NUR 318 Exam 2 - D.A. questions with
complete solutions
Corticotropin-releasing factor is produced by which tissues?
Hypothalamus
Ovaries
Anterior pituitary
Adrenal glands - CORRECT ANSWER-✔✔✅hypothalamus
Mr. Thompson's adrenal problem originates in the adrenal cortex.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Primary
Rationale:
Mrs. Jacobi's adrenal problem originates in the hypothalamus.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Tertiary
Rationale: Endocrine disorders originating in the hypothalamus are tertiary disorders.
Ms. Wallace's adrenal problem originates in the pituitary gland.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Secondary
Rationale: A secondary condition arises when the hormonal signaling problem occurs in the pituitary
gland.
,Ms. Lee is experiencing elevated thyroid-stimulating hormone (TSH) from the anterior pituitary and
reduced thyroid hormone levels.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Primary
Rationale: When TSH is elevated, but thyroid hormone levels remain low, this is a primary disorder. The
thyroid glands are the problem. They are receiving a signal to produce thyroid hormone, but are unable
to respond.
Mr. Ruiz is experiencing reduced adrenocorticotropic hormone (ACTH) from the anterior pituitary and
elevated cortisol from the adrenal cortex.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Primary
Rationale: A primary disorder occurs when the problem is in the end organ. In this example, the adrenal
cortex is not receiving a signal to produce cortisol, as shown by reduced ACTH from the anterior
pituitary. However, the adrenal cortex is continuing to produce cortisol despite a lack of signal.
Mrs. Smith is experiencing elevated thyrotropic-releasing hormone (TRH) from the hypothalamus,
elevated thyroid-stimulating hormone (TSH) from the anterior pituitary, and elevated thyroid hormones.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Tertiary
Rationale: A tertiary disorder is a signaling problem from the hypothalamus. In this case, the
hypothalamus is overproducing TRH, which stimulates TSH, which in turn stimulates the thyroid gland. In
a normal response, elevated thyroid hormones would suppress TRH from the hypothalamus through
negative feedback.
Mr. Wilson is experiencing elevated adrenocorticotropic hormone (ACTH) from the anterior pituitary
and elevated cortisol from the adrenal cortex.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Secondary
,Rationale: A secondary disorder arises from improper signaling from the anterior pituitary. Normally,
elevated cortisol levels should suppress further secretion of ACTH by the anterior pituitary. In a
secondary disorder, the anterior pituitary no longer responds appropriately to this signal.
Ms. Ang is experiencing low corticotropin releasing factor (CRF) from the hypothalamus, elevated
adrenocorticotropic hormone (ACTH) from the anterior pituitary, and elevated cortisol from the adrenal
gland.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Secondary
Rationale: Problems in the anterior pituitary result in secondary disorders. In this case, the anterior
pituitary is not responding correctly to signals from other glands. Elevated cortisol normally negatively
feedbacks and reduces ACTH. Low CRF indicates the anterior pituitary is not being signaled to produce
more ACTH. Despite this, the anterior pituitary is continuing to produce elevated ACTH levels, which in
turn cause elevated cortisol levels.
Janelle, a 30-year-old woman, presents at her primary care office complaining of feeling nervous and
anxious. She states that she even feels as if her heart is racing because she is "so stressed out." Janelle
would like to be prescribed antianxiety medication.Janelle's height and weight measurements reveal she
has lost 15 pounds in the last 6 months. She attributes her weight loss to stress.What hormone disorder
may lead to weight loss?
Thyroid hyperfunction
Thyroid hypofunction
Central diabetes insipidus
Posterior pituitary hyperfunction - CORRECT ANSWER-✔✔✅thyroid hyperfunction
Rationale: Thyroid hormone hyperfunction is commonly associated with weigh loss as thyroid hormones
regulate body metabolism. Hyperthyroidism causes an elevation in the basal metabolic rate, which may
result in significant weight loss.
You examine Janelle and notes her resting heart rate is 84 beats per minute and blood pressure is
144/88 mm Hg. Which hormone may increase resting heart rate and blood pressure?
