Week 9 Quiz Complete Graded A •

Diabetes insipidus, diabetes mellitus (DM), and SIADH share which of the following assessment manifestations? Selected Answer: Correct Answer: d. Thir st d. Thir st • Question 2 A 54-year-old patient with pulmonary tuberculosis (lung infection) is 1 out of 1 points evaluated for syndrome of inappropriate ADH secretion (SIADH). Which of the following electrolyte imbalances would be expected in this patient? Selected Answer: a. Hyponatre mia lOMoARcPSD| Correct Answer: a. Hyponatre mia • Question 3 1 out of 1 points Visual disturbances are a common occurrence in patients with untreated Graves disease. The endocrinologist explains to the patient that the main cause of these complications is: Selected Answer: Correct Answer: b. Orbital edema and protrusion of the eyeball b. Orbital edema and protrusion of the eyeball • Question 4 1 out of 1 points While planning care for a patient from general anesthesia, which principle should the nurse remember? A side effect of some general anesthetic agents is diabetes insipidus. Selected Answer: Correct Answer: b. Nephroge nic b. Nephroge nic • Question 5 A 22-year-old female has a low level of TSH. What condition does the 1 out of 1 points lOMoARcPSD| nurse expect the patient is experiencing? Selected Answer: Correct Answer: b. Secondary hypothyroidism b. Secondary hypothyroidism • Question 6 A 30-year-old male was diagnosed with hypothyroidism. Synthesis of which of the following would decrease in this patient? 0 out of 1 points Selected Answer: Correct Answer: c. Thyroid-binding globulin a. TSH and TH • Question 7 A 39-year-old female just had a baby. Which hormone will prevent excessive uterine bleeding? 1 out of 1 points Selected Answer: Correct Answer: d. Oxytoc in d. Oxytoc in • Question 8 A patient wants to know why ADH is important in the body. What is the 1 out of 1 points lOMoARcPSD| nurse’s best response? ADH is important in: Selected Answer: Correct Answer: a. The body’s water balance and urine concentration a. The body’s water balance and urine concentration • Question 9 1 out of 1 points If the patient has a problem with the pineal gland, which substance would the nurse monitor? Selected Answer: Correct Answer: a. Melaton in a. Melaton in • Question 10 If a patient’s posterior pituitary is removed, which hormone would the nurse expect to decrease? 1 out of 1 points Selected b. Answer: AD H Correct b. Answer: AD H • Question 11 1 out of 1 points lOMoARcPSD| When a patient wants to know what most commonly causes hypoparathyroidism, how should the nurse reply? It is most commonly caused by: Selected Answer: Correct Answer: c. Parathyroid gland injury c. Parathyroid gland injury • Question 12 1 out of 1 points A 30-year-old male presents to his primary care provider reporting visual disturbances. CT reveals a pituitary tumor and lab tests reveal elevated prolactin. He is diagnosed with prolactinoma. Which of the following treatments would the nurse help implement? Selected Answer: Correct Answer: a. Dopaminergic agonists a. Dopaminergic agonists • Question 13 1 out of 1 points A 50-year-old female presents with lightheadedness and overall abnormal feelings. Hyperaldosteronism is diagnosed. Which of the following symptoms would the nurse expect? Selected c. Answer: lOMoARcPSD| Hypokale Correct Answer: mia c. Hypokale mia • Question 14 A nurse is caring for a patient with SIADH. What severe complication should the nurse assess for? 1 out of 1 points Selected Answer: Correct Answer: c. Neurologic damage c. Neurologic damage • Question 15 1 out of 1 points Which principle should the nurse include while planning care for a patient with an ADH problem? ADH release from the posterior pituitary is stimulated by: Selected b. Answer: Correct Answer: High serum osmolarity sensed by osmoreceptors in the hypothalamus b. High serum osmolarity sensed by osmoreceptors in the hypothalamus • Question 16 1 out of 1 points A 40-year-old male undergoes surgery for a PTH-secreting tumor in which lOMoARcPSD| the parathyroid is removed. Which of the following would the nurse expect following surgery? Selected Answer: Correct Answer: c. Decreased calcium reabsorption in the kidney c. Decreased calcium reabsorption in the kidney • Question 17 1 out of 1 points An aide asks the nurse what is the most common cause of elevated levels of antidiuretic hormone (ADH) secretion. How should the nurse respond? Selected Answer: Correct Answer: b. Canc er b. Canc er • Question 18 A 45-year-old female has elevated thyroxine production. Which of the following would accompany this condition? 1 out of 1 points Selected Answer: Correct Answer: d. Decreased thyroid-stimulating hormone (TSH) d. Decreased thyroid-stimulating hormone (TSH) lOMoARcPSD| • Question 19 A 3-year-old male was diagnosed with congenital hypothyroidism. The parents ask the nurse if left untreated what will happen. What is the nurse’s best response? If left untreated, the child would have: 1 out of 1 points Selected Answer: Correct Answer: a. Mental retardation and stunted growth a. Mental retardation and stunted growth • Question 20 A 22-year-old male is admitted to the intensive care unit with a closed head injury sustained in a motorcycle accident. The injury has caused severe damage to the posterior pituitary. Which of the following complications should the nurse anticipate? 1 out of 1 points Selected Answer: Correct Answer: b. Dehydration from polyuria b. Dehydration from polyuria • Question 21 A 12-year-old female is newly diagnosed with type 1 DM. When the parents ask what causes this, what is the nurse’s best response? 1 out of 1 points Selected c. Answer: lOMoARcPSD| Immune destruction of the Correct Answer: pancreas c. Immune destruction of the pancreas • Question 22 A 44-year-old patient with pulmonary tuberculosis (lung infection) is 1 out of 1 points evaluated for SIADH. Which of the following assessment findings would be expected in this patient? Selected Answer: Correct Answer: d. Concentrated urine d. Concentrated urine • Question 23 When catecholamines are released in a patient, what should the nurse 1 out of 1 points assess for? Selected Answer: Correct Answer: d. Hyperglyce mia d. Hyperglyce mia • Question 24 A 12-year-old male is newly diagnosed with type 1 DM. Which of the 1 out of 1 points lOMoARcPSD| following tests should the nurse prepare the patient to best confirm the diagnosis? Selected Answer: Correct Answer: a. Fasting plasma glucose levels a. Fasting plasma glucose levels • Question 25 When a nurse is assessing the physical features of individuals with Cushing syndrome, these findings will include: 1 out of 1 points Selected Answer: Correct Answer: b. Truncal obesity and moon face b. Truncal obesity and moon face • Question 26 1 out of 1 points A patient wants to know what can cause ACTH to be released. How should the nurse respond? Selected Answer: Correct Answer: d. Acute stressors d. Acute stressors lOMoARcPSD| • Question 27 1 out of 1 points A 50-year-old male patient presents with polyuria and extreme thirst. He was given exogenous ADH. For which of the following conditions would this treatment be effective? Selected Answer: Correct Answer: a. Neurogenic diabetes insipidus a. Neurogenic diabetes insipidus • Question 28 A patient has researched lipid-soluble hormones on the Internet. Which 1 out of 1 points information indicates the patient has a good understanding? Lipid-soluble hormone receptors cross the plasma membrane by: Selected Answer: a. Diffusio n Correct a. Answer: Diffusio n • Question 29 A nurse is preparing to teach a patient about Addison disease. Which 1 out of 1 points information should the nurse include? The most common cause of Addison disease is: Selected a. Answer: lOMoARcPSD| An autoimmune Correct Answer: reaction a. An autoimmune reaction • Question 30 A 25-year-old male presents with fatigue, constipation, and sexual 1 out of 1 points dysfunction. Tests reveal all pituitary hormones are normal and no masses are present. The nurse suspects the most likely cause of his symptoms is a dysfunction in the: Selected Answer: Correct Answer: d. Pituitary stalk d. Pituitary stalk • Question 31 0 out of 1 points If a patient had a problem with the hypothalamus, which of the following hormones would be affected? Selected Answer: Correct Answer: a. Cortis ol c. ACTH • Question 32 1 out of 1 points A 19-year-old female with type 1 DM was admitted to the hospital with the following lab values: serum glucose 500 mg/dl (high), urine glucose and lOMoARcPSD| ketones 4+ (high), and arterial pH 7.20 (low). Her parents state that she has been sick with the “flu” for a week. Which of the following statements best explains her acidotic state? Selected Answer: Correct Answer: d. Insulin deficiency promotes lipid metabolism and ketone formation. d. Insulin deficiency promotes lipid metabolism and ketone formation. • Question 33 A student asks the instructor which of the following is the most potent naturally occurring glucocorticoid. How should the instructor respond? 