Following an illness, a patient becomes hypocalcemic. Which of the following negative feedback
compensatory mechanisms will increase the calcium in her
... [Show More] blood?
a. The pituitary will decrease its secretion of T4.
b. The thyroid will increase secretion of calcitonin.
c. The pituitary will decrease its secretion of parathyroid hormone (PTH).
d. The parathyroid will increase its secretion of PTH.
Rationale: If a patient is hypocalcemic, the body will sense that more calcium needs to be freed up from bone
storage and sent out into the blood, so PTH will be increased (low calcium triggers increase of PTH secretion—“low
triggers high”—classic negative feedback), not decreased (C)…. PTH increases osteoclastic activity & resorption,
therefore increasing calcium in the blood to normal levels. Calcitonin (B) would do the opposite—“CALCITONIN =
“BONE IN “(so its secretion would be triggered if the problem was hypercalcemia.) Answer A is wrong, as T4 is
secreted by the thyroid, not the pituitary, and besides T4 has little to do with calcium movement.
2. A person with Graves' disease likely has all the following EXCEPT:
a. an autoimmune disease
b. Hashimoto’s thyroiditis
c. goiter.
d. a heart rate of 120.
Rationale: Hashimoto’s thyroiditis is the outlier in this except question—it is a cause of hypothyroidism, not Graves’
disease, which is an autoimmune disease that results in hyperthyroidism. A goiter can be seen in either hypo or
hyperthyroidism. A heart rate of 120 is too high—this is part of the “overdrive” metabolic situation found in
hyperthyroidism.
3. Lab work is done on the patient above. The expected findings would be a ___TSH and a _____T4
a. low; high
b. high; low
c. normal; high
d. high; normal.
Rationale: T4 is high in hyperthyroidism, and because of negative feedback, it continually keeps the TSH suppressed
(low), whereas if everything was normal, the two would keep each other in the normal ranges. B would be true in
hypothyroidism. C & D are not the most likely combinations seen in the usual thyroid diseases.
4. The patient in question 2 with Graves Disease goes into a crisis state, which is called
a. myxedema coma.
b. tetany.
c. thyroid storm.
d. cretinism.
Rationale: Answer A would be true of a hypothyroid person whose condition significantly deteriorated. Tetany (B) is
the state of hyper-toned, rigid muscle reaction & it is associated with hypoparathyroidism or hypercalcitoninism.
Cretinism (D) is the state found in a child who has been born of a mother who did not get enough iodide in her diet
& therefore did not have adequate thyroid function. Because of this her fetus may not develop properly and may be
born with significant mental & physical handicaps; its physical features may also resemble the usual myxedema facies
(“facies” = facial characteristics) – puffiness, frog-like-- of a severely hypothyroid person.
Patho Module Eleven Assignment A & R, Su 19
Patho Module Eleven Assignment Answers and Rationales
Endocrine System Disorders
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5. Osteopenia is likely associated with all the following EXCEPT:
a. low dietary calcium.
b. hyperparathyroidism.
c. high levels of calcitonin.
d. increased osteoclastic activity.
Rationale: A, B, & D all result in the same situation: Low dietary calciumless calcium to use for bone
strengthening. Hyperparathyroidism is basically an increased secretion of PTH increased osteoclastic activity
more calcium resorption leeching bone of its calciumhypercalcemia & osteopenia (or worse, osteoporosis). A
similar situation might exist with hypocalcitonin states, but high levels of calcitonin (C—the outlier) would cause all
the opposite states.
6. A patient who just came out of general anesthesia has lab work done. The serum osmo is 165. The nurse
taking care of this patient suspects that his _____ is due to _________.
a. hyperosmolality: diabetes insipidus (DI).
b. hypoosmolality: syndrome of inappropriate ADH (SIADH).
c. dry mucus membranes: SIADH.
d. shift of calcium into blood: a state of hypopolarization inside the cells.
Rationale: A serum osmolality of 165 is lower than normal, so think of the blood being more dilute, or hypoosmolar,
than usual (not hyperosmolar, as in answer A). The second part of the question, SIADH, is what it is called when
there is TOO MUCH ADH circulating. It causes the retention of water, which dilutes the blood. As mentioned in the
notes, a postanesthesia situation often triggers the secretion of too much ADH, so the scenario and BOTH parts of
the question fit together. DI is the OPPOSITE—it occurs when there is NOT ENOUGH ADH—then the kidneys do not
hold on to water, you void it out with the urine in HUGE volumes, and eventually become dehydrated (which goes
with hyperosmolality of the blood, answer A). Dry mucus membranes (C) also goes with DI & dehydration, NOT
SIADH. Answer D has nothing to do with the scenario you were given.
7. The nurse in the previous question would expect all the following S&S EXCEPT:
a. signs of cerebral edema such as decreased LOC.
b. signs of cerebral cell dehydration such as headache.
c. generalized edema
d. crackles in the lungs upon auscultation.
Rationale: Three things go together in “except” questions… in this case A, C, & D all go together as being common in
a patient with fluid overload. So you WOULD see all those things in a person with SIADH (the correct answer in #6).
The only thing you wouldn’t see is answer B, which goes with a dehydration (fluid deficit) picture.
8. A 68 year old female patient’s bone density scan shows osteoporosis. Her healthcare
provider is trying to figure out the primary etiology. One possible cause is related to her past history of
having had a thyroidectomy. Which statement is most likely correct in linking this surgery with the risk of
osteoporosis?
a. When the thyroid is taken out, calcitonin decreases, thus diminishing the body's ability to absorb
calcium from food into the blood.
b. Often accidentally removed with the thyroid are parts of the parathyroid, so there will be less
calcitonin from the parathyroid and less calcium staying in the bone.
c. When the thyroid is taken out, calcitonin decreases, thus decreasing calcium movement into the
bone.
d. The surgery actually has less to do with osteoporosis than the patient’s age does; greater age means
decreased osteoclast activity, and less calcium being resorbed.
Rationale: The thyroid secretes calcitonin, whose job is to move calcium from blood to bone (“bone IN”
rhymes with calcitonin). If you take out the thyroid, less calcitonin less calcium goes into bone and
greater risk of osteoporosis. Answer A is wrong, since the second half of the answer is not correctly linked
to the first half. B is wrong because the parathyroids “rule” PTH, and if they were taken out, it would be
Patho Module Eleven Assignment A & R, Su 19
normal serum osmolality is 280 to
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less PTH rather than “less calcitonin” that would affect the patient. Greater age means INcreased
osteoclastic activity (not decreased), and thus GREATER calcium resorption—movement of calcium out of
bone into blood. (D) Greater age would indeed contribute to osteopenia and osteoporosis, but the
reasons here are not correct.
9. A patient with Type I diabetes has a pH of 7.32. This is most likely caused from the byproducts of increased
a. insulin resistance.
b. hyperinsulinism.
c. gluconeogenesis.
d. glucagon.
Rationale: Type I diabetics have no insulin at all, therefore [Show Less]