NURS 5315 Endocrine Disorders Actual Exam |
Complete Questions and Answers, Detailed
Rationales – Pass Guaranteed - A+ Graded
Part I: Master Gland – Hypothalamic-Pituitary Axis Disorders
Q1: Which hormone is primarily responsible for stimulating the secretion of cortisol from
the adrenal cortex?
A. Antidiuretic hormone (ADH)
B. Adrenocorticotropic hormone (ACTH) [CORRECT]
C. Thyroid-stimulating hormone (TSH)
D. Follicle-stimulating hormone (FSH)
Correct Answer: B
Rationale: The best answer is B because ACTH is the direct trophic hormone from the
anterior pituitary that triggers cortisol production, fitting perfectly into the
hypothalamic-pituitary-adrenal axis.
Q2: A 42-year-old patient presents to the clinic complaining of increasing shoe size,
prominent jaw protrusion, and severe headaches. You suspect acromegaly. What is the
underlying pathophysiology of these physical changes?
A. Excess growth hormone secretion after epiphyseal plate closure [CORRECT]
B. Excess growth hormone secretion before epiphyseal plate closure
C. Deficient thyroid hormone leading to soft tissue deposition
D. Hypersecretion of prolactin causing galactorrhea and bone changes
Correct Answer: A
Rationale: This choice is correct because acromegaly occurs when a pituitary adenoma
secretes growth hormone in adulthood, after the growth plates have fused, causing
thickening of bones and soft tissues rather than a proportional increase in height.
Q3: A 68-year-old man with small cell lung cancer presents with confusion and muscle
twitching. Serum sodium is 118 mEq/L, serum osmolality is 245 mOsm/kg, and urine
osmolality is 450 mOsm/kg. How do these lab findings compare to the expected findings
in diabetes insipidus?
A. The low serum osmolality and high urine osmolality indicate SIADH, whereas
diabetes insipidus would show high serum osmolality and low urine osmolality
[CORRECT]
,B. The low serum sodium and low serum osmolality indicate SIADH, whereas diabetes
insipidus would show low serum sodium and high serum osmolality
C. The high urine osmolality indicates diabetes insipidus, whereas SIADH would
present with a low urine osmolality
D. Both conditions present with dilutional hyponatremia, but diabetes insipidus is
characterized by a urine specific gravity greater than 1.030
Correct Answer: A
Rationale: This aligns with the pathophysiology of SIADH, where inappropriate water
retention dilutes serum sodium and lowers serum osmolality while the kidneys continue
to excrete concentrated urine, which is the exact opposite of diabetes insipidus where
massive water loss leads to high serum osmolality and very dilute urine.
Q4: A patient is diagnosed with syndrome of inappropriate antidiuretic hormone
(SIADH). What is the first-line treatment for a symptomatic patient with a serum sodium
of 120 mEq/L who is having seizures?
A. Normal saline infusion at 250 mL/hr
B. Fluid restriction to 800 mL/day
C. Hypertonic saline (3%) infusion [CORRECT]
D. Demeclocycline therapy
Correct Answer: C
Rationale: This choice is correct because a patient with severe, symptomatic
hyponatremia from SIADH requires immediate hypertonic saline to rapidly raise the
serum sodium and reduce cerebral edema, while fluid restriction is too slow for an acute
seizure setting.
Q5: Where does antidiuretic hormone (ADH) exert its primary physiological effect to
concentrate urine?
A. Proximal convoluted tubule
B. Loop of Henle
C. Afferent arteriole
D. Collecting ducts [CORRECT]
Correct Answer: D
Rationale: The best answer is D because ADH binds to V2 receptors in the collecting
ducts, making them permeable to water so it can be reabsorbed back into the
bloodstream, which is the core mechanism of water regulation.
Q6: A 30-year-old woman presents with galactorrhea and secondary amenorrhea. A
pituitary MRI reveals a 6 mm microadenoma. What is the most appropriate first-line
pharmacological treatment?
