NR 283 FINAL EXAM NEWEST ACTUAL EXAM
COMPLETE 450 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+ (CHAMBERLAINE
COLLEGE OF NURSING)
What regulates the release of hormones? - ANSWERfeedback systems
Positive Feedback - ANSWERtells a hormone to make more
Negative Feedback - ANSWERstops making a hormone
Secreting Cells - ANSWERwhat is pumped out of the cells (ADH released from the
posterior pituitary gland)
Receiving Cells - ANSWERwhat cells the hormones target (ADH targets the kidney)
Why are hormones are released? - ANSWER-altered cell environment (increases intake of
glucose leads to a release of insulin)
-maintaining levels of other hormones (cascades trigger the release of other hormones,
ex: TRH)
-neural control (autonomic NS - not in control)
Non-steroidal hormones - ANSWER-water soluble, can float around blood stream with no
issues since the blood stream is made up of water, but cannot get through phospholipid
bilayer - which is why we need receptors on the cells and second messengers (proteins
that live inside the cells to help get the message to the nucleus)
-ex: insulin: freely moves around bloodstream but has to connect with a second
messenger
Steroidal Hormones - ANSWER-lipid soluble, fatty hormones floating around
bloodstream cannot float around easily so they need carrier proteins to carry them.
When they get to the cell, they dont have any issues getting into the cell they can deliver
the message straight to the nucleus
,ex: sex hormones (estrogen, testosterone)
regulation - ANSWERrefers to the receptivity of cells, how open is that cell to allow a
hormone in
Upregulation - ANSWERif we starve a cell of a hormone, they will be much more likely to
get a hormone in
-this is why type II diabetes can be reversible, if the cells haven't seen insulin in a while,
the pancreas isn't overworking to pump out insulin
Downregulation - ANSWER-happens with type II diabetes, have tons of glucose in
bloodstream, in response the pancreas (beta cells) pump out insulin, in a normal state
the pancreas is able to pump out insulin, but since there is so much excess glucose in
the blood, insulin comes to the cell receptor and they wont let glucose in because they
have become sensitized.Now it will take more insulin to do the same job.
-also happens with narcotic addiction
Thyroid Cascade - ANSWERthyroid hormone helps us make ATP, the target cells for
thyroid hormone is every cell in the body so it affects many things.
-need more ATP? positive feedback loop is started. Hypothalamus release TRH which
reaches pituitary gland and then releases TSH, TSH reaches thyroid and the thyroid
gland release TH and then goes to target cells (all cells in the body), once we have
enough, negative feedback loop is initiated to stop making TRH
Cause of Endocrine Disorders - ANSWER-autoimmune
-most common cause is a tumor on gland (pituitary)
-target cell resistance (type II diabetes)
-congenital defect
-hyperplasia (increase in cell number - goiter)
Hyperthyroidism - ANSWER(graves disease)
-only affects women, autoimmune
-body produces antibodies (normally fight infection), but this AB's instead will go to the
thyroid and will mimic the cascade. They tell the thyroid to produce more thyroid
hormone, even when negative feedback is taking place
-Sx: exophalmos (bulging of the eyes caused by inflammation from cell mediators), toxic
goiter, symptoms are also due to everything speeding up (hot because of increased
metabolism which makes more ATP - ATP releases heat, shaky: everything is moving
fast through body, weight loss: crazy fast metabolism, tachycardia, increased BP:
thyroid hormone helps maintain BP
-Tx: iodine (kill part of thyroid) or surgically remove part of thyroid
Hypothryoidism - ANSWER-common, autoimmune
-thyroid does not make enough TH
- AB's are attacking the thyroid so it is not able to make as much TH
-usually affects women
-Sx: due to lowered metabolism, everything slows down. Cold: not making a lot of ATP,
super tired, apathy (disinterest)
-Tx: synthroid which acts as a superficial TH, easy treatment that has to be regulated
very closely as metabolism needs change
,SIADH - ANSWER-syndrome of inappropriate antidiuretic hormone
-high levels of ADH (ADH helps keep water)
-if we have too much ADH, we have too much water in the blood stream, end of with tons
of water and not enough sodium
-hyponatremia: imbalance of water to salt, brain is super sensitive to this, the brain will
know that this is off
-problems happen from being in a hypo-osmolar state (not enough solutes in blood)
-ADH works on last part of nephron so it gets the last say on deciding on how much
water to pull back
-causes: tumor on pituitary gland, occasionally after surgery
-Sx: irrational thirst: ratio of solute to water is off so the brain wants us to drink more
water, but we already have all this water in the bloodstream. Anorexia and GI problems:
wont want to eat when carrying around all this extra water. Dyspnea: extra fluid in blood
stream so increase in hydrostatic pressure, fluid could exit into lungs.
