Deck 47: Structure and Function of the Musculoskeletal System

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

"Your tumor in your vagina is secreting a hormone called adrenocorticotropic hormone (ACTH), which is responsible for these signs and symptoms."

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

Secondary

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

The man has a chronic platelet deficiency and is occasionally anemic.

Question 4

Growth hormone (GH) secretion is inhibited by

A) hypoglycemia.
B) starvation.
C) heavy exercise.
D) obesity.

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

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

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."

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."

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

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

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

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.

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

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

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.

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

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.

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.

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

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