Chapter 22

Question 1

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

a. Sodium and water retention
b. Sodium retention and water loss
c. Sodium dilution and water retention
d. Sodium dilution and water loss

Answer 1

c. Sodium dilution and water retention.

The symptoms of SIADH secretion are a result of dilutional hyponatremia and water retention. SIADH does not lead to sodium retention or water loss.

Question 2

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

a. Being treated for small cell carcinoma of the stomach
b. Taking high dose acetaminophen (Tylenol) for arthritis
c. Had a hip replacement operation 14 days ago
d. Has long-standing kidney disease from diabetes

Answer 2

a. Being treated for small cell carcinoma of the stomach.

A common cause of elevated levels of ADH secretion is ectopically produced ADH by tumors, such as small cell carcinoma of the duodenum, stomach, and pancreas; cancers of the bladder, prostate, and endometrium; lymphomas; and sarcomas. High doses of anti-inflammatory medications are a risk factor, but acetaminophen is not an anti-inflammatory medication. Surgery within the last 5 to 7 leads to increased ADH secretion. Kidney disease does not lead to excess levels of ADH.

Question 3

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

a. Hypernatremia and urine hypoosmolality
b. Serum potassium (K+) level of 5 mEq/L and urine hyperosmolality compared to serum
c. Serum sodium (Na+) level of 120 mEq/L and serum osmolality 260 mOsm/kg
d. Serum potassium (K+) of 2.8 mEq/L and serum hyperosmolality

Answer 3

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

A diagnosis of SIADH requires a serum sodium level of less than 135 mEq/L, serum hypoosmolality less than 280 mOsm/kg, and urine hyperosmolarity. Potassium levels are not considered a factor.

Question 4

What is diabetes insipidus a result of?

a. Antidiuretic hormone hyposecretion
b. Antidiuretic hormone hypersecretion
c. Insulin hyposecretion
d. Insulin hypersecretion

Answer 4

a. Antidiuretic hormone hyposecretion

Diabetes insipidus is a result of insufficient antidiuretic hormone (hyposecretion). It is not related to insulin secretion.

Question 5

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?

a. Administration of desmopressin
b. Serum copeptin testing
c. Insulin administration
d. Renal angiogram

Answer 5

a. Administration of desmopressin

The stated symptoms are reflective of neurogenic diabetes insipidus (DI) which can be treated with desmopressin. Desmopressin will cause an increased ability to concentrate urine. Copeptin is a precursor of ADH and obtaining a serum level is useful in diagnosing dipsogenic DI. The patient does not need insulin or a renal angiogram.

Question 6

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?

a. Stop the water deprivation test.
b. Administer salt tablets.
c. Continue with the test as planned.
d. Take the patient’s blood glucose.

Answer 6

a. Stop the water deprivation test.

In patients with severe diabetes insipidus the water deprivation test can be diagnostic. However, it can also be risky; if the patient loses more than 3% of body weight, cardiovascular collapse and shock can occur. This patient has lost 5% of initial body weight, so the professional should stop the test. Administering salt tablets does not take priority over stopping the test. Glucose measurement is not relevant.

Question 7

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

a. Anterior pituitary tumor
b. Thalamus hypofunction
c. Posterior pituitary trauma d. Renal tubule disease

Answer 7

c. Posterior pituitary trauma

Neurogenic DI is a result of dysfunctional antidiuretic hormone synthesis, caused by a lesion of the posterior pituitary, hypothalamus, or pituitary stalk. Injury of dysfunction of the anterior pituitary, the thalamus, or the renal tubules does not cause neurogenic DI.

Question 8

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

a. Neurogenic
b. Nephrogenic
c. Psychogenic
d. Ischemic

Answer 8

b. Nephrogenic

Only nephrogenic DI is associated with an insensitivity of the renal collecting tubules to ADH.

Question 9

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

a. Low urine-specific gravity b. Low serum sodium
c. Low urine protein
d. High serum total protein

Answer 9

a. Low urine-specific gravity

The basic criteria for diagnosing DI include a low urine-specific gravity while sodium levels are high. Protein levels are not considered.

Question 10

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

a. Exogenous ADH replacement
b. Intranasal desmopressin
c. Water and sodium restriction
d. Loop diuretic administration

Answer 10

a. Exogenous ADH replacement

Nephrogenic DI is usually treated with administration of fluids, or intranasal (or oral) desmopressin. Neurogenic DI is treated with ADH replacement therapy. Water restriction would not be helpful. Thiazide (not loop) diuretics can improve moderate nephrogenic DI.

