Deck 21: Alterations of Hormonal Regulation

Question 1

The most common cause of hypoparathyroidism is damage to the glands during surgery.

Answer 1

True

Question 2

Thyroid carcinoma,although rare,is the most common endocrine malignancy.

Answer 2

True

Question 3

Myxedema coma is caused by severe hypoparathyroidism.

Answer 3

False

Question 4

Gigantism occurs only in children and adolescents.

Question 5

Glucose levels are considerably lower in hyperosmolar hyperglycemic nonketosis syndrome (HHNKS)than in diabetic ketoacidosis (DKA).

Question 6

What is the most common cause of elevated levels of antidiuretic hormone (ADH)secretion?

A) Ectopically produced ADH
B) Inflammation of the hypothalamus
C) Posterior pituitary tumor
D) Inflammation of the nephrons

Question 7

Which is a cause of diabetes insipidus (DI)?

A) Organic lesion of the anterior pituitary
B) Organic lesion of the thalamus
C) Organic lesion of the posterior pituitary
D) Organic lesion of the renal tubules

Question 8

What are the effects of syndrome of inappropriate antidiuretic hormone (SIADH)?

A) Solute retention and water retention
B) Solute retention and water loss
C) Solute dilution and water retention
D) Solute dilution and water loss

Question 9

Diabetes insipidus is caused by insufficient secretion of insulin.

Question 10

Diabetes insipidus results from:

A) antidiuretic hormone (ADH)hyposecretion.
B) antidiuretic hormone (ADH)hypersecretion.
C) insulin hyposecretion.
D) insulin hypersecretion.

Question 11

Pituitary adenomas are malignant tumors.

Question 12

Syndrome of inappropriate antidiuretic hormone (SIADH)is characterized by increased levels of antidiuretic hormone (ADH).

Question 13

The nurse is evaluating a patient with oat cell adenocarcinoma of the lung for syndrome of inappropriate antidiuretic hormone (SIADH).Which of the following laboratory values would the nurse expect to find if the patient had SIADH?

A) Hypernatremia and urine hypo-osmolality
B) Serum K⁺ 5 and urine hyperosmolality
C) Serum Na⁺ 120 and serum hypo-osmolality
D) Hypokalemia and serum hyperosmolality

Question 14

Abnormal immunologic mechanisms producing autoantibodies are responsible for both Graves' disease and hypothyroidism.

Question 15

If the target cells for ADH do not have receptors,the result is _____ diabetes insipidus (DI).

A) neurogenic
B) nephrogenic
C) psychogenic
D) ischemic

Question 16

A patient with a closed head injury secondary to a motorcycle accident has a urine output of 6 to 8 L/day and electrolytes are within normal limits.The nurse draws a serum ADH level and conducts a water deprivation test.With no intake for 4 hours,there is no change in the patient's polyuria.The serum ADH level is low.These are an indication of:

A) neurogenic diabetes insipidus.
B) syndrome of inappropriate antidiuretic hormone (SIADH).
C) psychogenic polydipsia.
D) osmotically induced diuresis.

Question 17

Individuals with type 2 diabetes mellitus have a greater degree of pancreatic changes than individuals with type 1 diabetes.

Question 18

A person with syndrome of inappropriate antidiuretic hormone (SIADH)usually craves cold drinks.

Question 19

Which symptom is found in diabetes insipidus,diabetes mellitus,and syndrome of inappropriate antidiuretic hormone?

A) Polyuria
B) Edema
C) Vomiting and abdominal cramping
D) Thirst

Question 20

Type 2 diabetes mellitus is much more common than type 1.

Question 21

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

Question 22

Hyperpituitarism is generally caused by:

A) a pituitary adenomA.
B) hypothalamic hyposecretion.
C) autoimmune disorder of the pituitary.
D) a neurohypophysial tumor.

Question 23

How does Graves' disease develop?

A) A viral infection of the thyroid gland that causes overproduction of thyroid hormones
B) A chronic autoimmune process in which thyroid tissue is replaced by lymphocytes and fibrous tissue
C) A development of thyroid-stimulating immunoglobulins that causes overproduction of thyroid hormones
D) An ingestion of goitrogens or foods that inhibits synthesis of the thyroid hormones,causing a goiter

Question 24

A deficiency of _____ may result in hypothyroidism.

A) iron
B) iodine
C) zinc
D) magnesium

Question 25

The type of diabetes insipidus that is most likely to be treatable with exogenous ADH is:

A) neurogenic.
B) psychogenic
C) nephrogenic.
D) ischemic.

Question 26

Upon palpation of the neck of a patient with Graves' disease,what would the nurse expect to find?

A) Normal-sized thyroid
B) Small discrete thyroid nodule
C) Multiple discrete thyroid nodules
D) Diffuse thyroid enlargement

Question 27

Diagnosing thyroid carcinoma is best done with:

A) measurement of serum thyroid levels.
B) radioisotope scanning.
C) ultrasonography.
D) fine-needle aspiration biopsy.

