ACTUAL
MARYVILLE NURS 623 EXAM 2(ENDOCRINE & METABOLIC)
EXAM GUIDE NEWEST VERSION 2026-2027 EXPECTED
QUESTION AND CORRECT ANSWER FROM VERIFIED
SOURCES.
Which of the serum laboratory findings are present in the client with Cushing's
syndrome?
Increased cortisol, hypernatremia, and hypokalemia
Decreased cortisol, hypernatremia, and hypokalemia
Increased cortisol, hyponatremia, and hyperkalemia
Decreased cortisol, hyponatremia, and hyperkalemia
CORRECT ANSWER: Increased cortisol, hypernatremia, and hypokalemia
Expert Rationale: Cushing's syndrome is characterized by excessive cortisol production,
which leads to a cascade of metabolic effects. The increased cortisol causes sodium
retention (hypernatremia) and potassium excretion (hypokalemia) due to the
mineralocorticoid effects of cortisol. The excess cortisol also promotes gluconeogenesis,
leading to hyperglycemia, and causes protein catabolism, resulting in muscle wasting
and easy bruising. The classic laboratory findings include elevated serum cortisol levels
(loss of diurnal variation), elevated serum sodium, decreased serum potassium, elevated
blood glucose, and leukocytosis. The condition may be ACTH-dependent (Cushing's
disease from pituitary adenoma) or ACTH-independent (adrenal adenoma or exogenous
glucocorticoid use).
DIF: Cognitive Level: Understand (Comprehension)
TOP: Endocrine — Cushing's Syndrome
MSC: Maryville NURS 623 — Endocrine Disorders
Alice, age 48, has a benign thyroid nodule. The most common treatment involves:
Watchful waiting with an annual follow-up
Surgical removal of the nodule
, Radioactive iodine therapy
Thyroid hormone suppression therapy
CORRECT ANSWER: Watchful waiting with an annual follow-up
Expert Rationale: The majority of thyroid nodules are benign, and the most common
management approach is watchful waiting with annual follow-up. For benign nodules
that are asymptomatic and not causing compression symptoms, routine monitoring is
appropriate. The annual follow-up typically includes a physical examination and thyroid
ultrasound to assess for any changes in size or characteristics. If the nodule remains
stable, observation can continue. Surgical intervention is reserved for cases where there
is suspicion of malignancy, compressive symptoms (dysphagia, dysphonia, or dyspnea),
or significant growth. Thyroid hormone suppression therapy is controversial and not
routinely recommended for benign nodules due to the risk of inducing subclinical
hyperthyroidism and osteoporosis.
DIF: Cognitive Level: Apply (Application)
TOP: Endocrine — Thyroid Nodules
MSC: Maryville NURS 623 — Thyroid Disorders
ACE inhibitors are given to clients with diabetes who have:
Persistent proteinuria
Hypertension
Hyperglycemia
Nephropathy
CORRECT ANSWER: Persistent proteinuria
Expert Rationale: ACE inhibitors are the first-line therapy for diabetic patients with
persistent proteinuria (microalbuminuria or macroalbuminuria) because they provide
renoprotective effects beyond blood pressure control. These medications reduce
intraglomerular pressure and decrease urinary protein excretion, slowing the
progression of diabetic nephropathy. Even in normotensive patients with diabetes, ACE
inhibitors are recommended if persistent microalbuminuria is present. The
renoprotective effects are particularly important because diabetic nephropathy is a
leading cause of end-stage renal disease. ACE inhibitors also have beneficial effects on
, cardiovascular outcomes in diabetic patients. Monitoring for hyperkalemia and renal
function is essential when initiating these medications.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Endocrine — Diabetes Complications
MSC: Maryville NURS 623 — Diabetes Management
A newly diagnosed client with diabetes who has an HbA1c of 7.5 is started on
therapeutic lifestyle changes (TLC) and medical nutritional therapy (MNT). Which
oral antidiabetic agent is recommended as monotherapy?
Metformin
Sulfonylurea
DPP-4 inhibitor
SGLT-2 inhibitor
CORRECT ANSWER: Metformin
Expert Rationale: Metformin is the recommended first-line oral antidiabetic agent for
most patients with type 2 diabetes. It is the preferred initial pharmacologic therapy due
to its efficacy, safety profile, low cost, and beneficial effects on cardiovascular outcomes.
Metformin works by decreasing hepatic glucose production and increasing insulin
sensitivity in peripheral tissues. It does not cause hypoglycemia or weight gain when
used as monotherapy. Contraindications include significant renal impairment (GFR <30),
hepatic disease, and conditions predisposing to lactic acidosis. Metformin should be
started at a low dose and titrated gradually to minimize gastrointestinal side effects. If
glycemic targets are not achieved with metformin alone, a second agent may be added.
