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Endocrinology Practice Questions: A Comprehensive Review of Key Concepts, Exams of Nursing

University of Southern Indiana (USI)Nursing

This document offers a valuable resource for students studying endocrinology. it presents a series of multiple-choice questions covering various endocrine disorders, including adrenal insufficiency, cushing's syndrome, diabetes mellitus, and more. Each question includes a detailed rationale, enhancing understanding of the underlying concepts and promoting deeper learning. This resource is particularly useful for exam preparation and reinforcing key concepts in endocrinology.

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Available from 05/10/2025

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ATI RN ADULT MEDICAL SURGICAL PROCTORED EXAM
||2025-2026|| WITH NGN QUESTIONS WITH ANSWERS &
RATIONALES. A+ GRADE
1.
A nurse is caring for a client who is Postoperative following a bilateral adrenalectomy. The Nurse should
expect to administer glucocorticoids following the procedure to enhance which of the following therapeutic
effects?
B.
Inhibit glucose metabolism
C.
Compensate for decreased cortisol levels
D.
Decrease susceptibility to infection
E.
Acts as a diuretic to maintain urine output
Answer B
Rational: with an adrenalectomy, the client requires glucocorticoids before, during, and after surgery to prevent
an adrenal crisis caused by a sudden drop in cortisol levels. One of the hormones produced by the
glucocorticoid. Loss of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal
with stressors, Which is fatal if untreated
1.
A nurse is reviewing the laboratory values for a client who has hyperglycemic hyperosmolar nonketotic
syndrome. Which of the following laboratory values is consistent with hyperglycemic hyperosmolar
nonketotic syndrome?
A.
Positive Urine Ketones
B.
Blood pH 7.34
C.
Blood Glucose 320 mg/dL
D.
Blood osmolality >350mOsm/kg
Answer C.
Rational: A client who has hyperglycemic hyperosmolar nonketotic syndrome should have a blood glucose
level >250 mg/dL, which will cause spilling of ketones in the urine and development of metabolic acidosis
3.
A nurse is assisting with the plan of care for a client who has Cushing’s syndrome due to chronic
corticosteroid use. Which of the following actions should the nurse include in the plan of care? (SATA)
A. Check the client’s blood glucose for hypoglycemia
B. Check for hypertension
C. Weigh the client weekly
D. Insert an indwelling urinary catheter for the client
E. Check for infection
F. Weigh the client daily
G. Check for blood sugar
Rationale: The nurse should check the client for hypertension, which can indicate fluid volume overload.
4.
A nurse is assisting with the plan of care for a client who has Cushing’s syndrome due to chronic
corticosteroids use. Which of the following actions should the nurse include in the plan of care?
A.
Check the client’s blood glucose for the hyperglycemia
B.
Check for hypertension
C.
Weigh the client weekly
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Download Endocrinology Practice Questions: A Comprehensive Review of Key Concepts and more Exams Nursing in PDF only on Docsity!

ATI RN ADULT MEDICAL SURGICAL PROCTORED EXAM

|| 2025 - 2026|| WITH NGN QUESTIONS WITH ANSWERS &

RATIONALES. A+ GRADE

  1. A nurse is caring for a client who is Postoperative following a bilateral adrenalectomy. The Nurse should expect to administer glucocorticoids following the procedure to enhance which of the following therapeutic effects? B. Inhibit glucose metabolism C. Compensate for decreased cortisol levels D. Decrease susceptibility to infection E. Acts as a diuretic to maintain urine output Answer B Rational: with an adrenalectomy, the client requires glucocorticoids before, during, and after surgery to prevent an adrenal crisis caused by a sudden drop in cortisol levels. One of the hormones produced by the glucocorticoid. Loss of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressors, Which is fatal if untreated
    1. A nurse is reviewing the laboratory values for a client who has hyperglycemic hyperosmolar nonketotic syndrome. Which of the following laboratory values is consistent with hyperglycemic hyperosmolar nonketotic syndrome? A. Positive Urine Ketones B. Blood pH 7. C. Blood Glucose 320 mg/dL D. Blood osmolality >350mOsm/kg Answer C. Rational: A client who has hyperglycemic hyperosmolar nonketotic syndrome should have a blood glucose level >250 mg/dL, which will cause spilling of ketones in the urine and development of metabolic acidosis
    2. A nurse is assisting with the plan of care for a client who has Cushing’s syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care? (SATA) A. Check the client’s blood glucose for hypoglycemia B. Check for hypertension C. Weigh the client weekly D. Insert an indwelling urinary catheter for the client E. Check for infection F. Weigh the client daily G. Check for blood sugar Rationale: The nurse should check the client for hypertension, which can indicate fluid volume overload.
    3. A nurse is assisting with the plan of care for a client who has Cushing’s syndrome due to chronic corticosteroids use. Which of the following actions should the nurse include in the plan of care? A. Check the client’s blood glucose for the hyperglycemia B. Check for hypertension C. Weigh the client weekly

