NU 545 EXAM 3
Study Guide
Physio-Patho Basis of Adv Nsg
University of South Alabama
This Study Guide contains:
✓ verified questions and Answers with Reference pg.
✓ key concepts
✓ advanced clinical reasoning.
✓ Designed to help nursing students master course
outcomes
✓ prepare for midterm or final exams with confidence.
, lOMoARcPSD|51648332
CHAPTER 21
33. Know which hormones are water-soluble and which are lipid soluble. P. 645-647, Table
21.1 645
STRUCTURAL CATEGORY EXAMPLES
Water Soluble
Peptides Growth hormone
Insulin
Leptin
Parathyroid hormone
Prolactin
Glycoproteins Follicle-stimulating hormone
Luteinizing hormone
Thyroid-stimulating hormone
Polypeptides Adrenocorticotropic hormone
Antidiuretic hormone
Calcitonin
Endorphins
Glucagon
Hypothalamic hormones
Lipotropins
Melanocyte-stimulating hormone
Oxytocin
Somatostatin
Thymosin
Thyrotropin-releasing hormone
Amines Epinephrine
Norepinephrine
Lipid Soluble
Thyroxine (an amine but lipid soluble) Thyroxine (both thyroxine [T4] and
triiodothyronine [T3])
Steroids (cholesterol is a precursor for all Estrogens
Glucocorticoids
steroids) (cortisol)
Mineralocorticoids (aldosterone)
Progestins (progesterone)
Testosterone
Derivatives of arachidonic acid Leukotrienes
(autocrine or paracrine action) Prostacyclins
Prostaglandins
Thromboxanes
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40. Know how protein hormones are transmitted in the blood. P. 646-647
Once hormones are released into the circulatory system, they are distributed throughout the body.
a. Peptide or protein hormones are water-soluble and circulate in free (unbound) forms.
b. Water-soluble hormones generally have a short half-life because they are catabolized by circulating enzymes.
i. Insulin has a half-life of 3-5 minutes and is catabolized by insulinases.
c. Lipid-soluble hormones (cortisol and adrenal androgens) are transported bound to a carrier or transport protein and can remain in
the blood for hours to days.
Only free hormones can initiate changes within a target cell.
a. Because equilibrium exists between the concentrations of free hormones and hormones bound to plasma proteins, a significant
change in the concentration of binding proteins can affect the concentration of free hormones in the plasma.
b. When a hormone is release into circulatory system, it is distributed throughout the body, but only those cells with appropriate
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
hormone receptors for that hormone are affected. The target cell hormone receptors have two main functions
i. To recognize and bind with high affinity to their particular hormones
ii. To initiate a signal to appropriate intracellular effectors
27. What is oxytocin? How does it relate to the pituitary gland? Where is it secreted and what
are its effects? P. 649, 652-653
Origin: a polypeptide hormone synthesized in the supraoptic and paraventricular nuclei of the hypothalamus.
Define: oxytocin is implicated in behavior responses, especially in women. Plays role in brains responsiveness to stressful stimuli, especially
in the pregnant and postpartum states.
Relation to pituitary gland: the posterior pituitary secretes and stores oxytocin.
a. Once synthesized, it is packaged in secretory vesicles along with its neurophysin and moved down the axons of the pituitary stalk to
the pars nervosa for storage.
b. Release of oxytocin is mediated by cholinergic and adrenergic neurotransmitters, and the major stimulus for release is glutamate.
Effects: Oxytocin is responsible for the contraction of the uterus and milk ejection in lactating women and may affect sperm motility in men.
Secreted in response to suckling and mechanical distention of female reproductive tract.
a. Suckling Oxytocin bind to its receptors on myoepithelial cells in the mammary tissues and causes contract of those cells
increases intramammary pressure and milk expression = “let down” reflex
b. Distention of the uterus oxytocin stimulates contractions (functions as positive feedback loop to further increase oxytocin
secretion); functions near the end of labor to enhance effectiveness of contractions, promote delivery of placenta, and stimulate
postpartum uterine contractions (preventing excessive bleeding)
41. Know ADH. Where is it secreted? Where does it act? P. 653
Major homeostatic function of the posterior pituitary is the control of osmolality, which is regulated by ADH.
