NURS 5315 ENDOCRINE EXAM /UTA NURS 5315 ADVANCED
PATHOPHYSIOLOGY MODULE 8 ENDOCRINE EXAM ACTUAL EXAM
2026/2027 PRACTICE QUESTIONS AND STUDY
1. A patient is evaluated for fatigue, weight change, and altered metabolic
function. Laboratory testing shows elevated thyroid-stimulating hormone
with a low free thyroxine concentration. Which pathophysiologic process
best explains these findings?
A. Autonomous thyroid hormone secretion
B. Primary thyroid gland failure
C. Excess hypothalamic TRH secretion
D. Increased peripheral conversion of T4 to T3
Answer: B
2. A patient develops progressive fatigue, weight gain, constipation, dry skin,
and cold intolerance. Laboratory studies demonstrate elevated TSH and
decreased free T4. Which disorder is most consistent with this
presentation?
A. Graves disease
B. Central hypothyroidism
C. Primary hypothyroidism
D. Thyroid storm
Answer: C
3. A patient has antibodies directed against thyroid peroxidase and
thyroglobulin and develops gradually progressive thyroid failure. Which
underlying mechanism is most likely responsible?
A. Autoimmune destruction of thyroid tissue
B. Autonomous stimulation of the TSH receptor
C. Excessive ACTH secretion
D. Iodine-independent thyroid hormone synthesis
Answer: A
pg. 1
, 4. A patient presents with weight loss despite increased appetite, heat
intolerance, tremor, anxiety, tachycardia, and a diffuse goiter. Which
pathophysiologic mechanism most directly explains this disorder?
A. Destruction of thyroid follicles with reduced hormone production
B. Deficient TSH secretion from the pituitary
C. Antibodies stimulating the TSH receptor
D. Reduced peripheral conversion of T4 to T3
Answer: C
5. A patient with untreated hyperthyroidism develops fever, severe
tachycardia, agitation, vomiting, and cardiovascular instability during an
acute illness. Which endocrine emergency should be suspected?
A. Myxedema coma
B. Thyroid storm
C. Addisonian crisis
D. Hyperosmolar hyperglycemic state
Answer: B
6. A patient with severe hypothyroidism becomes progressively hypothermic,
bradycardic, hypotensive, and increasingly difficult to arouse. Which
condition best explains the acute deterioration?
A. Myxedema coma
B. Thyroid storm
C. Pheochromocytoma crisis
D. Hyperparathyroidism
Answer: A
7. A patient with Graves disease develops prominent ocular findings caused by
autoimmune inflammation and tissue expansion behind the eyes. Which
manifestation is characteristic?
A. Exophthalmos
B. Periorbital edema caused by hypoalbuminemia
C. Retinal detachment
pg. 2
, D. Cataract formation
Answer: A
8. A patient develops painful thyroid enlargement following a recent viral
upper respiratory infection. Thyroid hormone levels initially indicate
thyrotoxicosis, followed later by a transient hypothyroid phase. Which
disorder is most likely?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
Answer: C
9. A patient with hyperthyroidism has low TSH and elevated free T4. The
clinician explains that the low TSH is caused by suppression of pituitary
thyrotroph activity. Which physiologic principle does this illustrate?
A. Positive feedback
B. Negative feedback
C. Feed-forward stimulation
D. Receptor sensitization
Answer: B
10. A patient has low free T4 and an inappropriately low or normal TSH rather
than the elevated TSH expected with primary thyroid failure. Which
abnormality should be considered?
A. Central hypothyroidism
B. Graves disease
C. Toxic multinodular goiter
D. Primary hyperthyroidism
Answer: A
11. A patient with a thyroid nodule undergoes evaluation because of concern
for malignancy. Which finding generally increases concern for thyroid
cancer?
A. Tenderness that began during an acute viral illness
pg. 3
, B. A rapidly enlarging firm nodule with suspicious cervical
lymphadenopathy
C. Diffuse thyroid enlargement with tremor
D. Long-standing mild fatigue
Answer: B
12. A patient has a thyroid nodule and suppressed TSH. Which diagnostic
approach is particularly useful for determining whether the nodule is
functioning autonomously?
A. Serum calcium measurement alone
B. Radioactive iodine uptake and scan when appropriate
C. Serum cortisol testing alone
D. Urinalysis
Answer: B
13. A patient with thyroid dysfunction has normal TSH but persistently
abnormal free T4 levels. Which concept should the advanced practice nurse
consider before concluding that the thyroid gland itself is failing?
A. Laboratory assay interference or altered binding physiology
B. Immediate thyroid storm
C. Complete adrenal failure
D. Increased parathyroid hormone secretion
Answer: A
14. A patient with severe hypothyroidism has elevated serum cholesterol.
Which pathophysiologic mechanism contributes to this abnormality?