1 out of 1 points Selected Answer: Correct Answer: c. Cortis ol c. Cortis ol • Question 34 A nurse recalls insulin has an effect on which of the following groups of 1 out of 1 points electrolytes? Selected Answer: Correct Answer: d. Potassium, magnesium, phosphate d. Potassium, magnesium, lOMoARcPSD| phosphate • Question 35 An endocrinologist isolated a new hormone and found it to be a watersoluble amine. Which of the following is most like this new hormone? 1 out of 1 points Selected Answer: Correct Answer: d. Epinephri ne d. Epinephri ne Sunday, July 30, 2017 12:47:45 PM EDT Pathophysiology Quizzes combined Chapters 17, 18, 19, 20 Huether and McCance: Understanding Pathophysiology, 5th Edition Chapter 17: Mechanisms of Hormonal Regulation Test Bank MULTIPLE CHOICE OK lOMoARcPSD| 1. A nurse recalls direct stimulation of the insulin-secreting cells of the pancreas by the autonomic nervous system is an example of control. a. Negative feedback b. Positive feedback c. Neural d. Substrate-level dependent ANS: C Direct stimulation of the insulin-secreting cells of the pancreas by the autonomic nervous system is a form of neural control. Stimulation of the insulin cells of the pancreas by the autonomic nervous system is a form of neural control and is not regulated as a form of negative feedback. Negative feedback works like a thermostat. Stimulation of the insulin cells of the pancreas by the autonomic nervous system is a form of neural control and is not regulated as a form of positive feedback. Stimulation of the insulin cells of the pancreas by the autonomic nervous system is a form of neural control and is not substrate-level dependent. REF: p. 427 2. A nurse is teaching staff about protein hormones. Which information should the nurse include? One of the protein hormones is: a. Thyroxine (T4) b. Aldosterone c. Testosterone d. Insulin ANS: D lOMoARcPSD| Protein hormones are also water-soluble hormones, and insulin is a part of this group. Thyroxine is a lipid soluble hormone and is not a protein hormone. Aldosterone is a lipid soluble hormone and is not a protein hormone. Testosterone is a lipid soluble hormone and is not a protein hormone. REF: p. 427 3. A 45-year-old female has elevated thyroxine production. Which of the following would accompany this condition? a. Increased thyroid-releasing hormone (TRH) b. Increased anterior pituitary stimulation c. Decreased T4 d. Decreased thyroid-stimulating hormone (TSH) ANS: D Secretion of TSH stimulates the synthesis and secretion of thyroid hormones. Increasing levels of T4 and T3 then feed back negatively on the pituitary and hypothalamus to inhibit TRH and TSH synthesis. With increased thyroxine production, TRH will be decreased. Increased thyroxine would lead to decreased anterior pituitary stimulation. Thyroxine is T4; its level will be elevated. REF: p. 427 4. An endocrinologist isolated a new hormone and found it to be a water-soluble amine. Which of the following is most like this new hormone? lOMoARcPSD| a. Growth hormone (GH) b. Luteinizing hormone (LH) c. Antidiuretic hormone (ADH) d. Epinephrine ANS: D An example of a water-soluble amine is epinephrine. GH is a water-soluble hormone but is a peptide. LH is water-soluble hormone but is a polypeptide. ADH is water-soluble hormone but is a polypeptide. REF: p. 427 5. When insulin binds to its receptors on muscle cells, an increase in glucose uptake by the muscle cells occurs. This is an example of a effect by a hormone. a. Pharmacologic b. Permissive c. Biphasic d. Direct ANS: D Direct effects are the obvious changes in cell function that result specifically from stimulation by a particular hormone as is true with insulin. Pharmacologic effects are the result of high doses of a drug. Permissive effects are less obvious hormone-induced changes that facilitate the maximal response or functioning of a cell. Biphasic effects are twofold effects. lOMoARcPSD| REF: p. 429 6. A 30-year-old male was diagnosed with hypothyroidism. Synthesis of which of the following would decrease in this patient? a. Corticosteroid B globulin b. Sex hormone-binding globulin c. Thyroid-binding globulin d. Albumin ANS: C TH is transported in the blood in bound and free forms. Most of the TH is transported bound to thyroxine-binding globulin (TBG); thus, if TH is low, the patient would also be low in TBG. Thyroid-binding globulin is decreased with hypothyroidism, not corticosteroid B globulin. Thyroid-binding globulin is decreased with hypothyroidism, not sex hormone-binding globulin. Thyroid-binding globulin is decreased with hypothyroidism, not albumin. REF: p. 428 7. A patient has high levels of hormones. To adapt to the high hormone concentrations, the patient’s target cells have the capacity for: a. Negative feedback b. Positive feedback c. Down-regulation d. Up-regulation ANS: C High concentrations of hormone decrease the number of receptors; this is called downregulation; thus, the cell can adjust its sensitivity to the concentration of the signaling hormone. lOMoARcPSD| Adaptation to high hormone concentration is the process of down-regulation. Negative feedback regulates hormone release. Adaptation to high hormone concentration is the process of down-regulation. Positive feedback regulates some forms of hormone release. Up-regulation is a response to low concentrations of hormone, thus increasing the number of receptors per cell. REF: p. 429 8. A patient has researched lipid-soluble hormones on the Internet. Which information indicates the patient has a good understanding? Lipid-soluble hormone receptors cross the plasma membrane by: a. Diffusion b. Osmosis c. Active transport d. Endocytosis ANS: A Lipid-soluble hormones cross the plasma membrane by diffusion. Lipid-soluble hormones cross by diffusion, not osmosis. Lipid-soluble hormones cross by diffusion, not active transport. Lipid-soluble hormones cross by diffusion, not endocytosis. REF: p. 431 lOMoARcPSD| 9. When a patient asks about target cell receptors, which is the nurse’s best response? Target cell receptors for most water-soluble hormones are located in the: a. Cytosol b. Cell membrane c. Endoplasmic reticulum d. Nucleus ANS: B Water-soluble hormones bind to cell surface receptors. Water-soluble hormones bind to cell surface receptors, not cytosol. Water-soluble hormones bind to cell surface receptors, not endoplasmic reticulum. Water-soluble hormones bind to cell surface receptors, not the nucleus. REF: p. 427 10. When the endocrinologist asks the staff how the releasing hormones that are made in the hypothalamus travel to the anterior pituitary, how should the staff reply? Via the: a. Vessels of the zona fasciculata b. Chromophils c. Median eminence d. Hypophysial portal system ANS: D Neurons in the hypothalamus secrete releasing hormones into veins that carry the releasing