Negative Feedback Mechanism And Endocrine

NEGATIVE FEEDBACK MECHANISM AND ENDOCRINE A nurse is caring for a patient with a suspected pituitary disorder. Which of the following hormones would the nurse expect to be affected if the adenohypophysis(Anterior) is impaired? (Select all that apply.) Adrenocorticotropic hormone (ACTH)/Sex hormones, sugar, salt Follicle-stimulating Hormone (FSH)/Ovaries Growth hormone (GH)/bones Luteinizing (Ovaries) Melanocytes Stimulating Hormone (MSH)/Skin Thyroid-stimulating hormone (TSH)/Thyroid Prolactin (Breast production) * Which of the following is a primary function of the hypothalamus? a) Regulation of blood sugar levels b) Control of homeostasis and hormone production c) Secretion of digestive enzymes d) Regulation of heart rate Answer B * The pituitary gland is often referred to as the: a) Control center of the brain b) Master gland of the endocrine system c) Primary site of metabolism d) Target organ for insulin Answer B * Which part of the pituitary gland secretes seven hormones? a) The neurohypophysis b) The adenohypophysis c) The hypothalamus d) The pineal gland Answer B Which part of the pituitary gland secretes two hormones? a) The neurohypophysis b) The adenohypophysis c) The hypothalamus d) The pineal gland Answer: A What Hormones produces by Posterior (Neurohypophysis)? Oxytocin (Breast milk Ejection) Vasopressin(Kidney) A nurse is explaining the negative feedback mechanism of thyroid hormone regulation to a group of students. Which of the following correctly describes what happens when T3 and T4 levels are low? A. The hypothalamus secretes thyroid-releasing hormone (TRH), which stimulates the anterior pituitary gland (APG) to release thyroid-stimulating hormone (TSH). B. The anterior pituitary gland directly releases T3 and T4 to restore normal hormone levels. C. The thyroid gland inhibits the production of T3 and T4 to prevent further imbalance. D. The hypothalamus stops secreting TRH to allow the body to compensate naturally. Correct Answer: A. The hypothalamus secretes thyroid-releasing hormone (TRH), which stimulates the anterior pituitary gland (APG) to release thyroid-stimulating hormone (TSH). Rationale: When T3 and T4 levels are low, the hypothalamus releases TRH, which stimulates the anterior pituitary gland to release TSH. TSH then stimulates the thyroid gland to produce more T3 and T4 to restore balance. Which of the following best describes the role of thyroid-stimulating hormone (TSH) in the negative feedback mechanism? A. TSH is secreted by the thyroid gland to increase T3 and T4 levels. B. TSH stimulates the thyroid gland to produce and release T3 and T4. C. TSH inhibits the secretion of TRH from the hypothalamus when T3 and T4 are low. D. TSH is produced by the hypothalamus to regulate metabolism. Correct Answer: B. TSH stimulates the thyroid gland to produce and release T3 and T4. Rationale: TSH is secreted by the anterior pituitary gland (APG) in response to TRH from the hypothalamus. It then stimulates the thyroid gland to produce and release T3 and T4, helping regulate metabolism. A patient with hyperthyroidism has excessively high levels of T3 and T4. What effect would this have on the negative feedback mechanism? A. Increased T3 and T4 levels will inhibit TRH and TSH secretion, reducing thyroid hormone production. B. High T3 and T4 levels will stimulate the hypothalamus to release more TRH, increasing thyroid hormone production. C. The anterior pituitary gland will secrete more TSH to balance T3 and T4 levels. D. The hypothalamus will continue producing TRH at a constant rate, regardless of T3 and T4 levels. Correct Answer: A. Increased T3 and T4 levels will inhibit TRH and TSH secretion, reducing thyroid hormone production. Rationale: In a negative feedback mechanism, high levels of T3 and T4 inhibit the release of TRH from the hypothalamus and TSH from the anterior pituitary gland, leading to a reduction in thyroid hormone production. Which of the following best explains why patients with hypothyroidism often have high levels of TSH? A. The thyroid gland is not producing enough T3 and T4, leading to continuous stimulation from the pituitary gland. B. The hypothalamus is not responding to low thyroid hormone levels. C. The anterior