DIF: Cognitive Level: Apply (Application)
TOP: Endocrine — Diabetes Medications
MSC: Maryville NURS 623 — Diabetes Management
An elderly client with hyperthyroidism may present with atypical symptoms.
Which of the following manifestations are commonly seen in the elderly with
hyperthyroidism?
, Atrial fibrillation, depression, weight loss
Weight gain, bradycardia, heat intolerance
Exophthalmos, tachycardia, anxiety
Cold intolerance, weight gain, fatigue
CORRECT ANSWER: Atrial fibrillation, depression, weight loss
Expert Rationale: Elderly patients with hyperthyroidism often present with atypical
manifestations that differ from younger patients. This condition is sometimes called
"apathetic hyperthyroidism." Common atypical presentations include atrial fibrillation
(which may be the only manifestation), depression, confusion, weight loss despite
anorexia, and mild symptoms without the classic signs of hyperthyroidism. Elderly
patients may not demonstrate the typical tachycardia, tremor, or heat intolerance seen
in younger patients. The clinical presentation can be subtle and easily mistaken for
normal aging, depression, or other conditions. A high index of suspicion is required for
diagnosis, and thyroid function tests should be considered in elderly patients presenting
with unexplained atrial fibrillation, weight loss, or depression.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Endocrine — Hyperthyroidism in Elderly
MSC: Maryville NURS 623 — Thyroid Disorders
Diane has had Cushing's disease for 20 years and has been taking hydrocortisone
since her diagnosis. Today, she appears with a thick trunk and thin extremities.
She has a "moon face," a "buffalo hump," thin skin with visible capillaries, and a
number of bruises that appear to be slow in healing. To what do you attribute
these symptoms?
Excessive levels of cortisol
Inadequate levels of cortisol
Excessive levels of aldosterone
Inadequate levels of aldosterone
CORRECT ANSWER: Excessive levels of cortisol
Expert Rationale: The characteristic physical findings described—central obesity (thick
trunk with thin extremities), moon face, buffalo hump, thin skin with visible capillaries,
and easy bruising—are classic features of Cushing's syndrome caused by excessive
MARYVILLE NURS 623 EXAM 2(ENDOCRINE & METABOLIC)
EXAM GUIDE NEWEST VERSION 2026-2027 EXPECTED
QUESTION AND CORRECT ANSWER FROM VERIFIED
SOURCES.
Which of the serum laboratory findings are present in the client with Cushing's
syndrome?
Increased cortisol, hypernatremia, and hypokalemia
Decreased cortisol, hypernatremia, and hypokalemia
Increased cortisol, hyponatremia, and hyperkalemia
Decreased cortisol, hyponatremia, and hyperkalemia
CORRECT ANSWER: Increased cortisol, hypernatremia, and hypokalemia
Expert Rationale: Cushing's syndrome is characterized by excessive cortisol production,
which leads to a cascade of metabolic effects. The increased cortisol causes sodium
retention (hypernatremia) and potassium excretion (hypokalemia) due to the
mineralocorticoid effects of cortisol. The excess cortisol also promotes gluconeogenesis,
leading to hyperglycemia, and causes protein catabolism, resulting in muscle wasting
and easy bruising. The classic laboratory findings include elevated serum cortisol levels
(loss of diurnal variation), elevated serum sodium, decreased serum potassium, elevated
blood glucose, and leukocytosis. The condition may be ACTH-dependent (Cushing's
disease from pituitary adenoma) or ACTH-independent (adrenal adenoma or exogenous
glucocorticoid use).
DIF: Cognitive Level: Understand (Comprehension)
TOP: Endocrine — Cushing's Syndrome
MSC: Maryville NURS 623 — Endocrine Disorders
Alice, age 48, has a benign thyroid nodule. The most common treatment involves:
Watchful waiting with an annual follow-up
Surgical removal of the nodule
, Radioactive iodine therapy
Thyroid hormone suppression therapy
CORRECT ANSWER: Watchful waiting with an annual follow-up
Expert Rationale: The majority of thyroid nodules are benign, and the most common
management approach is watchful waiting with annual follow-up. For benign nodules
that are asymptomatic and not causing compression symptoms, routine monitoring is
appropriate. The annual follow-up typically includes a physical examination and thyroid
ultrasound to assess for any changes in size or characteristics. If the nodule remains
stable, observation can continue. Surgical intervention is reserved for cases where there
is suspicion of malignancy, compressive symptoms (dysphagia, dysphonia, or dyspnea),
or significant growth. Thyroid hormone suppression therapy is controversial and not
routinely recommended for benign nodules due to the risk of inducing subclinical
hyperthyroidism and osteoporosis.
