Unit3: Ch 41-Disorders of Endocrine Control (Porth's 5th Ed)

Question 1

A female patient presented to her primary care physician with classic signs and
symptoms of Cushing syndrome. Upon testing, it was discovered that the patient had
vaginal small cell carcinoma. How can the health care providers explain her Cushing
syndrome signs and symptoms to this patient?
A) “Your tumor in your vagina is secreting a hormone called adrenocorticotropic
hormone (ACTH), which is responsible for these signs and symptoms.”
B) “We are going to have to run some more tests. We think you might have a
problem with your pituitary gland.”
C) “There is no connection between the Cushing syndrome and the vaginal
carcinoma. You have two very distinct problems occurring at the same time.”
D) “We need to check your thyroid. Your Cushing syndrome may be caused by
hypofunction of this gland.”

Answer 1

Ans: A
Feedback:
Hyperfunction is usually associated with excessive hormone production. This can result
from excessive stimulation and hyperplasia of the endocrine gland or from a
hormone-producing tumor. A clinical example of this phenomenon is evidenced by the
case of a woman with vaginal small cell carcinoma who also presented with Cushing
syndrome. After testing, it was determined that the tumor is secreting ACTH. In this
situation, the cause is not related to a pituitary problem. There is a connection between
Cushing syndrome and the carcinoma. The thyroid gland is not responsible for Cushing
syndrome.

Question 2

Following destruction of the pituitary gland, ACTH stimulation stops.Without ACTH
to stimulate the adrenal glands, the adrenals’ production of cortisol drops. This is an
example of which type of endocrine disorder?
A) Primary
B) Secondary
C) Tertiary
D) Somatic

Answer 2

Ans: B
Feedback:
In secondary disorders of endocrine function, the target gland is essentially normal, but
defective levels of stimulating hormones or releasing factors from the pituitary system
alter its function.

Question 3

Following a long history of fatigue, weakness, and poor appetite, a 39-year-old male has
been diagnosed with hypopituitarism. Which of the following clinical findings would
most likely cause his care team to suspect that the man has an additional endocrine
disorder from a different source?
A) The man has a low sperm count and has been unable to have children.
B) The man has a chronic platelet deficiency and is occasionally anemic.
C) The client is 52 tall and was consistently short for his age as a child.
D) The man displays the signs and symptoms of hypothyroidism.

Answer 3

Ans: B
Feedback:
Low platelets and low hemoglobin are unlikely to be a manifestation of hypopituitarism.
A low sperm count, small stature, and hypothyroidism are all noted manifestations of
pituitary hypofunction.

Question 4

Growth hormone (GH) secretion is inhibited by
A) hypoglycemia.
B) starvation.
C) heavy exercise.
D) obesity.

Answer 4

Ans: D
Feedback:
GH is inhibited by increased glucose levels, free fatty acid release, cortisol, and obesity.
It is stimulated by hypoglycemia, fasting starvation, increased blood levels of amino acids increased blood levels of amino
acids, and stress conditions such as trauma, excitement, emotional stress, and heavy
exercise.

Question 5

Testing for short stature growth hormone (GH) problems can be done by pharmacologic
means. Which of the following medications can be utilized to test for a rise in GH?
Select all that apply.
A) Insulin
B) Levodopa
C) Persantine
D) Dobutamine
E) Sestamibi

Answer 5

Ans: A, B
Feedback:
Diagnostic procedures for short stature include tests to exclude nonendocrine causes. If
the cause is hormonal, extensive hormonal testing procedures are initiated. Tests can be
performed using insulin, CHRH, levodopa, and arginine, all of which stimulate GH
secretion so that GH reserve can be evaluated. Persantine, dobutamine, and sestamibi
are used in cardiac stress testing. Sestamibi is also used in the testing of the parathyroid.

Question 6

The mother of 6-year-old male and female fraternal twins has brought her son to see a
pediatrician because he is nearly 4 inches shorter than his sister. Which of the following
phenomena would the physician most likely suspect as contributing factor to the boy’s
short stature?
A) Genetic short stature
B) Lack of IGF receptors in epiphyseal long bones
C) A shortage of hypothalamic GHRH production
D) Excess insulin production resulting in chronically low blood glucose levels

Answer 6

Ans: C
Feedback:
Inadequate levels of hypothalamic GHRH will result in adequate production but
inadequate release of GH by the pituitary. Genetic short stature is less likely given the
disparity between his height and his twin’s, and a shortage of IGF receptors is not a
noted pathology. While poorly controlled diabetes can contribute to short stature, excess
insulin production is not a likely factor.