D. Insert an indwelling urinary catheter for the client. Answer: A Rational: The nurse should check the client for hyperglycemia because hypercortisolism elevated blood glucose levels.

  1. A nurse is preparing a 24- hour urine specimen for a client who is suspected to have pheochromocytoma. Which of the following laboratory tests from the 24 - hour specimen should the nurse use to determine the client’s condition? A. Creatinine clearance B. Catecholamine metabolites C. 17 - hydroxycorticosteroids (17-OHCS) D. Protein Answer. B Rational: The nurse should expect the 24-urine specimen to test for Catecholamine metabolites. The test is used to determine if the client has pheochromocytoma, which measures the levels of catecholamines( epinephrine and norepinephrine ) secretion in a 24- hr urine sample. pheochromocytoma is a rumor of the adrenal gland that causes excess release of the catecholamines (epinephrine and norepinephrine), which are hormones that regulate blood pressure and heart rate.
  2. A Nurse is reinforcing teaching with a client who has Addison’s disease about healthy snacks foods. Which of the following food choices by the client indicates an understanding of the teaching? A. Sliced Bananas B. Turkey and cheese sandwich C. Baked potato D. Plain yogurt with peaches Answer B Rational: A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. The client who has Addison’s disease requires a diet low in potassium and high in sodium, carbohydrates, and protein. Addison’s disease is a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). Addison’s disease occurs when the adrenal glands do not produce enough of the hormone cortisol and, in some cases, the hormone aldosterone.
  3. A nurse is collecting data from a client who has manifestations of acromegaly. Which of the following findings should the nurse expect? A. Concave chest wall B. Thinning of skeletal bone structure C. Increased head size D. Cardiomegaly E. High-pitched voice Answer C Rational: The client who has acromegaly will manifest an enlarged head size due to the excessive production of growth hormones after closing of the epiphyses (the "growth plate" at the ends of the long bones) by the pituitary gland. It results in the gradual enlargement of the client's body tissues, such as the bones of the face, jaw, hands, feet, and skull.
  1. A nurse is checking laboratory values to determine if a client who has diabetes mellitus is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination? A. Glucose tolerance test B. Urine sugar and acetone C. Glycosylated hemoglobin levels D. Fasting serum glucose Answer: C. Glycosylated hemoglobin levels Rationale: Checking glycosylated hemoglobin levels (HbA1c) is an accurate method to determine if the client is routinely compliant. Glycosylated hemoglobin refers to hemoglobin that is connected to glucose. Since the lifespan of an RBC is 4 months, this value will not be affected by recent changes in the client's diet or medications. A nurse is reviewing laboratory results for a client who has diabetes mellitus. Which of the following results indicates that the clients is controlling the diabetes? A. HbA1c 8% B. Postprandial blood glucose 210 mg/dL C. Casual blood glucose 100 mg/dL D. Fasting blood glucose 80 mg/dL E. Fasting blood glucose 140 mg/dL
  2. A nurse is assisting with a presentation about nutrition habits that prevent type 2 diabetes mellitus for a group of clients. Which of the following should the nurse include? (SATA) a. Eat less meat and processed food b. Decrease intake of saturated fats c. Increase daily fiber intake d. Limit unsaturated fat intake to 15% of daily caloric intake e. Include omega- 3 fatty acids in the diet Answers: A, B, C, E: Eat less meat and less processed food; decrease intake of saturated fats; increase daily fiber intake; include omega- 3 fatty acids in diet Rationale: Healthy nutrition should include decreasing the consumption of meats and processed food which can prevent diabetes and hyperlipidemia. Healthy nutrition should include lowering LDL by decreasing intake of saturated fats, which can prevent diabetes and hyperlipidemia. Healthy nutrition should include increasing dietary fiber to control weight gain and decrease the risk of diabetes and hyperlipidemia. Healthy nutrition should include omega- 3 fatty acids for secondary prevention of diabetes and heart disease.
  3. A nurse is caring for a client who is 12hr postop following a thyroidectomy. Which of the following findings indicate that the client is experiencing thyroid crisis? (SATA) A. Bradycardia B. Hypothermia C. Dyspnea D. Abdominal pain E. Mental confusion Answer: C, D, E: Dyspnea; Abdominal pain; Mental confusion

