Mmodule 09: Alterations of Hormonal Regulation

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1. Syndrome of inappropriate diuretic hormone (SIADH) results in excessive:

C. renal retention of water without sodium retention.
Elevated ADH secretion in SIADH stimulates increased water reabsorption in the distal and collecting tubules.

2. Neurological symptoms of SIADH are related to:

B. decreased serum sodium concentrations.
ADH secretion in SIADH causes a dilutional hyponatremia and decreased serum osmolarity.

3. Which of the following is a serious complication of SIADH?

A. Permanent neurological damage
Hyponatremia in SIADH can lead to severe, irreversible neurological damage.

4. Damage to the posterior pituitary caused by a cerebrovascular accident (stroke) results in _____ diabetes insipidus (DI).

D. neurogenic
When DI develops from injury to the CNS, it is called "neurogenic" DI.

5. Classic symptoms of diabetes insipidus (DI) include all of the following except:

A. hypertension.
Absence of ADH secretion in DI leads to increased urine output, volume depletion, and hypotension.

6. When evaluating the kidney function of an individual with diabetes insipidus (DI), the nurse would observe:

A. high volume urine output.
In DI, the kidneys are unable to conserve water in the distal and collecting tubules, resulting in the production of large volumes of dilute urine.

7. In adults, the most serious consequence of panhypopituitarism is the loss of:

C. adrenocorticotropic hormone (ACTH).
Loss of ACTH secretion leads to decreased cortisol production, resulting in life-threatening hypoglycemia.

8. Acromegaly is caused by increased secretion of:

B. growth hormone.
Acromegaly from increased growth hormone secretion results in giantism as well as other structural and physiological problems.

9. Prolactinomas (pituitary tumors that secrete prolactin) cause which of the following problems in women?

C. Breast milk production without pregnancy
Elevated prolactin in women causes galactorrhea, which is the discharge of milk from the breast.

10. A clinician would suspect thyrotoxicosis if a patient presented with which of the following symptoms?

B. Weight loss and enlarged thyroid gland
Weight loss and enlarged thyroid gland are common signs of hyperthyroidism in thyrotoxicosis.

11. Graves disease is characterized by:

B. excessive production of circulating thyroid-stimulating immunoglobulin.
Graves disease is caused by the production of antibodies to the TSH receptor called thyroid-stimulating immunoglobulins (TSIs). These antibodies stimulate the production of high levels of thyroid hormone.

12. Graves disease is an example of a:

B. type II hypersensitivity.
Graves disease is an example of a tissue-specific (type II) hypersensitivity.

13. In Graves disease, accumulation of edema in the orbit can lead to:

A. optic nerve damage.
B. eye muscle palsies.
C. exophthalmos.
D. all of the above.
Accumulation of edema behind the eyeball can lead to compression of the optic nerve, strain on the extraocular eye muscles resulting in palsies, and eyeball protrusion that is known as exophthalmos.

14. What is the cause of exophthalmos in Graves disease?

B. Degenerative changes in the muscle and orbital edema
Exophthalmos, the classic sign of Graves disease, is caused by extraocular eye muscle weakness and accumulation of edema behind the eyeball caused by the presence of thyroid-stimulating immunoglobulin.

15. The level of thyroid-stimulating hormone (TSH) in Graves disease is:

A. low.
In Graves disease, the presence of TSI mimics the activity of TSH at the thyroid receptor. The result is increased thyroid hormone production that suppresses TSH production from the anterior pituitary.

16. The physiologic stress of illness or surgery can induce a severe response in individuals who have unrecognized and untreated thyrotoxicosis. The pathophysiology of thyroid storm, also known as thyrotoxic crisis, involves:

D. fever and tachycardia leading to high-output heart failure.
High levels of thyroid hormone in conjunction with high levels of stress hormones lead to fever, tachycardia, and eventually high-output heart failure if the condition is not treated.

17. An endocrinologist orders a series of lab tests to assess thyroid function. Low levels of thyroid hormone (T3 and T4) and high levels of thyroid-stimulating hormone (TSH) are indicative of:

A. primary hypothyroidism.
Low levels of T3 and T4 production caused by the destruction or removal of the thyroid gland (primary hypothyroidism) stimulate the anterior pituitary to increase the production of TSH.

18. If left untreated, congenital hypothyroidism results in:

C. mental retardation and stunted growth.
Thyroid hormone is necessary for nervous system development and skeletal growth in fetuses and children.

19. Signs and symptoms of hypothyroidism include all of the following except:

B. diarrhea.
Decreased bowel activity in hypothyroidism generally leads to constipation. Diarrhea is a symptom of hyperthyroidism.

20. The most common cause of primary hypothyroidism in adults is:

D. autoimmune thyroiditis.
Autoimmune thyroiditis is the most common cause of primary hypothyroidism in adults.

21. Which of the following thyroid disorders can be caused by exposure of the thyroid gland to ionizing radiation?

C. Thyroid cancer
Ionizing radiation, often from treatment of a prior cancer, is a risk factor for thyroid cancer.

22. Causes of myxedema coma include:

A. untreated hypothyroidism.
Myxedema coma is caused by severe hypothyroidism. Symptoms include hypothermia, hypotension, and hypoglycemia.