hormones directly to the vessels of the adenohypophysis via the hypophysial portal system, thus bypassing the normal circulatory route. Zona fasciculata secretes abundant amounts of cortisol from the adrenal gland. Chromophils are the secretory cells of the adenohypophysis. lOMoARcPSD| The median eminence is a part of the posterior pituitary, not the anterior. REF: p. 433 11. An aide asks the nurse what activates tyrosine. What is the nurse’s best response? a. GH b. PRL c. Insulin d. Estrogen ANS: C Insulin receptor binding activates tyrosine kinase autophosphorylation and sends a cascade of signals to activate glucose transporters. Insulin binding, not growth hormone, activates tyrosine. Insulin, not PRL, activates tyrosine. Insulin, not estrogen, activates tyrosine. REF: p. 430 12. A nurse recalls prolactin-inhibiting factor’s target tissue is the: a. Hypothalamus b. Anterior pituitary c. Mammary glands d. Posterior pituitary ANS: B Prolactin-inhibiting factor (PIF) inhibits prolactin secretion by the anterior pituitary. PIF inhibits prolactin secretion by the anterior pituitary, not the hypothalamus. lOMoARcPSD| PIF inhibits prolactin secretion by the anterior pituitary, not the mammary glands. PIF inhibits prolactin secretion by the anterior pituitary, not the posterior pituitary. REF: p. 444 13. When a staff member asks the nurse which gland secretes ADH and oxytocin, how should the nurse respond? a. Anterior pituitary b. Posterior pituitary c. Hypothalamus d. Pineal gland ANS: B The posterior pituitary secretes ADH, which also is called vasopressin, and oxytocin. The anterior pituitary secretes ACTH, melanocyte-stimulating hormone (MSH), somatotropic hormones (GH, prolactin), and glycoprotein hormones—follicle-stimulating hormone (FSH), LH, and TSH. The hypothalamus secretes PRF, which stimulates secretion of prolactin; PIF (dopamine), which inhibits prolactin secretion; TRH, which affects release of thyroid hormones; GH-releasing hormone (GHRH), which stimulates the release of GH; somatostatin, which inhibits the release of GH; gonadotropin-releasing hormone (GnRH), which facilitates release FSH and LH; corticotropin-releasing hormone (CRH), which facilitates the release of ACTH and endorphins; and substance P, which inhibits ACTH release and stimulates release of a variety of other hormones. The pineal gland secretes melatonin. lOMoARcPSD| REF: p. 444 14. If a patient’s posterior pituitary is removed, which hormone would the nurse expect to decrease? a. PRF b. ADH c. ACTH d. GH ANS: B The hormones ADH and oxytocin are released from the posterior pituitary gland. PRF is released by the hypothalamus. ACTH is released by the anterior pituitary. GH is released by the hypothalamus. REF: p. 435 15. Which principle should the nurse include while planning care for a patient with an ADH problem? ADH release from the posterior pituitary is stimulated by: a. Low blood pressure sensed by baroreceptors in the kidneys b. High serum osmolarity sensed by osmoreceptors in the hypothalamus c. Low osmolality sensed by osmoreceptors in the kidneys d. High concentration of potassium sensed by chemoreceptors in the carotid body ANS: B As plasma osmolality increases, these osmoreceptors are stimulated, the rate of ADH secretion increases, more water is reabsorbed from the kidney, and the plasma is diluted back to its setpoint osmolality. ADH release is stimulated by high serum osmolality, not lowered blood pressure. lOMoARcPSD| ADH release is stimulated by high serum osmolality, not low osmolality. ADH release is stimulated by high serum osmolality, not high concentrations of potassium. REF: p. 435 16. A patient wants to know why ADH is important in the body. What is the nurse’s best response? ADH is important in: a. The body’s water balance and urine concentration b. Maintaining electrolyte levels and concentrations c. Follicular maturation d. Regulation of metabolic processes ANS: A ADH is important in the body’s water balance and its ability to concentrate urine. ADH aids in water balance, not electrolyte levels. ADH aids in water balance, not follicular maturation. ADH aids in water balance, not metabolic processes. REF: p. 429 17. If a patient had a problem with the hypothalamus, which of the following hormones would be affected? a. ACTH b. Oxytocin c. ADH d. TSH ANS: B lOMoARcPSD| The hypothalamus secretes oxytocin. The anterior pituitary secretes ACTH. The posterior pituitary secretes ADH. The anterior pituitary secretes TSH. REF: p. 431 18. A nurse is teaching the staff about oxytocin. Which information should the nurse include? Target cells for oxytocin are located in the: a. Renal tubules b. Thymus c. Liver d. Uterus ANS: D Oxytocin causes uterine contraction and lactation in women and may have a role in sperm motility in men. Oxytocin does not stimulate the renal tubules; it stimulates the uterus. Oxytocin does not stimulate the thymus; it stimulates the uterus. Oxytocin does not stimulate the liver; it stimulates the uterus. REF: p. 435 19. A 50-year-old male patient is deficient in ADH production. Which of the following assessment findings would the nurse expect to find? a. Increased blood volume lOMoARcPSD| b. Increased urine osmolality c. Increased urine volume d. Increased arterial vasoconstriction ANS: C With deficient ADH, the kidneys would not concentrate urine leading to increased urine output. Blood volume would decrease with increased renal excretion of fluid. Urine osmolality would decrease. Arteries would dilate with deficient ADH production. REF: pp. 434-435 20. A 70-year-old female has brittle bones secondary to osteoporosis. Her primary care provider prescribes calcitonin to: a. Activate vitamin D b. Stimulate osteoclastic activity c. Inhibit calcium resorption from bones d. Promote thyroid hormone release ANS: C Calcitonin lowers serum calcium levels by inhibition of bone-resorbing osteoclasts. Calcitonin inhibits bone-resorbing osteoclasts; it does not activate vitamin D. Calcitonin inhibits bone-resorbing osteoclasts; not stimulate it. Calcitonin inhibits bone-resorbing osteoclasts; it does not promote thyroid hormone release. REF: p. 14 | p. 17 | p. 435 lOMoARcPSD| 21. Which nutrient would the nurse encourage the patient to consume for thyroid hormone synthesis? a. Zinc b. Sodium c. Iodine d. Calcium ANS: C Iodine is necessary for the synthesis of thyroid hormone. Iodine, not zinc, is necessary for synthesis of thyroid hormone. Iodine, not sodium, is necessary for synthesis of thyroid hormone. Iodine, not calcium, is necessary for synthesis of thyroid hormone. REF: p. 436 22. A nurse is reviewing lab results. Which of the following lab results would slow down the rate of parathyroid hormone secretion? a. Increased serum calcium levels b. Decreased serum calcium levels c. Decreased levels of TSH d. Increased levels of TSH ANS: A An increase in serum calcium inhibits parathyroid hormone (PTH) secretion. An increase, not a decrease, in serum calcium inhibits PTH secretion. Thyroid-stimulating hormone would not affect PTH secretion. Thyroid-stimulating hormone would not affect PTH secretion. lOMoARcPSD| REF: p. 16 | p. 17 | p. 437 23. A 40-year-old male undergoes surgery for a PTH-secreting tumor in which the parathyroid is removed. Which of the following would the nurse expect following surgery? a. Increased serum calcium b. Decreased bone formation c. Decreased calcium reabsorption in the kidney d. Increased calcitonin ANS: C PTH also acts on the kidney to increase calcium reabsorption and to decrease phosphate reabsorption. Removal of the PTH-secreting tumor would result in decreased calcium reabsorption in the kidney, not increased serum calcium. Removal of the PTH-secreting tumor would result in decreased calcium reabsorption in the kidney, not decreased bone formation. Removal of the PTH-secreting tumor would result in decreased calcium reabsorption in the kidney, not increased calcitonin. REF: