Midterm Review
1) A nurse is completing an assessment on an
elderly client who is being admitted for a
diagnostic workup for primary
hyperparathyroidism. Which client complaint
would be characteristic of this disorder?
A) Diarrhea
B) Polyuria
C) Polyphagia
D) Weight gain
2) A nursing instructor asks a student to describe the
pathophysiology that occurs in Cushing’s disease.
Which statement by the student indicates an accurate
understanding of this disorder?
A) “It is characterized by an oversecretion of
glucocorticoid hormones.”
B) “It is characterized by an undersecretion of
glucocorticoid hormones.”
C) “It is characterized by an oversecretion of insulin.”
D) “It is characterized by an undersecretion of
corticotropic hormones.”
3) A nurse is monitoring a client with Grave’s
disease for signs of thyrotoxic crisis (thyroid
storm). Which of the following signs and
symptoms, if noted in the client, will alert the
nurse to the presence of this crisis?
A) Low grade fever and tachycardia
B) Fever and tachycardia
C) Restlessness and bradycardia
D) Agitation and bradycardia
4) A nurse is assessing a client with a
diagnosis of goiter. Which of the
following would the nurse expect to note
during the assessment of the client?
A) Client complaints of slow wound healing
B) Client complaints of chronic fatigue
C) An enlarged thyroid gland
D) The presence of heart damage
5) A nurse administers 20 units of NPH
insulin to a hospitalized client with
diabetes mellitus at 7:00am. The nurse
would monitor the client most closely for
a hypoglycemic reaction at:
A) 9:00 AM
B) 10:00 AM
C) 4:00 PM
D) 12:00 midnight
6) A client arrives in the ER complaining of severe
thirst and polyuria. The client tells a nurse that
she has a history of diabetes mellitus. A blood
glucose level is drawn, and the result is 685
mg/dL. Which of the following would the nurse
anticipate to be initially prescribed for the
client?
A) Glyburide (DiaBeta) by the oral route
B) Glucagon by the oral route
C) Regular insulin by the IV route
D) NPH insulin by the SC route
7) A home care nurse is visiting a client newly diagnosed
with diabetes mellitus. The client tells the nurse that
he/she is planning to eat a dinner meal at a local
restaurant this week. The client asks the nurse if
eating at a restaurant will affect the diabetic control and
if this is allowed. Which nursing response is most
appropriate?
A) “You are not allowed to eat in restaurants.”
B) “If you plan to eat in a restaurant you need to skip the
lunchtime meal.”
C) “You should order a half portion meal and have fresh
fruit for dessert.”
D) “You should increase your daily dose of insulin by half
on the day that you plan to eat in the restaurant.”
8) A nurse is monitoring a client receiving
chlorpropamide (Diabinese). The nurse
knows that which of the following is not a
therapeutic outcome for this client?
A) A decrease in polyuria
B) A fasting blood glucose of 110 mg/dL
C) A decrease in polyphagia
D) A glycosated hemoglobin of 10%
9) “A nurse provides dietary instructions to a client
with diabetes mellitus regarding the prescribed
diabetic diet. Which statement, if made by the
client, indicates a need for further teaching?”
A) “I need to drink diet soft drinks.”
B) “I’ll eat a balanced meal plan.”
C) “I need to purchase special dietetic foods.”
D) “I’ll snack on fruit instead of cake.”
10) The female adult client with diabetes mellitus has been
instructed in the dietary exchange system. The client
tells the nurse that she would like to eat 8 oz of nonfat
yogurt with breakfast. The nurse determines that the
client understands the principles of the exchange
system if the client states that she will:
A) Not eat ice cream for one week
B) Omit 8 oz. of skim milk at that meal
C) Omit salad dressing and butter for the day
D) Eat only half of a meat exchange at supper
11) A nurse performs a physical assessment on a
client with type 2 diabetes mellitus. Findings
include a fasting blood glucose of 120 mg/dL,
temperature of 101F, pulse of 88, respirations
of 22, and blood pressure of 140/84 mmHg.
Which finding would be of most concern to the
nurse?
A) Pulse
B) Blood pressure
C) Respiration
D) Temperature
12) A client received 20 units of NPH insulin
subcutaneously at 8:00AM. The nurse
should assess the client for a
hypoglycemic reaction at:
A) 10:00AM
B) 11:00AM
C) 5:00PM
D) 11:00PM
13) A nurse is caring for a client admitted to
the ER with diabetic ketoacidosis. (DKA).
In the acute phase, the priority nursing
action is to prepare to:
A) Administer IV regular insulin
B) Administer IV 5% Dextrose
C) Correct the acidosis
D) Apply an EKG monitor
14) A nurse is providing dietary instructions to a client
newly diagnosed with diabetes mellitus who will be
taking insluin about measures to control the diabetes.
The nurse instructs the client that it is best to:
A) Eat meals at approximately the same time each day.
B) Adjust meal times depending on blood glucose levels.
C) Avoid being concerned about the time of meals as long
as snacks are taken on time.
D) Vary meal times if insulin is not administered at the
same time every day.
15) A nurse develops a plan of care for a client
with hyperparathyroidism who is receiving
calcitonin salmon (Calcimar). Which of the
following outcome criteria has the highest
priority regarding this medication?
A) Absence of side effects
B) Achievement of normal serum calicum levels.
C) Relief of pain
D) Verbalization of appropriate medication
knowledge
16) A nurse is caring for a client with diabetes
insipidus who is receiving vasopressin
(Pitressin). The nurse monitors the client,
knowing that wihc of the following is not a
therapeutic effect of this medication?