A. Cabergoline [CORRECT]
B. Levothyroxine
, C. Octreotide
D. Desmopressin
Correct Answer: A
Rationale: This choice is correct because cabergoline is a dopamine agonist that
directly suppresses prolactin secretion from prolactinomas and often shrinks the tumor,
aligning with the pathophysiology where dopamine normally inhibits prolactin release.
Q7: A patient with a known pituitary macroadenoma suddenly develops a severe
headache, visual changes, and altered mental status. What is the priority nursing
intervention?
A. Administer oral levothyroxine
B. Prepare the patient for outpatient MRI scheduling
C. Administer high-dose IV corticosteroids and prepare for emergency surgery
[CORRECT]
D. Restrict fluids to prevent SIADH
Correct Answer: C
Rationale: The best answer is C because these are classic signs of pituitary apoplexy, a
neurosurgical emergency caused by sudden hemorrhage into the adenoma, requiring
immediate high-dose steroids to prevent acute adrenal insufficiency and emergent
decompression.
Q8: What is the primary physiological action of thyroid-stimulating hormone (TSH)?
A. Stimulate the thyroid gland to release T3 and T4 [CORRECT]
B. Stimulate the adrenal cortex to release cortisol
C. Inhibit prolactin release from the anterior pituitary
D. Stimulate bone growth at the epiphyseal plates
Correct Answer: A
Rationale: This matches the feedback loop where TSH acts directly on the thyroid gland
to promote the synthesis and secretion of triiodothyronine (T3) and thyroxine (T4),
which then negatively feedback to the pituitary.
Q9: A 50-year-old patient is recovering from a transsphenoidal hypophysectomy. The
provider orders baseline hormone panels. If the patient has developed
panhypopituitarism, which hormone replacement must be initiated first to prevent
life-threatening complications?
A. Levothyroxine
B. Desmopressin
C. Growth hormone
D. Hydrocortisone [CORRECT]
Correct Answer: D
Complete Questions and Answers, Detailed
Rationales – Pass Guaranteed - A+ Graded
Part I: Master Gland – Hypothalamic-Pituitary Axis Disorders
Q1: Which hormone is primarily responsible for stimulating the secretion of cortisol from
the adrenal cortex?
A. Antidiuretic hormone (ADH)
B. Adrenocorticotropic hormone (ACTH) [CORRECT]
C. Thyroid-stimulating hormone (TSH)
D. Follicle-stimulating hormone (FSH)
Correct Answer: B
Rationale: The best answer is B because ACTH is the direct trophic hormone from the
anterior pituitary that triggers cortisol production, fitting perfectly into the
hypothalamic-pituitary-adrenal axis.
Q2: A 42-year-old patient presents to the clinic complaining of increasing shoe size,
prominent jaw protrusion, and severe headaches. You suspect acromegaly. What is the
underlying pathophysiology of these physical changes?
A. Excess growth hormone secretion after epiphyseal plate closure [CORRECT]
B. Excess growth hormone secretion before epiphyseal plate closure
C. Deficient thyroid hormone leading to soft tissue deposition
D. Hypersecretion of prolactin causing galactorrhea and bone changes
Correct Answer: A
Rationale: This choice is correct because acromegaly occurs when a pituitary adenoma
secretes growth hormone in adulthood, after the growth plates have fused, causing
thickening of bones and soft tissues rather than a proportional increase in height.
Q3: A 68-year-old man with small cell lung cancer presents with confusion and muscle
twitching. Serum sodium is 118 mEq/L, serum osmolality is 245 mOsm/kg, and urine
osmolality is 450 mOsm/kg. How do these lab findings compare to the expected findings
in diabetes insipidus?