23. Thyroid carcinoma usually presents with the following thyroid tissue changes:

A. small nodules.
Thyroid carcinoma usually presents with small thyroid nodules.

24. Chronic hyperparathyroidism will lead to all of the following conditions except:

C. weight loss.
Weight loss is not associated with hyperparathyroidism.

25. Which of the following disorders can cause secondary hyperparathyroidism?

A. Chronic renal failure
In chronic renal failure, the kidney cannot activate vitamin D and cannot adequately reabsorb calcium from the tubules. Persistent hypocalcemia results in increased parathyroid hormone secretion.

26. The most common cause of hypoparathyroidism is:

D. parathyroid gland injury or removal.
Parathyroid gland injury or surgical removal of the gland is the most common cause of hypoparathyroidism.

27. One problem associated with untreated hypoparathyroidism is:

D. muscle spasms.

Hypocalcemia in untreated hyperparathyroidism can cause muscle spasms, including laryngeal spasms that can cause airway obstruction.

28. The pathophysiology of type 1 diabetes mellitus (DM) involves:

A. autoimmune destruction of pancreatic beta cells.
B. production of antibodies against insulin.
C. type IV hypersensitivity against pancreatic islet cells.
D. all of the above.
The insulin deficiency that results in type 1 DM is caused by three factors: (1) the production of antibodies that destroy the beta cells in the pancreatic islets of Langerhans, (2) the production of antibodies against insulin, and (3) cell-mediated destruction of the islet cells.

29. A new diagnosis of type 1 diabetes is based on:

B. fasting plasma glucose levels and glucose tolerance tests.
The suspicion of diabetes-based clinical manifestations can be confirmed by evaluating fasting plasma glucose levels and conducting glucose tolerance tests.

30. Hyperglycemia and lipid abnormalities in type 2 diabetes mellitus (DM) are a result of:

C. insulin resistance.
Type 2 DM is caused by cellular resistance to the physiologic effects of insulin.

31. Signs and symptoms common to both type 1 and type 2 diabetes mellitus (DM) include all of the following except:

A. polyphagia.
B. weight loss.
C. polydipsia.
D. polyuria.
Weight loss is a symptom of type 1 DM. Most individuals with type 2 DM are obese.

32. Signs and symptoms that a person with type 1 diabetes has administered too much insulin include:

B. dizziness and confusion.
Dizziness and confusion, combined with tachycardia, palpations, and visual disturbances are signs of hypoglycemia related to overadministration of insulin.

33. Gestational diabetes can occur:

C. during pregnancy.
Gestational diabetes is the development of glucose intolerance in women during pregnancy.

34. The purpose of monitoring glycosylated hemoglobin levels in persons with diabetes is to:

C. monitor long-term serum glucose control.
Monitoring hemoglobin A1c levels in a person with diabetes provides a measure of glucose control during the life span of the red blood cells being evaluated.

35. The symptom of polyuria in diabetes mellitus (DM) is caused by:

D. increased glucose in the urine.
When glucose levels in the blood are greater than 300 mg/dL, glucose is excreted in the urine. The presence of glucose in the urine filtrate draws water into the tubules, causing an "osmotic diuresis."

36. What effect does the presence of advanced glycosylation end products (AGEs) have in diabetes?

B. Tissue injury
AGEs cause tissue injury through a variety of mechanisms, including the production of free radicals and the induction of microvascular/macrovascular disease.

37. The development of an acute metabolic acidosis from insulin deficiency is due to which of the following processes?

C. Fatty acid metabolism with ketone production
An insulin deficiency will increase the release and utilization of fatty acids as fuel. Metabolizing fatty acids liberates acidic molecules called ketones.

38. Alterations in lipid and protein metabolism lead to chronic complications of DM through which of the following processes?

A. Activation of protein kinase C
B. Induction of the polyol pathway
C. Glycosylation
D. All of the above
Hyperglycemia activates protein kinase C, induction of the polyol pathway, and glycosylation.

39. Chronic complications of DM include which of the following?

A. Peripheral neuropathies
B. End-stage renal disease
C. Coronary artery disease
D. All of the above
Microvascular and macrovascular disease can lead to peripheral neuropathies, end-stage renal disease (nephropathy), and coronary artery disease.

40. Cushing disease is commonly caused by:

B. ectopic production of ACTH from a lung tumor.
Cushing disease (secondary hypercortisolism) is caused by ectopic production of ACTH, usually from a lung tumor.

41. Which of the following alterations would you expect to find in a patient with untreated Cushing disease or syndrome?

C. Truncal obesity
Truncal obesity secondary to central fat deposition is a common physical manifestation of hypercortisolism.

42. Which of the following problems arises from primary hyperaldosteronism?

A. Hypertension
Sodium and water retention from elevated aldosterone levels results in volume overload and hypertension.

43. Metabolic abnormalities in Addison disease include all of the following except:

A. hyperkalemia.
B. hyponatremia.
C. hypoglycemia.
D. hypercalcemia.
Serum calcium levels are not directly affected by cortisol.

44. The most common cause of Addison disease is:

B. autoimmune injury to the adrenal cortex.
In idiopathic Addison disease, antibodies against the adrenal cortex cause immunologic damage to the gland, resulting in hypocortisolism and hypoaldosteronism.

45. Hypersecretion of androgens from an adrenal tumor in female children causes virilization, which is:

B. the development of male sex characteristics.
Androgens are male sex hormones that stimulate the development of male sex characteristics in females.

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