Question 11

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

a. Hypothyroidism
b. Hypercortisolism
c. Diabetes insipidus
d. Insulin hyposecretion

Answer 11

a. Hypothyroidism

If the tumor exerts sufficient pressure, then thyroid and adrenal hypofunction may occur because of lack of thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH). These result in the symptoms of hypothyroidism and hypocortisolism. The remaining options are not associated with the pressure exerted by a pituitary tumor.

Question 12

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

a. The patient has a lack of all hormones associated with the anterior pituitary gland.
b. The patient has a lack of all hormones associated with the lateral pituitary gland.
c. The patient has total adrenocorticoptropic hormone deficiency.
d. The patient has a dysfunction of the posterior pituitary gland due to a tumor.

Answer 12

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

Panhypopituitarism is the term denoting the lack of all anterior pituitary hormones.

Question 13

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

a. Liberation of anterior pituitary hormones into the optic chiasm
b. Pituitary hormones clouding the lens of the eyes
c. Pressure of the tumor on the optic chiasm
d. Pressure of the tumor on the optic and oculomotor cranial nerves

Answer 13

c. Pressure of the tumor on the optic chiasm

Pressure on the optic chiasm is the only cause for visual disturbances resulting from a pituitary adenoma.

Question 14

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

a. Decreased blood glucose b. Increased growth hormone
c. Decreased ACTH
d. Increased TSH

Answer 14

b. Increased growth hormone

This patient has clinical findings suggestive of acromegaly which is caused by high levels of growth hormone (GH), often from a pituitary adenoma. It would result in high blood glucose and no effect on ACTH or TSH.

Question 15

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

a. Skin condition
b. Sleep patterns
c. Bowel function
d. Range of motion

Answer 15

b. Sleep patterns

Sleep patterns are important to assess for in patients with acromegaly because sleep-disordered breathing such as obstructive sleep apnea is common. The skin in patients with acromegaly will be coarse. Bowel function may or may not be altered. Range of motion is decreased as an expected consequence of the disease.

Question 16

Why does giantism occur only in children and adolescents?

a. Their growth hormones are still diminished.
b. Their epiphyseal plates have not yet closed.
c. Their skeletal muscles are not yet fully developed.
d. Their metabolic rates are higher than in adulthood.

Answer 16

b. Their epiphyseal plates have not yet closed.

Giantism is related to the effects of excess growth hormones on the growth of long bones at their epiphyseal plates in acromegaly. It is not related to skeletal muscle development of metabolic rate.

Question 17

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

a. Water deprivation test
b. Hemoglobin A1C
c. CT scan of the head
d. Ovarian biopsy

Answer 17

c. CT scan of the head

The patient presents with characteristics of a prolactinoma: a pituitary tumor that secretes prolactin. The professional would prepare the patient for a CT scan of the head. A water deprivation test is used to diagnose diabetes insipidus. The hemoglobin A1C is used to measure blood glucose over time. Polycystic ovary disease can lead to increased level of prolactin, but this is not diagnosed with a biopsy.

Question 18

What does Graves’ disease develop from?

a. A viral infection of the thyroid gland that causes overproduction of thyroid hormone
b. An autoimmune process during which lymphocytes and fibrous tissue replace thyroid tissue
c. A thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones
d. An ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing a goiter.

Answer 18

c. A thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones.

The pathologic features of Graves’ disease indicate that normal regulatory mechanisms are overridden by abnormal immunologic mechanisms resulting in the stimulation of excessive TH. Graves’ disease is not caused by a viral infection, lymphocyte and fibrous tissue infiltration, or ingestion of goitrogens.

Question 19

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

a. Constipation with gastric distention
b. Bradycardia and bradypnea
c. Hyperthermia and tachycardia
d. Constipation and lethargy

Answer 19

c. Hyperthermia and tachycardia

The systemic symptoms of thyrotoxic crisis include hyperthermia, tachycardia, diarrhea, and agitation or delirium, heart failure, dysrhythmias, nausea, and vomiting

Question 20

Which pathologic changes are associated with Graves’ disease?

a. High levels of circulating thyroid-stimulating immunoglobulins
b. Diminished levels of thyrotropin-releasing hormone
c. High levels of thyroid-stimulating hormone
d. Diminished levels of thyroid-binding globulin

Answer 20

a. High levels of circulating thyroid-stimulating immunoglobulins

Question 21

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

a. Parathyroids left of midline
b. Thyroid small with discrete nodules
c. Parathyroids normal in size
d. Thyroid diffusely enlarged

Answer 21

d. Thyroid diffusely enlarged

Graves’ disease is characterized by a diffusely enlarged thyroid gland. The parathyroid glands are not involved.

