NURSING PATHOPHYSIOLOGY EXAM #4B: ALTERATIONS IN ENDOCRINE FUNCTION
(2026/2027) | CASE STUDY & STANDARD QUESTIONS WITH CORRECT ANSWERS
Advanced Pathophysiology Examination: Focus on Endocrine System & Metabolic Regulation | Core
Domains: Pituitary, Thyroid, Adrenal, Pancreatic Disorders, Diabetes Mellitus & Complications, and
Reproductive Hormone Imbalances | Graduate-Level Nursing Focus | Case Study & Clinical Application
Exam Format
Exam Structure
This exam for the 2026/2027 cycle is a 50-question assessment that includes case study questions
challenging students to analyze disrupted feedback loops (e.g., Cushing's syndrome, DKA) and predict
multisystem clinical presentations based on hormonal imbalances.
Answer Format
All correct answers must be presented in bold and green, followed by rationales that trace the
pathophysiology from glandular dysfunction through hormonal imbalance to the systemic signs,
symptoms, and diagnostic findings described in the case studies and questions.
Questions (50 Total)
1.
A 45-year-old female reports fatigue, weight gain, cold intolerance, and dry skin. TSH is elevated, free T4
is low.
What condition is present?
A. Graves' disease
B. Primary hypothyroidism
C. Thyroid storm
D. Subacute thyroiditis
Primary hypothyroidism (e.g., Hashimoto’s) causes elevated TSH (loss of negative feedback) and low
T4. Symptoms reflect slowed metabolism. Treatment is levothyroxine replacement.
2.
A patient with adrenal insufficiency presents with hyponatremia, hyperkalemia, hypotension, and
hyperpigmentation.
,What is the underlying cause?
A. Cushing's syndrome
B. Addison's disease (primary adrenal insufficiency)
C. Secondary adrenal insufficiency
D. Conn's syndrome
Addison’s involves autoimmune destruction of the adrenal cortex, causing aldosterone deficiency (→ Na⁺
loss, K⁺ retention) and cortisol deficiency (→ hypotension, fatigue). ACTH is high, causing melanocyte
stimulation and hyperpigmentation.
3.
A patient with type 1 diabetes has blood glucose of 420 mg/dL, Kussmaul respirations, and fruity breath
odor. ABG: pH 7.20, HCO₃⁻ 12 mEq/L.
What is the priority intervention?
A. Administer IV insulin
B. Administer IV insulin and fluids
C. Give oral glucose
D. Restrict potassium
This is diabetic ketoacidosis (DKA). Priority is IV regular insulin to stop ketogenesis and IV fluids (0.9%
NaCl) to correct volume depletion. Potassium is usually replaced once levels are known, as total body K⁺
is depleted despite serum levels.
4.
A woman presents with oligomenorrhea, hirsutism, acne, and infertility. Pelvic ultrasound shows
polycystic ovaries.
What is the primary pathophysiological mechanism?
A. Hypothyroidism
B. Insulin resistance and hyperandrogenism
C. Hyperprolactinemia
, D. Premature ovarian failure
Polycystic ovary syndrome (PCOS) involves ovarian and adrenal overproduction of androgens, often
exacerbated by insulin resistance. This leads to anovulation, hirsutism, and increased risk of type 2
diabetes.
5.
A patient presents with moon face, central obesity, and purple striae. Dexamethasone suppression test
shows no cortisol reduction.
What is the most likely diagnosis?
A. Addison's disease
B. Cushing's syndrome
C. Hyperthyroidism
D. Pheochromocytoma
Cushing's syndrome results from chronic cortisol excess. Causes include exogenous steroids, pituitary
adenoma (Cushing's disease), or adrenal tumor. Failure to suppress cortisol with dexamethasone
confirms autonomous production.
6.
A 45-year-old female reports fatigue, weight gain, cold intolerance, and dry skin. TSH is elevated, free T4
is low.
What condition is present?
A. Graves' disease
B. Primary hypothyroidism
C. Thyroid storm
D. Subacute thyroiditis
Primary hypothyroidism (e.g., Hashimoto’s) causes elevated TSH (loss of negative feedback) and low
T4. Symptoms reflect slowed metabolism. Treatment is levothyroxine replacement.