Oxytocin
Growth hormone
Thyroid hormone
, Antidiuretic hormone - CORRECT ANSWER-✔✔✅thyroid hormone
rationale: Thyroid hormones have a stimulatory effect on cardiac tissue. Thyroid hormone increase
would be the most likely to account for the increase in heart rate and blood pressure.
You note slight tremors in Janelle's hands, and an area in her neck appears to be enlarged compared
with its appearance in previous visits. Janelle lists further complaints, including hair loss, diarrhea, and
"feeling hot all the time." Which of the following is true?
Parathyroid gland enlargement normally appears in the anterior neck area.
You should manually palpate Janelle's neck with moderate force to assess the size of the tissue.
Enlargement of the thyroid gland can make the neck area appear "fuller" than normal.
Any enlargement of the thyroid gland indicates the presence of thyroid cancer, which is likely Janelle's
diagnosis. - CORRECT ANSWER-✔✔✅Enlargement of the thyroid gland can make the neck area appear
"fuller" than normal.
Rationale: When the thyroid gland enlarges, changes in the appearance of the neck may be noticeable.
Janelle's neck should not be palpated with force as this can cause further damage to the thyroid gland.
The parathyroid glands are located behind the thyroid, not on the anterior neck. An enlarged thyroid
gland can occur for many reasons, not necessarily cancer.
Based on your assessment, the physician decides to have several blood tests completed. All results are
normal except the following: significantly elevated thyroid hormone levels (free T3 and free T4) and
undetectable TSH and TRH. What endocrine disorder does Janelle most likely have?
Primary thyroid hypofunction
Secondary thyroid hyperfunction
Tertiary thyroid hyperfunction
Primary thyroid hyperfunction - CORRECT ANSWER-✔✔✅Primary thyroid hyperfunction
Rationale: Janelle's condition is hyperthyroidism as indicated by the elevated thyroid hormone levels.
The condition is primary, a problem in the thyroid gland, because TSH levels (the signal from the anterior
pituitary that stimulates the thyroid gland) are low.
Further screening reveals elevated thyroid-stimulating antibodies. What condition is Janelle
experiencing?
Hashimoto's thyroiditis
Cushing's syndrome
complete solutions
Corticotropin-releasing factor is produced by which tissues?
Hypothalamus
Ovaries
Anterior pituitary
Adrenal glands - CORRECT ANSWER-✔✔✅hypothalamus
Mr. Thompson's adrenal problem originates in the adrenal cortex.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Primary
Rationale:
Mrs. Jacobi's adrenal problem originates in the hypothalamus.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Tertiary
Rationale: Endocrine disorders originating in the hypothalamus are tertiary disorders.
Ms. Wallace's adrenal problem originates in the pituitary gland.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Secondary
Rationale: A secondary condition arises when the hormonal signaling problem occurs in the pituitary
gland.
,Ms. Lee is experiencing elevated thyroid-stimulating hormone (TSH) from the anterior pituitary and
reduced thyroid hormone levels.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Primary
Rationale: When TSH is elevated, but thyroid hormone levels remain low, this is a primary disorder. The
thyroid glands are the problem. They are receiving a signal to produce thyroid hormone, but are unable
to respond.
Mr. Ruiz is experiencing reduced adrenocorticotropic hormone (ACTH) from the anterior pituitary and
elevated cortisol from the adrenal cortex.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Primary
Rationale: A primary disorder occurs when the problem is in the end organ. In this example, the adrenal
cortex is not receiving a signal to produce cortisol, as shown by reduced ACTH from the anterior
pituitary. However, the adrenal cortex is continuing to produce cortisol despite a lack of signal.
Mrs. Smith is experiencing elevated thyrotropic-releasing hormone (TRH) from the hypothalamus,
elevated thyroid-stimulating hormone (TSH) from the anterior pituitary, and elevated thyroid hormones.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Tertiary
Rationale: A tertiary disorder is a signaling problem from the hypothalamus. In this case, the
hypothalamus is overproducing TRH, which stimulates TSH, which in turn stimulates the thyroid gland. In
a normal response, elevated thyroid hormones would suppress TRH from the hypothalamus through
negative feedback.