p. 437 24. A nurse is teaching a patient about insulin. Which information should the nurse include? Insulin is primarily regulated by: a. Metabolic rate b. Serum glucose levels c. Prostaglandins d. Enzyme activation lOMoARcPSD| ANS: B Insulin secretion is promoted when blood levels of glucose rise. Insulin secretion is not based on metabolic rate but on blood levels of glucose. Insulin secretion is not based on prostaglandins but on blood levels of glucose. Insulin secretion is not based on enzyme activation but on blood levels of glucose. REF: p. 437 25. A 30-year-old male is diagnosed with a hormone-secreting tumor of the pancreas alpha cells. Which of the following would the nurse expect to be most likely increased in this patient? a. Amylin b. Glucagon c. Insulin d. Somatostatin ANS: B Glucagon is produced by the alpha cells of the pancreas. Amylin is secreted by the beta cells. Insulin is secreted by the beta cells. Somatostatin is produced by the delta cells. REF: p. 439 26. A nurse recalls insulin has an effect on which of the following groups of electrolytes? a. Sodium, chloride, phosphate b. Calcium, magnesium, potassium c. Hydrogen, bicarbonate, chloride lOMoARcPSD| d. Potassium, magnesium, phosphate ANS: D Insulin facilitates the intracellular transport of potassium (K+), phosphate, and magnesium. Insulin facilitates the intracellular transport of potassium (K+), phosphate, and magnesium, not sodium and chloride. Insulin facilitates the intracellular transport of potassium (K+), phosphate, and magnesium, not calcium. Insulin facilitates the intracellular transport of potassium (K+), phosphate, and magnesium, not hydrogen, bicarbonate, and chloride. REF: p. 439 27. A student asks the instructor which of the following is the most potent naturally occurring glucocorticoid. How should the instructor respond? a. Aldosterone b. Testosterone c. Cortisol d. Prolactin ANS: C The most potent naturally occurring glucocorticoid is cortisol. The most potent naturally occurring glucocorticoid is cortisol, not aldosterone. The most potent naturally occurring glucocorticoid is cortisol, not testosterone. The most potent naturally occurring glucocorticoid is cortisol, not prolactin. REF: p. 441 lOMoARcPSD| 28. A patient wants to know what can cause ACTH to be released. How should the nurse respond? a. High serum levels of cortisol b. Hypotension c. Hypoglycemia d. Stress ANS: D Stress increases ACTH secretion. ACTH regulates the release of cortisol from the adrenal cortex. It is not stimulated by high serum levels. Hypotension does not stimulate ACTH. Hypoglycemia does not stimulate ACTH. REF: p. 441 29. A 39-year-old female is recovering from the birth of her third child. Which hormone would help prevent uterine bleeding? a. Aldosterone b. Cortisol c. Prolactin d. Oxytocin ANS: D Oxytocin functions near the end of labor to enhance effectiveness of contractions, promote delivery of the placenta, and stimulate postpartum uterine contractions, thereby preventing excessive bleeding. Aldosterone regulates water balance. lOMoARcPSD| Cortisol helps protect from stress. Prolactin assists with milk production. REF: p. 435 30. The nurse is teaching the staff about aldosterone. Which information should the nurse include? The main site of aldosterone synthesis is the: a. Liver b. Kidneys c. Adrenal cortex d. Hypothalamus ANS: C The adrenal cortex synthesizes aldosterone. The adrenal cortex, not the liver, synthesizes aldosterone. The adrenal cortex, not the kidneys, synthesizes aldosterone. The adrenal cortex, not the hypothalamus, synthesizes aldosterone. REF: p. 441 31. A 50-year-old male with one kidney had to undergo surgery for an adrenal tumor. His zona glomerulosa was largely removed during the surgery. The nurse would expect the removal of this tumor to result in a decrease in: a. Sodium b. Aldosterone c. Potassium d. Acid lOMoARcPSD| ANS: B The zona glomerulosa, the outer layer, constitutes about 15% of the cortex and primarily produces the mineralocorticoid aldosterone. The zona glomerulosa produces aldosterone, not sodium. The zona glomerulosa produces aldosterone, not potassium. The zona glomerulosa produces aldosterone, not acid. REF: p. 441 32. An endocrinologist is teaching about aldosterone secretion. Which information should the endocrinologist include? Aldosterone secretion is regulated by: a. The sympathetic nervous system b. ACTH feedback c. The renin-angiotension system d. Positive feedback ANS: C Aldosterone synthesis and secretion are regulated primarily by the renin-angiotensin system. Aldosterone synthesis and secretion are regulated by the renin-angiotensin system, not the sympathetic nervous system. Aldosterone synthesis and secretion are regulated by the renin-angiotensin system, not adrenocorticotropic hormone feedback. Aldosterone synthesis and secretion are regulated by the renin-angiotensin system, not positive feedback. REF: p. 441 lOMoARcPSD| 33. If a patient had a problem with the adrenal medulla, which of the following hormones should the nurse monitor? a. Cortisol b. Epinephrine c. Androgens d. Estrogens ANS: B The major products stored and secreted by the adrenal medulla are the catecholamines epinephrine (adrenaline) and norepinephrine. The adrenal cortex secretes cortisol. The adrenal cortex secretes androgens. The pituitary secretes estrogens. REF: p. 443 34. When catecholamines are released in a patient, what should the nurse assess for? a. Nutrient absorption b. Fluid retention c. Hypotension d. Hyperglycemia ANS: D Catecholamines cause hyperglycemia and immune suppression. Catecholamines cause hyperglycemia, not nutrient absorption. Catecholamines cause hyperglycemia, not fluid retention. Catecholamines cause hypertension, not hypotension. lOMoARcPSD| REF: p. 443 35. If the patient has a problem with the pineal gland, which substance would the nurse monitor? a. Melatonin b. Epinephrine c. Cortisol d. Somatostatin ANS: A The pineal glands secrete melatonin. The adrenal medulla secretes epinephrine. The adrenal cortex secretes cortisol. The thyroid gland secretes somatostatin. REF: p. 435 MULTIPLE RESPONSE 1. Elevated levels of glucocorticoids result in which of the following assessment findings? (Select all that apply.) a. Polycythemia b. Increased appetite c. Weight loss d. Decreased calcium e. Increased height ANS: A, B, D lOMoARcPSD| Increased glucocorticoid secretion leads to polycythemia, increased appetite, fat deposition in the face and cervical areas, decreased serum calcium levels, and interference with the action of growth hormone so that somatic growth is inhibited. Weight gain and loss of height are expected. REF: pp. 440-441 Huether and McCance: Understanding Pathophysiology, 5th Edition Chapter 18: Alterations of Hormonal Regulation Test Bank MULTIPLE CHOICE 1. A nurse is discussing endocrine system dysfunction with a patient. Which statement indicates the patient understood? Endocrine system dysfunction can result from hyposecretion, hypersecretion, or from: a. Abnormal receptor activity b. Abnormal hormone levels c. Increased synthesis of second messengers d. Extracellular electrolyte alterations ANS: A Dysfunction may result from abnormal cell receptor function or from altered intracellular response to the hormone-receptor complex. Abnormal hormone levels can occur, but are not the cause. Intracellular storage of hormones would not lead to dysfunction; receptor function does. Extracellular electrolyte alterations may result from dysfunction, but it is not a cause. lOMoARcPSD| REF: p. 448 2. An aide asks the nurse what is the most common cause of elevated levels of antidiuretic hormone (ADH) secretion. How should the nurse respond? a. Autoimmune disease b. Cancer c. Pregnancy d. Heart failure ANS: B The most common cause of elevated levels of ADH is cancer. The most common cause of elevated levels of ADH is cancer, not autoimmune disorders. The most common cause