DIF: Cognitive Level: Apply (Application)
TOP: Endocrine — Thyroid Nodules
MSC: Maryville NURS 623 — Thyroid Disorders
ACE inhibitors are given to clients with diabetes who have:
Persistent proteinuria
Hypertension
Hyperglycemia
Nephropathy
CORRECT ANSWER: Persistent proteinuria
Expert Rationale: ACE inhibitors are the first-line therapy for diabetic patients with
persistent proteinuria (microalbuminuria or macroalbuminuria) because they provide
renoprotective effects beyond blood pressure control. These medications reduce
intraglomerular pressure and decrease urinary protein excretion, slowing the
progression of diabetic nephropathy. Even in normotensive patients with diabetes, ACE
inhibitors are recommended if persistent microalbuminuria is present. The
renoprotective effects are particularly important because diabetic nephropathy is a
leading cause of end-stage renal disease. ACE inhibitors also have beneficial effects on
, cardiovascular outcomes in diabetic patients. Monitoring for hyperkalemia and renal
function is essential when initiating these medications.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Endocrine — Diabetes Complications
MSC: Maryville NURS 623 — Diabetes Management
A newly diagnosed client with diabetes who has an HbA1c of 7.5 is started on
therapeutic lifestyle changes (TLC) and medical nutritional therapy (MNT). Which
oral antidiabetic agent is recommended as monotherapy?
Metformin
Sulfonylurea
DPP-4 inhibitor
SGLT-2 inhibitor
CORRECT ANSWER: Metformin
Expert Rationale: Metformin is the recommended first-line oral antidiabetic agent for
most patients with type 2 diabetes. It is the preferred initial pharmacologic therapy due
to its efficacy, safety profile, low cost, and beneficial effects on cardiovascular outcomes.
Metformin works by decreasing hepatic glucose production and increasing insulin
sensitivity in peripheral tissues. It does not cause hypoglycemia or weight gain when
used as monotherapy. Contraindications include significant renal impairment (GFR <30),
hepatic disease, and conditions predisposing to lactic acidosis. Metformin should be
started at a low dose and titrated gradually to minimize gastrointestinal side effects. If
glycemic targets are not achieved with metformin alone, a second agent may be added.
DIF: Cognitive Level: Apply (Application)
TOP: Endocrine — Diabetes Medications
MSC: Maryville NURS 623 — Diabetes Management
An elderly client with hyperthyroidism may present with atypical symptoms.
Which of the following manifestations are commonly seen in the elderly with
hyperthyroidism?
, Atrial fibrillation, depression, weight loss
Weight gain, bradycardia, heat intolerance
Exophthalmos, tachycardia, anxiety
Cold intolerance, weight gain, fatigue
CORRECT ANSWER: Atrial fibrillation, depression, weight loss
Expert Rationale: Elderly patients with hyperthyroidism often present with atypical
manifestations that differ from younger patients. This condition is sometimes called
"apathetic hyperthyroidism." Common atypical presentations include atrial fibrillation
(which may be the only manifestation), depression, confusion, weight loss despite
anorexia, and mild symptoms without the classic signs of hyperthyroidism. Elderly
patients may not demonstrate the typical tachycardia, tremor, or heat intolerance seen
in younger patients. The clinical presentation can be subtle and easily mistaken for
normal aging, depression, or other conditions. A high index of suspicion is required for
diagnosis, and thyroid function tests should be considered in elderly patients presenting
with unexplained atrial fibrillation, weight loss, or depression.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Endocrine — Hyperthyroidism in Elderly
MSC: Maryville NURS 623 — Thyroid Disorders
Diane has had Cushing's disease for 20 years and has been taking hydrocortisone
since her diagnosis. Today, she appears with a thick trunk and thin extremities.
She has a "moon face," a "buffalo hump," thin skin with visible capillaries, and a
number of bruises that appear to be slow in healing. To what do you attribute
these symptoms?
Excessive levels of cortisol
Inadequate levels of cortisol
Excessive levels of aldosterone
Inadequate levels of aldosterone
CORRECT ANSWER: Excessive levels of cortisol
Expert Rationale: The characteristic physical findings described—central obesity (thick
trunk with thin extremities), moon face, buffalo hump, thin skin with visible capillaries,
and easy bruising—are classic features of Cushing's syndrome caused by excessive