Question 7

A 28-year-old male who is 611 tall has a diagnosis of acromegaly. The man is
explaining to a curious but sympathetic coworker exactly what accounts for his
extraordinary height. Which of the following explanations demonstrates a sound
understanding of his health problem?
A) “My pituitary gland produced a much higher than normal amount of growth
hormone when I was a child.”
B) “A tumor in my brain threw off my hormone level after I was finished
adolescence.”
C) “My liver is malfunctioning and produces too many of the hormones that
ultimately cause growth.”
D) “The high sugar levels that go along with my diabetes made my pituitary gland
overproduce the hormones that cause you to grow.”

Answer 7

Ans: B
Feedback:
Acromegaly is associated with adult onset and nearly always involves an adenoma.
Increased GH as a child and liver dysfunction are not noted contributors to acromegaly.
High levels of GH can cause overproduction of insulin and eventual diabetes, but
diabetes does not itself lead to acromegaly.

Question 8

An endocrinologist is providing care for a 30-year-old male who has lived with the
effects of increased levels of growth hormone (GH). Which of the following teaching
points about the client’s future health risks is most accurate?
A) “It’s not unusual for high GH levels to cause damage to your hypothalamus.”
B) “GH excess inhibits your pancreas from producing enough insulin.”
C) “The high levels of GH that circulate in your body can result in damage to your
liver.”
D) “When your pituitary gland is enlarged, there’s a real risk that you’ll develop some
sight deficiencies.”

Answer 8

Ans: D
Feedback:
GH excess is associated with tumor formation and consequent compression of cranial
nerves responsible for vision. Damage to the hypothalamus and liver is not common
sequelae. While the beta cells of the pancreas can “burn out,” the primary effect of
excess GH is to increase insulin secretion.

Question 9

Of the following patient conditions, which patients would be at risk for experiencing a
thyroid problem due to a decrease in thyroxine-binding globulin (TBG)? Select all that
apply.
A) A 55-year-old male with cirrhosis due to alcohol abuse
B) A 47-year-old female experiencing hot flashes and excess diaphoresis related to
menopause
C) A 75-year-old man receiving chronic glucocorticoid therapy to treat his severe
chronic obstructive pulmonary disease (COPD)
D) A 18-year-old female anorexia nervosa patient weighing 78 lb and has consumed
no protein for the past 3 years

Answer 9

Ans: A, C, D
Feedback:
A number of disease conditions and pharmacologic agents can decrease the amount of
binding protein in the plasma or influence the binding of hormone. Glucocorticoid
medications and systemic disease conditions such as protein malnutrition, nephritic
syndrome, and cirrhosis decrease TBG concentrations

Question 10

An infant born with congenital hypothyroidism and has not sought care from any health
care provider is likely to develop which of the following complications? Select all that
apply.
A) Deformed joints and bone spurs
B) Impaired physical growth
C) Mental retardation
D) Loss of fine motor control and arthritis
E) Down syndrome

Answer 10

Ans: B, C
Feedback:
Thyroid hormone is essential for normal growth and brain development, almost half of
which occurs during the first 6 months of life. If untreated, congenital hypothyroidism
causes mental retardation and impairs physical growth. Down syndrome is a congenital
birth defect and not caused by hypothyroidism.

Question 11

Following the identification of low levels of T3 and T4 coupled with the presence of a
goiter, a 28-year-old female has been diagnosed with Hashimoto thyroiditis. In light of
this diagnosis, which of the following assessment results would constitute an
unexpected finding?
A) The presence of myxedema in the woman’s face and extremities
B) Recent weight gain despite a loss of appetite and chronic fatigue
C) Coarse, dry skin and hair with decreased sweat production
D) Increased white cell count and audible crackles on chest auscultation

Answer 11

Ans: D
Feedback:
An increased white cell count and the presence of adventitious fluid in the lungs are not
classic findings associated with hypothyroidism. Myxedema, weight gain, lethargy, and
dry skin and nails are commonly associated with low levels of thyroid hormones.

