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."

Accepted Answer

Hyperfunction is usually associated with excessive hormone production. This can result from excessive stimulation and hyperplasia of the endocrine gland or from ahormone-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

Accepted Answer

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.

Accepted Answer

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.

Accepted Answer

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, 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

Accepted Answer

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

Accepted Answer

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 levels 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."

Accepted Answer

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."

Accepted Answer

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

Accepted Answer

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

Accepted Answer

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

Accepted Answer

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.

Accepted Answer

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) $\beta$-Adrenergic-blocking medications 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

Accepted Answer

The hyperthyroidism that constitutes Graves disease can often be mitigated by the administration of $\beta$-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

Accepted Answer

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.

Accepted Answer

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

Accepted Answer

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.

Accepted Answer

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.

Accepted Answer

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

Accepted Answer

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 muscle; 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

Accepted Answer

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.

Quiz 47: Structure and Function of the Musculoskeletal System

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?

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?

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?

Growth hormone (GH) secretion is inhibited by

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.

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 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?

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?

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.

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.

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?

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 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?

After receiving change-of-shift report about the following four patients, which patient should the nurse assess first?

Which of the following statements best captures the role of the adrenal cortex in maintaining homeostasis?

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?

Which of the following statements best captures an aspect of the function of the hypothalamic-pituitary-adrenal (HPA) system?

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 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?