Pathophysiology Nursing Exam
– Endocrine & GI Disorders
(2026)
Comprehensive Practice
Examination
SECTION 1: ENDOCRINE DISORDERS (Questions 1-35)
Question 1:
A patient with type 1 diabetes mellitus presents with fruity breath odor, Kussmaul respirations, and
blood glucose of 620 mg/dL. Which acid-base imbalance is the patient experiencing?
A) Respiratory acidosis
B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis
Answer: B) Metabolic acidosis
Rationale: Diabetic ketoacidosis (DKA) results from accumulation of ketone bodies due to insufficient
insulin. Ketone bodies are organic acids that decrease serum bicarbonate, leading to metabolic acidosis.
Kussmaul respirations are the body's compensatory mechanism to blow off CO2. Fruity breath odor is
from acetone, a ketone body.
Question 2:
A patient with Cushing's syndrome would MOST likely exhibit which clinical manifestation?
A) Hypotension and weight loss
B) Moon face, buffalo hump, and purple striae
C) Exophthalmos and goiter
D) Hypoglycemia and hyperpigmentation
,Answer: B) Moon face, buffalo hump, and purple striae
Rationale: Cushing's syndrome results from chronic excess cortisol. Characteristic features include central
obesity, moon facies, buffalo hump (fat deposition between shoulders), purple striae (stretch marks),
hypertension, hyperglycemia, and easy bruising. Exophthalmos and goiter are seen in Graves' disease.
Hyperpigmentation occurs in Addison's disease.
Question 3:
Which laboratory finding is MOST consistent with primary hypothyroidism?
A) Elevated TSH, low T3 and T4
B) Low TSH, elevated T3 and T4
C) Elevated TSH, elevated T3 and T4
D) Low TSH, low T3 and T4
Answer: A) Elevated TSH, low T3 and T4
Rationale: Primary hypothyroidism indicates dysfunction of the thyroid gland itself. The pituitary gland
responds by increasing TSH production in an attempt to stimulate the underactive thyroid, but T3 and T4
remain low. Secondary hypothyroidism (pituitary dysfunction) would show low TSH and low T3/T4.
Question 4:
A patient with Addison's disease is at risk for which life-threatening complication?
A) Thyroid storm
B) Myxedema coma
C) Addisonian crisis
D) Pheochromocytoma
Answer: C) Addisonian crisis
Rationale: Addisonian crisis is an acute, life-threatening complication of adrenal insufficiency
characterized by severe hypotension, hypoglycemia, hyponatremia, hyperkalemia, and shock. It can be
triggered by stress, infection, trauma, or abrupt discontinuation of corticosteroids. Thyroid storm is
associated with hyperthyroidism, and myxedema coma with severe hypothyroidism.
Question 5:
The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which
intervention is MOST appropriate?
A) Restrict fluids to 500-1000 mL/day
B) Administer IV normal saline rapidly
C) Encourage oral fluid intake of 3000 mL/day
D) Restrict sodium intake
Answer: A) Restrict fluids to 500-1000 mL/day
Rationale: SIADH causes excessive water retention and dilutional hyponatremia. Fluid restriction is the
,primary intervention to correct the fluid overload and increase serum sodium concentration. Rapid IV
saline can worsen hyponatremia by further diluting sodium. Sodium intake should not be restricted as
the patient is already sodium-deficient.
Question 6:
Which finding indicates that treatment for diabetic ketoacidosis is effective?
A) Decreasing serum bicarbonate level
B) Increasing blood glucose level
C) Increasing serum potassium level
D) Decreasing anion gap
Answer: D) Decreasing anion gap
Rationale: The anion gap increases in DKA due to accumulation of unmeasured anions (ketones). As
insulin therapy corrects the metabolic acidosis, the anion gap decreases toward normal. Bicarbonate
should increase, not decrease. Blood glucose should decrease, and potassium may shift intracellularly
requiring careful monitoring.
Question 7:
A patient with hyperthyroidism is prescribed propylthiouracil (PTU). What is the primary mechanism of
action of this medication?
A) Blocks conversion of T4 to T3
B) Destroys thyroid tissue with radioactive iodine
C) Blocks synthesis of thyroid hormones
D) Blocks release of thyroid hormones
Answer: A) Blocks conversion of T4 to T3
Rationale: PTU inhibits thyroid peroxidase (preventing T4 and T3 synthesis) AND blocks peripheral
conversion of T4 to T3. This dual mechanism makes it particularly effective. Methimazole only blocks
synthesis. Radioactive iodine destroys thyroid tissue. Beta-blockers block the sympathetic symptoms but
do not affect hormone production.
Question 8:
Which assessment finding is characteristic of pheochromocytoma?
