Medical Surgical Nursing II (NURS223) Final Exam Question/TEST BANK, All Answered-The nurse is teaching a client who has been newly diagnosed with hypothyr... [Show More] oidism about the function of the thyroid. Which of these does the nurse explain to the client is the role of the thyroid gland?
a) The thyroid gland is responsible for increasing the metabolic rate.
b) The thyroid gland promotes development of secondary sex characteristics.
c) The thyroid gland releases neurotransmitters when the "flight or flight" mechanism is stimulated.
d) The thyroid gland is responsible for regulating serum calcium levels. - a) The thyroid gland is responsible for increasing the metabolic rate.
The thyroid gland produces thyroid hormones, T3 and T4. These hormones increase the metabolic rate; increase protein and bone turnover; increase responsiveness to catecholamines; are necessary for fetal and infant growth and development. The parathyroid gland regulates calcium metabolism. The adrenal glands regulate flight or fight and the testes or ovaries regulate development of secondary sex characteristics.
Release and synthesis of anterior pituitary hormones are mainly regulated by the inhibiting or releasing actions of the:
a) hypothalamus.
b) cell receptors.
c) thymus gland.
d) adrenal gland. - a) hypothalamus.
The hypophysis (pituitary plus hypothalamus) and hypothalamus stimulatory hormones regulate the release and synthesis of anterior pituitary hormones. The adrenal gland and thymus gland hormones are regulated by the hypothalamus. Cell receptors are involved with the target cell response to the hormones.
A nursing instructor is teaching a group of students about the action of hormones. The instructor determined that teaching was effective when the students' recognize the local action of hormones as:
a) Autocrine
b) Pancreatic
c) Paracrine
d) Hormonal - c) Paracrine
When hormones act locally on cells other than those that produced the hormone, the action is called paracrine. Hormones also can exert an autocrine action on the cells in which they were produced. Pancreatic and hormonal are not actions.
When explaining factors that influence the number of receptors present on target cells, the instructor will likely mention: Select all that apply.
a) A decreased hormone level may produce increased receptor numbers.
b) The role antibodies may have on receptor proteins.
c) A sustained excess hormone level brings about a decrease in receptor numbers.
d) It may take days to weeks before a hormone can react to target cells.
e) How any given hormone can change its affinity to supply a need to all cells. - a) A decreased hormone level may produce increased receptor numbers.
b) The role antibodies may have on receptor proteins.
c) A sustained excess hormone level brings about a decrease in receptor numbers.
Target cell response varies with the number and affinity of the relevant receptors. The number of hormone receptors on a cell may be altered for any of several reasons. Antibodies may destroy or block the receptor proteins. Increased or decreased hormone levels often induce changes in the activity of the genes that regulate receptor synthesis. For example, decreased hormone levels often produce an increase in receptor numbers by means of a process called up-regulation; this increases the sensitivity of the body to existing hormone levels. Likewise, sustained levels of excess hormone often bring about a decrease in receptor numbers by down-regulation, producing a decrease in hormone sensitivity.
A patient experiences an increase in thyroid hormone as a result of a thyroid tumor. Which of the following hormonal responses demonstrates the negative feedback mechanism?
a) Decreased adrenocorticotropic hormone
b) Increased follicle-stimulating hormone
c) Decreased thyroid-stimulating hormone (TSH)
d) Increased thyrotropin-releasing hormone - c) Decreased thyroid-stimulating hormone (TSH)
Negative feedback occurs when secretion of one hormone causes a reduction in the secretion of the hormone that stimulates production of the first hormone. In this case, TSH, which is manufactured by the anterior pituitary gland, would normally stimulate release of thyroid hormones, but with the increase of those hormones by the secreting tumor, enough thyroid hormones flood the system that there should be a reduction in TSH levels.
The nurse is planning to collect a 24-hour urine sample for hormone assay. In which of these situations does the nurse collaborate with the health care provider to find an alternate type of testing?
a) Client has anemia.
b) Client has diabetes.
c) Client has anuria.
d) Client has hypothyroidism. - c) Client has anuria.
The advantages of a urine test include the relative ease of obtaining urine samples and the fact that blood sampling is not required. The disadvantage is that reliably timed urine collections often are difficult to obtain and rely on adequate renal function. Anuria refers to the absence of urine output.