A. The low serum osmolality and high urine osmolality indicate SIADH, whereas
diabetes insipidus would show high serum osmolality and low urine osmolality
[CORRECT]
,B. The low serum sodium and low serum osmolality indicate SIADH, whereas diabetes
insipidus would show low serum sodium and high serum osmolality
C. The high urine osmolality indicates diabetes insipidus, whereas SIADH would
present with a low urine osmolality
D. Both conditions present with dilutional hyponatremia, but diabetes insipidus is
characterized by a urine specific gravity greater than 1.030
Correct Answer: A
Rationale: This aligns with the pathophysiology of SIADH, where inappropriate water
retention dilutes serum sodium and lowers serum osmolality while the kidneys continue
to excrete concentrated urine, which is the exact opposite of diabetes insipidus where
massive water loss leads to high serum osmolality and very dilute urine.
Q4: A patient is diagnosed with syndrome of inappropriate antidiuretic hormone
(SIADH). What is the first-line treatment for a symptomatic patient with a serum sodium
of 120 mEq/L who is having seizures?
A. Normal saline infusion at 250 mL/hr
B. Fluid restriction to 800 mL/day
C. Hypertonic saline (3%) infusion [CORRECT]
D. Demeclocycline therapy
Correct Answer: C
Rationale: This choice is correct because a patient with severe, symptomatic
hyponatremia from SIADH requires immediate hypertonic saline to rapidly raise the
serum sodium and reduce cerebral edema, while fluid restriction is too slow for an acute
seizure setting.
Q5: Where does antidiuretic hormone (ADH) exert its primary physiological effect to
concentrate urine?
A. Proximal convoluted tubule
B. Loop of Henle
C. Afferent arteriole
D. Collecting ducts [CORRECT]
Correct Answer: D
Rationale: The best answer is D because ADH binds to V2 receptors in the collecting
ducts, making them permeable to water so it can be reabsorbed back into the
bloodstream, which is the core mechanism of water regulation.
Q6: A 30-year-old woman presents with galactorrhea and secondary amenorrhea. A
pituitary MRI reveals a 6 mm microadenoma. What is the most appropriate first-line
pharmacological treatment?
A. Cabergoline [CORRECT]
B. Levothyroxine
, C. Octreotide
D. Desmopressin
Correct Answer: A
Rationale: This choice is correct because cabergoline is a dopamine agonist that
directly suppresses prolactin secretion from prolactinomas and often shrinks the tumor,
aligning with the pathophysiology where dopamine normally inhibits prolactin release.
Q7: A patient with a known pituitary macroadenoma suddenly develops a severe
headache, visual changes, and altered mental status. What is the priority nursing
intervention?
A. Administer oral levothyroxine
B. Prepare the patient for outpatient MRI scheduling
C. Administer high-dose IV corticosteroids and prepare for emergency surgery
[CORRECT]
D. Restrict fluids to prevent SIADH
Correct Answer: C
Rationale: The best answer is C because these are classic signs of pituitary apoplexy, a
neurosurgical emergency caused by sudden hemorrhage into the adenoma, requiring
immediate high-dose steroids to prevent acute adrenal insufficiency and emergent
decompression.
Q8: What is the primary physiological action of thyroid-stimulating hormone (TSH)?
A. Stimulate the thyroid gland to release T3 and T4 [CORRECT]
B. Stimulate the adrenal cortex to release cortisol
C. Inhibit prolactin release from the anterior pituitary
D. Stimulate bone growth at the epiphyseal plates
Correct Answer: A
Rationale: This matches the feedback loop where TSH acts directly on the thyroid gland
to promote the synthesis and secretion of triiodothyronine (T3) and thyroxine (T4),
which then negatively feedback to the pituitary.
Q9: A 50-year-old patient is recovering from a transsphenoidal hypophysectomy. The
provider orders baseline hormone panels. If the patient has developed
panhypopituitarism, which hormone replacement must be initiated first to prevent
life-threatening complications?
A. Levothyroxine
B. Desmopressin
C. Growth hormone
D. Hydrocortisone [CORRECT]
Correct Answer: D