of elevated levels of ADH is cancer, not pregnancy. The most common cause of elevated levels of ADH is cancer, not heart failure. REF: p. 449 3. A 54-year-old patient with pulmonary tuberculosis (lung infection) is evaluated for syndrome of inappropriate ADH secretion (SIADH). Which of the following electrolyte imbalances would be expected in this patient? a. Hyponatremia b. Hyperkalemia c. Hypernatremia d. Hypokalemia ANS: A Hyponatremia occurs due to increased water reabsorption by kidneys. lOMoARcPSD| Hyperkalemia does not occur, but hyponatremia occurs due to increased water reabsorption. Sodium levels are lowered, with hyponatremia they are not elevated. Hypokalemia does not occur; SIADH is a problem of sodium. REF: p. 449 4. A 44-year-old patient with pulmonary tuberculosis (lung infection) is evaluated for SIADH. Which of the following assessment findings would be expected in this patient? a. Peripheral edema b. Tachycardia c. Low blood pressure d. Concentrated urine ANS: D Clinical manifestations of SIADH include urine that is inappropriately concentrated with respect to serum osmolarity. Peripheral edema is not a symptom of SIADH; concentrated urine is. Tachycardia is not a symptom of SIADH, but confusion and lethargy are. Low blood pressure is not a symptom of SIADH, but gastrointestinal symptoms and dyspnea are. REF: p. 449 5. A nurse is caring for a patient with SIADH. What severe complication should the nurse assess for? a. Stroke b. Diabetes insipidus c. Neurologic damage lOMoARcPSD| d. Renal failure ANS: C When the hyponatremia of SIADH becomes severe, 110 mEq/L to 115 mEq/L, confusion, lethargy, muscle twitching, convulsions, and severe and sometimes irreversible neurologic damage may occur. Stoke is not associated with SIADH, but confusion and convulsions do occur. Diabetes insipidus is not associated with SIADH, as it is manifested by increased urine output and in SIADH urine output decreases. Neurological failure, not renal failure, occurs in SIADH. REF: p. 449 6. A 22-year-old male is admitted to the intensive care unit with a closed head injury sustained in a motorcycle accident. The injury has caused severe damage to the posterior pituitary. Which of the following complications should the nurse anticipate? a. Dilutional hyponatremia b. Dehydration from polyuria c. Cardiac arrest from hyperkalemia d. Metabolic acidosis ANS: B Diabetes insipidus is a well-recognized complication of closed head injury and is manifested by polyuria leading to dehydration. The patient will experience hypernatremia, not hyponatremia. Electrolytes other than sodium are typically not affected with diabetes insipidus. Acidosis is not associated with diabetes insipidus. lOMoARcPSD| REF: p. 449 7. While planning care for a patient from general anesthesia, which principle should the nurse remember? A side effect of some general anesthetic agents is diabetes insipidus. a. Neurogenic b. Nephrogenic c. Psychogenic d. Allogenic ANS: B General anesthetics can lead to nephrogenic diabetes insipidus. General anesthetics can lead to nephrogenic, not neurogenic, diabetes insipidus; neurogenic diabetes may be due to primary brain tumors, hypophysectomy, aneurysms, thrombosis, infections, and immunologic disorders and head injury. General anesthetics can lead to nephrogenic, not psychogenic, diabetes insipidus; psychogenic is due to ingestion of large quantities of fluid. General anesthetics can lead to nephrogenic, not allogenic, diabetes insipidus. REF: p. 449 8. Diabetes insipidus, diabetes mellitus (DM), and SIADH share which of the following assessment manifestations? a. Polyuria b. Edema c. Vomiting and abdominal cramping d. Thirst lOMoARcPSD| ANS: D All three share thirst as a common clinical manifestation. SIADH does not have polyuria as a clinical manifestation. Insipidus does not have edema as a clinical manifestation. SIADH is manifested by gastrointestinal symptoms, the other two are not. REF: p. 449 9. A 50-year-old male patient presents with polyuria and extreme thirst. He was given exogenous ADH. For which of the following conditions would this treatment be effective? a. Neurogenic diabetes insipidus b. Psychogenic diabetes insipidus c. Nephrogenic diabetes insipidus d. SIADH ANS: A Neurogenic diabetes insipidus is caused by the insufficient secretion of ADH; thus, exogenous ADH would be useful in the treatment of this disorder. Psychogenic diabetes insipidus is due to increased intake of water and would not respond to exogenous ADH. ADH is high in nephrogenic diabetes insipidus; thus, exogenous ADH would be contraindicated. SIADH is manifested by high levels of ADH; thus, exogenous administration of ADH would be contraindicated. REF: p. 449 lOMoARcPSD| 10. A 25-year-old male presents with fatigue, constipation, and sexual dysfunction. Tests reveal all pituitary hormones are normal and no masses are present. The nurse suspects the most likely cause of his symptoms is a dysfunction in the: a. Anterior pituitary b. Posterior pituitary c. Pars intermedia d. Pituitary stalk ANS: D When pituitary hormones are normal, dysfunction in the action of hypothalamic hormones are most commonly related to interruption of the connection between the hypothalamus and pituitary, the pituitary stalk. Pituitary hormones are normal so the dysfunction cannot be in the anterior pituitary. Pituitary hormones are normal, so the dysfunction cannot be in the posterior pituitary. Pituitary hormones are normal, so the dysfunction cannot be in the pars intermedia. REF: p. 450 11. A 15-year-old female presents with breast discharge, dysmenorrhea, and excessive excitability. Tests reveal that all her pituitary hormones are elevated. What does the nurse suspect as the most likely cause for these assessment findings? a. A pituitary adenoma b. Hypothalamic hyposecretion c. Hypothalamic inflammation d. Pheochromocytoma ANS: A lOMoARcPSD| Hormonal effects of pituitary adenomas include hypersecretion from the adenoma, itself, and hyposecretion from surrounding pituitary cells; in this case prolactin would be elevated with the manifestation of menstrual irregularities and secretion from the breast. These symptoms are indicative of hypersecretion, not hyposecretion. These symptoms are indicative of hypersecretion, not hypothalamic inflammation, which would lead to hyposecretion. Pheochromocytoma is a tumor of the adrenal gland and would be manifested by elevated blood pressure. REF: p. 450 12. What common neurologic disturbances should the nurse assess for in a patient with a pituitary adenoma? a. Coma b. Visual disturbances c. Confused states d. Breathing abnormalities ANS: B The clinical manifestations of pituitary adenomas are visual changes including visual field impairments (often beginning in one eye and progressing to the other) and temporary blindness. Coma is not associated with pituitary adenoma, visual disturbances are. Confused states are not associated with pituitary adenoma, visual disturbances are. Breathing abnormalities are not associated with pituitary adenoma, visual disturbances are. REF: p. 451 lOMoARcPSD| 13. A 35-year-old female with Graves disease is admitted to a medical-surgical unit. While the nurse is reviewing the lab tests, which results would the nurse expect to find? a. High levels of circulating thyroid-stimulating antibodies b. Ectopic secretion of thyroid-stimulating hormone (TSH) c. Low circulating levels of thyroid hormones d. Increased circulation of iodine ANS: A Graves disease results from a form of Type II hypersensitivity in which there is stimulation of the thyroid by autoantibodies directed against the TSH receptor. The thyroid-stimulating antibodies stimulate TSH receptors; it is not an ectopic secretion. Graves disease is manifested by elevated levels of thyroid hormones. Iodine deficiency leads to goiter, but not Graves disease. REF: pp. 454-455 14. While checking the lab results for a patient with Graves