Laryngeal stridor and hoarseness Rationale: When a thyroid crisis occurs, clients can experience GI conditions such as vomiting, diarrhea, and abdominal pain. Excessive levels of thyroid hormone can cause the client to experience dyspnea and confusion.

  1. A nurse is assessing a client's thyroid gland. Which of the following instructions should the nurse give the client before inspecting and palpating this gland? A. “ Tilt your head slightly forward" B. "Keep your head straight and look ahead of you” C. “ Tilt your head back and swallow” D. “ Turn your head to the side against my hand” Answer: C To examine the thyroid gland, the nurse should instruct the client to extend her head backward and to swallow. The nurse should be able to feel the thyroid gland ascend as the client swallows. And observe any enlargement of the gland.
  2. A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (Select all that apply) A. B. Respiratory rate 16/min C. Negative Chvostek's sign D. E. Positive Trousseau's sign Answer: A D E A thyrotoxic crisis (thyroid storm) is a life-threatening condition with a sudden onset that includes tachycardia, a fever, sweating, restlessness, and tremors. Congestive heart failure and pulmonary edema can develop rapidly and lead to death. Tachycardia and hypertension are unexpected findings that can indicate the occurrence of thyroid storm following removal of the thyroid gland, especially if the client was in a hyperthyroid state prior to the surgery. Laryngeal stridor and hoarseness are unexpected findings and can indicate swelling in the area of the surgery or damage to the laryngeal nerve. This should be reported to the provider before respiratory distress develops. A positive Trousseau's sign is an indication of hypocalcemia, which is a complication of thyroid removal that occurs when the parathyroid glands are also removed and regulation of serum calcium is impaired.
  3. A nurse is monitoring a client following a thyroidectomy. Which of the following findings should the nurse identify as an indication of hypoparathyroidism? A. Elevated blood pressure B. Involuntary muscle spasms C. Cold intolerance D. Weight loss Answer: B. Involuntary muscle spasms Tachycardia and hypertension

E. Good appetite

  1. A nurse is collecting data from a client who has Cushing's syndrome. Which of the following skin manifestations should the nurse expect to find? A. Purple striae on the chest and abdomen B. Butterfly rash across the bridge of the nose C. Bronze skin pigmentation D. Jaundice of the face and sclera Correct Answer: A. Purple striae on the chest and abdomen Rationale: A client who has Cushing's disease should have purple striae (streaks or stripes) on the chest and abdomen because cortisol destroys collagen under the skin.
  2. A nurse is caring for a client who is scheduled to receive peritoneal dialysis. Which of the following actions should the nurse take? A. Warm the dialysate solution to room temperature prior to administration B. Cleanse the catheter site using a back and forth motion beginning at the end of the catheter and moving inward C. Place the drainage bag at the level of the client's chest D. Apply the clean gloves and cleanse the client's catheter site with cold water Correct Answer: A Rationale: The nurse should warm the dialysate solution to room temperature prior to administration. This prevents the client from experiencing pain and abdominal cramping due to a cold solution during dialysis
  3. A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect? A. Polyuria B. Dehydration C. Hyponatremia D. Hyperthermia Answer: C. This client with SIADH will have hyponatremia caused by the excessive release of antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water, which causes dilutional hyponatremia.
  4. A nurse is reviewing the laboratory report for a client and notes an elevated thyroid-stimulating hormone (TSH) level. When collecting data from the client, which of the following should the nurse expect? A. Tremors B. Bradycardia C. Low-grade fever D. Diaphoresis

tremors hypotension Correct answer and Rationales: B. Bradycardia: an elevated TSH level indicates hypothyroidism which is characterized by weight gain, bradycardia, cold intolerance, paresthesia, hearing loss, depression, and many other manifestations

