ch 21 patho

Created by gchristison 

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58 terms

Diabetes insipidus is caused by insufficient secretion of insulin.

false, insufficient amounts of ADH

Giantism occurs only in children and adolescents

true

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

true

Pituitary adenomas are malignant tumors

false, benign

Abnormal immunologic mechanisms producing autoantibodies are responsible for Graves disease as well as hypothyroidism.

false, hyperthyroidism

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

true

Myxedema coma is caused by severe hypoparathyroidism

false, hypothyroidism

Type 2 diabetes mellitus is more common than type 1.

true

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

true

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

false

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

true

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

false

1. The effects of syndrome of inappropriate antidiuretic hormone (SIADH) include solute:
a.
retention and water retention.
b.
retention and water loss.
c.
dilution and water retention.
d.
dilution and water loss.

dilution and water retention.

2. The most common cause of elevated levels of antidiuretic hormone (ADH) secretion is:
a.
ectopically produced ADH.
b.
inflammation of the hypothalamus.
c.
posterior pituitary tumor.
d.
inflammation of the nephrons

ectopically produced ADH.

3. Which of the following laboratory values would the nurse expect to find if a person is experiencing syndrome of inappropriate antidiuretic hormone (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

Serum Na+ 120 and serum hypo-osmolality

4. Diabetes insipidus is a result of:
a.
antidiuretic hormone (ADH) hyposecretion.
b.
antidiuretic hormone (ADH) hypersecretion.
c.
insulin hyposecretion.
d.
insulin hypersecretion

antidiuretic hormone (ADH) hyposecretion.

5. A man with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits but his antidiuretic hormone (ADH) level is low. Although he has had no intake for 4 hours, there is no change in his polyuria. These are indications of:
a.
neurogenic diabetes insipidus.
b.
syndrome of inappropriate antidiuretic hormone (SIADH).
c.
psychogenic polydipsia.
d.
osmotically induced diuresis

neurogenic diabetes insipidus

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

Thirst

7. The cause of neurogenic diabetes insipidus (DI) is related to an organic lesion of the:
a.
anterior pituitary.
b.
thalamus.
c.
posterior pituitary.
d.
renal tubules.

posterior pituitary.

8. If the target cells for antidiuretic hormone (ADH) do not have receptors, the result is which type of diabetes insipidus (DI)?
a.
Neurogenic
b.
Nephrogenic
c.
Psychogenic
d.
Ischemic

Nephrogenic

9. Which of the following laboratory values is consistently low in a client with diabetes insipidus (DI)?
a.
Urine specific gravity
b.
Serum sodium
c.
Urine protein
d.
Serum total protein

Urine specific gravity

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

Neurogenic

11. Hyperpituitarism is generally caused by:
a.
a pituitary adenoma.
b.
hypothalamic hyposecretion.
c.
autoimmune disorder of the pituitary.
d.
a neurohypophysial tumor.

a pituitary adenoma

12. The term used to describe a person who experiences a lack of all hormones associated with the anterior pituitary is:
a.
panhypopituitarism.
b.
adrenocorticotropic hormone (ACTH) deficiency.
c.
hypopituitarism.
d.
anterior pituitary failure.

panhypopituitarism

13. Visual disturbances are a result of a pituitary adenoma because of the:
a.
liberation of anterior pituitary hormones into the optic chiasm.
b.
pituitary hormones clouding the lens of the eyes.
c.
pressure of the tumor on the optic chiasm.
d.
pressure of the tumor on the optic and oculomotor cranial nerves.

pressure of the tumor on the optic chiasm

14. A primary adenoma causes thyroid and adrenal hypofunction because the tumor:
a.
metastasizes to the thyroid and adrenal glands through the lymphatic system causing reduced secretion of necessary hormones.
b.
has a paradoxical effect on adjacent cells, which results in hyposecretion of other anterior pituitary hormones.
c.
invades the hypothalamus adjacent to it and causes a reduction in the amount of hormones produced.
d.
releases tumor markers that occupy the hormone receptor sites of other endocrine organs

has a paradoxical effect on adjacent cells, which results in hyposecretion of other anterior pituitary hormones

15. Which disorder is caused by hypersecretion of the growth hormone (GH) in adults?
a.
Cushing syndrome
b.
Acromegaly
c.
Giantism
d.
Myxedema

Acromegaly

16. Giantism only occurs in children and adolescents because their:
a.
growth hormones are still diminished.
b.
epiphyseal plates have not yet closed.
c.
skeletal muscles are not yet fully developed.
d.
metabolic rates are higher than in adulthood.

epiphyseal plates have not yet closed.
c.

17. Amenorrhea, galactorrhea, hirsutism, and osteopenia are each caused by a:
a.
posterior pituitary adenoma.
b.
thymoma.
c.
prolactinoma.
d.
growth hormone adenoma.

prolactinoma.

18. Graves disease develops from a(n):
a.
viral infection of the thyroid gland that causes overproduction of thyroid hormone (TH).
b.
autoimmune process in which thyroid tissue is replaced by lymphocytes and fibrous tissue.
c.
thyroid-stimulating immunoglobulins that causes overproduction of thyroid hormones.
d.
ingestion of goitrogens that inhibits synthesis of the thyroid hormones, causing a goiter.

thyroid-stimulating immunoglobulins that causes overproduction of thyroid hormones.
d.

19. The signs of thyroid crisis resulting from Graves disease include:
a.
constipation with gastric distention.
b.
bradycardia and bradypnea.
c.
hyperthermia and tachycardia.
d.
constipation and lethargy.

hyperthermia and tachycardia.

