Ch. 13 Altered Metabolism

Question 1

A nurse is caring for a client who asks why the provider bases the medication regimen on HbA1c results instead of the log of morning fasting blood glucose results. Which of the following responses should the nurse make?

A. “HbA1c measures how well insulin is regulating your blood glucose between meals.”
B. “HbA1c indicates how well your have regulated your blood glucose over the past 120 days.”
C. “HbA1c is the first test your doctor prescribed to determine that you have diabetes.”
D. “HbA1c determines if the your doctor
should adjust your insulin dosage.”

Answer 1

B. CORRECT: HbA1c measures blood glucose
control over the past 120 days

Question 2

A nurse is reviewing the laboratory findings for a client who might have hyperthyroidism. The nurse should identify an elevation of which of the following substances as an indication that the client has this disorder?

A. Triiodothyronine
B. Plasma-free metanephrine
C. Urine cortisol
D. Urine osmolality

Answer 2

A. CORRECT: Increased triiodothyronine (T3) indicates hyperthyroidism.

Question 3

A nurse is reviewing the health record of a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory findings should the nurse expect? (Select all that apply.)

A. Low sodium
B. High potassium
C. Increased urine osmolality
D. High urine sodium
E. Increased urine specific gravity

Answer 3

A. CORRECT: SIADH results in water retention, causing a low sodium level.

C. CORRECT: SIADH results in an increase in urine osmolality due to the decreased urine volume.

D. CORRECT: SIADH results in water retention, causing a high urine sodium level.

E. CORRECT: SIADH results in water retention, causing an increase in urine specific gravity.

Question 4

A nurse is caring for a client who has primary adrenal insufficiency and is preparing to undergo an ACTH stimulation test. Which of the following findings should the nurse expect after an IV injection of cosyntropin?

A. No change in plasma cortisol
B. Elevated fasting blood glucose
C. Decrease in sodium
D. Increase in urinary output

Answer 4

A. CORRECT: No change in plasma cortisol indicates primary adrenal insufficiency (Addison’s disease or hypocortisolism) after an IV injection of cosyntropin during an ACTH stimulation test due to an inadequate production of cortisol.

Question 5

A nurse is assessing a client during a water deprivation test. For which of the following complications should the nurse monitor the client?

A. Bradycardia
B. Orthostatic hypotension
C. Neck vein distention
D. Crackles in lungs

Answer 5

B. CORRECT: Monitor for orthostatic hypotension resulting from dehydration during a water deprivation test.

Question 6

Which of the following is not a major role of hormones?

a. Growth stimulation
b. Platelet synthesis
c. Fluid balance and regulation
d. Metabolic rate regulation

Answer 6

b. Platelet synthesis

Question 7

The release of hormones from glands is most often controlled by

a. negative feedback mechanisms.
b. nephrogenic mechanisms.
c. ectopic hormone production.
d. active transport.

Answer 7

a. negative feedback mechanisms.

Question 8

The most common cause of endocrine disorders is

a. surgical removal of endocrine glands.
b. infection.
c. adenomas.
d. immunodeficiency.

Answer 8

c. adenomas.

Question 9

Excess cortisol is represented by which condition?

a. Addison disease
b. Cushing syndrome
c. Diabetes insipidus
d. Hyperthyroidism

Answer 9

b. Cushing syndrome

Question 10

Diabetes insipidus, if left untreated, will rapidly develop into

a. malignant hypertension.
b. diabetic coma.
c. dehydration.
d. metabolic alkalosis.

Answer 10

c. dehydration.

Question 11

A patient is asked to collect a 24-hour urine test to check a hormone level. Why is the 24-hour urine needed?

a. This is done to measure female reproductive hormone levels.
b. This is done to obtain a measurement of hormone secretion over time.
c. It is easier than obtaining a blood sample.
d. Urine is not an effective method of measuring hormone levels.

Answer 11

b. This is done to obtain a measurement of hormone secretion over time.