Question 12

Of the following list of nursing interventions, which would be considered priority when
managing a patient with life-threatening myxedematous coma? Select all that apply.
A) Administer 3% sodium IV solution to increase sodium levels.
B) Administer 50% dextrose to raise glucose levels.
C) Place on oxygen therapy to encourage deep breathing.
D) Place on a warming bed to raise body temperature.
E) Administer sedatives frequently to prevent seizures.

Answer 12

Ans: A, B, C
Feedback:
Myxedematous coma is a life-threatening, end-stage expression of hypothyroidism. It is
characterized by coma, hypothermia, CV collapse, hypoventilation, and severe
metabolic disorders that include low sodium, low glucose, and lactic acidosis. Treatment
includes aggressive management of precipitating factors; supportive therapy such as
management of CV status, hyponatremia, and hypoglycemia; and thyroid replacement
therapy. If hypothermia is present, active rewarming is contraindicated because it may
induce vasodilation and vascular collapse. Administering sedatives frequently could be
harmful since the person is unable to metabolize sedatives, analgesics, and anesthetic
drugs.

Question 13

A nurse on a medical unit is providing care for a 37-year-old female patient who has a
diagnosis of Graves disease. Which of the following treatments would the nurse most
likely anticipate providing for the client?
A) -Adrenergic–blocking medication to reduce sympathetic nervous stimulation
B) Administration of levothyroxine to supplement thyroid function
C) Calcium channel blocking medications to reduce heart rate and cardiac risks
D) Administration of somatostatin analogs to inhibit GH production

Answer 13

Ans: A
Feedback:
The hyperthyroidism that constitutes Graves disease can often be mitigated by the
administration of -adrenergic–blocking medications. Levothyroxine would be used to
address hypothyroidism, and calcium channel blockers are not an identified treatment
modality for Graves disease. Somatostatin analogs are used to treat GH excess

Question 14

After receiving change-of-shift report about the following four patients, which patient
should the nurse assess first?
A) A 22-year-old admitted with SIADH who has a serum sodium level of 130 mEq/L
B) A 31-year-old who has iatrogenic Cushing syndrome with a capillary blood
glucose level of 204 mg/dL
C) A 53-year-old who has Addison disease and is due for a scheduled dose of
hydrocortisone (Solu-Cortef)
D) A 70-year-old returning from PACU following partial thyroidectomy who is
extremely agitated, has an irregular pulse rate of 134, and has an elevated
temperature of 103.2°F

Answer 14

Ans: D
Feedback:
Manipulation of a hyperactive thyroid gland during thyroidectomy can cause thyroid
storm. It is manifested by very high fever, extreme cardiovascular effects (tachycardia,
HF, angina), and severe CNS effects (agitation, restlessness, and delirium). Answer
choice A refers to normal sodium levels. Answer choice B refers to high blood
glucose level but not critical level. Answer choice C refers to lower priority. It is always
preferred to give medications in a timely manner; however, thyroid storm signs and
symptoms are the priority for this group of patients.

Question 15

Which of the following statements best captures the role of the adrenal cortex in
maintaining homeostasis?
A) The adrenal cortex is responsible for the production of epinephrine and
norepinephrine that are part of the sympathetic nervous system.
B) The adrenal cortical hormones are primarily steroids and sex hormones.
C) Redundant, secondary production of adrenal cortical hormones can compensate
for the loss of the adrenal glands.
D) Normal sexual function is dependent on adequate adrenal cortical function

Answer 15

Ans: B
Feedback:
The adrenal cortex is responsible for secreting three types of hormones: the
glucocorticoids, the mineralocorticoids, and the adrenal androgens. The adrenal medulla
produces epinephrine and norepinephrine, and there are no alternate production sites for
adrenal cortical hormones. The adrenal androgens are least responsible for normal
sexual function.

Question 16

Following the identification of low blood levels of cortisol and low 24-hour urinary free
cortisol, a 51-year-old female client has been diagnosed with a primary adrenal cortical
insufficiency. Which of the following health consequences would be attributable to her
low levels of cortisol?
A) Visible exophthalmos
B) Impaired immunological and inflammatory response
C) Diminished secondary sex characteristics
D) Insufficient regulation of serum potassium and sodium levels

Answer 16

Ans: B
Feedback:
Cortisol plays a central role in the normal functioning of the immune response and
inflammation. Exophthalmos is associated with Graves disease, and secondary sex
characteristics are functions of adrenal androgens. Potassium and sodium are regulated
by mineralocorticoids.