disease, the nurse would check the T3 level to be abnormally: a. Low b. High c. Variable d. Absent ANS: B T3 levels are elevated in Graves disease. T3 levels are elevated in Graves disease. T3 levels are elevated in Graves disease, not variable. lOMoARcPSD| T3 levels are elevated in Graves disease, not absent. REF: p. 454 15. A 35-year-old female with Graves disease is admitted to a medical-surgical unit. Which of the following symptoms would the nurse expect to find before treatment? a. Weight gain, cold intolerance b. Slow heart rate, rash c. Skin hot and moist, rapid heart rate d. Constipation, confusion ANS: C Symptoms of Graves disease include heat intolerance and increased tissue sensitivity to stimulation by the sympathetic division of the autonomic nervous system. Weight loss, rather than weight gain, and heat intolerance would result. Tachycardia, not slow heart rate, would occur. Diarrhea would occur as opposed to constipation. REF: p. 454 16. Visual disturbances are a common occurrence in patients with untreated Graves disease. The endocrinologist explains to the patient that the main cause of these complications is: a. Decreased blood flow to the eye b. Orbital edema and protrusion of the eyeball c. TSH neurotoxicity to retinal cells d. Local lactic acidosis ANS: B lOMoARcPSD| Visual disturbances with Graves disease include orbital fat accumulation, inflammation, and edema of the orbital contents resulting in exophthalmos (protrusion of the eyeball), periorbital edema, and extraocular muscle weakness leading to diplopia (double vision). Blood flow to the eye is not an effect, but visual changes occur. Functional abilities of the eye results from hyperactivity of the sympathetic system. Lactic acid is not involved with visual changes in the eye. REF: p. 455 17. A 25-year-old female with Graves disease is admitted to a medical-surgical unit. Palpation of her neck would most likely reveal: a. A normal-sized thyroid b. A small discrete thyroid nodule c. Multiple discrete thyroid nodules d. Diffuse thyroid enlargement ANS: D A patient with Graves disease would reveal stimulation of the gland causing diffuse thyroid enlargement. In Graves disease, the thyroid will be enlarged, not normal sized. In Graves disease, the entire gland will be enlarged, not just a small nodule. In Graves disease, the entire gland will be enlarged, not multiple discrete nodules. REF: p. 455 lOMoARcPSD| 18. A 22-year-old female has a low level of TSH. What condition does the nurse expect the patient is experiencing? a. Primary hypothyroidism b. Secondary hypothyroidism c. Autoimmune hypothyroidism d. Atypical hypothyroidism ANS: B Causes of secondary hypothyroidism are related to either pituitary or hypothalamic failure, which would be evident by low levels of TSH. Primary hypothyroidism would be evident by elevated levels of TSH. Autoimmune hypothyroidism would be evident by elevated TSH. Atypical hypothyroidism would be evident by normal or elevated TSH. REF: p. 456 19. While planning care for a patient with hypothyroidism, which principle should the nurse remember? The basal metabolic rate is unusually with hypothyroidism. a. High b. Low c. Steady d. Variable ANS: B The metabolic rate with hypothyroidism is low. The metabolic rate with hypothyroidism is low, not high. The metabolic rate with hypothyroidism is low, not steady. The metabolic rate with hypothyroidism is low, not variable. lOMoARcPSD| REF: p. 456 20. A 3-year-old male was diagnosed with congenital hypothyroidism. The parents ask the nurse if left untreated what will happen. What is the nurse’s best response? If left untreated, the child would have: a. Mental retardation and stunted growth b. Increased risk of childhood thyroid cancer c. Hyperactivity and attention deficit disorder d. Liver, kidney, and pancreas failure ANS: A Cognitive disability varies with the severity of congenital hypothyroidism and the length of delay before treatment is initiated. Cognitive disability varies with the severity of congenital hypothyroidism and the length of delay before treatment is initiated. There is not an increased risk for thyroid cancer. Cognitive disability varies with the severity of congenital hypothyroidism and the length of delay before treatment is initiated. There is not a risk for hyperactivity and attention deficit disorder. Cognitive disability varies with the severity of congenital hypothyroidism and the length of delay before treatment is initiated. There is not a risk for liver, kidney, and pancreas failure. REF: p. 457 21. A 30-year-old male was diagnosed with thyroid carcinoma. The lab tests the nurse would most likely find are T3 and T4 levels. a. High lOMoARcPSD| b. Low c. Normal d. Variable ANS: C Most individuals with thyroid carcinoma have normal T3 and T4 levels and are therefore euthyroid. Most individuals with thyroid carcinoma have normal T3 and T4 levels and are therefore euthyroid, not hyperthyroid. Most individuals with thyroid carcinoma have normal T3 and T4 levels and are therefore euthyroid, not hypothyroid. Most individuals with thyroid carcinoma have normal T3 and T4 levels and are therefore euthyroid, not variable in their levels. REF: p. 457 22. What problem should the nurse assess for in a patient with chronic hyperparathyroidism? a. Seizure disorders b. Vitamin D malabsorption c. Hyponatremia d. Osteoporosis and pathologic fractures ANS: D Excessive osteoclastic and osteocytic activity resulting in bone resorption may cause pathologic fractures, kyphosis of the dorsal spine, and compression fractures of the vertebral bodies. Pathologic fractures are associated with chronic hyperparathyroidism, not a seizure disorder. Pathologic fractures are associated with chronic hyperparathyroidism, not vitamin D malabsorption. lOMoARcPSD| Pathologic fractures are associated with chronic hyperparathyroidism, not hyponatremia. REF: p. 457 23. A 45-year-old female with Graves disease underwent surgical removal of her thyroid gland. During the postoperative period, her serum calcium was low. The most probable reason for her low serum calcium is: a. Hyperparathyroidism secondary to Graves disease b. Myxedema secondary to surgery c. Hypoparathyroidism caused by surgical injury to the parathyroid glands d. Hypothyroidism resulting from lack of thyroid replacement ANS: C Hypoparathyroidism is most commonly caused by damage to the parathyroid glands during thyroid surgery. Hypoparathyroidism is most commonly caused by damage to the parathyroid glands during thyroid surgery, not secondary to Graves disease. Hypoparathyroidism is most commonly caused by damage to the parathyroid glands during thyroid surgery, not due to myxedema. Hypoparathyroidism is most commonly caused by damage to the parathyroid glands during thyroid surgery; it does not result from the lack of thyroid replacement. REF: p. 458 lOMoARcPSD| 24. A 30-year-old female with Graves disease is admitted to a hospital unit for the surgical removal of her thyroid gland. During the postoperative period, the nurse notes that the patient’s serum calcium is low. The nurse should observe the patient for which of the following signs/symptoms? a. Muscle weakness and constipation b. Laryngeal spasms and hyperreflexia c. Abdominal pain and fever d. Anorexia, nausea, and vomiting ANS: B Symptoms of low calcium are associated with tetany, a condition characterized by muscle spasms, hyperreflexia, clonic-tonic convulsions, and laryngeal spasms. Symptoms of low calcium are associated with tetany, a condition characterized by muscle spasms, hyperreflexia, clonic-tonic convulsions, and laryngeal spasms. It does not involve muscle weakness and constipation. Symptoms of low calcium are associated with tetany, a condition characterized by muscle spasms, hyperreflexia, clonic-tonic convulsions, and laryngeal spasms. It does not cause abdominal pain. Symptoms of low calcium are associated with tetany, a condition