Question 12

You are experiencing constipation, dry skin, weight gain, and cold intolerance. Which condition are you most likely experiencing?

a. Hyperthyroidism
b. Addison disease
c. Cushing syndrome
d. Hypothyroidism

Answer 12

d. Hypothyroidism

Question 13

Which of the following occurs with elevated levels of cortisol?

a. Fatty acids are mobilized.
b. Glucose levels are suppressed.
c. Plasma protein levels increase.
d. Inflammation increases.

Answer 13

a. Fatty acids are mobilized.

Question 14

Which type of hormone is not produced in the adrenal cortex?

a. Mineralocorticoids
b. Glucocorticoids
c. Adrenal sex hormones
d. Neurotransmitters

Answer 14

d. Neurotransmitters

Question 15

Diagnosis of SIADH is based on which of the following?

a. Hyponatremia
b. Hypertonicity
c. Increased urine volume
d. Dilute urine with a low sodium content

Answer 15

a. Hyponatremia

Question 16

Release of hormones from the anterior pituitary differs from those released by the posterior pituitary. What is the major way in which these are different?

a. The posterior pituitary is much less complicated.
b. The anterior pituitary releases only two hormones.
c. The posterior pituitary follows the positive feedback loop.
d. The anterior pituitary is controlled by the hypothalamus.

Answer 16

a. The posterior pituitary is much less complicated.

Question 17

Which of the following major pathways occurs when a hormone is produced in a cell and can have an effect on neighboring cells and on its own cell?

a. Paracrine pathway
b. Autocrine pathway
c. Synaptic pathway
d. Neuroendocrine pathway

Answer 17

b. Autocrine pathway

Question 18

A patient presents with SIADH and a serum sodium level of 100 mEq/L. What would you expect for clinical manifestations for this patient?

a. Polyuria, polydipsia, polyphagia
b. Nausea, vomiting, headache
c. Muscle cramps, weakness, irritability
d. Seizures, psychosis, gait disturbances

Answer 18

c. Muscle cramps, weakness, irritability

Question 19

A patient presents with exophthalmos. What condition are they likely experiencing?

a. Addison disease
b. Cushing disease
c. Graves disease
d. Diabetes insipidus

Answer 19

c. Graves disease

Question 20

Which blood test can be used to differentiate the diagnosis between hypothyroidism and hyperthyroidism? Select all that apply.

A) PTH level
B) TSH stimulating test
C) T3
D) T4
E) TSH

Answer 20

C) T3
D) T4
E) TSH

There are specific blood tests that can be used to differentiate between hypothyroidism and hyperthyroidism. These tests include measuring blood values of triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH). With hyperthyroidism there will be an increase in T3 and T4. With hypothyroidism there will be a decrease in T3 and T4. In hyperthyroidism the TSH will be decreased with Grave’s disease, but increased with secondary or tertiary hyperthyroidism. With hypothyroidism, TSH will be increased with primary disease, but decreased with secondary or tertiary hypothyroidism. The TSH stimulation tests only provide information for hypothyroidism. It is not applicable for hyperthyroidism.

Question 21

What dietary deficiency is one of the leading causes of hypothyroidism?

A) K
B) Na
C) Cl
D) I

Answer 21

Iodine

Worldwide, hypothyroidism is common in areas where the soil and water have little natural iodide. This deficiency can cause an endemic goiter. This was at one time a common problem in the United State, especially in the midwest. This deficiency was corrected by the addition of iodide to table salt. Another source of iodide is saltwater fish.

Question 22

The nurse is conducting teaching regarding the pathophysiology of the development of goiter in clients with Grave’s disease. How does the nurse best explain this to the client?

A) In clients with Grave’s, the immune system causes the thyroid to over produce its hormones, leading to enlargement of the gland.
B) Because the thyroid does not produce enough of its hormones, it becomes over-stimulated by the pituitary gland causing it to enlarge.
C) In Grave’s, the thyroid enlarges due to taking prescribed anti-thyroid medications.
D) The thyroid decreases in size due to long term underproduction of thyroid hormones.

Answer 22

A) In clients with Grave’s, the immune system causes the thyroid to over produce its hormones, leading to enlargement of the gland.