Acts on vasopressin 2 (V2) receptors of the renal tubular cells to increase their permeability, which leads to increased water
absorption into the blood, concentrating the urine and reducing serum osmolality.
o Effects may be inhibited by hypercalcemia, prostaglandin E, and hypokalemia.
Causes of secretion of ADH
The secretion of ADH (polypeptide hormone) is regulated by the osmoreceptors of the hypothalamus, located near or in the supraoptic
nuclei. ADH secretion is increased:
1. plasma osmolality increases osmoceptors are stimulated rate of ADH secretion increases more water is absorbed from
kidney plasma is diluted to its set-point osmolality (approx. 280 mOsm/kg)
a. ADH has no direct effect on electrolytes, but with increased water absorption serum electrolytes may decrease due to a
dilutional effect.
2. changes in intravascular volume (monitored by baroreceptors in the left atrium and in the carotid arteries and aortic arch
volume loss of 7-25% stimulates receptors)
3. Stress, trauma, pain, exercise, nausea, nicotine, exposure to heat, and drugs (morphine)
ADH secretion decreases with a decrease in plasma osmolality, an increase in intravascular volume, hypertension, an increase in estrogen,
progesterone, and angiotensin II levels, and alcohol ingestion.
ADH does not affect vessel tone however, pathophysiological high serum levels of ADH acts on vasopressin I (V1) receptors
vasoconstriction increase in arterial blood pressure. (Ex. Vasopressin may be given during hemorrhage to achieve homeostatic and
raise blood pressure in shock states)
32. Where are the target cells for each hormone located? P. 649-652, Table 21.4/21.5
Downloaded by Benjamin Luca ()
Study Guide
Physio-Patho Basis of Adv Nsg
University of South Alabama
This Study Guide contains:
✓ verified questions and Answers with Reference pg.
✓ key concepts
✓ advanced clinical reasoning.
✓ Designed to help nursing students master course
outcomes
✓ prepare for midterm or final exams with confidence.
, lOMoARcPSD|51648332
CHAPTER 21
33. Know which hormones are water-soluble and which are lipid soluble. P. 645-647, Table
21.1 645
STRUCTURAL CATEGORY EXAMPLES
Water Soluble
Peptides Growth hormone
Insulin
Leptin
Parathyroid hormone
Prolactin
Glycoproteins Follicle-stimulating hormone
Luteinizing hormone
Thyroid-stimulating hormone
Polypeptides Adrenocorticotropic hormone
Antidiuretic hormone
Calcitonin
Endorphins
Glucagon
Hypothalamic hormones
Lipotropins
Melanocyte-stimulating hormone
Oxytocin
Somatostatin
Thymosin
Thyrotropin-releasing hormone
Amines Epinephrine
Norepinephrine
Lipid Soluble
Thyroxine (an amine but lipid soluble) Thyroxine (both thyroxine [T4] and
triiodothyronine [T3])
Steroids (cholesterol is a precursor for all Estrogens
Glucocorticoids
steroids) (cortisol)
Mineralocorticoids (aldosterone)
Progestins (progesterone)
Testosterone
Derivatives of arachidonic acid Leukotrienes
(autocrine or paracrine action) Prostacyclins
Prostaglandins
Thromboxanes
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
40. Know how protein hormones are transmitted in the blood. P. 646-647
Once hormones are released into the circulatory system, they are distributed throughout the body.
a. Peptide or protein hormones are water-soluble and circulate in free (unbound) forms.
b. Water-soluble hormones generally have a short half-life because they are catabolized by circulating enzymes.
i. Insulin has a half-life of 3-5 minutes and is catabolized by insulinases.
c. Lipid-soluble hormones (cortisol and adrenal androgens) are transported bound to a carrier or transport protein and can remain in
the blood for hours to days.