Mr. Wilson is experiencing elevated adrenocorticotropic hormone (ACTH) from the anterior pituitary
and elevated cortisol from the adrenal cortex.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Secondary
,Rationale: A secondary disorder arises from improper signaling from the anterior pituitary. Normally,
elevated cortisol levels should suppress further secretion of ACTH by the anterior pituitary. In a
secondary disorder, the anterior pituitary no longer responds appropriately to this signal.
Ms. Ang is experiencing low corticotropin releasing factor (CRF) from the hypothalamus, elevated
adrenocorticotropic hormone (ACTH) from the anterior pituitary, and elevated cortisol from the adrenal
gland.
Primary
Secondary
Tertiary - CORRECT ANSWER-✔✔✅Secondary
Rationale: Problems in the anterior pituitary result in secondary disorders. In this case, the anterior
pituitary is not responding correctly to signals from other glands. Elevated cortisol normally negatively
feedbacks and reduces ACTH. Low CRF indicates the anterior pituitary is not being signaled to produce
more ACTH. Despite this, the anterior pituitary is continuing to produce elevated ACTH levels, which in
turn cause elevated cortisol levels.
Janelle, a 30-year-old woman, presents at her primary care office complaining of feeling nervous and
anxious. She states that she even feels as if her heart is racing because she is "so stressed out." Janelle
would like to be prescribed antianxiety medication.Janelle's height and weight measurements reveal she
has lost 15 pounds in the last 6 months. She attributes her weight loss to stress.What hormone disorder
may lead to weight loss?
Thyroid hyperfunction
Thyroid hypofunction
Central diabetes insipidus
Posterior pituitary hyperfunction - CORRECT ANSWER-✔✔✅thyroid hyperfunction
Rationale: Thyroid hormone hyperfunction is commonly associated with weigh loss as thyroid hormones
regulate body metabolism. Hyperthyroidism causes an elevation in the basal metabolic rate, which may
result in significant weight loss.
You examine Janelle and notes her resting heart rate is 84 beats per minute and blood pressure is
144/88 mm Hg. Which hormone may increase resting heart rate and blood pressure?
Oxytocin
Growth hormone
Thyroid hormone
, Antidiuretic hormone - CORRECT ANSWER-✔✔✅thyroid hormone
rationale: Thyroid hormones have a stimulatory effect on cardiac tissue. Thyroid hormone increase
would be the most likely to account for the increase in heart rate and blood pressure.
You note slight tremors in Janelle's hands, and an area in her neck appears to be enlarged compared
with its appearance in previous visits. Janelle lists further complaints, including hair loss, diarrhea, and
"feeling hot all the time." Which of the following is true?
Parathyroid gland enlargement normally appears in the anterior neck area.
You should manually palpate Janelle's neck with moderate force to assess the size of the tissue.
Enlargement of the thyroid gland can make the neck area appear "fuller" than normal.
Any enlargement of the thyroid gland indicates the presence of thyroid cancer, which is likely Janelle's
diagnosis. - CORRECT ANSWER-✔✔✅Enlargement of the thyroid gland can make the neck area appear
"fuller" than normal.
Rationale: When the thyroid gland enlarges, changes in the appearance of the neck may be noticeable.
Janelle's neck should not be palpated with force as this can cause further damage to the thyroid gland.
The parathyroid glands are located behind the thyroid, not on the anterior neck. An enlarged thyroid
gland can occur for many reasons, not necessarily cancer.
Based on your assessment, the physician decides to have several blood tests completed. All results are
normal except the following: significantly elevated thyroid hormone levels (free T3 and free T4) and
undetectable TSH and TRH. What endocrine disorder does Janelle most likely have?
Primary thyroid hypofunction
Secondary thyroid hyperfunction
Tertiary thyroid hyperfunction
Primary thyroid hyperfunction - CORRECT ANSWER-✔✔✅Primary thyroid hyperfunction
Rationale: Janelle's condition is hyperthyroidism as indicated by the elevated thyroid hormone levels.
The condition is primary, a problem in the thyroid gland, because TSH levels (the signal from the anterior
pituitary that stimulates the thyroid gland) are low.
Further screening reveals elevated thyroid-stimulating antibodies. What condition is Janelle
experiencing?
Hashimoto's thyroiditis
Cushing's syndrome