A) Increased GI tract smooth muscle tone and
contractions
B) Decreased urine output
C) Increased reabsorption of water by the renal
tubules
D) Vasodilation of vascular vessels
17) After a thyroidectomy a nurse is monitoring a
client for signs of hypocalcemia. Which of the
following signs, if noted in the client, would
most likely indicate the presence of
hypocalcemia?
A) Tingling around mouth
B) Flaccid paralysis
C) Negative Chvostek’s sign
D) Bradycardia
18) A nurse is monitoring a client with diabetes
insipidus. Desmopressin (DDAVP, Stimate)
has been prescribed for the client. Which of
the following outcomes reflects a therapeutic
effect of this medication?
A) Serum osmolality greater than 320 mOsm/kg
B) Increased blood pressure
C) Decreased urine output
D) Urine osmolality less than 100 mOsm/kg
19) A client with type 1 diabetes mellitus calls the nurse to
report recurrent episodes of hypoglycemia with
exercising. Which statement by the client indicates an
inadequate understanding of the peak action of NPH
insulin and exercise?
A) “The best time for me to exercise is every afternoon.”
B) “The best time for me to exercise is after I eat.”
C) “The best time for me to exercise is before bedtime.”
D) “The best time for me to exercise is before breakfast.”
20) A client with diabetes mellitus is being discharged following
treatment for hyperglycemic hyperosmolar nonketotic syndrome
(HHNS) precipitated by acute illness. The client tells the nurse, “I
will call the doctor next time I can’t eat for more than a day or so.”
Which of the following statements reflects the most appropriate
analysis of this client’s level of knowledge?
A) The client needs immediate education before discharge.
B) The client’s statement is accurate, but knowledge should be
evaluated further.
C) The client’s statement is inaccurate, and the client should be
scheduled for outpatient diabetic counseling.
D) The client requires follow-up teaching regarding the administration
of insulin
21) A client is brought to the ER in an
unresponsive state, and a diagnosis of
hyperglycemic hyperosmolar nonketotic
syndrome (HHNS) is made. The nurse would
prepare to immediately initiate which of the
following anticipated physician’s orders?
A) 100 units of NPH insulin
B) Endotracheal intubation
C) IV replacement of sodium bicarbonate
D) IV infusion of normal saline
22) An external insulin pump is prescribed for a client with diabetes
mellitus. The client asks the nurse about the functioning of the
pump. The nurse bases the response on the information that the
pump:
A) Gives a small continuous dose of regular insulin subcutaneously,
and the client can self-bolus with an additional dosage from the
pump prior to each meal
B) Is times to release programmed doses of Regular or NPH insulin
into the bloodstream at specific intervals
C) Is surgically attached to the pancreas and infuses regular insulin
into the pancreas, which in turn releases the insulin into the
bloodstream
D) Continuously infuses small amounts of NPH insulin into the
bloodstream while regularly monitoring blood glucose levels
23) A young male client with type 1 diabetes tells a nurse
that he might lose his job because he has been having
frequent hypoglycemic reactions. His boss thinks that
he is drunk during these episodes, and that he has
been drinking on the job. Which action by the nurse
would best assist this client to meet his needs?
A) Contact the local employment office to help him find
another job
B) Ask the client if he indeed has been drinking at work
C) Examine factors with the client that may be causing
frequent hypoglycemic episodes
D) Ask the client what he does to treat his hypoglycemia
24) A nurse is performing an assessment of
a client with a diagnosis of Cushing’s
syndrome. Which of the following would
the nurse expect to note?
A) A drooping on one side of the face.
B) Skin atrophy
C) A rounded “moon-like” appearance to the
face
D) The presence of sunken eyes
25) A nurse is reviewing the assessment findings
and lab data of a client with inappropriate
secretion of antidiuretic hormones (SIADH).
The nurse understands that which of the
following is not characteristic of this disorder?
A) Signs of water intoxication
B) Hypernatremia
C) High urine osmolality
D) Low serum osmolality
26) A nurse is interviewing a client with type 2
diabetes mellitus. Which statement by the
client indicates an understanding of the
treatment for this disorder?
A) “I am taking oral insulin instead of shots.”
B) “The medications I’m taking help release the
insulin I already make.”
C) “By taking these medications I am able to eat
more.”
D) “When I become ill, I need to increase the
number of pills I take.”
27) A registered nurse (RN) is caring for a client
with a diagnosis of Cushing’s syndrome. A
licensed practical nurse (LPN) is working with
the RN for the day. The RN determines that
the LPN has an understanding of Cushing’s
syndrome when the LPN states that the
condition is caused by which of the following?
A) Excessive amounts of cortisol
B) Decreased amounts of cortisol
C) Excessive amounts of antidiuretic hormone
D) Decreased amounts of antidiuretic hormone
28) A nurse is assessing a client with a
diagnosis of goiter. Which of the
following would the nurse expect to note
during the assessment of the client?
A) Client complaints of slow would healing.
B) Client complaints of chronic fatigue
C) An enlarged thyroid gland
D) The presence of heart damage
29) A nurse is assessing the learning readiness of a client
newly diagnosed with diabetes mellitus. Which client
behavior indicates to the nurse that the client is not
ready to learn?
A) The client complains of fatigue whenever the nurse
plans a teaching session.
B) The client asks if the spouse can attend the teaching
session.
C) The client asks for written materials about diabetes
mellitus before class
D) The client asks appropriate questions about what will
be taught