  1. A nurse is reinforcing teaching with a client who has hyperthyroidism about managing this disorder. Which of the following recommendations should the nurse include? A. Reduce her total hours of sleep B. Keep her immediate environment warm C. Increase her caloric intake with meals D. Gradually increase her activity Answer: c) Increase her caloric intake with meals. Clients whose thyroid hormone levels are high have increased protein, lipid, and carbohydrate metabolism, resulting in a loss of protein stores and a negative nitrogen balance. Even with an increased appetite, it is often difficult to meet energy demands, and weight loss is common. Muscle weakness and wasting can develop without adequate caloric and protein intake.
  2. A home health nurse is assessing a client who requires lifelong replacement hormone therapy for the treatment of hypothyroidism. The client has not been taking his medication regularly. Which of the following findings should the nurse expect? A. increased urine output B. persistent diarrhea C. tachycardia D. Answer: D. hypotension Rationale: hypotension is an expected finding with hypothyroidism, along with bradypnea, dysrhythmias, cold intolerance, and cool, dry skin. .A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurse should expect which of the following findings? A. cold intolerance B. lethargy C. D. sunken eyes E. Heat intolerance F. Bulging eyes Answer:tremors Rationale: findings of hyperthyroidism include tremors, diaphoresis, insomnia, heat intolerance, restlessness, and irritability
  3. The nurse determines that the patient in acute adrenal insufficiency is responding favorably to treatment when A. the patient appears alert and oriented B. the patient's urinary output has increased

D. “your child will need to take thyroid hormone replacement for her entire life” Answer:D Rationale: in congenital hypothyroidism, the child does not manufacture an adequate amount of thyroid hormone to maintain the appropriate metabolic rate. The child will require lifelong thyroid hormone replacement to support normal growth and development

  1. A nurse is reviewing laboratory values for a client who reports fatigue and cold intolerance. The client has an increased thyroid- stimulating hormone (TSH) level and a decreased total T3 and T4 level. The nurse should anticipate a prescription for which of the following medications? A. methimazole B. somatropin C. levothyroxine D. propylthiouracil Answer: C. Rationale: Levothyroxine replaces thyroid hormone for a client who has hypothyroidism. Laboratory values for hypothyroidism include an increased TSH level and a decreased total T3 and T4 levels. Clinical manifestations of hypothyroidism include fatigue , cold intolerance, and a decreased body temperature and pulse. A nurse is reviewing laboratory values for a client who reports fatigue and cold intolerance. The client has a decreased thyroid-stimulating hormone (TSH) level and an increased total T3 and T4 level. The nurse should anticipate a prescription for which for the following medication? A. Vasopressin B. Somatropin C. Levothyroxine D. Propylthiouracil . A nurse is reviewing the medical record of a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory findings should the nurse expect? (SATA) A. Low Sodium B. High Potassium C. Increased urine osmolality D. High urine sodium E. Increased urine specific gravity Answer: A, C, D, E Rationale: A. SIADH results in water retention, causing a low sodium level B. SIADH results in an increase in urine osmolality due to the decreased urine volume

C. SIADH results in water retention, causing a high urine sodium level D. SIADH results in water retention, causing an increase in urine specific gravity

