Question 1.1. A three-year-old girl has just been diagnosed with type 1A diabetes and her parents are currently receiving education from the diabetes education nurse at the hospital where their daughter is receiving treatment. How can the nurse best explain the etiology of their daughter's health problem to her parents?

• "The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin."
• "It's not known exactly why your daughter has completely stopped making insulin, and treatment will consist of your rigidly controlling her diet."
• "This tendency to produce insufficient amounts of insulin is likely something that she inherited."
• "Environmental and lifestyle factors are known to play a part in the fact that her pancreas secretes and withholds insulin at the wrong times."

Question 2. A 60-year-old man has presented to his nurse practitioner because of an earache that has become progressively more painful in recent days. After giving his history and having an examination with an otoscope, the man has been diagnosed with otitis externa. Which of the nurse practitioner's following statements to the man is most accurate?

• "You'll need to avoid getting any water in your ear until you finish your course of antibiotic pills."
• "I'm going to instill some warm water into your ear to flush out debris and bacteria."
• "I'll prescribe some ear drops for you, and in the meantime it's important not to use ear swabs."
• "This likely happened because your ears aren't draining like they should, but antibiotics that you'll put in your ears will resolve this."

Question 3. A patient with a new diagnosis of an endocrine disorder is unclear about how the body can control the levels of different hormones over time. Which of the following statements most accurately underlies the dominant regulation process of hormone levels in the body?

• A positive feedback cycle ensures that stable levels of hormones exist in the body over time.
• With input from various sensors, hormone production and release are adjusted based on existing hormone levels.
• The hypothalamus ensures that hormone levels correspond accurately to the diurnal cycle.
• The pituitary gland is genetically programmed to stimulate and inhibit hormone production and/or release based on needs at different points in the life cycle.

Question 4. What does a high level of thyroid-stimulating hormone indicate?

• Hypothyroidism
• Myxedema
• Hyperthyroidism
• Thyroid nodule

5. Following the identification of low levels of T3 and T4 coupled with the presence of a goiter, a 28-year-old female has been diagnosed with Hashimoto thyroiditis. In light of this diagnosis, which of the following assessment results would constitute an unexpected finding?

• The presence of myxedema in the woman's face and extremities
• Recent weight gain despite a loss of appetite and chronic fatigue
• Coarse, dry skin and hair with decreased sweat production
• Increased white cell count and audible crackles on chest auscultation

6. A stroke affecting which of the following areas of the brain would be most likely to leave an individual's vestibular system intact and posture and balance maintained?

• The brain stem
• The thalamus
• The temporal and parietal cortex
• The limbic system of the cerebrum

Question 7. A care aide at a long-term care facility has informed a resident's nurse practitioner that the 80-year-old woman's eyes appear to be inflamed and her eyelids are caked with sticky secretions. The woman subsequently has been diagnosed with posterior blepharitis. Which of the following treatments is the nurse practitioner likely to initiate?

• Surgical repair of the woman's blocked meibomian glands
• Warm compresses to be applied regularly to her eyes in addition to oral antibiotics
• Regularly scheduled cleansing of the woman's eyes with normal saline
• Intravenous steroids coupled with topical antibiotic ointment

Question 8. An endocrinologist is providing care for a 30-year-old male who has lived with the effects of increased levels of GH. Which of the following teaching points about the patient's future health risks is most accurate?

• "It's not unusual for unusually high GH levels to cause damage to your hypothalamus."
• "GH excess inhibits your pancreas from producing enough insulin."
• "The high levels of GH that circulate in your body can result in damage to your liver."
• "When your pituitary gland is enlarged, there's a real risk that you'll develop some sight deficiencies.

Question 9. A 46-year-old male has presented to the emergency department because of the eye pain, severe headache, and blurred vision that have followed an eye exam at an optometrist's office earlier in the day. The patient tells the triage nurse that he received eyedrops during the exam "to keep my pupils wide open." What differential diagnosis will the care team first suspect?

• Infectious conjunctivitis
• Keratitis
• Corneal trauma
• Angle-closure glaucoma

Question 10. A patient with a history of an endocrine disorder exhibits signs and symptoms of hormone deficiency. Which of the following processes would the patient's care team most likely rule out first as a contributing factor?

• The patient's target cells lack sufficient receptors for the hormone in question.
• Hormone production is sufficient, but affinity on the part of the target cells is lacking.
• The process of down-regulation has resulted in decreased hormone sensitivity.
• Up-regulation has increased the sensitivity of the body to particular hormone levels.

Question 11. A 51-year-old woman has been experiencing signs and symptoms of perimenopause and has sought help from her nurse practitioner. Doctors have confirmed a deficiency in estrogen levels as a contributing factor. Which of the following phenomena could potentially underlie the woman's health problem?

• Sufficient synthesis of estrogen but inadequate vesicle-mediated release
• Inadequate synthesis in the rough endoplasmic reticulum of her ovarian cells
• Insufficient estrogen production within the smooth endoplasmic reticulum of the relevant cells
• A lack of prohormone precursors needed for estrogen synthesis and release

12. Which of the following hormones are derivatives of cholesterol?

• Epinephrine and norepinephrine
• Insulin and glucagon
• Aldosterone and testosterone
• Eicosanoids and retinoids

Question 13. A 32-year-old man is complaining of burning, itching, photophobia, and severe pain in his right eye after swimming in the ocean. To determine that the eye condition is corneal rather than a conjunctival disease, which of the following would be the distinguishing symptom?

• Burning
• Itching
• Photophobia
• Severe pain