-Severe Sx: changes in LOC, confusion, lethargy, muscle twitching, convulsions
-NOT A SODIUM PROBLEM, this is a water problem
-Tx: IV fluids or a hypertonic solution, important to give fluids slowly since a if there is a
sudden increase in solutes, water will be attracted from the brain cells so they will shrink
and die and will put you into a coma OR water can be rushed into the brain cells too
quickly and the brain can burst or die, which leads to coma or death
diabetes insipidus (DI) - ANSWER-rare
-causes by trauma, tumor on pituitary, craniotomy
-Sx: polyuria (frequent urination) and polydipsia (increases thirst)
-not enough ADH so dumping tons of water into urine, so pt. is severely dehydrated. All
of the water is exiting through the kidneys and now have an inability to concentrate urine
(ability to pick and choose what we want in the nephron)
-increased plasma osmolality: blood vessel with not enough water and tons of solutes,
hyperosmolar state, blood is thick and viscous, syrupy due to lots of solutes
-hypernatremia not related with intake of salt, all a water problem
-Sx: increased thirst due to losing a lot, urinating at night, can lose up to 20 L of urine in
a day (hypovolemic), tachycardic: super dehydrated so heart has to work harder and
there isnt a lot of volume
tx: vasopressin (artificial ADH)
Diabetes - ANSWER-common
-important to note that insulin is dangerous
-beta cells in pancreas produce insulin
-normally: when there is glucose in the blood, insulin gets released from the beta cells
into the blood stream. insulin acts a key to get glucose inside the cells. insulin is water
soluble so it needs a second messenger to take it to the nucleus.
-hyperglycemia: tons of sugar in blood
-type 1: dont make enough insulin
-type 2: insulin resistant, down regulation
-Diagnose: hemoglobin A1C or HbA1c - draw blood and look at RBC's, look at how blood
sugar levels have fluctuated in the last 3 months, want this to be below 7.
Type 1 Diabetes - ANSWER-insulin deficient
-hypoglycemia that is caused by autoimmune
-childhood disease
, -For some reason our body produces AB's that attack pancreas and we stop making
insulin. We become deficient, lose ability for beta cells to pump out insulin. If we don't
have insulin we end up with tons of glucose molecules in blood stream and none of it is
making it into cells
-RF: family history, environment, asians, african americans
Sx: 3 p's, weight loss initially since sugar is not entering into cells, starving, fatigue (no
ATP), increased infection (bugs love sugar), rapid onset.
-will need external insulin forever
3 P's of diabetes - ANSWER-polyuria: increased urination due to body trying to get rid of
excess sugar, kidneys are helping out, trying to get rid of sugar molecules, but its not a
good thing for glucose to up in urine and nephron (indicator that something is off)
-polyphagia: increased hunger - glucose is not making its way into cells, staying in blood
stream so cells are starving
-polydipsia: increased thirst - a lot of solutes in blood (syrup blood), brain is going to
increase thirst mechanism to try and balance osmolality of the blood, also due to
increased urination
Type II Diabetes - ANSWER-problem is insulin resistance, pancreas is pumping out so
much insulin to make up for tons of glucose and cells are super tired of seeing insulin,
cells become insulin resistant
-RF: lifestyle related, obesity, age, HTN (blood moving to quickly, epithelial injury
damage - glucose damaging to body because all of the complications that come from
diabetes are from how damaging this molecule is, as glucose is rocketing through a
blood vessel at a fast rate and it stabs the side of a blood vessel and causes damage and
can start atherosclerosis, also has issues getting through kidneys and tiny arteries
-decreased insulin secretion: diabetes is a progressive problem - can move forwards or
backwards
-Tx: strict diet or oral medication: glycerides, metformin (helps pancreas to produce
more insulin or on cells themselves to be become more receptive - can still move
backwards and cure yourself of diabetes)
-once you become insulin dependent and cant go backwards and need insulin for life,
pancreas has quit and pancreas does not work anymore so resembles type 1.
Sx: 3 p's decreased energy, obese, recurrent infections (bacteria loves sugar), FBS is
greater than 125 mg/dl
Acute complications of diabetes - ANSWER-Slightly incorrect dose of insulin can drop
blood sugar so low so they can slip into a coma and die (hypoglycemia) - insulin shock -
too much insulin, rapid onset (sweaty, irritability, confusion, seizures, coma)
-Diabetic ketoacidosis: crazy high blood sugar (600, 700)
-Occurs from too little insulin and body is starving and we go into backup metabolism -
break down fats and proteins and get ketones. Ketones are extremely acidic cant live on
this alone. When we get super high levels of ketones then you end up in metabolic
acidosis - DKA is most common cause. Body compensates by respiratory system - deep,
rapid respiration (kussmaul respirations) using accessory muscles to blow of CO2, sweet
smelling breath or urine or sweat from ketones (acetone production which is super
sweet), will all this acidity you have CNS depression
-Causes: type 1 diabetic about to be diagnosed (come into ED lifeless - cells have been
starving for so long, so body has to do backup metabolism, type 2 that doesn't follow
diabetic diet, diabetics who are sick (vomiting, flu) - so don't take insulin. Metabolic
needs change when you are sick.