While reviewing the concept of nuclear receptors with a group of pathophysiology students, the instructor uses the example of clients with type 2 diabetes mellitus taking pioglitazone, a thiazolidinedione medication. Because of the peroxisome proliferator-activated receptors (PPARs), the drug has which effect on the clients' diabetes? Select the best answer.
a) Increases the clients' metabolic rate, thereby giving them more energy, which results in weight loss.
b) Help the body burn fats more effectively thereby preventing any cardiovascular problems like myocardial infarction.
c) This medicines increases insulin resistance in muscle and fat and increases the amount of glucose produced by the liver.
d) Promote glucose uptake and increase the synthesis of certain proteins involved in fat metabolism, which reduces levels of certain types of lipids. - d) Promote glucose uptake and increase the synthesis of certain proteins involved in fat metabolism, which reduces levels of certain types of lipids.
The peroxisome proliferator-activated receptors (PPARs) bind intracellular lipid metabolites and regulate the transcription of genes involved in lipid metabolism and adipose tissue metabolism. Pioglitazone is not given solely to increase metabolic rate or to just burn fats, even though this may occur. Thiazolidimedione medications lower insulin resistance in muscle and fat. They also reduce glucose produced by the liver.
The physician suspects a client may be experiencing hypofunction of an endocrine organ. Select the most appropriate test to determine organ function.
a) Suppression tests
b) Imaging studies
c) Genetic testing
d) Stimulation tests - d) Stimulation tests
Stimulation tests are used when hypofunction of an endocrine organ is suspected. Suppression tests are used when hyperfunction of an endocrine organ is suspected. Genetic testing is used for DNA analysis, and imaging may be used as a follow-up after the diagnosis.
An adult patient with suspected hypothyroidism is scheduled for a thyrotropin-releasing hormone (TRH) stimulation test to evaluate pituitary response. Which of the following test results would confirm secondary hypothyroidism?
a) No increase in TSH
b) No increase in calcitonin
c) Increased calcitonin
d) Increased thyroid-stimulating hormone (TSH) - a) No increase in TSH
A stimulation test is intended to determine if an organ that is undersecreting will produce an increased response. A normal response to the TRH stimulation test would be for the pituitary to produce an increased amount of TSH. If the pituitary gland responds with increased production, then hypothalamic undersecretion may be the cause of the condition. If the pituitary does not increase secretion, it can indicate secondary hypothyroidism. Calcitonin is not secreted by the pituitary.
The nurse is teaching a new diabetic about fingerstick blood glucose testing. When the client obtains a pre-meal fingerstick reading of 206 mg/dL, which teaching by the nurse is most appropriate?
a) This is an elevated reading - let's talk about adherence to insulin and diet.
b) This is a normal reading for after meals.
c) Blood glucose levels of 206 are acceptable when you are ill.
d) This reading is within normal range - continue your regimen. - a) This is an elevated reading - let's talk about adherence to insulin and diet.
Normal fasting or pre-meal blood glucose levels are between 70 and 110 mg/dL. The nurse should ensure the client understands the diet and medication regimen, as diabetes is a self-managed disease; maintaining good glucose control can prevent complications of the disease.
A client is scheduled for a suppression test as part of the diagnostic testing for his suspected endocrine disorder. The results of this test will help the care team determine:
a) whether the client is producing excessive hormone levels.
b) if the client's hypothalamus is functioning correctly.
c) if a target endocrine gland is capable of hormone production.
d) whether the client's pituitary gland is functioning normally. - a) whether the client is producing excessive hormone levels.
Suppression tests are used when hyperfunction of an endocrine organ is suspected. Suppression tests are not used to gauge pituitary or hypothalamus function. Stimulation tests are used to rule out hypofunction of an endocrine organ.
What is the most common mechanism of hormone control?
a) Positive feedback
b) Hypothalamic-pituitary-adrenal axis
c) Negative feedback
d) Hypothalamic-pituitary-target cell feedback - c) Negative feedback
With negative feedback, the most common mechanism of hormone control, some feature of hormone action directly or indirectly inhibits further hormone secretion so that the hormone level returns to an ideal level or set point.
The nurse explains to a client in labor who has demonstrated ineffective contractions impeding progression of labor that the health care provider has added oxytocin infusion to the orders. Which of these does the nurse teach the client is the purpose of oxytocin?
a) To reduce pain of uterine contractions
b) To contribute to maturation of fetal lungs
c) To stimulate contraction of the uterus
d) To protect the fetus from effects of forceful contractions - c) To stimulate contraction of the uterus [Show Less]
