A&P 2 Midterm Practice Test – Anatomy & Physiology II
Comprehensive Exam Prep
2025/2026 A&P 2 Midterm Practice Test
Official Practice Examination for Competitive Nursing Programs
ENDOCRINE SYSTEM (Questions 1-7)
1. Question: A 58-year-old patient with Type 2 diabetes presents with recurrent urinary tract infections
and reports feeling "lightheaded" when standing. Current medications include metformin and a new
prescription for empagliflozin (Jardiance). Which physiological mechanism explains both the therapeutic
effect and the adverse effects?
A. Increased insulin secretion from pancreatic beta cells
B. Inhibition of SGLT2 transporters in proximal convoluted tubule
C. Activation of GLP-1 receptors delaying gastric emptying
D. Blockade of alpha-glucosidase enzymes in intestinal brush border
Answer: B
Explanation: SGLT2 inhibitors block sodium-glucose cotransport in the PCT, causing glucosuria and
osmotic diuresis that lowers blood glucose. However, glycosuria promotes bacterial growth (UTIs), and
volume depletion from osmotic diuresis causes orthostatic hypotension. Option A describes
sulfonylureas; C describes GLP-1 agonists like semaglutide; D describes acarbose.
2. Question: A patient with Cushing's syndrome secondary to prolonged prednisone use develops
hypertension and hyperglycemia. Which hormone's action is being mimicked by the exogenous
corticosteroid, and what is the mechanism of the glucose elevation?
A. Aldosterone; increased gluconeogenesis via PEPCK activation
B. Cortisol; increased hepatic gluconeogenesis and peripheral insulin resistance
C. Epinephrine; glycogenolysis via cyclic AMP activation
D. Growth hormone; decreased glucose uptake in adipose tissue
Answer: B
Explanation: Prednisone mimics cortisol, which stimulates hepatic gluconeogenic enzymes (PEPCK,
glucose-6-phosphatase) and induces insulin resistance in muscle/adipose by downregulating GLUT4
transporters. Aldosterone (A) causes Na+ retention and hypertension but minimal metabolic effects.
Epinephrine (C) causes acute hyperglycemia, not chronic. GH (D) causes insulin resistance but is not the
target of prednisone.
,3. Question: A 32-year-old woman presents with heat intolerance, weight loss, and exophthalmos.
Laboratory studies show elevated free T4 and suppressed TSH. Which of the following is NOT a
physiological effect of the elevated hormone in this condition?
A. Increased basal metabolic rate
B. Upregulation of beta-adrenergic receptors in cardiac tissue
C. Increased synthesis of Na+/K+-ATPase pumps
D. Decreased bone mineral density via osteoblast stimulation
Answer: D
Explanation: Hyperthyroidism increases bone turnover by stimulating OSTEOCLASTS (not osteoblasts),
causing bone resorption and osteoporosis. Options A-C are correct: T3 increases BMR, sensitizes the
heart to catecholamines by upregulating beta-receptors, and increases Na+/K+-ATPase synthesis
(contributing to heat production). The question asks for the exception.
4. Question: A patient with Addison's disease presents with hypotension, hyperkalemia, and
hyponatremia. The nurse understands that the hyponatremia is primarily caused by which mechanism?
A. Decreased aldosterone leading to reduced Na+ reabsorption in the collecting duct
B. Decreased cortisol causing impaired free water clearance at the collecting duct
C. Decreased ADH secretion from posterior pituitary dysfunction
D. Increased ANP release due to volume depletion
Answer: B
Explanation: While aldosterone deficiency (A) causes Na+ wasting and hyperkalemia, the hyponatremia
in Addison's is primarily due to cortisol deficiency. Cortisol normally suppresses ADH secretion; without
it, ADH is inappropriately elevated, causing water retention and dilutional hyponatremia. Additionally,
cortisol deficiency reduces free water clearance at the renal collecting duct. Option C is incorrect
because ADH is elevated, not decreased.
5. Question: A nurse is caring for a patient who underwent transsphenoidal hypophysectomy. Which
hormone deficiency would develop FIRST if the surgeon accidentally damaged the posterior pituitary?
A. Growth hormone
B. Thyroid-stimulating hormone
C. Antidiuretic hormone
D. Adrenocorticotropic hormone
Answer: C
Explanation: The posterior pituitary stores/releases ADH and oxytocin synthesized in the hypothalamus.
Damage causes immediate diabetes insipidus (ADH deficiency). GH, TSH, and ACTH (A, B, D) are anterior
pituitary hormones. While posterior pituitary damage is anatomically separate from anterior hormones,
the question tests knowledge that ADH is the only option from the posterior lobe.