pituitary gland is failing to regulate hormone levels. D. High levels of T3 and T4 cause an increase in TSH secretion. Correct Answer: A. The thyroid gland is not producing enough T3 and T4, leading to continuous stimulation from the pituitary gland. Rationale: In hypothyroidism, the thyroid gland fails to produce enough T3 and T4, causing the pituitary gland to continuously release TSH in an attempt to stimulate thyroid hormone production. A nurse is caring for a patient with a suspected thyroid disorder. Which lab results would indicate primary hypothyroidism? A. Low T3 and T4, high TSH B. High T3 and T4, high TSH C. Low T3 and T4, low TSH D. High T3 and T4, low TSH Correct Answer: A. Low T3 and T4, high TSH Rationale: •Primary hypothyroidism occurs when the thyroid gland is not producing enough T3 and T4. •This leads to elevated TSH levels because the pituitary gland continues releasing TSH to stimulate thyroid hormone production. (SIADH): Which of the following best describes the pathophysiology of SIADH? A) Increased secretion of aldosterone, leading to sodium retention B) Excessive release of antidiuretic hormone (ADH), causing water retention C) Decreased secretion of ADH, leading to dehydration D) Increased excretion of sodium and water due to a lack of ADH Answer: B) Excessive release of antidiuretic hormone (ADH), causing water retention Which of the following conditions is a primary cause of SIADH (Neurological)? A) Small cell lung cancer B) Pituitary gland tumor C) Chronic kidney disease D) Diabetes insipidus Answer: B) Pituitary gland tumor A patient diagnosed with SIADH secondary to cancer (CNS) is likely experiencing which of the following? A) Hypernatremia and dehydration B) Hyponatremia and fluid overload C) Hypokalemia and metabolic alkalosis D) Hypercalcemia and polyuria Answer: B) Hyponatremia and fluid overload Sign and Sympton for SIADH? Urine specific gravity >1.030 Low hematocrit/Hemodilution Hyponatremia (Low sodium) A client is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which of the following intravenous solutions would the nurse anticipate administering to correct the client's hyponatremia? a) 0.45% Normal Saline b) 0.9% Normal Saline c) 3% Hypertonic Saline d) Dextrose 5% in Water (D5W) Answer : C A nurse is educating a patient about medications that can rarely cause SIADH. Which of the following should be included? A) Selective serotonin reuptake inhibitors (SSRIs) and steroids B) Loop diuretics C) Beta-blockers D) Calcium channel blockers Answer: A) Selective serotonin reuptake inhibitors (SSRIs) Which of the following Most Common Electrolytes balance if patient had SIADH? A) Polyuria, weight loss, and hypernatremia B) hyponatremia (Dilutional) C) Increased thirst, dry mucous membranes, and hypotension D) Decreased urine osmolality and hyperkalemia Answer: B) hyponatremia Which of the following is the most important precaution for a patient with SIADH? A) Encourage fluid intake to prevent dehydration B) Implement seizure precautions due to hyponatremia C) Place the patient in Trendelenburg position to increase perfusion D) Encourage high-potassium foods to prevent hypokalemia Answer: B) Implement seizure precautions due to hyponatremia A nurse is implementing seizure precautions for a patient with severe SIADH. Which actions are appropriate? (Select all that apply.) • A) Padded side rails • B) Maintain IV access • C) Explain to patient why they need Seizure Precaution • D) Keep suction equipment at the bedside • E) Put the patient in the lowest potion A nurse is caring for a patient undergoing a stimulation test. Which of the following conditions is this test most likely used to diagnose? A. Hyperthyroidism B. Cushing’s syndrome C. Addison’s disease D. SIADH Correct Answer: C Rationale: Stimulation tests are used to assess for hypofunctioning endocrine disorders. Addison’s disease (adrenal insufficiency) is a condition where the adrenal glands do not produce enough cortisol, making a stimulation test useful in diagnosis. Hyperthyroidism, Cushing’s syndrome, and SIADH are associated with excess hormone production, requiring suppression tests instead. A nurse is reviewing a patient's lab results after a dexamethasone suppression test. The results show that cortisol