Question 17

Which of the following statements best captures an aspect of the function of the
hypothalamic–pituitary–adrenal (HPA) system?
A) Adrenocorticotropic hormone (ACTH) released by the hypothalamus controls to
release of cortisol.
B) The pituitary gland communicates with the adrenal cortex through the release of
ACTH.
C) The adrenal cortex receives corticotrophin-releasing hormone (CRH) and in turn
releases cortisol.
D) The pituitary gland causes a release of CRH from the hypothalamus, which
promotes hormone release from the adrenal cortex.

Answer 17

Ans: B
Feedback:
ACTH mediates between the anterior pituitary gland and the adrenal cortex in the HPA
system. ACTH is released by the pituitary, not the hypothalamus, and CRH acts on the
pituitary, not the adrenal cortex. CRH flows from the hypothalamus to the pituitary, not
vice versa.

Question 18

A 38-year-old male has presented to a clinic for the treatment of severe dermatitis after
contact with poison ivy on a camping trip. The client has been prescribed prednisone, a
corticosteroid, for the treatment of his skin condition. The client’s care provider has
emphasized that dosages of the drug will be gradually tapered off rather than stopped
upon resolution of the symptoms. What is the most accurate rationale for this dosing
protocol?
A) The client’s hypothalamic–pituitary–adrenal (HPA) system will require recovery
time before normal function is restored.
B) Steroids can induce a dependency that it best addressed with a gradual
withdrawal.
C) HPA function is heightened during steroid administration and must return to
normal levels before the drug is completely stopped.
D) Abrupt cessation of the drug can contribute to symptoms similar to Cushing
syndrome.

Answer 18

Ans: A
Feedback:
The suppression of the HPA system that accompanies steroid therapy requires time for a
return to normal function. Dependency on the drug itself is not the rationale for tapering,
and HPA function is suppressed, not heightened during therapy. Abrupt cessation can
contribute to an Addison disease–like response, not Cushing syndrome.

Question 19

A patient is admitted to the hospital in adrenal crisis 1 month after a diagnosis of
Addison disease. The nurse knows which of the following clinical manifestations would
support this diagnosis?
A) Hyperactive deep tendon reflexes and slow, shallow breathing
B) Cerebral spinal fluid leakage and impaired swallowing
C) Irregular heart rate and decreased temperature
D) Change in the level of consciousness and profound hypotension

Answer 19

Ans: D
Feedback:
Acute adrenal crisis is a life-threatening situation. Exposure to even a minor illness or
stress can cause a client with Addison disease to develop nausea, vomiting, muscular
weakness, hypotension, dehydration, and vascular collapse (which causes a change in
LOC). Hemorrhage (low BP) can be caused by septicemia, adrenal trauma,
anticoagulant therapy, adrenal vein thrombosis, or adrenal metastases. A hyperactive
reflex may indicate disease of the pyramidal tract above the level of the reflex arc being
tested. Generalized hyperactivity of DTRs may be caused by hyperthyroidism. Any tear
or hole in the membrane that surrounds the brain and spinal cord (dura) can allow the
fluid that surrounds those organs to leak. This fluid is called the cerebrospinal fluid
(CSF). When it leaks out, the pressure around the brain and spinal cord drops. Causes of
leakage through the dura include certain head, brain, or spinal surgeries; head injury;
placement of tubes for epidural anesthesia or pain medications; or lumbar puncture.
Irregular heart rates (arrhythmias) may be caused by many different factors, including
coronary artery disease; electrolyte imbalances in your blood (such as sodium or
potassium); changes in your heart muscles or injury from a heart attack.

Question 20

A 51-year-old woman has been diagnosed with Cushing syndrome after a diagnostic
workup that reveals cortisol hypersecretion. The nurse knows which of the following
assessment findings would be inconsistent with her diagnosis?
A) Increased blood pressure and decreased potassium levels
B) A protruding abdomen and a “buffalo hump” on the back
C) Poor stress management and hyperpigmentation
D) A “moon face” and muscle weakness

Answer 20

Ans: C
Feedback:
A low tolerance for stress and hyperpigmentation is associated with Addison disease
and its consequent elevated levels of ACTH. High blood pressure, hypokalemia, buffalo
hump, and moon face are all characteristics of the elevated steroid levels that denote
Cushing syndrome.