NURS 317 Unit 3 Chapter 40 Path Point Questions Flashcards
A nurse has just completed client education on how hormones are normally regulated by feedback mechanisms. The client asks, “What, if anything, can alter the regulation of anterior pituitary hormones?” Which response by the nurse would be considered an appropriate reply? Select all that apply.
A) Temperature
B) Nutritional status
C) Stress
D) Weight
E) Age
F) Genetics
A) Temperature
B) Nutritional status
C) Stress
The nurse is educating a client with a newly diagnosed thyroid cancer. Which testing procedure should be reviewed because it allows good examination of the tissue structure and provides information about the tissue function as well?
A) Dual-electron x-ray absorptiometry (DEXA) scan
B) Magnetic-resonance imaging (MRI)
C) Ultrasonography
D) Positron emission tomography/CT (PET/CT)
D) Positron emission tomography/CT (PET/CT)
Select the most appropriate statement that describes the function of hormones.
A) Hormones function as modulators of cellular and systematic responses.
B) Hormones respond to cellular and systematic interactions.
C) Hormones initiate reactions of cellular and systematic responses.
D) Hormones have little involvement in cellular and systematic responses.
A) Hormones function as modulators of cellular and systematic responses.
Rationale: Hormones act as modulators of cellular and systematic responses rather than initiate them.
A client asks the nurse what causes the secretion of growth hormone (GH) and adrenocorticotrophic hormone (ACTH) to fluctuate. The best response by the nurse would be:
A) Dietary factors
B) Feedback mechanisms
C) Sleep–wake cycles
D) Complicated cyclic manner
C) Sleep–wake cycles
Rationale: Growth hormone (GH) and adrenocorticotropic hormone (ACTH) have diurnal fluctuations that vary with the sleep–wake cycles. Others, such as the female sex hormones, are secreted in a complicated cyclic manner. The levels of hormones such as insulin and antidiuretic hormone (ADH) are regulated by feedback mechanisms that monitor substances such as glucose (insulin) and water (ADH) in the body.
Which hormone is secreted based on a cyclic rather than a diurnal manner?
A) Growth hormone
B) Antidiuretic hormone (ADH)
C) Follicle-stimulating hormone (FSH)
D) Adrenocorticotropic hormone (ACTH)
C) Follicle-stimulating hormone (FSH)
Rationale: Hormone secretion varies widely over a 24-hour period. Some hormones, such as GH and adrenocorticotropic hormone (ACTH), have diurnal fluctuations that vary with the sleep–wake cycle. Others, such as the female sex hormones (e.g., follicle-stimulating hormone [FSH]) are secreted in a complicated cyclic manner. The levels of hormones such as insulin and antidiuretic hormone (ADH) are regulated by feedback mechanisms that monitor substances such as glucose (insulin) and water (ADH) in the body. The levels of many of the hormones are regulated by feedback mechanisms that involve the hypothalamic–pituitary–target cell system
What is the most common mechanism of hormone control?
A) Negative feedback
B) Hypothalamic–pituitary–adrenal axis
C) Positive feedback
D) Hypothalamic–pituitary–target cell feedback
A) Negative feedback
Rationale: With negative feedback, the most common mechanism of hormone control, some feature of hormone action directly or indirectly inhibits further hormone secretion so that the hormone level returns to an ideal level or set point.
A client comes to a scheduled appointment in the endocrine clinic. The primary care physician referred the client, suspecting acromegaly. Knowing the usual testing involved, the nurse should educate the client about which lab/diagnostic procedure?
A) A genetic test
B) A suppression test
C) A stimulation test
D) A brain scan
B) A suppression test
Rationale: Suppression tests are used when hyperfunction of an endocrine organ is suspected. When an organ or tissue is functioning autonomously (i.e., is not responding to the normal negative feedback control mechanisms and continues to secrete excessive amounts of hormone), a suppression test may be useful to confirm the situation. For example, when a GH-secreting tumor is suspected, the GH response to a glucose load is measured as part of the diagnostic workup. Normally, a glucose load would suppress GH levels. However, in adults with GH-secreting tumors (a condition known as acromegaly), GH levels are not suppressed. Stimulation tests are used when hypofunction of an endocrine organ is suspected. The diagnosis of genetic diseases using DNA analysis is rapidly becoming a routine part of endocrine practice. Completion of the human genome sequence has revealed the presence of about 30,000 genes. The considerable interest in the field of genomics (i.e., examination of the DNA) and transcriptomics (i.e., examination of the mRNA) has been complemented by advances in proteomics. Brain scans may be advised after initial suppression testing if a tumor is suspected.
The physician suspects a client may be experiencing hypofunction of an endocrine organ. Select the most appropriate test to determine organ function.
A) Suppression tests
B) Stimulation tests
C) Imaging studies
D) Genetic testing
B) Stimulation tests
Rationale: Stimulation tests are used when hypofunction of an endocrine organ is suspected. Suppression tests are used when hyperfunction of an endocrine organ is suspected. Genetic testing is used for DNA analysis, and imaging may be used as a follow-up after the diagnosis.
Which manifestation would the nurse observe when assessing a client diagnosed with a benign secreting tumor of the adrenal medulla?