Clients with Grave’s disease produce autoantibodies that directly attack the thyroid gland causing overstimulation and overproduction of thyroid hormones. The overstimulation of the thyroid to produce T3 and T4 causes the gland to become overworked causing it to enlarge in appearance. Enlargement of the thyroid gland is referred to as goiter which is a classic manifestation of Grave’s disease.

Question 23

The nurse caring for a client diagnosed with myxedema coma places priority on performing which assessment:

A) Droopy appearing eyelids
B) The client’s intake in mL
C) Rectal temperature
D) Apical heart rate

Answer 23

D) Apical heart rate

Myxedema coma is the most significant complication of hypothyroidism. Manifestations include decreased mental status, decreased body temperature, bradycardia, and hypotension. The nurse must place priority on assessing the client’s apical heart rate and rhythm to prevent complications from decreased cardiac output.

Question 24

Which manifestation would be most helpful to confirm a diagnosis of Grave’s disease?

A) Protruding eyeballs
B) Myxedema
C) Bradycardia
D) Reports of headache

Answer 24

A) Protruding eyeballs

Exophthalmos is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be unilateral or bilateral and is classically associated with Grave’s disease. In clients with Graves disease, exophthalmos results from abnormal deposition of connective tissue within the orbital socket.

Question 25

When working with a client diagnosed with Cushing’s syndrome which is considered a cause? Select all that apply.

A) Damage to adrenal gland
B) Autoimmune response
C) Long-term steroid use
D) Pituitary adenoma
E) Small cell carcinoma

Answer 25

C) Long-term steroid use
D) Pituitary adenoma
E) Small cell carcinoma

Cushing’s syndrome/disease occurs with excessive secretion of corticosteroids. The problem is seen as excessive secretion of cortisol from the adrenal cortex. Endogenous secretion (Cushing’s disease) occurs most commonly because of a pituitary adenoma. Another cause related to endogenous secretion is malignancies as with small cell lung cancer. Exogenous administration (Cushing’s syndrome) occurs from long term steroid therapy as in the treatment for asthma, chronic fibrosis, and autoimmune disorders.

Question 26

Which clinical manifestation assessed in a client admitted to the intensive care unit confirms a diagnosis of Cushing’s syndrome? Select all that apply.

A) Hypotension
B) Purple striae
C) Hirsutism
D) Moon face
E) Truncal obesity

Answer 26

B) Purple striae
C) Hirsutism
D) Moon face
E) Truncal obesity

In Cushing’s syndrome all body systems are affected by hypercortisolism. The general appearance will be a moon face, buffalo hump, and truncal obesity. Cardiovascular manifestations include: hypertension and dependent edema. Skin manifestations include: thinning skin, rosey cheeks, increased pigmentation, hirsutism, and purple striae on the face and abdomen. Osteoporosis results in bone fractures. Other clinical manifestations include: slow healing, hyperglycemia, and hypernatremia.

Question 27

What is the underlying pathophysiology for edema in clients with Cushing syndrome?

A) Excess K
B) Decreased Na
C) Excess aldosterone
D) Decreased angiotensin II

Answer 27

C) Excess aldosterone

Cushing syndrome is an endocrine disorder in which the adrenal cortex produces too much cortisol, aldosterone, and androgens. Excess cortisol results in elevated blood glucose levels and decreased immunity. The presence of androgens in excess results in gynecomastia in males and excess body hair in females. Excess aldosterone causes the kidneys to retain sodium and fluid leading to the manifestation of peripheral edema.

Question 28

While providing care for a client diagnosed with Addison’s disease, which clinical manifestation is expected? Select all that apply.