Question 28

The level of TSH in Graves' disease is usually:

A) high.
B) low.
C) normal.

Question 29

An adult female had a thyroidectomy this morning.She develops muscle spasms,increased deep tendon reflexes,and laryngeal spasm.What is the most common cause of these findings?

A) Calcium deficit due to reduced parathormone
B) Overuse of radioactive iodine given pre-operatively
C) A history of insufficient dietary intake of iodine
D) An increase in serum phosphorous caused by reduced calcitonin

Question 30

What pathologic changes occur in Graves' disease?

A) High levels of circulating thyroid-stimulating immunoglobulins
B) Stimulation by thyrotropin-releasing hormone (TRH)
C) Stimulation by thyroid-stimulating hormone (TSH)
D) Stimulation of thyroid-binding globulin

Question 31

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

A) Cushing syndrome
B) Acromegaly
C) Gigantism
D) Myxedema

Question 32

Renal failure is the most common cause of _____ hyperparathyroidism.

A) primary
B) secondary
C) exogenous
D) inflammatory

Question 33

Why are visual disturbances caused by a pituitary adenoma?

A) Because of liberation of anterior pituitary hormones into the optic chiasm,which is adjacent to the pituitary gland
B) Because of pituitary hormones clouding the lens of the eyes so that light cannot pass through to the retina
C) Because of the pressure of the tumor on the optic chiasm,which is adjacent to the pituitary gland
D) Because of the pressure of the tumor on the optic (CN I)and oculomotor (CN III)cranial nerves that alters their functions

Question 34

What tumor causes amenorrhea,galactorrhea,hirsutism,and osteopenia?

A) Posterior pituitary adenoma
B) Thymoma
C) Prolactinoma
D) Growth hormone adenoma

Question 35

How does a primary adenoma cause thyroid and adrenal hypofunction?

A) The tumor metastasizes to the thyroid and adrenal glands through the lymphatic system causing reduce secretion of necessary hormones.
B) The tumor has a paradoxical effect on adjacent cells,which results in hyposecretion of other anterior pituitary hormones.
C) The tumor invades the hypothalamus adjacent to it and causes a reduction in the amount of hormones produced.
D) The tumor releases tumor markers that occupy the hormone receptor sites of other endocrine organs.

Question 36

Why does giantism only occur in children and adolescents?

A) Because they have not reached puberty when the effects of growth hormone are diminished
B) Because their epiphyseal plates have not yet closed
C) Because their skeletal muscles are not fully developed
D) Because their metabolic rates are higher than they are in adulthood

Question 37

What is the most common cause of hypoparathyroidism?

A) Pituitary hyposecretion
B) Parathyroid adenoma
C) Parathyroid gland damage
D) Autoimmune parathyroid disease

Question 38

What is the term used to describe a patient who experiences cortisol deficiency from lack of adrenocorticotropic hormone (ACTH),thyroid deficiency from lack of thyroid stimulating hormone (TSH),and gonadal failure with loss of secondary sex characteristics from the absence of follicle stimulating hormone (FSH)and luteinizing hormone (LH)?

A) Panhypopituitarism
B) Adrenocorticotropic hormone (ACTH)deficiency
C) Hypopituitarism
D) Anterior pituitary failure

Question 39

What are signs of thyroid crisis from Graves' disease?

A) Weight gain to 155 lb with height of 5'8"
B) Heart rate 90 beats/min and respiratory rate 16 breaths/min
C) Hot and moist skin with protrusion of eyeballs
D) Constipation and amenorrhea

Question 40

Which laboratory value is consistent with diabetes insipidus (DI)?

A) Urine specific gravity is low.
B) Serum sodium is low.
C) Urine protein is low.
D) Serum total protein is low.

Question 41

Why does hyperkalemia develop in diabetic ketoacidosis?

A) Because sodium is low,which stimulates aldosterone to retain sodium and potassium
B) Because hydrogen shifts into the cell in exchange for potassium to compensate for metabolic acidosis
C) Because phosphorus shifts into the cell in exchange for potassium due to the lack of insulin
D) Because the blood is concentrated due to the loss of water from polyuria

Question 42

Why does retinopathy develop in patients with type 2 diabetes?

A) Because there are plaques of lipids within the retinal vessels
B) Because of an increased pressure within the retinal vessels from the increased osmotic pressure
C) Because ketones cause microaneurysms within the retinal vessels
D) Because of increased retinal capillary permeability and microaneurysm formation

Question 43

Hypoglycemia followed by rebound hyperglycemia is seen in:

A) the Somogyi effect.
B) the dawn phenomenon.
C) diabetic ketoacidosis (DKA).
D) hyperosmolar hyperglycemic nonketosis syndrome (HHNKS).

Question 44

MATCHING
Match the phrases with the corresponding terms.
Hypersecretion of adrenal medulla hormones

A)Acromegaly
B)Cushing disease
C)Addison disease
D)Graves' disease
E)Myxedema
F)Pheochromocytoma

Question 45

Why does polyuria occur with diabetes mellitus?