Question 22

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

a. Iron
b. Iodine
c. Zinc
d. Magnesium

Answer 22

b. Iodine

A lack of iodine can lead to hypothyroidism.

Question 23

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

a. Measurement of serum thyroid levels
b. Radioisotope scanning
c. Ultrasonography
d. Fine-needle aspiration biopsy

Answer 23

d. Fine-needle aspiration biopsy

Fine-needle aspiration of a thyroid nodule is generally performed to diagnose thyroid carcinoma. Serum thyroid levels probably will not be abnormal early in disease. Radioisotope scanning is not used and ultrasound is not specific enough for diagnosis.

Question 24

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

a. Primary
b. Secondary
c. Exogenous
d. Inflammatory

Answer 24

b. Secondary

Chronic renal failure is the most common cause of secondary hyperparathyroidism because of the resulting hyperphosphatemia that stimulates parathyroid hormone secretion. Although the other options may occur, they are not the most common types of the disorder.

Question 25

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?
a. TSH and T4
b. Serum sodium
c. Serum calcium
d. Urine osmolality

Answer 25

c. Serum calcium

The patient is displaying signs of hypocalcemia, which can be caused by hypoparathyroidism. The most common cause of hypoparathyroidism is damage caused during thyroid surgery. The healthcare professional would be more informed by a serum calcium test. Thyroid hormones, serum sodium, and urine osmolality will not provide information related to this condition.

Question 26

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?

a. Increased glucose use causes the shift of fluid from the intravascular to the intracellular space.
b. Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis.
c. Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis.
d. Decreased glucose use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss.

Answer 26

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

Decreased glucose causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis, which have resulted in the symptoms listed in the question. Glucose is not being used which accounts for the high serum glucose. The pH indicates acidosis, not alkalosis. DKA is a metabolic, not respiratory, process.

Question 27

Why does polyuria occur with diabetes mellitus?

a. Formation of ketones
b. Chronic insulin resistance
c. Elevation in serum glucose
d. Increase in antidiuretic hormone

Answer 27

c. Elevation in serum glucose

Glucose accumulates in the blood and appears in the urine as the renal threshold for glucose is exceeded, producing an osmotic diuresis and the symptoms of polyuria and thirst. Ketone formation would lead to acidosis. Insulin resistance will promote hyperglycemia. And increase in antidiuretic hormone leads to water

Question 28

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?

a. Resistance to insulin by insulin-sensitive tissues
b. Need for lifelong insulin injections
c. Increase of glucagon secretion from beta cells of the pancreas
d. Presence of insulin autoantibodies that destroy beta cells in the pancreas.

Answer 28

a. Resistance to insulin by insulin-sensitive tissues

One of the basic pathophysiologic characteristics of type 2 diabetes is the development of insulin-resistant tissue cells. Type 1 diabetes always must be treated with insulin. Type 2 diabetes can be treated with insulin but there are other options. Pancreatic beta cells are destroyed in Type 1 diabetes. Increased glucagon is not secreted from pancreatic beta cells in Type 2 diabetes.

Question 29

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?

a. Hyperglycemia caused by incorrect insulin administration
b. Dawn phenomenon from eating a snack before bedtime
c. Hypoglycemia caused by increased exercise
d. Somogyi effect from insulin sensitivity

Answer 29

c. Hypoglycemia caused by increased exercise.

The most likely cause of these symptoms is hypoglycemia, which is often caused by a lack of systemic glucose as a result of muscular activity or decreased food intake. Hyperglycemia is not characterized by these symptoms. The Dawn phenomenon is manifested by an early morning elevation in blood glucose. The Somogyi effect is distinguished by early morning (i.e., 4 AM) hypoglycemia followed by hyperglycemia upon arising.