A) Hypotension and bradycardia
B) Hypertension and tachycardia with episodic headaches
C) Hypoglycemia and weight gain
D) Hyperpigmentation and hypotension
Answer: B) Hypertension and tachycardia with episodic headaches
Rationale: Pheochromocytoma is a tumor of the adrenal medulla that secretes excessive catecholamines.
The classic triad includes severe headache, diaphoresis, and tachycardia with paroxysmal or sustained
, hypertension. Hypotension and bradycardia are not characteristic. Weight gain and hypoglycemia
suggest adrenal insufficiency or hypothyroidism.
Question 9:
A patient with type 2 diabetes is prescribed metformin. Which adverse effect should the nurse monitor?
A) Hypoglycemia
B) Weight gain
C) Lactic acidosis
D) Pancreatitis
Answer: C) Lactic acidosis
Rationale: Metformin can cause lactic acidosis, a rare but serious adverse effect, especially in patients
with renal impairment, liver disease, or cardiac insufficiency. It should be held before procedures with
contrast dye. Metformin typically causes weight loss (not gain), does not usually cause significant
hypoglycemia alone, and pancreatitis is not a common adverse effect.
Question 10:
Which laboratory value is consistent with diabetes insipidus?
A) Serum sodium 155 mEq/L, urine specific gravity 1.003
B) Serum sodium 130 mEq/L, urine specific gravity 1.030
C) Serum sodium 140 mEq/L, urine specific gravity 1.015
D) Serum sodium 135 mEq/L, urine specific gravity 1.025
Answer: A) Serum sodium 155 mEq/L, urine specific gravity 1.003
Rationale: Diabetes insipidus is characterized by inability to concentrate urine due to ADH deficiency or
resistance. This leads to large volumes of dilute urine (specific gravity <1.005) and hypernatremia (serum
sodium >145 mEq/L) from excessive water loss. Option B suggests SIADH (dilutional hyponatremia with
concentrated urine).
Question 11:
The nurse is assessing a patient with Graves' disease. Which finding requires immediate intervention?
A) Heart rate 110 bpm
B) Tremors in the hands
C) Temperature 103.2°F (39.6°C)
D) Exophthalmos
Answer: C) Temperature 103.2°F (39.6°C)
Rationale: This temperature indicates thyroid storm, a life-threatening complication characterized by
hyperthermia, severe tachycardia, agitation, and cardiovascular collapse. Immediate intervention is
required. While tachycardia and tremors are expected in Graves' disease, they do not indicate an
immediate crisis. Exophthalmos is a non-emergent manifestation.
– Endocrine & GI Disorders
(2026)
Comprehensive Practice
Examination
SECTION 1: ENDOCRINE DISORDERS (Questions 1-35)
Question 1:
A patient with type 1 diabetes mellitus presents with fruity breath odor, Kussmaul respirations, and
blood glucose of 620 mg/dL. Which acid-base imbalance is the patient experiencing?
A) Respiratory acidosis
B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis
Answer: B) Metabolic acidosis
Rationale: Diabetic ketoacidosis (DKA) results from accumulation of ketone bodies due to insufficient
insulin. Ketone bodies are organic acids that decrease serum bicarbonate, leading to metabolic acidosis.
Kussmaul respirations are the body's compensatory mechanism to blow off CO2. Fruity breath odor is
from acetone, a ketone body.
Question 2:
A patient with Cushing's syndrome would MOST likely exhibit which clinical manifestation?
A) Hypotension and weight loss
B) Moon face, buffalo hump, and purple striae
C) Exophthalmos and goiter
D) Hypoglycemia and hyperpigmentation
,Answer: B) Moon face, buffalo hump, and purple striae
Rationale: Cushing's syndrome results from chronic excess cortisol. Characteristic features include central
obesity, moon facies, buffalo hump (fat deposition between shoulders), purple striae (stretch marks),
hypertension, hyperglycemia, and easy bruising. Exophthalmos and goiter are seen in Graves' disease.
Hyperpigmentation occurs in Addison's disease.
Question 3:
Which laboratory finding is MOST consistent with primary hypothyroidism?
A) Elevated TSH, low T3 and T4
B) Low TSH, elevated T3 and T4
C) Elevated TSH, elevated T3 and T4
D) Low TSH, low T3 and T4
Answer: A) Elevated TSH, low T3 and T4
Rationale: Primary hypothyroidism indicates dysfunction of the thyroid gland itself. The pituitary gland
responds by increasing TSH production in an attempt to stimulate the underactive thyroid, but T3 and T4
remain low. Secondary hypothyroidism (pituitary dysfunction) would show low TSH and low T3/T4.
Question 4:
A patient with Addison's disease is at risk for which life-threatening complication?