levels remain elevated. What does this indicate? A. The patient has adrenal insufficiency. B. The patient has normal adrenal function. C. The patient likely has Cushing’s syndrome. D. The patient has hypothyroidism. Correct Answer: C Rationale: The dexamethasone suppression test is used to assess for Cushing’s syndrome. If cortisol levels remain elevated despite dexamethasone administration, it indicates an inability to suppress cortisol production, which is characteristic of Cushing’s syndrome. Stimulating Test are done for HYPOFUNCTION problems Suppression Test are done for HYPERFUNCTION Problems A nurse is caring for a patient with SIADH. Which of the following interventions is the priority? A) Encourage oral fluid intake of at least 3,000 mL/day B) Restrict fluid intake to 800 mL/day plus urine output C) Administer IV hypotonic saline to correct sodium levels D) Monitor for polyuria and excessive thirst Answer: B) Restrict fluid intake to 800 mL/day plus urine output (Fluid restriction is the first-line treatment for SIADH to prevent further water retention and worsening hyponatremia. Hypotonic fluids would worsen the condition. Polyuria is more associated with diabetes insipidus.) A patient with SIADH is placed on seizure precautions. What is the primary reason for this intervention? A) Hyperkalemia due to fluid retention B) Risk of cerebral edema from severe hyponatremia C) Hypernatremia caused by excessive sodium administration D) Increased risk of hypoglycemia from treatment Answer: B) Risk of cerebral edema from severe hyponatremia (SIADH leads to severe hyponatremia, which can cause cerebral edema, confusion, and seizures. Seizure precautions help prevent injury.) Which medication is prescribed to help decrease ADH levels in a patient with SIADH? A) Desmopressin B) Demeclocycline C) Vasopressin D) Insulin Answer: B) Demeclocycline (Demeclocycline is an antibiotic that inhibits ADH activity, promoting water excretion and helping correct SIADH. Desmopressin and vasopressin increase ADH, which would worsen SIADH.) A patient with a pituitary tumor causing SIADH is scheduled for a transsphenoidal hypophysectomy. Which post-op complication should the nurse monitor for? A) Pulmonary embolism B) Cerebrospinal fluid (CSF) leak and Diabetes Insipidus C) Acute kidney injury D) Respiratory alkalosis Answer: B) Cerebrospinal fluid (CSF) leak and Diabetes insipidus (A transsphenoidal hypophysectomy (removal of the pituitary tumor) can cause a CSF leak, leading to rhinorrhea (CSF drainage from the nose) and increased risk of infection and brain herniation.) A nurse is educating a patient about the potential long-term effects of transsphenoidal hypophysectomy. Which statement by the patient indicates correct understanding? A) “I will need to take hormone replacements for the rest of my life.” B) “Once the tumor is removed, my body will produce normal hormone levels again.” C) “I will need to increase my fluid intake to prevent dehydration.” D) “I will no longer need to monitor my sodium levels.” Answer: A) “I will need to take hormone replacements for the rest of my life.” (After a hypophysectomy, hormone replacement therapy is required for life because the pituitary gland plays a key role in hormone regulation. Without it, the body cannot naturally produce essential hormones.) DIABETES INSIPIDUS Which of the following best describes the underlying issue in Nephrogenic Diabetes Insipidus? A) The pituitary gland does not produce enough ADH. B) The kidneys do not respond properly to ADH. C) There is damage to the thirst center in the brain. D) The patient is not drinking enough fluids. Correct Answer: B) The kidneys do not respond properly to ADH. what is the most common cause of Nephrogenic Diabetes Insipidus? A) Brain injury B) Lithium toxicity C) Pituitary gland tumor D) Dehydration Correct Answer: B) Lithium toxicity Neurogenic Diabetes Insipidus is characterized by which of the following? A) Kidney resistance to ADH B) Low or underproduction of ADH in the pituitary gland C) Excessive ADH production D) Increased fluid intake due to kidney dysfunction Correct Answer: B) Low or underproduction of ADH in the pituitary gland Which of Sign and Symptom Diabetes Insipidus? Massive Polyuria up to 20 litter a