Syndrome of inappropriate diuretic hormone (SIADH) results in excessive:
Renal retention of water without sodium retention
Elevated ADH secretion in SIADH stimulates increased water reabsorption in the distal and collecting tubules.
Neurological symptoms of SIADH are related to:
Decreased serum sodium concentrations
ADH secretion in SIADH causes a dilutional hyponatremia and decreased serum osmolarity.
Which of the following is a serious complication of SIADH?
Permanent neurological damage
Hyponatremia in SIADH can lead to severe, irreversible neurological damage.
Damage to the posterior pituitary caused by a cerebrovascular accident (stroke) results in _________ diabetes insipidus (DI).
Neurogenic
When DI develops from injury to the CNS, it is called "neurogenic" DI.
Classic symptoms of diabetes insipidus (DI) include all of the following except:
Hypertension
Absence of ADH secretion in DI leads to increased urine output, volume depletion, and hypotension.
When evaluating the kidney of an individual with diabetes insipidus (DI), the nurse would observe:
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.
In adults, the most serious consequence of panhypopituitarism is the loss of:
Adrenocorticotropic hormone (ACTH)
Loss of ACTH secretion leads to decreased cortisol production, resulting in life-threatening hypglycemia.
Acromegaly is caused by increased secretion of:
Growth hormone
Acromegaly from increased growth hormone secretion results in giantism as well as other structural and physiological problems.
Prolactinomas (pituitary tumors that secrete prolactin) cause which of the following problems in women?
Breast milk production without pregnancy
Elevated prolactin in women causes galactorrhea, which is the discharge of milk from the breast.
A clinician would suspect thyrotoxicosis if a patient presented with which of the following symptons?
Weight loss and enlarged thyroid gland
Weight loss and enlarged thyroid gland are common signs of hyperthyroidism in thyrotoxicosis.
Graves disease is characterized by:
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 level
Graves disease is an example of a:
Type II hypersensitivity
Graves disease is an example of a tissue-specific (type II) hypersensitivity.
In Graves disease, accumulation of edema in the orbit can lead to:
Eye muscle palsies, exophthalmos, and optic nerve damage
Accumulation of edema behind the eyeball can lead to compresion of the optic nerve, strain on the extraocular eye muscles resulting in palsies, and eyeball protrusion that is known as exophthalmos.
What is the cause of exophthalmos in Graves disease?
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.
The level of thyroid-stimulating hormone (TSH) in Graves disease is:
Low
In Graves disease, the presence of TSI (thyroid stimulating immunoglobulin) mimics the activity of TSH at the thyroid receptor. The result is increased thyroid hormone production that suppresses TSH production from the anterior pituitary.
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:
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-ouput heart failure if the condition is not treated.
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:
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.
If left untreated, congenital hypothyroidism results in:
Mental retardation and stunted growth
Thyroid hormone is necessary for nervous system development and skeletal growth in fetuses and children.
Signs and symptoms of hypothyroidism include all of the following except:
Diarrhea
Decreased bowel activity in hypothyroidism generally leads to constipation. Diarrhea is a symptom of hyperthyroidism.
The most common cause of primary hypothyroidism in adults is:
Autoimmune thyroiditis
Autoimmune thyroiditis is the most common cause of primary hypothyroidism in adults.
Which of the following thyroid disorders can be caused by exposure of the thyroid gland to ionizing radiation?
Thyroid cancer
Ionizing radiation, often from treatment of a prior cancer, is a risk factor for thyroid cancer.
Causes of myxedema coma include:
Untreated hypothyroidism
Myxedema coma is caused by severe hypothyroidism. Symptoms include hypothermia, hypotension, and hypoglycemia.
Thyroid carcinoma usually presents with the following thyroid tissue changes:
Small nodules
Thyroid carcinoma usually presents with small thyroid nodules.
Chronic hyperparathyroidism will lead to all of the following conditions except:
Weight loss
Weight loss is not associated with hyperparathyroidism.