characterized by muscle spasms, hyperreflexia, clonic-tonic convulsions, and laryngeal spasms. It does not cause anorexia, nausea, or vomiting. REF: p. 458 25. When a patient wants to know what most commonly causes hypoparathyroidism, how should the nurse reply? It is most commonly caused by: a. Pituitary hyposecretion lOMoARcPSD| b. Parathyroid adenoma c. Parathyroid gland injury d. Hypothalamic inactivity ANS: C Hypoparathyroidism is most commonly caused by damage to the parathyroid glands. Hypoparathyroidism is most commonly caused by damage to the parathyroid glands, not pituitary hyposecretion. Hypoparathyroidism is most commonly caused by damage to the parathyroid glands, not parathyroid adenoma. Hypoparathyroidism is most commonly caused by damage to the parathyroid glands, not inactivity of the hypothalamus. REF: p. 458 26. A 25-year-old male presents to his primary care provider reporting changes in facial features. CT scan reveals a mass on the anterior pituitary, and lab tests reveal severely elevated growth hormone (GH). Which of the following would the nurse also expect to find? a. Decreased IGF-1 b. Hypotension c. Sexual dysfunction d. Height increases ANS: C In addition to elevated levels of GH, sexual dysfunction in men can occur. In addition to elevated levels of GH, sexual dysfunction in men can occur, and IGF-1 increases. In addition to elevated levels of GH, sexual dysfunction in men can occur, not hypotension. lOMoARcPSD| In addition to elevated levels of GH, sexual dysfunction in men can occur, and overgrowth of bone occurs but not an increase in height. REF: p. 452 27. A 30-year-old male presents to his primary care provider reporting visual disturbances. CT reveals a pituitary tumor and lab tests reveal elevated prolactin. He is diagnosed with prolactinoma. Which of the following treatments would the nurse help implement? Administering: a. Dopaminergic agonists b. Calcium c. Insulin d. Radiation ANS: A Dopaminergic agonists (bromocriptine and cabergoline) are the treatment of choice for prolactinomas. Calcium is used to treat parathyroid disease. Insulin is used to treat diabetes. Radiation is used to treat GH. REF: p. 453 28. A 12-year-old female is newly diagnosed with type 1 DM. When the parents ask what causes this, what is the nurse’s best response? a. A familial, autosomal dominant gene defect lOMoARcPSD| b. Obesity and lack of exercise c. Immune destruction of the pancreas d. Hyperglycemia from eating too many sweets ANS: C The most common cause of type 1 DM is a slowly progressive autoimmune T cell-mediated disease that destroys the beta cells of the pancreas. The most common cause of type 1 DM is a slowly progressive autoimmune T cell-mediated disease that destroys the beta cells of the pancreas; it is not due to a gene defect. Although obesity can contribute to diabetes, the most common cause of type 1 DM is a slowly progressive autoimmune T cell-mediated disease that destroys the beta cells of the pancreas. Eating too many sweets does not contribute to the development of diabetes; the most common cause of type 1 DM is a slowly progressive autoimmune T cell-mediated disease that destroys the beta cells of the pancreas. REF: p. 459 29. A 12-year-old male is newly diagnosed with type 1 DM. Which of the following tests should the nurse prepare the patient to best confirm the diagnosis? a. Fasting plasma glucose levels b. Random serum glucose levels c. Genetic testing d. Glycosylated hemoglobin measurements ANS: A Fasting blood glucose levels are most beneficial in confirming the diagnosis of diabetes. Random serum levels are not as accurate as fasting. Genetic testing may be important for future determination, but it does not confirm the diagnosis. lOMoARcPSD| Glycosylated testing measures glucose control over time. REF: p. 18 | p. 435 | p. 462 30. An 11-year-old male is newly diagnosed with type 1 DM. Which classic symptoms should the nurse assess the patient for? a. Recurrent infections, visual changes, fatigue, and paresthesias b. Polydipsia, polyuria, polyphagia, and weight loss c. Vomiting; abdominal pain; sweet, fruity breath; dehydration; and Kussmaul breathing d. Weakness, vomiting, hypotension, and mental confusion ANS: B Classic symptoms of type 1 DM include polydipsia, polyuria, polyphagia, and weight loss. Recurrent infections and visual changes are complications of diabetes. Vomiting, abdominal pain, and sweet breath are signs of diabetic ketoacidosis. Weakness, hypotension, and mental confusion are signs of hypoglycemia. REF: p. 461 31. A 19-year-old female with type 1 DM was admitted to the hospital with altered consciousness and the following lab values: serum glucose 500 mg/dl (high) and serum K+ 2 (low). Her parents state that she has been sick with the “flu” for a week. The diagnosis is hyperosmolar hyperglycemia nonketotic syndrome (HHNKS). What relationship do these values have with her insulin deficiency? a. Increased glucose utilization causes the shift of fluid from the intravascular to the lOMoARcPSD| intracellular space. b. Decreased insulin causes hyperglycemia and osmotic diuresis. c. Increased glucose and fatty acid metabolism stimulates renal diuresis and electrolyte loss. d. Increased insulin use results in protein catabolism, tissue wasting, and electrolyte loss. ANS: B Because the amount of insulin required to inhibit fat breakdown is less than that needed for effective glucose transport, insulin levels are sufficient to prevent excessive lipolysis and ketosis. Volume is depleted, not increased. Electrolyte loss does occur, but it is not due to fatty acids and glucose metabolism, it is due to insufficient insulin. Insulin is decreased, not increased. REF: p. 465 32. A nurse is reviewing lab results for glycosylated hemoglobin (hemoglobin A1c) levels. A nurse recalls the purpose of this test is to: a. Measure fasting glucose levels. b. Monitor long-term serum glucose control. c. Detect acute complications of diabetes. d. Check for hyperlipidemia. ANS: B Glycosylated hemoglobin refers to the permanent attachment of glucose to hemoglobin molecules and reflects the average plasma glucose exposure over the life of a red blood cell (approximately 120 days). lOMoARcPSD| Glycosylated hemoglobin does not measure fasting, but glucose control over time. Glycosylated hemoglobin does not identify complications, but could provide data if the patient is at risk. Glycosylated does not check for hyperlipidemia. REF: p. 459 33. When a patient asks what causes hyperglycemia in type 2 DM, how should the nurse respond? Hyperglycemia is a result of: a. Insulin deficiency b. Hyperinsulinemia c. Glucagon deficiency d. Liver dysfunction ANS: B Type 2 diabetes is due to hyperinsulinemia and insulin resistance. Type 1 is due to insulin deficiency; type 2 is due to insulin resistance. Type 2 diabetes is due to hyperinsulinemia and insulin resistance, not glucagon deficiency. Type 2 diabetes is due to hyperinsulinemia, not liver dysfunction. REF: p. 462 34. A 19-year-old female with type 1 DM was admitted to the hospital with the following lab values: serum glucose 500 mg/dl (high), urine glucose and ketones 4+ (high), and arterial pH 7.20 (low). Her parents state that she has been sick with the “flu” for a week. Which of the following statements best explains her acidotic state? lOMoARcPSD| a. Increased insulin levels promote protein breakdown and ketone formation. b. Her uncontrolled diabetes has led to renal failure. c. Low serum insulin promotes lipid storage and a corresponding release of ketones. d. Insulin deficiency promotes lipid metabolism and ketone formation. ANS: D With insulin deficiency, lipolysis is enhanced, and there is an increase in the amount of nonesterified fatty acids delivered to the liver. The consequence is increased glyconeogenesis contributing to hyperglycemia and production of ketone bodies (acetoacetate, hydroxybutyrate, and acetone) by the mitochondria