A) Thyroid storm
B) Myxedema coma
C) Addisonian crisis
D) Pheochromocytoma
Answer: C) Addisonian crisis
Rationale: Addisonian crisis is an acute, life-threatening complication of adrenal insufficiency
characterized by severe hypotension, hypoglycemia, hyponatremia, hyperkalemia, and shock. It can be
triggered by stress, infection, trauma, or abrupt discontinuation of corticosteroids. Thyroid storm is
associated with hyperthyroidism, and myxedema coma with severe hypothyroidism.
Question 5:
The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which
intervention is MOST appropriate?
A) Restrict fluids to 500-1000 mL/day
B) Administer IV normal saline rapidly
C) Encourage oral fluid intake of 3000 mL/day
D) Restrict sodium intake
Answer: A) Restrict fluids to 500-1000 mL/day
Rationale: SIADH causes excessive water retention and dilutional hyponatremia. Fluid restriction is the
,primary intervention to correct the fluid overload and increase serum sodium concentration. Rapid IV
saline can worsen hyponatremia by further diluting sodium. Sodium intake should not be restricted as
the patient is already sodium-deficient.
Question 6:
Which finding indicates that treatment for diabetic ketoacidosis is effective?
A) Decreasing serum bicarbonate level
B) Increasing blood glucose level
C) Increasing serum potassium level
D) Decreasing anion gap
Answer: D) Decreasing anion gap
Rationale: The anion gap increases in DKA due to accumulation of unmeasured anions (ketones). As
insulin therapy corrects the metabolic acidosis, the anion gap decreases toward normal. Bicarbonate
should increase, not decrease. Blood glucose should decrease, and potassium may shift intracellularly
requiring careful monitoring.
Question 7:
A patient with hyperthyroidism is prescribed propylthiouracil (PTU). What is the primary mechanism of
action of this medication?
A) Blocks conversion of T4 to T3
B) Destroys thyroid tissue with radioactive iodine
C) Blocks synthesis of thyroid hormones
D) Blocks release of thyroid hormones
Answer: A) Blocks conversion of T4 to T3
Rationale: PTU inhibits thyroid peroxidase (preventing T4 and T3 synthesis) AND blocks peripheral
conversion of T4 to T3. This dual mechanism makes it particularly effective. Methimazole only blocks
synthesis. Radioactive iodine destroys thyroid tissue. Beta-blockers block the sympathetic symptoms but
do not affect hormone production.
Question 8:
Which assessment finding is characteristic of pheochromocytoma?
A) Hypotension and bradycardia
B) Hypertension and tachycardia with episodic headaches
C) Hypoglycemia and weight gain
D) Hyperpigmentation and hypotension
Answer: B) Hypertension and tachycardia with episodic headaches
Rationale: Pheochromocytoma is a tumor of the adrenal medulla that secretes excessive catecholamines.
The classic triad includes severe headache, diaphoresis, and tachycardia with paroxysmal or sustained
, hypertension. Hypotension and bradycardia are not characteristic. Weight gain and hypoglycemia
suggest adrenal insufficiency or hypothyroidism.
Question 9:
A patient with type 2 diabetes is prescribed metformin. Which adverse effect should the nurse monitor?
A) Hypoglycemia
B) Weight gain
C) Lactic acidosis
D) Pancreatitis
Answer: C) Lactic acidosis
Rationale: Metformin can cause lactic acidosis, a rare but serious adverse effect, especially in patients
with renal impairment, liver disease, or cardiac insufficiency. It should be held before procedures with
contrast dye. Metformin typically causes weight loss (not gain), does not usually cause significant
hypoglycemia alone, and pancreatitis is not a common adverse effect.
Question 10:
Which laboratory value is consistent with diabetes insipidus?
A) Serum sodium 155 mEq/L, urine specific gravity 1.003
B) Serum sodium 130 mEq/L, urine specific gravity 1.030
C) Serum sodium 140 mEq/L, urine specific gravity 1.015
D) Serum sodium 135 mEq/L, urine specific gravity 1.025
Answer: A) Serum sodium 155 mEq/L, urine specific gravity 1.003
Rationale: Diabetes insipidus is characterized by inability to concentrate urine due to ADH deficiency or
resistance. This leads to large volumes of dilute urine (specific gravity <1.005) and hypernatremia (serum
sodium >145 mEq/L) from excessive water loss. Option B suggests SIADH (dilutional hyponatremia with
concentrated urine).
Question 11:
The nurse is assessing a patient with Graves' disease. Which finding requires immediate intervention?
A) Heart rate 110 bpm
B) Tremors in the hands
C) Temperature 103.2°F (39.6°C)
D) Exophthalmos
Answer: C) Temperature 103.2°F (39.6°C)
Rationale: This temperature indicates thyroid storm, a life-threatening complication characterized by
hyperthermia, severe tachycardia, agitation, and cardiovascular collapse. Immediate intervention is
required. While tachycardia and tremors are expected in Graves' disease, they do not indicate an
immediate crisis. Exophthalmos is a non-emergent manifestation.
