Chapter 18: Alterations of Hormonal Regulation My Nursing Test Banks

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.

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.

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

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.

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

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

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

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

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.

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

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

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.

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 nurses 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

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.

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

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 patients 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

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.

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 nurses best response?

a.

A familial, autosomal dominant gene defect

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.

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 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).

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?

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.

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:

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.

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

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:

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

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 bodys 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.

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

d.

Hypersensitivity of melanocytes with sun exposure

ANS: C

Bronze or brownish hyperpigmentation of the skin, mucous membranes, and hair occurs when there are very high levels of ACTH.

The pigmentation changes associated with Cushing and Addison are due to increased levels of ACTH, not cortisol.

The pigmentation changes associated with Cushing and Addison are due to increased levels of ACTH, not aldosterone, which affects fluid balance.

The pigmentation changes associated with Cushing and Addison are due to increased levels of ACTH, not hypersensivity of melanocytes.

REF: p. 470

48. A 30-year-old female presents with hypertension, headache, tachycardia, impaired glucose tolerance, and weight loss. Which of the following diagnosis will the nurse see documented on the chart?

a.

Addison disease

b.

Conn disease

c.

Cushing disease

d.

Pheochromocytoma

ANS: D

Symptoms of pheochromocytoma include hypertension, palpitations, tachycardia, glucose intolerance, excessive sweating, and constipation.

Manifestations of Addison disease include weakness, fatigability, hypoglycemia and related metabolic problems, lowered response to stressors, hyperpigmentation, vitiligo, and manifestations of hypovolemia and hyperkalemia.

Hypertension and hypokalemia are the hallmarks of Conn disease.

Weight gain is the most common feature in Cushing disease 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.

REF: p. 472

49. A nurse wants to determine if there is kidney dysfunction in a patient with diabetes. Which of the following is the earliest manifestation?

a.

Polyuria

b.

Glycosuria

c.

Microalbuminuria

d.

Decreased glomerular filtration

ANS: C

Microalbuminuria is the first manifestation of kidney dysfunction.

Polyuria occurs due to increased fluid in the vascular space, and microalbuminuria is the earliest manifestation.

Glycosuria occurs due to hyperglycemia, but microalbuminuria is the first sign of kidney dysfunction.

Decreased glomerular filtration can occur due to changes, but microalbuminuria is the first sign of kidney dysfunction.

REF: p. 467

50. Which of the following diseases should the nurse teach the patient to prevent as it is the ultimate cause of death in the patient with diabetes?

a.

Renal disease

b.

Stroke

c.

Cardiovascular disease

d.

Cancer

ANS: C

Cardiovascular disease is the ultimate cause of death in up to 75% of people with diabetes.

Cardiovascular, not renal, disease is the ultimate cause of death in up to 75% of people with diabetes.

Cardiovascular disease, not stroke, is the ultimate cause of death in up to 75% of people with diabetes.

Cardiovascular disease, not cancer, is the ultimate cause of death in up to 75% of people with diabetes.

REF: p. 467

MULTIPLE RESPONSE

1. A nurse is assessing a patient with hypoparathyroidism. Clinical manifestations of hypoparathyroidism include (select all that apply):

a.

Tetany

b.

Chvostek sign

c.

Trousseau sign

d.

Oily skin

e.

Hair loss

ANS: A, B, C, E

Symptoms of hypoparathyroidism includes tetany, Chvostek and Trousseau signs, dry (not oily) skin, and loss of body and scalp hair.

REF: p. 18 | p. 29 | p. 458

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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