Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 22: Alterations of Hormonal RegulationMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include which solute?a. Sodium and water retentionb. Sodium retention and water lossc. Sodium dilution and water retentiond. Sodium dilution and water lossANS: CThe symptoms of SIADH secretion are a result of dilutional hyponatremia and water retention. SIADH does not lead to sodium retention or water loss.PTS: 1 DIF: Cognitive Level: Remembering 2. Which patient would the healthcare professional assess for elevated levels of antidiuretic hormone (ADH) secretion?a. Being treated for small cell carcinoma of the stomachb. Taking high dose acetaminophen (Tylenol) for arthritisc. Had a hip replacement operation 14 days agod. Has long-standing kidney disease from diabetesANS: AA common cause of elevated levels of ADH secretion is ectopically produced ADH by tumors, such as small cell carcinoma of the duodenum, stomach, and pancreas; cancers of the bladder, prostate, and endometrium; lymphomas; and sarcomas. High doses of antiinflammatory medications are a risk factor, but acetaminophen is not an antiinflammatory medication. Surgery within the last 5 to 7 leads to increased ADH secretion. Kidney disease does not lead to excess levels of ADH.PTS: 1 DIF: Cognitive Level: Applying 3. Which laboratory value would the nurse expect to find if a person is experiencing syndrome of inappropriate antidiuretic hormone (SIADH)?a. Hypernatremia and urine hypoosmolalityb. Serum potassium (K+) level of 5 mEq/L and urine hyperosmolality compared to serumc. Serum sodium (Na+) level of 120 mEq/L and serum osmolality 260 mOsm/kgd. Serum potassium (K+) of 2.8 mEq/L and serum hyperosmolalityANS: CA diagnosis of SIADH requires a serum sodium level of less than 135 mEq/L, serum hypoosmolality less than 280 mOsm/kg, and urine hyperosmolarity. Potassium levels are not considered a factor.PTS: 1 DIF: Cognitive Level: Remembering 4. What is diabetes insipidus a result of?a. Antidiuretic hormone hyposecretionb. Antidiuretic hormone hypersecretionc. Insulin hyposecretiond. Insulin hypersecretionANS: ADiabetes insipidus is a result of insufficient antidiuretic hormone (hyposecretion). It is not related to insulin secretion.PTS: 1 DIF: Cognitive Level: Remembering 5. A patient who is diagnosed with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits, but the antidiuretic hormone (ADH) level is low. Although the patient has had no intake for 4 hours, no change in the polyuria level has occurred. What treatment or diagnostic testing does the healthcare professional prepare the patient for?a. Administration of desmopressinb. Serum copeptin testingc. Insulin administrationd. Renal angiogramANS: AThe stated symptoms are reflective of neurogenic diabetes insipidus (DI) which can be treated with desmopressin. Desmopressin will cause an increased ability to concentrate urine. Copeptin is a precursor of ADH and obtaining a serum level is useful in diagnosing dipsogenic DI. The patient does not need insulin or a renal angiogram.PTS: 1 DIF: Cognitive Level: ApplyingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. A patient is having a water deprivation test. The patient’s initial weight was 220 pounds (100 kg). The next weight is 209 pounds (95 kg). What action by the healthcare professional is most appropriate?a. Stop the water deprivation test.b. Administer salt tablets.c. Continue with the test as planned.d. Take the patient’s blood glucose.ANS: AIn patients with severe diabetes insipidus the water deprivation test can be diagnostic. However, it can also be risky; if the patient loses more than 3% of body weight, cardiovascular collapse and shock can occur. This patient has lost 5% of initial body weight, so the professional should stop the test. Administering salt tablets does not take priority over stopping the test. Glucose measurement is not relevant.PTS: 1 DIF: Cognitive Level: Analyzing 7. A healthcare professional is caring for four patients. Which patient does the professional assess for neurogenic diabetes insipidus (DI)?a. Anterior pituitary tumorb. Thalamus hypofunctionc. Posterior pituitary traumad. Renal tubule diseaseANS: CNeurogenic DI is a result of dysfunctional antidiuretic hormone synthesis, caused by a lesion of the posterior pituitary, hypothalamus, or pituitary stalk. Injury of dysfunction of the anterior pituitary, the thalamus, or the renal tubules does not cause neurogenic DI.PTS: 1 DIF: Cognitive Level: Applying 8. Which form of diabetic insipidus (DI) will result if the target cells for antidiuretic hormone (ADH) in the renal collecting tubules demonstrate insensitivity?a. Neurogenicb. Nephrogenicc. Psychogenicd. IschemicANS: BOnly nephrogenic DI is associated with an insensitivity of the renal collecting tubules to ADH.PTS: 1 DIF: Cognitive Level: Remembering 9. Which laboratory value is consistent with diabetes insipidus (DI)?a. Low urine-specific gravityb. Low serum sodiumc. Low urine proteind. High serum total proteinANS: AThe basic criteria for diagnosing DI include a low urine-specific gravity while sodium levels are high. Protein levels are not considered.PTS: 1 DIF: Cognitive Level: Remembering 10. A patient has nephrogenic diabetes insipidus (DI). What treatment does the healthcare professional anticipate for this patient?a. Exogenous ADH replacementb. Intranasal desmopressinc. Water and sodium restrictiond. Loop diuretic administrationANS: ANephrogenic DI is usually treated with administration of fluids, or intranasal (or oral) desmopressin. Neurogenic DI is treated with ADH replacement therapy. Water restriction would not be helpful. Thiazide (not loop) diuretics can improve moderate nephrogenic DI.PTS: 1 DIF: Cognitive Level: Remembering 11. Which condition may result from pressure exerted by a pituitary tumor?a. Hypothyroidismb. Hypercortisolismc. Diabetes insipidusd. Insulin hyposecretionANS: AIf the tumor exerts sufficient pressure, then thyroid and adrenal hypofunction may occur because of lack of thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH). These result in the symptoms of hypothyroidism and hypocortisolism. The remaining options are not associated with the pressure
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