A. Increased hepatic LDL receptor activity
B. Reduced LDL clearance from decreased thyroid hormone action
C. Increased insulin secretion alone
D. Increased intestinal calcium absorption
Answer: B
15. A patient with hyperthyroidism develops muscle weakness and increased
bone turnover. Which physiologic consequence of excess thyroid hormone
contributes to these manifestations?
pg. 4
PATHOPHYSIOLOGY MODULE 8 ENDOCRINE EXAM ACTUAL EXAM
2026/2027 PRACTICE QUESTIONS AND STUDY
1. A patient is evaluated for fatigue, weight change, and altered metabolic
function. Laboratory testing shows elevated thyroid-stimulating hormone
with a low free thyroxine concentration. Which pathophysiologic process
best explains these findings?
A. Autonomous thyroid hormone secretion
B. Primary thyroid gland failure
C. Excess hypothalamic TRH secretion
D. Increased peripheral conversion of T4 to T3
Answer: B
2. A patient develops progressive fatigue, weight gain, constipation, dry skin,
and cold intolerance. Laboratory studies demonstrate elevated TSH and
decreased free T4. Which disorder is most consistent with this
presentation?
A. Graves disease
B. Central hypothyroidism
C. Primary hypothyroidism
D. Thyroid storm
Answer: C
3. A patient has antibodies directed against thyroid peroxidase and
thyroglobulin and develops gradually progressive thyroid failure. Which
underlying mechanism is most likely responsible?
A. Autoimmune destruction of thyroid tissue
B. Autonomous stimulation of the TSH receptor
C. Excessive ACTH secretion
D. Iodine-independent thyroid hormone synthesis
Answer: A
pg. 1
, 4. A patient presents with weight loss despite increased appetite, heat
intolerance, tremor, anxiety, tachycardia, and a diffuse goiter. Which
pathophysiologic mechanism most directly explains this disorder?
A. Destruction of thyroid follicles with reduced hormone production
B. Deficient TSH secretion from the pituitary
C. Antibodies stimulating the TSH receptor
D. Reduced peripheral conversion of T4 to T3
Answer: C
5. A patient with untreated hyperthyroidism develops fever, severe
tachycardia, agitation, vomiting, and cardiovascular instability during an
acute illness. Which endocrine emergency should be suspected?
A. Myxedema coma
B. Thyroid storm
C. Addisonian crisis
D. Hyperosmolar hyperglycemic state
Answer: B
6. A patient with severe hypothyroidism becomes progressively hypothermic,
bradycardic, hypotensive, and increasingly difficult to arouse. Which
condition best explains the acute deterioration?
A. Myxedema coma
B. Thyroid storm
C. Pheochromocytoma crisis
D. Hyperparathyroidism
Answer: A
7. A patient with Graves disease develops prominent ocular findings caused by
autoimmune inflammation and tissue expansion behind the eyes. Which
manifestation is characteristic?
A. Exophthalmos
B. Periorbital edema caused by hypoalbuminemia
C. Retinal detachment
pg. 2
, D. Cataract formation
Answer: A
8. A patient develops painful thyroid enlargement following a recent viral
upper respiratory infection. Thyroid hormone levels initially indicate
thyrotoxicosis, followed later by a transient hypothyroid phase. Which
disorder is most likely?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
Answer: C
9. A patient with hyperthyroidism has low TSH and elevated free T4. The
clinician explains that the low TSH is caused by suppression of pituitary
thyrotroph activity. Which physiologic principle does this illustrate?
A. Positive feedback
B. Negative feedback
C. Feed-forward stimulation
D. Receptor sensitization
Answer: B
10. A patient has low free T4 and an inappropriately low or normal TSH rather
than the elevated TSH expected with primary thyroid failure. Which
abnormality should be considered?
A. Central hypothyroidism
B. Graves disease
C. Toxic multinodular goiter
D. Primary hyperthyroidism
Answer: A
11. A patient with a thyroid nodule undergoes evaluation because of concern
for malignancy. Which finding generally increases concern for thyroid
cancer?
A. Tenderness that began during an acute viral illness
pg. 3
, B. A rapidly enlarging firm nodule with suspicious cervical
lymphadenopathy
C. Diffuse thyroid enlargement with tremor
D. Long-standing mild fatigue
Answer: B
12. A patient has a thyroid nodule and suppressed TSH. Which diagnostic
approach is particularly useful for determining whether the nodule is
functioning autonomously?
A. Serum calcium measurement alone
B. Radioactive iodine uptake and scan when appropriate
C. Serum cortisol testing alone
D. Urinalysis
Answer: B
13. A patient with thyroid dysfunction has normal TSH but persistently
abnormal free T4 levels. Which concept should the advanced practice nurse
consider before concluding that the thyroid gland itself is failing?
A. Laboratory assay interference or altered binding physiology
B. Immediate thyroid storm
C. Complete adrenal failure
D. Increased parathyroid hormone secretion
Answer: A
14. A patient with severe hypothyroidism has elevated serum cholesterol.
Which pathophysiologic mechanism contributes to this abnormality?
A. Increased hepatic LDL receptor activity
B. Reduced LDL clearance from decreased thyroid hormone action
C. Increased insulin secretion alone
D. Increased intestinal calcium absorption
Answer: B
15. A patient with hyperthyroidism develops muscle weakness and increased
bone turnover. Which physiologic consequence of excess thyroid hormone
contributes to these manifestations?
pg. 4