  1. A nurse is caring for a client who has acromegaly. Which of the following findings should the nurse expect? A. Muscle rigidity B. Sunken eyes C. Sluggish deep tendon reflexes D. Visual disturbances E. Sexual dysfunction Answer: D. Rationale: The nurse should expect a client who has acromegaly to report visual changes such as double vision and to have decreased visual acuity.
  2. A nurse is caring for a client who is taking methimazole. For which of the following adverse effects of this medication should the nurse monitor? A. Bradycardia B. Insomnia C. Heat intolerance D. Weight loss Rationale A. The nurse should monitor for bradycardia which is an adverse effect of methimazole.
  3. A nurse is collecting data for a client who takes desmopressin for diabetes insipidus. For which of the following adverse effects should the nurse monitor? A. Hypovolemia B. Hypercalcemia C. Agitation D. Headache Rationale D. Headache during desmopressin therapy is an indication of water intoxication.
  4. A nurse in a provider's office is reviewing laboratory results for a client who has secondary hypothyroidism. Which of the following findings should the nurse expect? A. Elevated serum T B. Decreased serum T Decreased serum T Elevated serum T C. Elevated serum thyroid-stimulating hormone D. Decreased serum cholesterol Answer: B

Answer: A Rationale: The nurse should expect hypotension in a client who has adrenal insufficiency (Addison’s disease). The nurse should monitor the client’s BP closely. If an Addisonian crisis occurs., the client’s hypotension can become severe due to blood volume depletion caused by the aldosterone

  1. A nurse is caring for a patient who has primary adrenal insufficiency and is preparing to undergo an ACTH stimulation test. Which of the following findings should the nurse expect after an IV infection of cosyntropin? A. No change in plasma control B. Elevated fasting blood glucose C. Decrease in sodium D. Increase in urinary frequency Answer A. No change in plasma cortisol indicates primary adrenal insufficiency (Addisons disease or hypocortisolism) after an IV injection of cosyntropin during an ACTH stimulation test due to an inadequate production of cortisol.
  2. A nurse is assisting with the care of a client who has Addison’s disease and was admitted with muscle weakness and dehydration, as well as nausea and vomiting for the past 2 days. Which of the following prescribed medications should the nurse plan to administer? a. Rifampin b. Loperamide c. Hydrocortisone d. Spironolactone Answer: C. Hydrocortisone. This client with Addison’s disease will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison’s disease has adrenal corticoid insufficiency, which is the inability of the pituitary to produce cortisol. Illness and stress can require steroids such as hydrocortisone to restore hormone levels.
  3. A nurse is assisting with the care of a client who has been diagnosed with an Addisonian crisis and has a blood pressure of 74/42 mmHg. Which of the following medication prescriptions should the nurse anticipate? a. Desmopressin b. Hydrocortisone c. Dopamine d. Furosemide Answer: B. Hydrocortisone. The nurse should identify that a client who has Addison’s disease and is experiencing an Addisonian crisis will require hydrocortisone to assist with replacing cortisol levels. A client with Addison’s disease has adrenal corticoid insufficiency due to the pituitary’s inability to produce cortisol. Illness and stress can require steroids such as hydrocortisone to restore hormone levels. An Addisonian crisis can cause sudden destruction to the adrenal gland or pituitary and be life-threatening.
  4. A nurse is caring for a client who is taking somatropin to stimulate growth. The nurse should plan to monitor the client’s urine for which of the following? a. Bilirubin b. Protein c. Potassium d. Calcium

Answer: D. Calcium Rationale: A large amount of calcium can be present in the urine of a client who takes somatropin. This puts clients at a risk for renal calculi.

  1. Which electrolyte disorder is most likely to trigger early symptoms of syndrome of inappropriate antidiuretic hormone (SIADH)? A. Hypokalemia B. Hyponatremia C. Hypercalcemia D. Hyperglycemia Answer: B; Hyponatremia triggers the earliest symptoms. Most signs and symptoms (nausea, vomiting, irritability, confusion, tremors, seizures, stupor, coma, and pathologic reflexes) appear when serum sodium levels fall below 125 mEq/L
  2. What are early signs/symptoms of hypothyroidism? (SATA) A. Weight gain B. Difficulty concentrating C. Constipation D. Infertility E. Depression F. Mood swings Answers: A, B, C; For hypothyroidism, early signs include weight gain, difficulty concentrating, constipation, and fluid/weight gain. Late signs include mood swings, infertility (in women), acute fatigue syndrome, and depression.
  3. A nurse is collecting data from a client who has graves’ disease. Which of the following findings should the nurse expect the client to display? A. Constipation B. Cold intolerance C. Difficulty sleeping D. Anorexia Answer C. Difficulty sleeping: a client who has graves’ disease can have difficulty sleeping and anxiety due to the overproduction of thyroid hormone.
  4. A nurse is conducting a home visit with an older adult client who has diabetes mellitus and takes regular insulin subcutaneously before each meal. The client appears disoriented and weak and has slurred speech. Which of the following conditions should the nurse consider first when responding to these manifestations? A. dementia B. hypoglycemia C. infection