day Urine Diluted < 1.010 Hematocrit Increased Hypotension Dehydration Which diagnostic test is considered the gold standard for confirming diabetes insipidus? A. Serum Sodium Test B. Cold Water Deprivation Test C. Urine Specific Gravity Test D. Hemoglobin A1C Correct Answer: B. Cold Water Deprivation Test HYPOTHYROIDSM A patient presents with fatigue, weight gain, and constipation. Lab results show a decreased T4, Decrease T3 and an elevated TSH. Which of the following is the most likely diagnosis? a) Hyperthyroidism b) Cushing's Syndrome c) Primary Hypothyroidism (Hashimoto) d) Secondary Hypothyroidism Answer : C 2. Which of the following is a common cause of primary hypothyroidism? a) Pituitary tumor b) Hashimoto's thyroiditis (Autoimmune disease Causing Low T3&T4) c) Excessive iodine intake d) Hypersecretion of TSH Answer: B Which of the following is a common cause of Secondary hypothyroidism? a) Hypofunction Pituitary Gland b) Hashimoto's thyroiditis c) Excessive iodine intake d) Hypersecretion of TSH Answer: A 3. Which medication commonly used to treat hypothyroidism and when should be taken: a) With food to prevent nausea. b) At bedtime to promote sleep. c) Levothyroxine, In the morning before breakfast. d) Only when experiencing symptoms. Answer : C 4. A patient with untreated hypothyroidism develops myxedema coma. Which of the following is a priority intervention? a) Administering oral levothyroxine. b) Encouraging ambulation to improve circulation. c) Managing the airway and providing IV Levothyroxine fluids d) Applying ice packs to reduce swelling. Answer : C 5. Which dietary recommendation is appropriate for a patient with hypothyroidism? a) High-calorie, high-protein diet. b) Low-calorie, high-fiber diet. c) Gluten-free diet. d) High-sodium diet. Answer : B 6. A patient with hypothyroidism reports experiencing cold intolerance. Which of the following nursing interventions would be most appropriate? a) Encouraging the patient to engage in vigorous exercise. b) Providing warm, thick clothing and blankets. c) Administering antipyretic medication. d) Limiting fluid intake. Answer : B 7. In secondary hypothyroidism, what would you expect the Lab Value to be? a) Decrease T3, Decrease T4, Increase TSH b) Normal c) Decreased d) Fluctuating Answer : A 8. Which of the following is a symptom of myxedema coma? a) Tachycardia b) Hypertension c) Swelling of the legs and face d) Increased alertness Answer : C HYPERTHYROIDISM ? Which of the following is a primary cause of hyperthyroidism? a) Pituitary tumor b) Thyroid Gland Cause Graves' disease c) Hypothyroidism d) Adrenal insufficiency ? What are the typical hormonal changes seen in hyperthyroidism? a) Increased TSH, decreased T3 and T4 b) Decreased TSH, increased T3 and T4 c) Decreased TSH, decreased T3 and T4 d) Increased TSH, increased T3 and T4 ? Which of the following symptoms is associated with hyperthyroidism? Weight loss Goiter (Enlargement Throat) Heat intolerance Tachycardia Exopthalamus or Grape Eye (Protuding Eye) ? What does RAIU stand for, and how to give? a) Renal Artery Imaging Ultrasound b) Radioactive Iodine Uptake , 1-2 doses c) Respiratory Airway Infection Unit d) Rapid Assessment of Iodine Utilization What is the Diagnosis test used for Hypo and Hyperthyroidism? RAIU ? What is the significance of a RAIU result greater than >30%? a) Hypothyroidism b) Normal thyroid function c) Hyperthyroidism (Normal 10-30% @ 24hrs) d) Thyroid cancer What potential side effect is noted for Propylthiouracil (PTU)? a) Kidney toxicity b) Liver toxicity c) Cardiac toxicity d) Pulmonary toxicity Answer: b) Liver toxicity What is the purpose of S.S.K.I. in the treatment of hyperthyroidism and how to given? a) To increase thyroid hormone production b) To reduce vascularity of the thyroid , given 8 to 10 days c) To stimulate TSH production d) To block iodine absorption Answer: b) To reduce vascularity of the thyroid , given 8 to 10 days When is the serum iodine typically taken after administering radioactive iodine in the RAIU test? a) Immediately b) 1 hour after c) 3 hours or 24 hours after d) 48 hours after Answer: c) 3 hours or 24 hours after Which of the following is a potential complication of Subtotal thyroidectomy surgery? a) Pneumonia b) Thyroid Storm