention
  • Sodium dilution and water loss

Question 2

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

Question 3

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

Question 4

Question
What is diabetes insipidus a result of?
Answer
  • Antidiuretic hormone hyposecretion
  • Antidiuretic hormone hypersecretion
  • Insulin hyposecretion
  • Insulin hypersecretion

Question 5

Question
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?
Answer
  • Administration of desmopressin
  • Serum copeptin testing
  • Insulin administration
  • Renal angiogram

Question 6

Question
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?
Answer
  • Stop the water deprivation test.
  • Administer salt tablets.
  • Continue with the test as planned.
  • Take the patient’s blood glucose.

Question 7

Question
A healthcare professional is caring for four patients. Which patient does the professional assess for neurogenic diabetes insipidus (DI)?
Answer
  • Anterior pituitary tumor
  • Thalamus hypofunction
  • Posterior pituitary trauma
  • Renal tubule disease

Question 8

Question
Which form of diabetic insipidus (DI) will result if the target cells for antidiuretic hormone (ADH) in the renal collecting tubules demonstrate insensitivity?
Answer
  • Neurogenic
  • Nephrogenic
  • Psychogenic
  • Ischemic

Question 9

Question
Which laboratory value is consistent with diabetes insipidus (DI)?
Answer
  • Low urine-specific gravity
  • Low serum sodium
  • Low urine protein
  • High serum total protein

Question 10

Question
A patient has nephrogenic diabetes insipidus (DI). What treatment does the healthcare professional anticipate for this patient?
Answer
  • Exogenous ADH replacement
  • Intranasal desmopressin
  • Water and sodium restriction
  • Loop diuretic administration

Question 11

Question
Which condition may result from pressure exerted by a pituitary tumor?
Answer
  • Hypothyroidism
  • Hypercortisolism
  • Diabetes insipidus
  • Insulin hyposecretion

Question 12

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

Question 13

Question
Visual disturbances are a result of a pituitary adenoma because of what?
Answer
  • 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

Question 14

Question
A patient has an enlarged tongue, body odor, rough skin, and coarse hair. Which laboratory result does the healthcare professional associate with this presentation?
Answer
  • Decreased blood glucose
  • Increased growth hormone
  • Decreased ACTH
  • Increased TSH

Question 15

Question
A patient has acromegaly. What assessment by the healthcare professional would be most important?
Answer
  • Skin condition
  • Sleep patterns
  • Bowel function
  • Range of motion

Question 16

Question
Why does giantism occur only in children and adolescents?
Answer
  • 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.

Question 17

Question
A patient chart notes the patient has amenorrhea, galactorrhea, hirsutism, and osteoporosis. What diagnostic test would the healthcare professional prepare the patient for?
Answer
  • Water deprivation test
  • Hemoglobin A1C
  • CT scan of the head
  • Ovarian biopsy

Question 18

Question
What does Graves’ disease develop from?
Answer
  • 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

Question 19

Question
Which patient would the healthcare professional assess for other signs of thyrotoxic crisis?
Answer
  • Constipation with gastric distention
  • Bradycardia and bradypnea
  • Hyperthermia and tachycardia
  • Constipation and lethargy

Question 20

Question
Which pathologic changes are associated with Graves’ disease?
Answer
  • 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

Question 21

Question
A healthcare professional is palpating the neck of a person diagnosed with Graves’ disease. What finding would the professional associate with this disorder?
Answer
  • Parathyroids left of midline
  • Thyroid small with discrete nodules
  • Parathyroids normal in size
  • Thyroid diffusely enlarged

Question 22

Question
A person has hypothyroidism. What chemical does the healthcare professional advise the person to include in the diet?
Answer
  • Iron
  • Iodine
  • Zinc
  • Magnesium

Question 23

Question
A patient has a suspected thyroid carcinoma. What diagnostic test does the healthcare professional prepare the patient for?
Answer
  • Measurement of serum thyroid levels
  • Radioisotope scanning
  • Ultrasonography
  • Fine-needle aspiration biopsy

Question 24

Question
Renal failure is the most common cause of which type of hyperparathyroidism?
Answer
  • Primary
  • Secondary
  • Exogenous
  • Inflammatory

Question 25

Question
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?
Answer
  • TSH and T4
  • Serum sodium
  • Serum calcium
  • Urine osmolality

Question 26

Question
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?
Answer
  • 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

Question 27

Question
Why does polyuria occur with diabetes mellitus?
Answer
  • Formation of ketones
  • Chronic insulin resistance
  • Elevation in serum glucose
  • Increase in antidiuretic hormone

Question 28

Question
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?
Answer
  • 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

Question 29

Question
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?
Answer
  • Hyperglycemia caused by incorrect insulin administration
  • Dawn phenomenon from eating a snack before bedtime
  • Hypoglycemia caused by increased exercise
  • Somogyi effect from insulin sensitivity

Question 30

Question
Which serum glucose level would indicate hypoglycemia in a newborn?
Answer
  • 28 mg/dL
  • 40 mg/dL
  • 60 mg/dL
  • 80 mg/dL

Question 31

Question
When comparing the clinical manifestations of both diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNKS), which condition is associated with only DKA?
Answer
  • Fluid loss
  • Weight loss
  • Increased serum glucose
  • Kussmaul respirations

Question 32

Question
Hypoglycemia, followed by rebound hyperglycemia, is observed in those with what?
Answer
  • The Somogyi effect
  • The dawn phenomenon
  • Diabetic ketoacidosis
  • Hyperosmolar hyperglycemic nonketotic syndrome

Question 33

Question
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?
Answer
  • More frequent blood glucose monitoring
  • Moderate dietary sodium restriction
  • Treatment with an ACE inhibitor
  • Home blood pressure monitoring

Question 34

Question
Which classification of oral hypoglycemic drugs decreases hepatic glucose production and increases insulin sensitivity and peripheral glucose uptake?
Answer
  • Biguanide (metformin)
  • Sulfonylureas (glyburide)
  • Meglitinides (glinides)
  • α-Glycosidase inhibitor (miglitol)

Question 35

Question
What causes the microvascular complications in patients with diabetes mellitus?
Answer
  • 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.

Question 36

Question
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?
Answer
  • 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.

Question 37

Question
A person has acne, easy bruising, thin extremities, and truncal obesity. The healthcare professional assesses the person for which of these?
Answer
  • Previous thyroid surgery
  • Urine osmolality
  • Serum electrolytes
  • Use of glucocorticoids

Question 38

Question
A person may experience which complications as a result of a reduction in parathyroid hormone (PTH)? (Select all that apply.)
Answer
  • Muscle spasms
  • Tonic-clonic seizures
  • Laryngeal spasms
  • Hyporeflexia
  • Asphyxiation

Question 39

Question
A chronic complication of diabetes mellitus is likely to result in microvascular complications in which areas? (Select all that apply.)
Answer
  • Eyes
  • Coronary arteries
  • Renal system
  • Peripheral vascular system
  • Nerves

Question 40

Question
What are clinical manifestations of hypothyroidism? (Select all that apply.)
Answer
  • Intolerance to heat
  • Restlessness
  • Constipation
  • Bradycardia
  • Lethargy
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