A) Hypertension
B) Pale, thin skin
C) Salt craving
D) Decreased weight
E) Cold intolerance

Answer 28

C) Salt craving
D) Decreased weight
E) Cold intolerance

Adrenal insufficiency, also known as Addison’s disease, is related to an insufficiency of adrenocortical steroids. Clinical manifestations of Addison’s disease depend on the degree of hormone deficiency. Neuromuscular manifestations include: muscle weakness, fatigue, joint and muscle pain. Gastrointestinal manifestations include: weight loss, salt craving, and anorexia. Cardiovascular manifestations include: hypotension, hyponatremia (< 135 mg/dL), and hyperkalemia (> 5.0 mg/dL). Other clinical manifestations include: hyperpigmentation alopecia, cold intolerance, and depression.

Question 29

Which risk factor is an identified cause of Addisonian crisis? Select all that apply.

A) Increase steroid dosing
B) Increasing age
C) Environmental changes
D) Cessation of steroid therapy
E) Acute infection

Answer 29

D) Cessation of steroid therapy
E) Acute infection

Addisonian crisis occurs when there is an acute insufficiency of adrenal hormones. This crisis may occur gradually or quickly with increased stress. These life-threatening manifestations may appear without warning. The most common cause of this crisis is acute infection. It can also occur in the client that abruptly stops steroid replacement therapy. Initial clinical manifestations include: nausea, vomiting, fever, and neurological changes. If interventions are not implemented quickly the condition will rapidly lead to severe hypotension, circulatory collapse and shock.

Question 30

Hormones are chemical messengers that provide which function in the body?

A) Cause one specific tissue effect
B) Regulate body functions

Answer 30

B) Regulate body functions

Question 31

A client who has been diagnosed with gastric ulcer disease asks how chronically elevated stress hormones contribute to ulcer formation. Which is the nurse’s best response?

A) “Chronic stress leads to poor dietary choices, including high-fat foods and increased alcohol use. These dietary habits greatly increase the risk for gastric ulcers.”
B) “Chronically elevated levels of stress hormones reduce blood flow to the gastrointestinal system, decreasing oxygen supply and increasing the risk for ulcer formation.”

Answer 31

B) “Chronically elevated levels of stress hormones reduce blood flow to the gastrointestinal system, decreasing oxygen supply and increasing the risk for ulcer formation.”

Question 32

The nurse is caring for a client with impairment of the adrenal gland. The nurse notes abnormal sodium and potassium levels. Which hormone is the most likely to be impaired?

A) Cortisol
B) Aldosterone

Answer 32

B) Aldosterone

Question 33

The nurse is teaching a group of clients recovering from recent myocardial infarctions about the effects of chronic stress on body functioning. Which information will the nurse include? Select all that apply.

A) Increased muscle breakdown
B) Elevated blood glucose
C) Reduced fertility
D) Excessive fluid loss
E) Increased inflammatory response

Answer 33

A) Increased muscle breakdown
B) Elevated blood glucose
C) Reduced fertility
E) Increased inflammatory response

Question 34

Which will influence the level of secretion of antidiuretic hormone (ADH)? Select all that apply.

A) serum osmolality
B) presence of renin
C) intracellular sodium levels
D) intravascular fluid volume
E) extracellular potassium levels

Answer 34

A) serum osmolality
D) intravascular fluid volume

Question 35

The client is prescribed prednisone. Which effects of therapy will the nurse address as likely to interfere with the client’s ability to adhere to treatment? Select all that apply.

A) Changes in fat metabolism
B) Elevations in blood glucose
C) Integumentary changes
D) Osteoporosis
E) Behavioral changes

Answer 35

A) Changes in fat metabolism
C) Integumentary changes
E) Behavioral changes

Question 36

A client with polymyalgia rheumatica (PR) is being discharged on prednisone. What teaching should the nurse include? Select all that apply.

A) “You should notice rapid improvement in your symptoms with this medication.”
B) “There are many adverse effects with this medication that make it difficult to take.”
C) “It is normal to have fluctuations in your PR symptoms while on this medication.”
D) “You will be taught how to titrate the dosing of the drug based on your symptoms.”
E) “Stopping the medication abruptly can have very serious health consequences.”

Answer 36

A) “You should notice rapid improvement in your symptoms with this medication.”
B) “There are many adverse effects with this medication that make it difficult to take.”
E) “Stopping the medication abruptly can have very serious health consequences.”