c) Appendicitis d) Kidney failure Answer: b) Thyroid storm ? What are common signs and symptoms of thyroid storm (thyrotoxicosis), as listed in the notes? a) Bradycardia, hypothermia, hypotension. b) Tachycardia, tachypnea, fever, hypertension. c) Hypoglycemia, confusion, tremors. d) Constipation, abdominal pain, nausea. Answer: b) Tachycardia, tachypnea, fever, hypertension. CONN’S DISEASE What is the cause of Conn's disease (Hyperaldosteronism)? a) Pituitary tumor b) Adrenal gland atrophy c) Tumor in the adrenal cortex , Excessive secretion of aldostrone d) Kidney disease Answer: c) Tumor in the adrenal cortex , increase aldosterone ? What are the cause of clinical features changes seen in Conn's disease? a) Hyponatremia, hyperkalemia b) Hypernatremia, hypokalemia c) Normal sodium and potassium levels d) Hypocalcemia, hyperphosphatemia Answer: b) Hypernatremia, hypokalemia ? Which of the following ECG changes is associated with hypokalemia? a) ST elevation b) "U" wave c) T wave inversion d) QRS widening Answer: b) "U" wave What is the primary focus of nursing interventions After surgery Adrenalectomy for patients with Conn's disease? a) Monitoring blood glucose levels b) Monitoring blood pressure c) Monitoring respiratory rate d) Monitoring bowel movements Answer: b) Monitoring blood pressure What is the Medication for patient that have Hyperaldosteronism? a) It increases potassium excretion. b) Spinorolactone c) It increases sodium excretion. d) It lowers blood pressure by increasing heart rate. Answer: b) Spinorolactone A client with Conn's disease is experiencing hypervolemia. Which of the following nursing interventions is a priority? a) Administering a high-sodium diet b) Restricting fluid intake c) Encouraging ambulation d) Providing a potassium supplement Answer: b) Restricting fluid intake PHEOCHROMOCYTOMA A patient is diagnosed with pheochromocytoma. From your nursing knowledge, you know that the patient will present with Hypertension, sweating, and palpitation due to excessive catecholamine production from the? A)Adrenal cortex B)Adrenal ZONA C)Adrenal Medulla D)Adrenal Glomerulosa Answer) C What is the most conclusive test for diagnosis Pheochromocytoma? CT Scan MRI Vanillymendellic Acid (VMA) 24 hour urine test Ultrasonography Answer: C Which is most common symptom related to Pheochromocytoma? Pyuresis Nausea Vomitting Anxiety Hypertension Answer: D What is the primary treatment for this Pheochromocytoma? Insulin Chemotherapy Adrenalectomy Radiation Answer: C You are educating a patient about the post op care for a bilateral adrenalectomy. Which statement indicate is correct? I will have to take mineralocorticoid daily for 2 years I will take glucocorticoids and mineralocortoid daily for 2 years I will have to take glucocorticoids and mineralocorticoids daily for life When I experience sign of stress I will have to take as needed Answer : C CUSHING Disease and Syndrome 1.? ?A patient is diagnosed with Cushing's syndrome. Which of the following assessment findings would the nurse expect to observe? A) Decreased blood glucose levels B) Weight loss and muscle wasting C) Moon face and buffalo hump, Truncal obesity D) Hyperpigmentation of the skin Answer : C 2.? ?The nurse is reviewing the laboratory results for a patient suspected of having Cushing's disease. Which of the following test results would be most indicative of this condition? A) Decrease ACTH, Elevated Gluco, Elevated Aldo, Elevated Sex (Cushing Syndrome) B) Decreased cortisol levels C) Elevated ACTH, Elevated Gluco, Elevated Aldo, Elevated Sex D) Decreased blood glucose levels Answer : C *3. A patient is scheduled for a dexamethasone suppression test. The nurse understands that this test is used to differentiate between: * A) Cushing's disease and Cushing's syndrome B) Addison's disease and Cushing's syndrome C) Diabetes insipidus and SIADH D) Hyperthyroidism and hypothyroidism Answer : A A nurse is providing dietary teaching for a client with Cushing’s disease. Which of the following dietary recommendations should the nurse include? A)High-protein, low-carbohydrate, high-sodium diet B. Low-protein, high-fat, low-sodium diet C. High-protein, low-fat, low-sodium diet D. High-carbohydrate, high-sodium, low-protein diet Answer : C