Question 30

Which serum glucose level would indicate hypoglycemia in a newborn?

a. 28 mg/dL
b. 40 mg/dL
c. 60 mg/dL
d. 80 mg/dL

Answer 30

a. 28 mg/dL

Serum glucose <30 mg/dL in newborn (first 2 to 3 days) and <55 to 60 mg/dL in adults is associated with hypoglycemia.

Question 31

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

a. Fluid loss
b. Weight loss
c. Increased serum glucose
d. Kussmaul respirations

Answer 31

d. Kussmaul respirations

Kussmaul respirations are only observed in those with DKA. This is due to compensation by the lungs for the metabolic acidosis. Both DKA and HHNKS show fluid loss, weight loss, and hyperglycemia.

Question 32

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

a. The Somogyi effect
b. The dawn phenomenon
c. Diabetic ketoacidosis
d. Hyperosmolar hyperglycemic nonketotic syndrome

Answer 32

a. The Somogyi effect

Hypoglycemia, followed by rebound hyperglycemia, is observed only in the Somogyi effect.

Question 33

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?

a. More frequent blood glucose monitoring
b. Moderate dietary sodium restriction
c. Treatment with an ACE inhibitor
d. Home blood pressure monitoring

Answer 33

c. Treatment with an ACE inhibitor

Microalbuminuria is the first manifestation of diabetic nephropathy. Treatment with an ACE inhibitor or angiotensin receptor blocker is the treatment of choice. Depending on the patient, more frequent blood glucose and blood pressure monitoring may be in order, but is not specific to this disorder and does not treat it. The patient may benefit from a moderate or even severe sodium restriction for several reasons (nephropathy, hypertension, etc.) but that is not as specific to nephropathy treatment as the medications are.

Question 34

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

a. Biguanide (metformin)
b. Sulfonylureas (glyburide)
c. Meglitinides (glinides)
d. α-Glycosidase inhibitor (miglitol)

Answer 34

a. Biguanide (metformin)

Only biguanides decrease hepatic glucose production and increase insulin sensitivity and peripheral glucose uptake. The sulfonylureas and meglitinides stimulate insulin release from pancreatic beta cells. The α-glycosidase inhibitors delay carbohydrate absorption in the gut.

Question 35

What causes the microvascular complications in patients with diabetes mellitus?

a. The capillaries contain plaques of lipids that obstruct blood flow.
b. Pressure in capillaries increases as a result of the elevated glucose attracting water.
c. The capillary basement membranes thicken, and cell hyperplasia develops.
d. Fibrous plaques form from the proliferation of subendothelial smooth

Answer 35

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

Microvascular complications are a result of capillary basement membranes thickening and endothelial cell hyperplasia. They do not occur due to plaque accumulation, increased capillary pressure, or from proliferation of subendothelial smooth muscle.

Question 36

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?

a. Plaques of lipids develop in the retinal vessels.
b. Pressure in the retinal vessels increase as a result of increased osmotic pressure.
c. Ketones cause microaneurysms in the retinal vessels.
d. Retinal ischemia and red blood cell aggregation occur.

Answer 36

d. Retinal ischemia and red blood cell aggregation occur.

Retinopathy appears to be a response to retinal ischemia and red blood cell aggregation. None of the remaining explanations appropriately describe the relationship between retinopathy and diabetes mellitus.

Question 37

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

a. Previous thyroid surgery
b. Urine osmolality
c. Serum electrolytes
d. Use of glucocorticoids

Answer 37

d. Use of glucocorticoids

These symptoms are characteristic of Cushing disease (or Cushing-like syndrome) which can be caused by long-term use of glucocorticoids to treat other medical conditions. Thyroid surgery, urine osmolality, and serum electrolytes would not give information about the disorder.

Question 38

The common cause of elevated levels of antidiuretic hormone (ADH) secretion is:
a. Ectopically produced ADH
b. Inflammation of the hypothalamus
c. Posterior pituitary tumor
d. Inflammation of the nephrons

Answer 38

a. Ectopically produced ADH

A common cause of elevated levels of ADH secretion is ectopically produced ADH, which makes the other options incorrect.

Question 39

The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include solute:
a. Retention and water retention
b. Retention and water loss
c. Dilution and water retention
d. Dilution and water loss

Answer 39

c. Dilution and water retention

The symptoms of SIADH secretion are a result of dilutional hyponatremia and water retention.