, 6. Question: A patient with Type 1 diabetes is prescribed pramlintide (Symlin) to improve glycemic
control. The nurse understands this drug mimics which hormone, and what is its primary action?
A. Glucagon; stimulates hepatic glucose output
B. Amylin; slows gastric emptying and suppresses postprandial glucagon
C. Somatostatin; inhibits both insulin and glucagon secretion
D. Incretin; enhances glucose-dependent insulin secretion
Answer: B
Explanation: Amylin is co-secreted with insulin from beta cells and is deficient in Type 1 diabetes.
Pramlintide slows gastric emptying, suppresses inappropriate postprandial glucagon secretion, and
promotes satiety. GLP-1 agonists (D) enhance insulin secretion; somatostatin (C) inhibits multiple
hormones; glucagon (A) raises glucose—opposite of desired effect.
7. Question: A patient presents with severe hypocalcemia, high phosphate, and low PTH. The nurse
suspects hypoparathyroidism. Which physiological response is responsible for the neuromuscular
irritability (positive Chvostek's sign) observed?
A. Depolarization of neural membranes due to decreased threshold potential
B. Hyperpolarization of muscle membranes from increased potassium conductance
C. Increased neurotransmitter release at the neuromuscular junction
D. Decreased acetylcholinesterase activity prolonging muscle stimulation
Answer: A
Explanation: Low extracellular calcium decreases the voltage threshold for sodium channel activation in
excitable membranes, causing spontaneous depolarization and tetany. Calcium normally stabilizes the
sodium channel inactivation gate. Hyperpolarization (B) would decrease excitability. Options C and D
describe mechanisms unrelated to calcium's membrane-stabilizing effects.
CARDIOVASCULAR SYSTEM: BLOOD (Questions 8-12)
8. Question: A patient with atrial fibrillation is prescribed warfarin. The nurse monitors the INR and
notes the patient also takes omeprazole and eats large amounts of leafy greens. Which coagulation
factors are affected by warfarin, and what dietary consideration is essential?
A. Factors II, VII, IX, X; vitamin K intake should remain consistent
B. Factors V, VIII, XI, XIII; avoid all green vegetables
C. Fibrinogen and platelet aggregation; increase vitamin K-rich foods
D. Factors II, V, VII, X; eliminate vitamin K from diet completely
Answer: A
Comprehensive Exam Prep
2025/2026 A&P 2 Midterm Practice Test
Official Practice Examination for Competitive Nursing Programs
ENDOCRINE SYSTEM (Questions 1-7)
1. Question: A 58-year-old patient with Type 2 diabetes presents with recurrent urinary tract infections
and reports feeling "lightheaded" when standing. Current medications include metformin and a new
prescription for empagliflozin (Jardiance). Which physiological mechanism explains both the therapeutic
effect and the adverse effects?
A. Increased insulin secretion from pancreatic beta cells
B. Inhibition of SGLT2 transporters in proximal convoluted tubule
C. Activation of GLP-1 receptors delaying gastric emptying
D. Blockade of alpha-glucosidase enzymes in intestinal brush border
Answer: B
Explanation: SGLT2 inhibitors block sodium-glucose cotransport in the PCT, causing glucosuria and
osmotic diuresis that lowers blood glucose. However, glycosuria promotes bacterial growth (UTIs), and
volume depletion from osmotic diuresis causes orthostatic hypotension. Option A describes
sulfonylureas; C describes GLP-1 agonists like semaglutide; D describes acarbose.
2. Question: A patient with Cushing's syndrome secondary to prolonged prednisone use develops
hypertension and hyperglycemia. Which hormone's action is being mimicked by the exogenous
corticosteroid, and what is the mechanism of the glucose elevation?
A. Aldosterone; increased gluconeogenesis via PEPCK activation
B. Cortisol; increased hepatic gluconeogenesis and peripheral insulin resistance
C. Epinephrine; glycogenolysis via cyclic AMP activation
D. Growth hormone; decreased glucose uptake in adipose tissue
Answer: B
Explanation: Prednisone mimics cortisol, which stimulates hepatic gluconeogenic enzymes (PEPCK,
glucose-6-phosphatase) and induces insulin resistance in muscle/adipose by downregulating GLUT4
transporters. Aldosterone (A) causes Na+ retention and hypertension but minimal metabolic effects.
Epinephrine (C) causes acute hyperglycemia, not chronic. GH (D) causes insulin resistance but is not the
target of prednisone.
,3. Question: A 32-year-old woman presents with heat intolerance, weight loss, and exophthalmos.