7.
(2026/2027) | CASE STUDY & STANDARD QUESTIONS WITH CORRECT ANSWERS
Advanced Pathophysiology Examination: Focus on Endocrine System & Metabolic Regulation | Core
Domains: Pituitary, Thyroid, Adrenal, Pancreatic Disorders, Diabetes Mellitus & Complications, and
Reproductive Hormone Imbalances | Graduate-Level Nursing Focus | Case Study & Clinical Application
Exam Format
Exam Structure
This exam for the 2026/2027 cycle is a 50-question assessment that includes case study questions
challenging students to analyze disrupted feedback loops (e.g., Cushing's syndrome, DKA) and predict
multisystem clinical presentations based on hormonal imbalances.
Answer Format
All correct answers must be presented in bold and green, followed by rationales that trace the
pathophysiology from glandular dysfunction through hormonal imbalance to the systemic signs,
symptoms, and diagnostic findings described in the case studies and questions.
Questions (50 Total)
1.
A 45-year-old female reports fatigue, weight gain, cold intolerance, and dry skin. TSH is elevated, free T4
is low.
What condition is present?
A. Graves' disease
B. Primary hypothyroidism
C. Thyroid storm
D. Subacute thyroiditis
Primary hypothyroidism (e.g., Hashimoto’s) causes elevated TSH (loss of negative feedback) and low
T4. Symptoms reflect slowed metabolism. Treatment is levothyroxine replacement.
2.
A patient with adrenal insufficiency presents with hyponatremia, hyperkalemia, hypotension, and
hyperpigmentation.
,What is the underlying cause?
A. Cushing's syndrome
B. Addison's disease (primary adrenal insufficiency)
C. Secondary adrenal insufficiency
D. Conn's syndrome
Addison’s involves autoimmune destruction of the adrenal cortex, causing aldosterone deficiency (→ Na⁺
loss, K⁺ retention) and cortisol deficiency (→ hypotension, fatigue). ACTH is high, causing melanocyte
stimulation and hyperpigmentation.
3.
A patient with type 1 diabetes has blood glucose of 420 mg/dL, Kussmaul respirations, and fruity breath
odor. ABG: pH 7.20, HCO₃⁻ 12 mEq/L.
What is the priority intervention?
A. Administer IV insulin
B. Administer IV insulin and fluids
C. Give oral glucose
D. Restrict potassium
This is diabetic ketoacidosis (DKA). Priority is IV regular insulin to stop ketogenesis and IV fluids (0.9%
NaCl) to correct volume depletion. Potassium is usually replaced once levels are known, as total body K⁺
is depleted despite serum levels.
4.
A woman presents with oligomenorrhea, hirsutism, acne, and infertility. Pelvic ultrasound shows
polycystic ovaries.
What is the primary pathophysiological mechanism?
A. Hypothyroidism
B. Insulin resistance and hyperandrogenism
C. Hyperprolactinemia
, D. Premature ovarian failure
Polycystic ovary syndrome (PCOS) involves ovarian and adrenal overproduction of androgens, often
exacerbated by insulin resistance. This leads to anovulation, hirsutism, and increased risk of type 2
diabetes.
5.
A patient presents with moon face, central obesity, and purple striae. Dexamethasone suppression test
shows no cortisol reduction.
What is the most likely diagnosis?
A. Addison's disease
B. Cushing's syndrome
C. Hyperthyroidism
D. Pheochromocytoma
Cushing's syndrome results from chronic cortisol excess. Causes include exogenous steroids, pituitary
adenoma (Cushing's disease), or adrenal tumor. Failure to suppress cortisol with dexamethasone
confirms autonomous production.
6.
A 45-year-old female reports fatigue, weight gain, cold intolerance, and dry skin. TSH is elevated, free T4
is low.
What condition is present?
A. Graves' disease
B. Primary hypothyroidism
C. Thyroid storm
D. Subacute thyroiditis
Primary hypothyroidism (e.g., Hashimoto’s) causes elevated TSH (loss of negative feedback) and low
T4. Symptoms reflect slowed metabolism. Treatment is levothyroxine replacement.
7.