Question 40

Which laboratory value would the nurse expect to find if a person is experiencing syndrome of inappropriate antidiuretic hormone (SIADH)?
a. Hypernatremia and urine hypoosmolality
b. Serum potassium (K+) level of 5 mEq/L and urine hyperosmolality
c. Serum sodium (Na+) level of 120 mEq/L and serum hypoosmolality
d. Hypokalemia and serum hyperosmolality

Answer 40

c. Serum sodium (Na+) level of 120 mEq/L and serum hypoosmolality

A diagnosis of SIADH requires a serum sodium level of less than 135 mEq/L, serum hypoosmolality less than 280 mOsm/kg, and urine hyperosmolarity. Potassium levels are not considered a factor.

Question 41

Diabetes insipidus, diabetes mellitus, and syndrome of inappropriate antidiuretic hormone all exhibit which symptom?
a. Polyuria
b. Edema
c. Vomiting
d. Thirst

Answer 41

d. Thirst

Thirst is the only symptom common to all these conditions.

Question 42

The cause of neurogenic diabetes insipidus (DI) is related to an organic lesion of the:
a. Anterior pituitary
b. Thalamus
c. Posterior pituitary
d. Renal tubules

Answer 42

c. Posterior pituitary

Neurogenic DI is a result of dysfunctional antidiuretic hormone synthesis, caused by a lesion of the posterior pituitary, hypothalamus, or pituitary stalk.

Question 43

Which form of diabetes insipidus (DI) is treatable with exogenous antidiuretic hormone (ADH)?
a. Neurogenic
b. Psychogenic
c. Nephrogenic
d. Ischemic

Answer 43

a. Neurogenic

Neurogenic DI is treated with ADH replacement therapy.

Question 44

The term used to describe a person who experiences a lack of all hormones associated with the anterior pituitary is:
a. Panhypopituitarism
b. Adrenocorticotropic hormone deficiency
c. Hypopituitarism
d. Anterior pituitary failure

Answer 44

a. Panhypopituitarism

Panhypopituitarism is the only available term that is correctly associated with the lack of all anterior pituitary hormones.

Question 45

Which disorder is considered a co-morbid condition of acromegaly?
a. Hypotension
b. Diabetes
c. Brain cancer
d. Thyroid cancer

Answer 45

b. Diabetes

Symptoms of type 2 diabetes mellitus, such as polyuria and polydipsia, may occur. Acromegaly-associated hypertension is usually asymptomatic until symptoms of heart failure develop.

Question 46

Which disorder is caused by hypersecretion of the growth hormone (GH) in adults?
a. Cushing syndrome
b. Acromegaly
c. Giantism
d. Myxedema

Answer 46

b. Acromegaly

Acromegaly is a term for adults who have been exposed to continuously high levels of GH, whereas the term giantism is reserved for children and adolescents.

Question 47

Amenorrhea, galactorrhea, hirsutism, and osteoporosis are each caused by a:
a. Posterior pituitary adenoma
b. Thymoma
c. Prolactinoma
d. Growth hormone adenoma

Answer 47

c. Prolactinoma

Of the options available, the hallmark of a prolactinoma is the sustained elevation of serum prolactin that is responsible for the symptoms listed in the question.

Question 48

Graves disease develops from a(n):
a. Viral infection of the thyroid gland that causes overproduction of thyroid hormone
b. Autoimmune process during which lymphocytes and fibrous tissue replace thyroid
tissue
c. Thyroid-stimulating immunoglobulin that causes overproduction of thyroid
hormones
d. Ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing
a goiter

Answer 48

c. Thyroid-stimulating immunoglobulin that causes overproduction of thyroid
hormones

The pathologic features of Graves disease indicates that normal regulatory mechanisms are overridden by abnormal immunologic mechanisms that result in the stimulation of excessive TH.

Question 49

The signs of thyrotoxic crisis include:
a. Constipation with gastric distention
b. Bradycardia and bradypnea
c. Hyperthermia and tachycardia
d. Constipation and lethargy

Answer 49

c. Hyperthermia and tachycardia

The systemic symptoms of thyrotoxic crisis include hyperthermia and tachycardia.

Question 50

Pathologic changes associated with Graves disease include:
a. High levels of circulating thyroid-stimulating immunoglobulins
b. Diminished levels of thyrotropin-releasing hormone
c. High levels of thyroid-stimulating hormone
d. Diminished levels of thyroid-binding globulin

Answer 50

a. High levels of circulating thyroid-stimulating immunoglobulins

The only option that correctly describes the changes associated with Graves disease identifies high levels of circulating thyroid-stimulating immunoglobulins that are found in more than 95% of individuals diagnosed with the disease.