A) Because of formation of ketones
B) Because of insulin resistance
C) Because of an elevated serum glucose
D) Because of an increase in antidiuretic hormone

Question 46

A male patient with diabetic ketoacidosis (DKA)has the following laboratory values: arterial pH 7.20;serum glucose 500 mg/dl;urine glucose and ketones positive;serum K⁺ 2 mEq/L;serum Na⁺ 130 mEq/L.He 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.

Question 47

What causes the macrovascular complications of clients with diabetes mellitus?

A) The capillaries contain plaques of lipids that obstruct blood flow.
B) There is increased pressure within capillaries caused by the elevated glucose attracting water.
C) The capillary basement membranes thicken and there is endothelial cell hyperplasia.
D) Fibrous plaques form from the proliferation of subendothelial smooth muscle of arteries.

Question 48

Which clinical finding occurs first in metabolic acidosis of the patient with type 1 diabetes mellitus?

A) Ketones in the urine
B) Palpitations,anxiety,and confusion
C) Hyperlipidemia
D) Kussmaul respirations

Question 49

A patient 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 (DI)
D) Cushing disease

Question 50

Why do patients with diabetes mellitus develop hyperlipidemia?

A) Because they have increases in low density lipoproteins ( $\uarr$ DL)and triglycerides ( $\uarr$ TG)
B) Because they have decreased low density lipoproteins ( $\darr$ LDL)and increased triglycerides ( $\uarr$ G)
C) Because they have decreased low density lipoproteins ( $\darr$ LDL)and increased high density lipoproteins ( $\uarr$ HDL)
D) Because they have increased high density lipoproteins ( $\uarr$ HDL)and decreased triglycerides ( $\darr$ TG)

Question 51

What is a description of diabetes mellitus type 2?

A) There is a resistance to insulin by insulin-sensitive tissues.
B) The patient uses lispro instead of regular insulin.
C) There is an increased glucagon secretion from-cells of the pancreas.
D) There are insulin autoantibodies that destroy ß-cells in the pancreas.

Question 52

A patient with diabetes mellitus type 1 experiences hunger,lightheadedness,tachycardia,pallor,headache,and confusion.What is the most probable cause of these symptoms?

A) Hyperglycemia caused by incorrect insulin administration
B) Dawn phenomenon from eating a snack before bed time
C) Hypoglycemia caused by increased exercise
D) Somogyi effect from insulin sensitivity

Question 53

What is the first lab test that indicates a patient with type 1 diabetes is developing nephropathy?

A) Dipstick test for urine ketones
B) Increase in serum creatinine and blood urea nitrogen (BUN)
C) Protein in the urinalysis
D) Cloudy urine on the urinalysis

Question 54

Which chronic complication of diabetes mellitus is caused by microvascular complications?

A) Nephropathy
B) Coronary artery disease
C) Neuropathy
D) Peripheral vascular disease

Question 55

What is a difference in clinical manifestations between diabetic ketoacidosis and hyperglycemic,hyperosmolar non-ketosis syndrome?

A) Fluid loss
B) Glycosuria
C) Increased serum glucose
D) Kussmaul respirations

Question 56

What is the most probable cause of low serum calcium following thyroidectomy?

A) Hyperparathyroidism secondary to Graves' disease
B) Myxedema secondary to surgery
C) Hypoparathyroidism caused by surgical injury
D) Hypothyroidism caused by lack of thyroid replacement

Question 57

MATCHING
Match the phrases with the corresponding terms.
Hyposecretion of thyroid hormone (TH)

A)Acromegaly
B)Cushing disease
C)Addison disease
D)Graves' disease
E)Myxedema
F)Pheochromocytoma

Question 58

MATCHING
Match the phrases with the corresponding terms.
Hypersecretion of thyroid hormone (TH)

A)Acromegaly
B)Cushing disease
C)Addison disease
D)Graves' disease
E)Myxedema
F)Pheochromocytoma

Question 59

What causes the microvascular complications of clients with diabetes mellitus?

A) The capillaries contain plaques of lipids that obstruct blood flow.
B) There is increased pressure within capillaries as a result of the elevated glucose attracting water.
C) The capillary basement membranes thicken and there is endothelial cell hyperplasia.
D) Fibrous plaques form from the proliferation of subendothelial smooth muscle of arteries.

Question 60

MATCHING
Match the phrases with the corresponding terms.
Hypersecretion of adrenocorticotropic hormone (ACTH)

A)Acromegaly
B)Cushing disease
C)Addison disease
D)Graves' disease
E)Myxedema
F)Pheochromocytoma

Question 61

MATCHING
Match the phrases with the corresponding terms.
Hypersecretion of growth hormone (GH)

A)Acromegaly
B)Cushing disease
C)Addison disease
D)Graves' disease
E)Myxedema
F)Pheochromocytoma

Question 62

MATCHING
Match the phrases with the corresponding terms.
Hyposecretion of adrenal cortex hormones

A)Acromegaly
B)Cushing disease
C)Addison disease
D)Graves' disease
E)Myxedema
F)Pheochromocytoma