Pathophysiology: Chapter 22: Alterations of Hormonal Regulation Flashcards
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
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.
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
ANS: A
A common cause of elevated levels of ADH secretion is ectopically produced ADH, which
makes the other options incorrect.
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
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.
Diabetes insipidus is a result of:
a. Antidiuretic hormone hyposecretion
b. Antidiuretic hormone hypersecretion
c. Insulin hyposecretion
d. Insulin hypersecretion
ANS: A
Of the available options, diabetes insipidus is a result of insufficient antidiuretic hormone.
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
ANS: A
The stated symptoms are reflective of neurogenic diabetes insipidus and not of the
remaining options.
Diabetes insipidus, diabetes mellitus, and syndrome of inappropriate antidiuretic hormone all exhibit which symptom? a. Polyuria b. Edema c. Vomiting d. Thirst
ANS: D
Thirst is the only symptom common to all these conditions.
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
ANS: C
Neurogenic DI is a result of dysfunctional antidiuretic hormone synthesis, caused by a
lesion of the posterior pituitary, hypothalamus, or pituitary stalk.
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
ANS: B
Only nephrogenic DI is associated with an insensitivity of the renal collecting tubules to
ADH.
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
ANS: A
The basic criteria for diagnosing DI include a low urine-specific gravity while sodium
levels are high. Protein levels are not considered.
Which form of diabetes insipidus (DI) is treatable with exogenous antidiuretic hormone (ADH)? a. Neurogenic b. Psychogenic c. Nephrogenic d. Ischemic
ANS: A
Neurogenic DI is treated with ADH replacement therapy. The other options are incorrect.
Which condition may result from pressure exerted by a pituitary tumor?
a. Hypothyroidism c. Diabetes insipidus
b. Hypercortisolism d. Insulin hyposecretion
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.
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
ANS: A
Panhypopituitarism is the only available term that is correctly associated with the lack of
all anterior pituitary hormones.
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
ANS: C
Of the available options, pressure on the optic chiasm is the only cause for visual
disturbances resulting from a pituitary adenoma.
Which disorder is considered a co-morbid condition of acromegaly?
a. Hypotension c. Brain cancer
b. Diabetes d. Thyroid cancer
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.
Which disorder is caused by hypersecretion of the growth hormone (GH) in adults?
a. Cushing syndrome c. Giantism
b. Acromegaly d. Myxedema
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.
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.
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.
Amenorrhea, galactorrhea, hirsutism, and osteoporosis are each caused by a:
a. Posterior pituitary adenoma
b. Thymoma
c. Prolactinoma
d. Growth hormone adenoma
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.
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
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.
The signs of thyrotoxic crisis include:
a. Constipation with gastric distention
b. Bradycardia and bradypnea
c. Hyperthermia and tachycardia
d. Constipation and lethargy
ANS: C
The systemic symptoms of thyrotoxic crisis include hyperthermia and tachycardia. The
remaining options are not associated with this disorder.
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
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.
The level of thyroid-stimulating hormone (TSH) in individuals with Graves disease is usually: a. High b. Low c. Normal d. In constant flux
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.
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
ANS: D
The only option that characterizes Graves disease is a diffused enlargement of the thyroid
gland.
A deficiency of which chemical may result in hypothyroidism?
a. Iron c. Zinc
b. Iodine d. Magnesium
ANS: B
The only cause of hypothyroidism from among the provided options is a deficiency of
endemic iodine.
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
ANS: D
The lower levels of thyroid hormone result in decreased energy metabolism, resulting in
constipation, bradycardia, and lethargy, thus eliminating the remaining options.
Diagnosing a thyroid carcinoma is best performed with:
a. Measurement of serum thyroid levels
b. Radioisotope scanning
c. Ultrasonography
d. Fine-needle aspiration biopsy
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.
Renal failure is the most common cause of which type of hyperparathyroidism?
a. Primary c. Exogenous
b. Secondary d. Inflammatory
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.
The most common cause of hypoparathyroidism is:
a. Pituitary hyposecretion
b. Parathyroid adenoma
c. Parathyroid gland damage
d. Autoimmune parathyroid disease
ANS: C
The most common cause of hypoparathyroidism is damage caused during thyroid surgery,
thus eliminating the other options as being correct.
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
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.
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.
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.
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
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.
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
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.
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
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.
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
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.
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
ANS: D
Kussmaul respirations are only observed in those with DKA.
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
ANS: A
Hypoglycemia, followed by rebound hyperglycemia, is observed only in the Somogyi
effect.
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
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.
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)
ANS: A
Only biguanides decrease hepatic glucose production and increase insulin sensitivity and
peripheral glucose uptake.
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.
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.
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.
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.
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
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.
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
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.
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
ANS: A, C, E
Of the options provided, the areas most often affected are the retina, kidneys, and nerves.
Hypersecretion of thyroid hormone (TH) is called?
Graves disease
Hypersecretion of adrenocorticotropic hormone (ACTH) is called?
Cushing disease
Hypersecretion of adrenal medulla hormones is called?
Pheochromocytoma
Hyposecretion of thyroid hormone (TH) is called?
Myxedema
Hyposecretion of adrenal cortex hormones is called?
Addison disease
Hypersecretion of growth hormone (GH) is called?
Acromegaly