Question 51

The level of thyroid-stimulating hormone (TSH) in individuals with Graves disease is usually:
a. High
b. Low
c. Normal
d. In constant flux

Answer 51

b. Low

The hyperfunction of the thyroid gland leads to suppression of TSH because of the normal negative feedback mechanism, thus eliminating the other options as being correct.

Question 52

Palpation of the neck of a person diagnosed with Graves disease would detect a thyroid that is:
a. Left of midline
b. Small with discrete nodules
c. Normal in size
d. Diffusely enlarged

Answer 52

d. Diffusely enlarged

The only option that characterizes Graves disease is a diffused enlargement of the thyroid gland

Question 53

What are clinical manifestations of hypothyroidism?
a. Intolerance to heat, tachycardia, and weight loss
b. Oligomenorrhea, fatigue, and warm skin
c. Restlessness, increased appetite, and metrorrhagia
d. Constipation, decreased heat rate, and lethargy

Answer 53

d. Constipation, decreased heat rate, and lethargy

The lower levels of thyroid hormone result in decreased energy metabolism, resulting in constipation, bradycardia, and lethargy, thus eliminating the remaining options.

Question 54

Renal failure is the most common cause of which type of hyperparathyroidism?
a. Primary
b. Secondary
c. Exogenous
d. Inflammatory

Answer 54

b. Secondary

Chronic renal failure is the most common cause of secondary hyperparathyroidism because of the resulting hyperphosphatemia that stimulates parathyroid hormone secretion.

Question 55

The most common cause of hypoparathyroidism is:
a. Pituitary hyposecretion
b. Parathyroid adenoma
c. Parathyroid gland damage
d. Autoimmune parathyroid disease

Answer 55

c. Parathyroid gland damage

The most common cause of hypoparathyroidism is damage caused during thyroid surgery, thus eliminating the other options as being correct.

Question 56

The most probable cause of low serum calcium after a thyroidectomy is:
a. Hyperparathyroidism, secondary to Graves disease
b. Myxedema, secondary to surgery
c. Hypoparathyroidism caused by surgical injury.
d. Hypothyroidism caused by the lack of thyroid replacement.

Answer 56

c. Hypoparathyroidism caused by surgical injury

The most common cause of hypoparathyroidism is damage caused during thyroid surgery, resulting in a lack of circulating PTH and causing a depressed level of serum calcium.

Question 57

Polyuria occurs with diabetes mellitus because of the:
a. Formation of ketones
b. Chronic insulin resistance
c. Elevation in serum glucose
d. Increase in antidiuretic hormone

Answer 57

c. Elevation in serum glucose

Glucose accumulates in the blood and appears in the urine as the renal threshold for glucose is exceeded, producing an osmotic diuresis and the symptoms of polyuria and thirst.

Question 58

Type 2 diabetes mellitus is best described as a(an):
a. Resistance to insulin by insulin-sensitive tissues
b. Need for lispro instead of regular insulin
c.Increase of glucagon secretion from a cells of the pancreas
d. Presence of insulin autoantibodies that destroy B cells in the pancreas

Answer 58

a. Resistance to insulin by insulin-sensitive tissues

One of the basic pathophysiologic characteristics of type 2 diabetes is the development of insulin-resistant tissue cells.

Question 59

The first laboratory test that indicates type 1 diabetes is causing the development of diabetic nephropathy is:
a. Dipstick test for urine ketones
b. Increase in serum creatinine and blood urea nitrogen
c. Protein on urinalysis
d. Cloudy urine on the urinalysis.

Answer 59

c. Protein on urinalysis

Microalbuminuria is the first manifestation of this form of renal failure. Although the other options may develop, they occur after protein is found in the urine.

Question 60

Retinopathy develops in patients with diabetes mellitus because:
a. Plaques of lipids develop in the retinal vessels.
b. Pressure in the retinal vessels increase as a result of increased osmotic pressure.
c. Ketones cause microaneurysms in the retinal vessels.
d. Retinal ischemia and red blood cell aggregation occur.

Answer 60

d. Retinal ischemia and red blood cell aggregation occur.

Retinopathy appears to be a response to retinal ischemia and red blood cell aggregation.