20. Pathologic changes associated with Graves disease include:
a.
high levels of circulating thyroid-stimulating immunoglobulins.
b.
high levels of thyrotropin-releasing hormone (TRH).
c.
diminished levels of thyroid-stimulating hormone (TSH).
d.
diminished levels of thyroid-binding globulin

high levels of circulating thyroid-stimulating immunoglobulins.

21. The level of thyroid-stimulating hormone (TSH) in Graves disease is usually:
a.
high.
b.
low.
c.
normal.
d.
in constant flux

low.

22. Palpation of the neck of a person with Graves disease would detect a thyroid that is:
a.
left of midline.
b.
small with discrete nodules.
c.
normal in size.
d.
enlarged diffusely.

enlarged diffusely.

23. A deficiency of which of the following may result in hypothyroidism?
a.
Iron
b.
Iodine
c.
Zinc
d.
Magnesium

Iodine

24. What are clinical manifestations of hypothyroidism?
a.
Intolerance to heat, tachycardia, and weight loss
b.
Oligomenorrhea, fatigue, and warm skin
c.
Restlessness, increased appetite, and metrorrhagia
d.
Constipation, decreased heat rate, and lethargy

Constipation, decreased heat rate, and lethargy

25. Diagnosing a thyroid carcinoma is best done with:
a.
measurement of serum thyroid levels.
b.
radioisotope scanning.
c.
ultrasonography.
d.
fine-needle aspiration biopsy.

fine-needle aspiration biopsy.

26. Renal failure is the most common cause of which type of hyperparathyroidism?
a.
Primary
b.
Secondary
c.
Exogenous
d.
Inflammatory

Secondary

27. The most common cause of hypoparathyroidism is:
a.
pituitary hyposecretion.
b.
parathyroid adenoma.
c.
parathyroid gland damage.
d.
autoimmune parathyroid disease

parathyroid gland damage.

29. The most probable cause of low serum calcium following a thyroidectomy is:
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

hypoparathyroidism caused by surgical injury.

30. A man 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.

Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis.

31. Polyuria occurs with diabetes mellitus because of:
a.
the formation of ketones.
b.
chronic insulin resistance.
c.
an elevation in serum glucose.
d.
an increase in antidiuretic hormone

an elevation in serum glucose.

32. Type 2 diabetes mellitus is best described as:
a.
a resistance to insulin by insulin-sensitive tissues.
b.
the need for lispro instead of regular insulin.
c.
an increase of glucagon secretion from α cells of the pancreas.
d.
the presence of insulin autoantibodies that destroy ß cells in the pancreas

a resistance to insulin by insulin-sensitive tissues.

33. A person with type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is:
a.
hyperglycemia caused by incorrect insulin administration.
b.
fawn phenomenon from eating a snack before bedtime.
c.
hypoglycemia caused by increased exercise.
d.
Somogyi effect from insulin sensitivity.

hypoglycemia caused by increased exercise.

34. Hyperkalemia develops in the presence of diabetic ketoacidosis because:
a.
serum sodium is low stimulating aldosterone to retain sodium and potassium.
b.
hydrogen ions shift into the cell in exchange for potassium to compensate for metabolic acidosis.
c.
phosphorus shifts into the cell in exchange for potassium due to the lack of insulin.
d.
the blood is concentrated due to the loss of water from polyuria.

hydrogen ions shift into the cell in exchange for potassium to compensate for metabolic acidosis.
c.

35. Which of the following clinical manifestations is not common to both diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNKS)?
a.
Fluid loss
b.
Glycosuria
c.
Increased serum glucose
d.
Kussmaul respirations

Kussmaul respirations

36. Hypoglycemia followed by rebound hyperglycemia is seen in:
a.
the Somogyi effect.
b.
the dawn phenomenon.
c.
diabetic ketoacidosis (DKA).
d.
hyperosmolar hyperglycemic nonketotic syndrome (HHNKS

the Somogyi effect.

37. The first lab test that indicates type 1 diabetes is causing the development of diabetic nephropathy is:
a.
dipstick test for urine ketones.
b.
increase in serum creatinine and blood urea nitrogen (BUN).
c.
protein on urinalysis.
d.
cloudy urine on the urinalysis.

protein on urinalysis.

38. Patients with diabetes mellitus develop hyperlipidemia because of:
a.
increases in both low-density lipoproteins (LDLs) and triglycerides (TGs).
b.
decreased low-density lipoproteins (LDLs) and increased triglycerides (TGs).
c.
decreased low-density lipoproteins (LDLs) and increased high-density lipoproteins (HDLs).
d.
increased high-density lipoproteins (HDLs) and decreased triglycerides (TGs).

increases in both low-density lipoproteins (LDLs) and triglycerides (TGs).

39. 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

The capillary basement membranes thicken and there is endothelial cell

40. Retinopathy develops in patients with diabetes mellitus because:
a.
there are plaques of lipids within the retinal vessels.
b.
of an increased pressure within the retinal vessels from the increased osmotic pressure.
c.
ketones cause microaneurysms within the retinal vessels.
d.
of retinal ischemia and red blood cell aggregation.

of retinal ischemia and red blood cell aggregation.

chronic complication of diabetes mellitus is likely to result in microvascular complications in which of the following areas

eyes, renal system nerves

hypersecretion of thyroid hormone (TH)

graves disease

hypersecretion of adrenocorticotropic hormone (ACTH)

cushing disease

hypersecretion of adrenal medulla hormones

pheochromocytoma

hyposecretion of thyroid hormone (TH)

myxedema

hyposecretion of adrenal cortex hormones

addison disease

hypersecretion of growth hormone (GH)

acromegaly

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