Only free hormones can initiate changes within a target cell.
a. Because equilibrium exists between the concentrations of free hormones and hormones bound to plasma proteins, a significant
change in the concentration of binding proteins can affect the concentration of free hormones in the plasma.
b. When a hormone is release into circulatory system, it is distributed throughout the body, but only those cells with appropriate
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
hormone receptors for that hormone are affected. The target cell hormone receptors have two main functions
i. To recognize and bind with high affinity to their particular hormones
ii. To initiate a signal to appropriate intracellular effectors
27. What is oxytocin? How does it relate to the pituitary gland? Where is it secreted and what
are its effects? P. 649, 652-653
Origin: a polypeptide hormone synthesized in the supraoptic and paraventricular nuclei of the hypothalamus.
Define: oxytocin is implicated in behavior responses, especially in women. Plays role in brains responsiveness to stressful stimuli, especially
in the pregnant and postpartum states.
Relation to pituitary gland: the posterior pituitary secretes and stores oxytocin.
a. Once synthesized, it is packaged in secretory vesicles along with its neurophysin and moved down the axons of the pituitary stalk to
the pars nervosa for storage.
b. Release of oxytocin is mediated by cholinergic and adrenergic neurotransmitters, and the major stimulus for release is glutamate.
Effects: Oxytocin is responsible for the contraction of the uterus and milk ejection in lactating women and may affect sperm motility in men.
Secreted in response to suckling and mechanical distention of female reproductive tract.
a. Suckling Oxytocin bind to its receptors on myoepithelial cells in the mammary tissues and causes contract of those cells
increases intramammary pressure and milk expression = “let down” reflex
b. Distention of the uterus oxytocin stimulates contractions (functions as positive feedback loop to further increase oxytocin
secretion); functions near the end of labor to enhance effectiveness of contractions, promote delivery of placenta, and stimulate
postpartum uterine contractions (preventing excessive bleeding)
41. Know ADH. Where is it secreted? Where does it act? P. 653
Major homeostatic function of the posterior pituitary is the control of osmolality, which is regulated by ADH.
Acts on vasopressin 2 (V2) receptors of the renal tubular cells to increase their permeability, which leads to increased water
absorption into the blood, concentrating the urine and reducing serum osmolality.
o Effects may be inhibited by hypercalcemia, prostaglandin E, and hypokalemia.
Causes of secretion of ADH
The secretion of ADH (polypeptide hormone) is regulated by the osmoreceptors of the hypothalamus, located near or in the supraoptic
nuclei. ADH secretion is increased:
1. plasma osmolality increases osmoceptors are stimulated rate of ADH secretion increases more water is absorbed from
kidney plasma is diluted to its set-point osmolality (approx. 280 mOsm/kg)
a. ADH has no direct effect on electrolytes, but with increased water absorption serum electrolytes may decrease due to a
dilutional effect.
2. changes in intravascular volume (monitored by baroreceptors in the left atrium and in the carotid arteries and aortic arch
volume loss of 7-25% stimulates receptors)
3. Stress, trauma, pain, exercise, nausea, nicotine, exposure to heat, and drugs (morphine)
ADH secretion decreases with a decrease in plasma osmolality, an increase in intravascular volume, hypertension, an increase in estrogen,
progesterone, and angiotensin II levels, and alcohol ingestion.
ADH does not affect vessel tone however, pathophysiological high serum levels of ADH acts on vasopressin I (V1) receptors
vasoconstriction increase in arterial blood pressure. (Ex. Vasopressin may be given during hemorrhage to achieve homeostatic and
raise blood pressure in shock states)
32. Where are the target cells for each hormone located? P. 649-652, Table 21.4/21.5
Downloaded by Benjamin Luca ()