of the liver at a rate that exceeds peripheral use. Insulin is deficient, not increased. The patient is in acidosis, not renal failure. Insulin is low, but the ketones are the result of fatty acid breakdown due to lack of insulin, not because of lipid storage. REF: p. 465 35. A 13-year-old male who uses insulin to control his type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion during gym class. The most probable cause of these symptoms is: a. Hyperglycemia resulting from incorrect insulin administration b. Dawn phenomenon caused by eating a snack before gym class c. Hypoglycemia caused by increased exercise d. Somogyi effect caused by insulin sensitivity ANS: C The boy is experiencing hypoglycemia due to increased glucose utilization with exercise. The boy is experiencing hypoglycemia, not hyperglycemia. lOMoARcPSD| The boy is experiencing hypoglycemia, not dawn phenomenon, which occurs as an early morning rise in blood glucose concentration with no hypoglycemia during the night. The Somogyi effect is a combination of hypoglycemia with rebound hyperglycemia. REF: p. 465 36. A 55-year-old female is admitted to the medical unit for complications of long-term, poorly controlled type 2 DM. Which of the following would the nurse expect to find in addition to elevated glucose? a. Atherosclerosis b. Metabolic alkalosis c. Elevated liver enzymes d. Anemia ANS: A Macrovascular disease (lesions in large and medium sized arteries) increases morbidity and mortality and increases risk for accelerated atherosclerosis. Acidosis, rather than alkalosis, would occur in this patient. Elevated enzymes do not occur, but atherosclerosis does. Anemia would not be expected, but atherosclerosis is. REF: p. 468 37. When a staff member asks the nurse what causes the chronic complications of DM such as microvascular and macrovascular disease, how should the nurse respond? These complications are primarily related to: lOMoARcPSD| a. Pancreatic changes b. Hyperglycemia c. Ketone toxicity d. Hyperinsulinemia ANS: B The underlying cause of the micro and macro diseases associated with diabetes is due to hyperglycemia. The underlying cause of the micro and macro diseases is related to hyperglycemia, not pancreatic changes. The underlying cause of the micro and macro diseases is related to hyperglycemia, not ketone toxicity. The underlying cause of the micro and macro diseases is related to hyperglycemia, not hyperinsulinemia. REF: p. 465 38. A nurse checks lab results as both Cushing syndrome and Addison disease can manifest with elevated levels of: a. ADH b. Cortisol c. Adrenocorticotropic hormone (ACTH) d. Aldosterone ANS: C Cushing syndrome and Addison are related to elevated levels of ACTH. Cushing syndrome and Addison are related to elevated levels of ACTH, not ADH. Cushing syndrome and Addison are related to elevated levels of ACTH, not cortisol. lOMoARcPSD| Cushing syndrome and Addison are related to elevated levels of ACTH, not aldosterone. REF: p. 469 39. Which of the following alterations would the nurse expect to find in a patient with untreated Cushing disease or syndrome? a. Bradycardia b. Tachypnea c. Hyperkalemia d. Hypertension ANS: D With elevated cortisol levels, vascular sensitivity to catecholamines increases significantly, leading to vasoconstriction and hypertension. Tachycardia is more likely than bradycardia due to increased sensitivity to catecholamines. Tachypnea does not occur; the patient experiences hypertension. Hyokalemia, not hyperkalemia, occurs. REF: p. 470 40. When a nurse is assessing the physical features of individuals with Cushing syndrome, these findings will include: a. Weight loss and muscle wasting b. Truncal obesity and moon face c. Pallor and swollen tongue d. Depigmented skin and eyelid lag ANS: B lOMoARcPSD| Weight gain is the most common feature and results from the accumulation of adipose tissue in the trunk, facial, and cervical areas. These characteristic patterns of fat deposition have been described as “truncal obesity,” “moon face,” and “buffalo hump.” Weight gain, not loss, is the most common feature of Cushing syndrome. Pallor is not associated with Cushing syndrome. The skin of the patient with Cushing syndrome is bronze in color. REF: p. 469 41. A 35-year-old female took corticosteroid therapy for several months. Which of the following would the nurse expect to find? a. Renal toxicity b. Episodes of hypoglycemia c. Hypotension d. Type 2 DM ANS: D Overt DM develops in approximately 20% of individuals with hypercortisolism. Diabetes develops, not renal toxicity. Hypoglycemia does not occur; hyperglycemia does. Hypertension, not hypotension, occurs; hypotension occurs with Addison. REF: p. 470 42. A nurse is preparing to teach a patient about Addison disease. Which information should the nurse include? The most common cause of Addison disease is: lOMoARcPSD| a. An autoimmune reaction b. Dietary deficiency of sodium and potassium c. Cancer d. Viral infection of the pituitary gland ANS: A Addison disease is caused by autoimmune mechanisms that destroy adrenal cortical cells and is more common in women. Addison disease is an autoimmune disorder and is not due to dietary deficiency. Addison disease is an autoimmune disorder and is not due to cancer. Addison disease is an autoimmune disorder and is not due to a viral infection. REF: p. 471 43. A 50-year-old female presents with lightheadedness and overall abnormal feelings. Hyperaldosteronism is diagnosed. Which of the following symptoms would the nurse expect? a. Hypovolemia b. Hypotension c. Hypokalemia d. Hyponatremia ANS: C Hypokalemia occurs due to increased renal secretion of potassium. Hypervolemia, not hypovolemia, occurs. Hypertension, not hypotension, occurs. Hypernatremia, not hyponatremia, occurs. REF: p. 470 lOMoARcPSD| 44. A 49-year-old female is diagnosed with hypercortisolism. Which of the following would the nurse expect? a. Weight loss b. Hypoglycemia c. Decreased urination d. Osteoporosis ANS: D The effects of hypercortisolism in bone cause loss of the protein matrix leading to osteoporosis, with pathologic fractures, vertebral compression fractures, bone and back pain, kyphosis, and reduced height. Weight gain occurs especially in the face and upper back with hypercortisolism. Hyperglycemia occurs even leading to diabetes in hypercortisolism. Polyuria, or increased urination, occurs in association with hypercortisolism. REF: p. 470 45. The body’s inability to conserve water and sodium when affected by Addison disease is explained by which of the following conditions? a. Elevated levels of cortisol b. Decreased levels of ACTH c. Hypersecretion of ADH d. Aldosterone deficiency ANS: D The symptoms of Addison disease are primarily a result of hypocortisolism and hypoaldosteronism. lOMoARcPSD| The symptoms of Addison disease are primarily a result of hypocortisolism and hypoaldosteronism, not elevated levels of cortisol. Addison disease is characterized by inadequate corticosteroid and mineralocorticoid synthesis and elevated serum ACTH. ADH does not play a role in Addison disease. REF: p. 471 46. A patient with Addison disease has weakness and easy fatigability. A nurse recalls this is due to: a. Hyperkalemia b. Hypoglycemia c. Hypocortisolism d. Metabolic acidosis ANS: C With mild to moderate hypocortisolism, symptoms usually begin with weakness and easy fatigability. The weakness is due to hypocortisolism, not hyperkalemia. The weakness is due to hypocortisolism, not hypoglycemia. The weakness is due to hypocortisolism, not metabolic acidosis. REF: p. 471 47. What is the cause of the hyperpigmentation seen in people with Cushing syndrome? a. Abnormal levels of cortisol b. Permissive effects of aldosterone when cortisol levels are altered c. Elevated levels of ACTH lOMoARcPSD| d. Hypersensitivity of melanocytes with sun exposure ANS: C Bronze or brownish hyperpigmentation of the skin, mucous membranes, and hair occurs