Answer: A. Encourage the client to control weight. Rationale: The nurse should encourage weight control to stabilize blood glucose and improve glycosylated hemoglobin levels. Obesity is a risk factor for type 2 diabetes, and moderate calorie restriction can improve control of diabetes. The client should inspect the feet daily because they are at risk for foot injury due to impaired circulation and reduced sensation in the lower extremities. The client should increase physical activity to reduce weight and improve blood glucose control. Applying moisturizer between client’s toes increases the risk of skin breakdown due to excess moisture.

  1. A nurse is caring for a client who is postoperative following a parathyroidectomy to treat hyperparathyroidism. Which of the following laboratory values should the nurse expect to decrease as a therapeutic effect of the procedure? A. Phosphorus B. Sodium C. Potassium D. Calcium Answer: D. Calcium. Rationale: The parathyroid hormone regulates calcium, phosphorus and magnesium balance within the client’s blood and bone by maintaining a balance between mineral levels in blood and bone. Hyperparathyroidism is associated with hypercalcemia; therefore, a decrease in the calcium level indicates an improvement in the client’s condition.
  2. A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus about the pathophysiology of the disease. Which of the following statements by the client indicates an understanding of the teaching? A. “My cells are resistant to the effects of insulin.” B. “My body breaks down sugars too efficiently.” C. “My pancreas does not produce insulin.: D. “My body produces antibodies against pancreatic beta cells.” Answer: A. “My cells are resistant to the effects of insulin.” Rationale: This client who has type 2 diabetes mellitus will have resistance to insulin and a decrease in the secretion of insulin by the pancreatic beta cells. A nurse is reinforcing teaching with a client who has type1 DM about the pathophysiology of the disease, Which of the following statements by the client indicates an understanding of the teaching? My Pancreases does not produce insulin.
  3. A nurse is reviewing laboratory results for a client who has diabetes mellitus. Which of the following results indicates that the client is controlling the diabetes?

A. HbA1c 8.5% B. Postprandial blood glucose 190 mg/dL C. Casual blood glucose 205 mg/dL D. Fasting blood glucose 95 mg/dL Answer: D. Fasting blood glucose 95 mg/dL Rationale: The nurse should identify that a fasting blood glucose of 95 mg/dL is within the expected reference range of 7- to 110 mg/dL, which indicates that the client has the diabetes under control. HbA1c 8.5% is above the expected reference of less than 7%. A post-prandial blood glucose of 190 mg/dL is above the expected range of less than 160 mg/dL. A casual blood glucose of 205 mg/dL is above the expected reference of less than 200 mg/dL.

  1. You are caring for a patient who is taking exenatide (Byetta) to treat type 2 diabetes mellitus. The patient reports severe abdominal pain. You suspect which of the following adverse reactions to this medication? a. peptic ulcer disease b. Hyperkalemia c. hyperglycemia d. pancreatitis Answer: d. Pancreatitis Exenatide, an incretin mimetic agent, can cause pancreatitis. You instructed to pt to watch for and report severe or persistant abd pain, so you should now inform the provider and tell the pt to stop taking the drug.
  2. You are caring for a pt who takes acarbose (Precose) and a sulfonylurea to treat type 2 diabetes mellitus. Which of the following is an indication of an adverse reaction to this drug combination? a. Polyuria b. Tremors c. bradycardia d. thirst Answer: b. Tremors This drug can cause hypoglycemia. Indications of hypoglycemia: hunger tachycardia, shakiness, tremors, diaphoresis.