Pathophysiology: Chapter 22: Alterations of Hormonal Regulation

Question 1

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 1

ANS: C
The symptoms of SIADH secretion are a result of dilutional hyponatremia and water
retention. This information supports the elimination of the other options.

Question 2

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 2

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

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

Answer 3

ANS: C
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

Diabetes insipidus is a result of:

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

Answer 4

ANS: A

Of the available options, diabetes insipidus is a result of insufficient antidiuretic hormone.

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 his antidiuretic hormone (ADH) level is low.
Although he has had no intake for 4 hours, no change in his polyuria level has occurred.
These symptoms support a diagnosis of:
a. Neurogenic diabetes insipidus
b. Syndrome of inappropriate antidiuretic hormone
c. Psychogenic polydipsia
d. Osmotically induced diuresis

Answer 5

ANS: A
The stated symptoms are reflective of neurogenic diabetes insipidus and not of the
remaining options.

Question 6

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

Answer 6

ANS: D

Thirst is the only symptom common to all these conditions.

Question 7

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 7

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

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

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

Question 9

Which laboratory value is consistently low in a patient with diabetes insipidus (DI)?

a. Urine-specific gravity
b. Serum sodium
c. Urine protein
d. Serum total protein

Answer 9

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

Question 10

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

Answer 10

ANS: A

Neurogenic DI is treated with ADH replacement therapy. The other options are incorrect.

Question 11

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

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

Answer 11

ANS: A
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

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 12

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

Question 13

Visual disturbances are a result of a pituitary adenoma because of the:

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

ANS: C
Of the available options, pressure on the optic chiasm is the only cause for visual
disturbances resulting from a pituitary adenoma.

Question 14

Which disorder is considered a co-morbid condition of acromegaly?

a. Hypotension c. Brain cancer
b. Diabetes d. Thyroid cancer

Answer 14

ANS: B
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. Neither thyroid nor brain cancer has been associated with acromegaly.

Question 15

Which disorder is caused by hypersecretion of the growth hormone (GH) in adults?

a. Cushing syndrome c. Giantism
b. Acromegaly d. Myxedema

Answer 15

ANS: B
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. The other options do
not apply to hypersecretion of GH.

Question 16

Giantism occurs only in children and adolescents because their:

a. Growth hormones are still diminished.
b. Epiphyseal plates have not yet closed.
c. Skeletal muscles are not yet fully developed.
d. Metabolic rates are higher than in adulthood.

Answer 16

ANS: B
Giantism is related to the effects of growth hormones on the growth of long bones at their
epiphyseal plates. This information makes the other options incorrect.

Question 17

Amenorrhea, galactorrhea, hirsutism, and osteoporosis are each caused by a:

a. Posterior pituitary adenoma
b. Thymoma
c. Prolactinoma
d. Growth hormone adenoma

Answer 17

ANS: C
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 18

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 18

ANS: C
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. The remaining options are incorrect statements.

Question 19

The signs of thyrotoxic crisis include:

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

Answer 19

ANS: C
The systemic symptoms of thyrotoxic crisis include hyperthermia and tachycardia. The
remaining options are not associated with this disorder.

Question 20

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 20

ANS: A
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 21

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 21

ANS: B
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 22

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 22

ANS: D
The only option that characterizes Graves disease is a diffused enlargement of the thyroid
gland.

Question 23

A deficiency of which chemical may result in hypothyroidism?

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

Answer 23

ANS: B
The only cause of hypothyroidism from among the provided options is a deficiency of
endemic iodine.

Question 24

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 24

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

Question 25

Diagnosing a thyroid carcinoma is best performed with:

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

Answer 25

ANS: D
Fine-needle aspiration of a thyroid nodule is generally performed to diagnose this
condition; this method is best for early detection, thus eliminating the other options.

Question 26

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

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

Answer 26

ANS: B
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 27

The most common cause of hypoparathyroidism is:

a. Pituitary hyposecretion
b. Parathyroid adenoma
c. Parathyroid gland damage
d. Autoimmune parathyroid disease

Answer 27

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

Question 28

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 28

ANS: C
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. This
information supports the elimination of the other options.