Laboratory studies show elevated free T4 and suppressed TSH. Which of the following is NOT a
physiological effect of the elevated hormone in this condition?
A. Increased basal metabolic rate
B. Upregulation of beta-adrenergic receptors in cardiac tissue
C. Increased synthesis of Na+/K+-ATPase pumps
D. Decreased bone mineral density via osteoblast stimulation
Answer: D
Explanation: Hyperthyroidism increases bone turnover by stimulating OSTEOCLASTS (not osteoblasts),
causing bone resorption and osteoporosis. Options A-C are correct: T3 increases BMR, sensitizes the
heart to catecholamines by upregulating beta-receptors, and increases Na+/K+-ATPase synthesis
(contributing to heat production). The question asks for the exception.
4. Question: A patient with Addison's disease presents with hypotension, hyperkalemia, and
hyponatremia. The nurse understands that the hyponatremia is primarily caused by which mechanism?
A. Decreased aldosterone leading to reduced Na+ reabsorption in the collecting duct
B. Decreased cortisol causing impaired free water clearance at the collecting duct
C. Decreased ADH secretion from posterior pituitary dysfunction
D. Increased ANP release due to volume depletion
Answer: B
Explanation: While aldosterone deficiency (A) causes Na+ wasting and hyperkalemia, the hyponatremia
in Addison's is primarily due to cortisol deficiency. Cortisol normally suppresses ADH secretion; without
it, ADH is inappropriately elevated, causing water retention and dilutional hyponatremia. Additionally,
cortisol deficiency reduces free water clearance at the renal collecting duct. Option C is incorrect
because ADH is elevated, not decreased.
5. Question: A nurse is caring for a patient who underwent transsphenoidal hypophysectomy. Which
hormone deficiency would develop FIRST if the surgeon accidentally damaged the posterior pituitary?
A. Growth hormone
B. Thyroid-stimulating hormone
C. Antidiuretic hormone
D. Adrenocorticotropic hormone
Answer: C
Explanation: The posterior pituitary stores/releases ADH and oxytocin synthesized in the hypothalamus.
Damage causes immediate diabetes insipidus (ADH deficiency). GH, TSH, and ACTH (A, B, D) are anterior
pituitary hormones. While posterior pituitary damage is anatomically separate from anterior hormones,
the question tests knowledge that ADH is the only option from the posterior lobe.
, 6. Question: A patient with Type 1 diabetes is prescribed pramlintide (Symlin) to improve glycemic
control. The nurse understands this drug mimics which hormone, and what is its primary action?
A. Glucagon; stimulates hepatic glucose output
B. Amylin; slows gastric emptying and suppresses postprandial glucagon
C. Somatostatin; inhibits both insulin and glucagon secretion
D. Incretin; enhances glucose-dependent insulin secretion
Answer: B
Explanation: Amylin is co-secreted with insulin from beta cells and is deficient in Type 1 diabetes.
Pramlintide slows gastric emptying, suppresses inappropriate postprandial glucagon secretion, and
promotes satiety. GLP-1 agonists (D) enhance insulin secretion; somatostatin (C) inhibits multiple
hormones; glucagon (A) raises glucose—opposite of desired effect.
7. Question: A patient presents with severe hypocalcemia, high phosphate, and low PTH. The nurse
suspects hypoparathyroidism. Which physiological response is responsible for the neuromuscular
irritability (positive Chvostek's sign) observed?
A. Depolarization of neural membranes due to decreased threshold potential
B. Hyperpolarization of muscle membranes from increased potassium conductance
C. Increased neurotransmitter release at the neuromuscular junction
D. Decreased acetylcholinesterase activity prolonging muscle stimulation
Answer: A
Explanation: Low extracellular calcium decreases the voltage threshold for sodium channel activation in
excitable membranes, causing spontaneous depolarization and tetany. Calcium normally stabilizes the
sodium channel inactivation gate. Hyperpolarization (B) would decrease excitability. Options C and D
describe mechanisms unrelated to calcium's membrane-stabilizing effects.
CARDIOVASCULAR SYSTEM: BLOOD (Questions 8-12)
8. Question: A patient with atrial fibrillation is prescribed warfarin. The nurse monitors the INR and
notes the patient also takes omeprazole and eats large amounts of leafy greens. Which coagulation
factors are affected by warfarin, and what dietary consideration is essential?
A. Factors II, VII, IX, X; vitamin K intake should remain consistent
B. Factors V, VIII, XI, XIII; avoid all green vegetables
C. Fibrinogen and platelet aggregation; increase vitamin K-rich foods
D. Factors II, V, VII, X; eliminate vitamin K from diet completely
Answer: A