Which of the following disorders can cause secondary hyperparathyroidism?
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.
The most common cause of hypoparathyroidism is:
Parathyroid gland injury or removal
Parathyroid gland injury or surgical removal of the gland is the most common cause of hypoparathyroidism.
One problem associated with untreated hypoparathyroidism is:
Muscle spasms
Hypocalcemia in untreated hypoparathyroidism can cause muscle spasms, including laryngeal spasms that can cause airway obstruction.
The pathophysiology of type 1 diabetes mellitus (DM) involves:
Production of antibodies against insulin, autoimmune destruction of pancreatic beta cells, type IV hypersensitivity against pancreatic islet cells
The insulin deficiency that results in type 1 DM is caused by three factors: (1) the production of antibodie
A new diagnosis of type 1 DM is based on:
Fasting plasma glucose levels and glycosylated hemoglobin (A1c).
The suspicion of diabetes-based clinical manifestations can be confirmed by evaluating fasting plasma glucose levels and glycosylated hemoglobin (A1c).
Hyperglycemia and lipid abnormalities in type 2 DM are a result of:
Insulin resistance
Type 2 DM is caused by cellular resistance to the physiologic effects of insulin.
Signs and symptoms common to both type 1 and type 2 diabetes mellitus (DM) include all of the following except:
Weight loss
Weight loss is a symptom of type 1 DM. Most individuals with type 2 DM are obese.
Signs and symptoms that a person with type 1 diabetes has administered too much insulin include:
Dizziness and confusion
Dizziness and confusion, combined with tachycardia, palpations, and visual disturbances are signs of hypoglycemia related to overadministration of insulin.
Gestational diabetes can occur:
During pregnancy
Gestational diabetes is the development of glucose intolerance in women during pregnancy.
The purpose of monitoring glycosylated hemoglobin levels in persons with diabetes is to:
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.
The symptom of polyuria in diabetes mellitus (DM) is caused by:
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.
What effect does the presence of advanced glycosylation end products (AGEs) have in diabetes?
Tissue injury
AGEs cause tissue injury through a variety of mechanisms, including the production of free radicals and the induction of microvascular/macrovascular disease.
The development of an acute metabolic acidosis from insulin deficiency is due to which of the following processes?
Fatty acid metabolism with ketone production
An insulin definciency will increase the release and utilization of fatty acids as fuel. Metabolizing fatty acids liberates acidic molecules called ketones.
Alterations in lipid and protein metabolism lead to chronic complications of DM through which of the following processes?
Induction of the polyol pathway, activation of protein kinase C, and glycosylation
Hyperglycemia activates protein kinase C, induction of the polyol pathway, and glycosylation.
Chronic complications of DM include which of the following?
Peripheral neuropathies, coronary artery disease and end-stage renal disease
Microvascular and macrovascular disease can lead to peripheral neuropathies, end-stage renal disease (nephropathy), and coronary artery disease.
Cushing disease is commonly caused by:
Ectopic production of ACTH from a lung tumor.
Cushing disease (secondary hypercortisolism) is caused by ectopic production of ACTH, usually from a lung tumor.
Which of the following alterations would you expect to find in a patient with untreated Cushing disease or syndrome?
Truncal obesity
Truncal obesity secondary to central fat deposition is a common physical manifestation of hypercortisolism.
Which of the following problems arises from primary hyperaldosteronism?
Hypertension
Sodium and water retention from elevated aldosterone levels results in volume overload and hypertension.
Metabolic abnormalities in Addison disease include all of the following except:
Hypercalcemia
Serum calcium levels are not directly affected by cortisol.
The most common cause of Addison disease is:
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.
Mental status changes in people with Addison disease are caused by:
Hypoglycemia
Mental status changes in people with Addison disease are caused by hypoglycemia from low cortisol levels.
Hypersecretion of androgens from an adrenal tumor in female children causes virilization, which is:
The development of male sex characteristics
Androgens are male sex hormones that stimulate the development of male sex characteristics in females.