A) Elevated catecholamine levels and tachycardia
B) Enhanced estrogen levels and breast enlargement
C) Increased aldosterone and fluid retention
D) Rising thyroid hormone and insomnia
A) Elevated catecholamine levels and tachycardia
Rationale: The adrenal medulla secretes the neurotransmitters epinephrine (adrenalin) and norepinephrine (a precursor to epinephrine). A secreting tumor will cause the client to experience manifestations of sympathetic stimulation, such as episodic anxiety, tachycardia, and hypertension. A tumor of the adrenal medulla will not impact thyroid or aldosterone secretion.
A client has developed a tumor of the anterior pituitary gland. The nurse is aware that the client is at risk for alterations in which body function? Select all that apply.
A) Oxytocin secretion
B) Growth and metabolism
C) Function of the thyroid gland
D) Storage and release of ADH
E) Glucocorticoid hormone levels
F) Function of the gonads
B) Growth and metabolism
C) Function of the thyroid gland
E) Glucocorticoid hormone levels
F) Function of the gonad
Rationale: Hormones produced by the anterior pituitary control body growth and metabolism (GH), function of the thyroid gland (TSH), glucocorticoid hormone levels (ACTH), function of the gonads (FSH and LH), and breast growth and milk production (prolactin). The posterior pituitary gland stores and releases antidiuretic hormone (ADH) and oxytocin
Which events are involved in the negative feedback mechanism that keeps the serum thyroid hormone level within appropriate range? Select all that apply.
A) Decreased serum levels of gonadotropin (FSH)
B) Stimulation of sensors in the hypothalamus
C) Increased levels of thyroid hormone
D) Stimulation of sensors in the anterior pituitary gland
E) Decrease in secretion of thyroid stimulating hormone (TSH)
B) Stimulation of sensors in the hypothalamus
C) Increased levels of thyroid hormone
D) Stimulation of sensors in the anterior pituitary gland
E) Decrease in secretion of thyroid stimulating hormone (TSH)
Rationale: The level of many of the hormones in the body is regulated by negative feedback mechanisms. In the endocrine system, sensors detect a change in the hormone level and adjust hormone secretion so that body levels are maintained within an appropriate range. For example, sensors in the hypothalamus or anterior pituitary gland detect an increase in thyroid hormone, and this causes a reduction in the secretion of TSH, with a subsequent decrease in the output of thyroid hormone from the thyroid gland. Gonadotropin (FSH) is not involved in thyroid level maintenance.
A nursing instructor is teaching a group of students about the action of hormones. The instructor determined that teaching was effective when the students recognize the local action of hormones as:
A) Autocrine
B) Hormonal
C) Pancreatic
D) Paracrine
D) Paracrine
Rationale: When hormones act locally on cells other than those that produced the hormone, the action is called paracrine. Hormones can also exert an autocrine action on the cells in which they were produced. Pancreatic and hormonal are not actions.
The nurse is reviewing the test results of a client who was given thyrotropin-releasing hormone (TRH) to evaluate the function of the pituitary gland. The nurse would recognize pituitary dysfunction as:
A) Decreased TRH levels
B) Decreased TSH levels
C) Increased TSH levels
D) Increased TRH levels
B) Decreased TSH levels
Rationale: Stimulation tests are used when hypofunction of an endocrine organ is suspected. Failure to increase TSH levels after a TRH stimulation test suggests an inadequate capacity to produce TSH by the pituitary (i.e., the pituitary is dysfunctional in some way).
The nurse is assessing a client with thyrotoxicosis and the nurse is explaining how the thyroid gland is stimulated to release thyroid hormones. The nurse should describe what process?
A) Steady-state continuous release
B) Action of releasing hormones from hypothalamus
C) Homeostatic receptors on surface of gland
D) Direct neural stimulation
B) Action of releasing hormones from hypothalamus
Rationale: The synthesis and release of anterior pituitary hormones are largely regulated by the action of releasing or inhibiting hormones from the hypothalamus, which is the coordinating center of the brain for endocrine activity such as thyroid activity. There are no direct innervations for hormone release from the thyroid gland, and homeostatic receptors do not exist. Steady-state release of hormones does not occur.
A client receives steroids for several months to treat an inflammatory condition. Which action by the primary health care provider indicates an understanding of the negative feedback mechanism when the client no longer needs the medication?
A) Prescribing a tapering dose of the medication over weeks
B) Instructing the client to stop taking the medication
C) Scheduling a positron emission tomography scan a week after stopping the drug
D) Measuring urine catecholamine levels before stopping the drug
A) Prescribing a tapering dose of the medication over weeks
Rationale: Negative feedback occurs when secretion of one hormone causes a reduction in the secretion of the hormone that stimulates production of the first hormone. In this case, adrenocorticotropic hormone (ACTH) manufactured by the anterior pituitary would normally stimulate release of cortisol, but with the increase of cortisol produced by the secreting tumor, enough cortisol already floods the system that there should be a reduction in the ACTH level. Sudden withdrawal of the medication would leave the client without glucocorticoids and risk an Addisonian crisis. Gradual withdrawal of the medication allows the pituitary to measure the drop in cortisol levels and begin secreting ACTH.