Question 29

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 29

ANS: B
Decreased glucose causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic
diuresis, which have resulted in the symptoms listed in the question. The relationship
between the stated assessment values and insulin deficiency is not effectively described by
any of the other options.

Question 30

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 30

ANS: C
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. None of the other options appropriately describes the pathologic features of diabetes
mellitus–induced polyuria.

Question 31

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 Beta cells of the pancreas
d. Presence of insulin autoantibodies that destroy beta cells in the pancreas

Answer 31

ANS: A
One of the basic pathophysiologic characteristics of type 2 diabetes is the development of
insulin-resistant tissue cells. None of the remaining options appropriately describes type 2
diabetes.

Question 32

A person diagnosed with type 1 diabetes experiences hunger, lightheadedness, tachycardia,
pallor, headache, and confusion. The most probable cause of these symptoms is:
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 32

ANS: C
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. None of the remaining options
appropriately describes why a person diagnosed with type 1 diabetes experiences the
described symptoms.

Question 33

Which serum glucose level would indicate hypoglycemia in a newborn?

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

Answer 33

ANS: A
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 34

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 34

ANS: D

Kussmaul respirations are only observed in those with DKA.

Question 35

Hypoglycemia, followed by rebound hyperglycemia, is observed in those with:

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

Answer 35

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

Question 36

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 36

ANS: C
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 37

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. Alpha-Glycosidase inhibitor (miglitol)

Answer 37

ANS: A
Only biguanides decrease hepatic glucose production and increase insulin sensitivity and
peripheral glucose uptake.

Question 38

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 increase 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 muscle of
arteries.

Answer 38

ANS: C
Microvascular complications are a result of capillary basement membranes thickening and
endothelial cell hyperplasia. None of the remaining options appropriately describes the
cause of microvascular complications in patients with diabetes mellitus.

Question 39

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 39

ANS: D
Retinopathy appears to be a response to retinal ischemia and red blood cell aggregation.
None of the remaining options appropriately describes the relationship between
retinopathy and diabetes mellitus.

Question 40

A person has acne, easy bruising, thin extremities, and truncal obesity. These clinical
manifestations are indicative of which endocrine disorder?
a. Hyperthyroidism
b. Hypoaldosteronism
c. Diabetes insipidus
d. Cushing disease

Answer 40

ANS: D
These symptoms are characteristic of Cushing disease and are caused by excessive ACTH
secretion. The symptoms described are not characteristic of any of the other options.

Question 41

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

Answer 41

ANS: A, B, C, E
Symptoms associated with hypoparathyroidism are related to hypocalcemia.
Hypocalcemia causes a lowering of the threshold for nerve and muscle excitation so that a
slight stimulus anywhere along the length of a nerve or muscle fiber may initiate a nerve
impulse. This creates tetany manifested as muscle spasms, hyperreflexia, tonic-clonic
convulsions, laryngeal spasms, and, in severe cases, death from asphyxiation.

Question 42

A chronic complication of diabetes mellitus is likely to result in microvascular
complications in which areas? (Select all that apply.)
a. Eyes
b. Coronary arteries
c. Renal system
d. Peripheral vascular system
e. Nerves

Answer 42

ANS: A, C, E

Of the options provided, the areas most often affected are the retina, kidneys, and nerves.

Question 43

Hypersecretion of thyroid hormone (TH) is called?

Answer 43

Graves disease

Question 44

Hypersecretion of adrenocorticotropic hormone (ACTH) is called?

Answer 44

Cushing disease

Question 45

Hypersecretion of adrenal medulla hormones is called?

Answer 45

Pheochromocytoma

Question 46

Hyposecretion of thyroid hormone (TH) is called?

Answer 46

Myxedema

Question 47

Hyposecretion of adrenal cortex hormones is called?

Answer 47

Addison disease

Question 48

Hypersecretion of growth hormone (GH) is called?

Answer 48

Acromegaly