Medical Surgical Questions
From Lippincott's_Review_for_NCLEX
Nursing Care of Clients with Disorders of
the Pituitary Gland
After suffering head trauma, a client develops signs and
symptoms of diabetes insipidus.
1. Which characteristic symptom of the client’s disorder
would the nurse expect to fi nd during an assessment?
[ ] 1. Polyphagia
[ ] 2. Polyuria
[ ] 3. Glycosuria
[ ] 4. Hyperglycemia
2. How does the nurse expect the urine that is collected
for a routine urinalysis to appear?
[ ] 1. Tea-colored
[ ] 2. Pale yellow
[ ] 3. Colorless
[ ] 4. Light pink
3. Which nursing intervention is essential for monitoring
the client’s condition?
[ ] 1. Measuring intake and output
[ ] 2. Analyzing blood glucose levels
[ ] 3. Inserting a Foley catheter
[ ] 4. Sending urine samples to the laboratory
The nursing care plan indicates that the client must be
weighed each day.
4. When directing the nursing assistant to weigh the
client, which instruction is most important for obtaining
accurate data?
[ ] 1. Have the client stand on a bedside scale.
[ ] 2. Weigh the client at the same time each day.
[ ] 3. Ask that slippers be removed when being weighed.
[ ] 4. Ask about the client’s pre-disease weight.
The client is treated with intranasal lypressin (Diapid),
2 sprays q.i.d. and as needed.
5. The nurse observes the client self-administering the
medication. Which action indicates that the client is using
the medication correctly?
[ ] 1. The client shakes the medication vigorously
[ ] 2. The client’s head is tilted to the side.
[ ] 3. The client inverts the drug container.
[ ] 4. The client inhales with each spray.
6. Before the client is discharged, the physician orders
lypressin (Diapid) to be administered p.r.n. When instructing
the client about how to take this drug at home, the
nurse tells the client to administer the drug when experiencing
which sign or symptom?
[ ] 1. Increased thirst
[ ] 2. Onset of a headache
[ ] 3. Dark yellow urine
[ ] 4. A runny nose
The nurse is assessing a client who is experiencing signs
and symptoms related to a diagnosis of acromegaly.
7. During the physical assessment of this client, which
fi nding is the nurse most likely to observe?
[ ] 1. Shortened height
[ ] 2. Enlarged hands
[ ] 3. Gonadal atrophy
[ ] 4. Loss of teeth
8. Which nursing diagnosis should the nursing team
consider when developing this client’s care plan?
[ ] 1. Activity intolerance
[ ] 2. Self-care defi cit
[ ] 3. Ineffective breathing
[ ] 4. Impaired swallowing
Because medical treatment was unsuccessful, the client
with acromegaly is scheduled for a trans-sphenoidal hypophysectomy.
The night before surgery, the nurse provides
the client with information about what to expect during the
postoperative period.
9. Which statement by the client indicates a misunderstanding
of the expected surgical outcome?
[ ] 1. “My appearance will gradually become normal.”
[ ] 2. “I’ll need to take replacement hormones.”
[ ] 3. “I’ll need to see my physician regularly.”
[ ] 4. “The surgical incision will be inconspicuous.”
10. Immediately after surgery, the nurse assesses the
client for bleeding. Where is the best location to assess for
bleeding?
[ ] 1. The skull
[ ] 2. The nose
[ ] 3. The ear canal
[ ] 4. The tongue
Nursing Care of Clients with Disorders of
the Thyroid Gland
A 35-year-old seeks medical attention to determine the
reason menstruation has ceased. The physician orders a
radioactive iodine uptake test.
11. After the test, the nurse provides the client with
instructions. Which statement of the nurse is most
accurate?
[ ] 1. “You must remain isolated until the radiation level
decreases suffi ciently.”
[ ] 2. “You’re free to go without further precautionary
instructions.”
[ ] 3. “You must follow special precautions for a short
period of time.”
[ ] 4. “You’ll be given an antidote to reduce the radioactivity
level.”
The results of the diagnostic tests confi rm that the client
has myxedema.
12. In addition to amenorrhea, which other signs of myxedema
is the nurse likely to observe in this client? Select
all that apply.
[ ] 1. Hoarse, raspy voice
[ ] 2. Oily skin with large pores
[ ] 3. Thin trunk and extremities
[ ] 4. Extreme restlessness
[ ] 5. Low body temperature
[ ] 6. Decreased blood pressure
13. When the nurse conducts an admission history, which
subjective symptom is the client likely to describe?
[ ] 1. Diffi culty urinating
[ ] 2. Intolerance to cold
[ ] 3. Profuse perspiration
[ ] 4. Excessive appetite
The client with myxedema is treated with levothyroxine
(Synthroid), one tablet P.O. every day.
14. Which statement provides the best evidence that the
client understands the prescribed drug therapy?
[ ] 1. “I must take this drug after meals.”
[ ] 2. “I should avoid driving when sleepy.”
[ ] 3. “I’ll need to take this drug life-long.”
[ ] 4. “I can skip a dose if I’m nauseated.”
15. Because the client is receiving levothyroxine (Synthroid)
for the fi rst time, the nurse recognizes the need to
observe the client for adverse effects related to thyroid
replacement therapy. For which signs and symptoms
should the nurse assess? Select all that apply.
[ ] 1. Dyspnea
[ ] 2. Palpitations
[ ] 3. Excessive bruising
[ ] 4. Raised, red rash
[ ] 5. Hyperactivity
[ ] 6. Insomnia
A client seeks medical attention after noticing fullness in
the neck. After several diagnostic tests, a large endemic
goiter is diagnosed.
16. As the nurse provides care for the client newly diagnosed
with a large goiter, which interventions should be
implemented? Select all that apply.
[ ] 1. Observe the client’s respiratory status
[ ] 2. Elevate the head of the client’s bed
[ ] 3. Provide a diet high in iodized salt
[ ] 4. Obtain an order for a soft diet
[ ] 5. Assess for high fever
[ ] 6. Administer prescribed antibiotics
A client is undergoing treatment for Graves’ disease.
17. Which characteristic facial feature would the nurse
expect to note during a physical examination of this client?
[ ] 1. Bulging eyes
[ ] 2. Bulbous nose
[ ] 3. Thick lips
[ ] 4. Large tongue
The physician prescribes propylthiouracil (Propyl-Thyracil)
to treat the client’s condition.
18. Before administering this medication, what is essential
for the nurse to ask the client?
[ ] 1. “Do you have trouble swallowing?”
[ ] 2. “Do you prefer a liquid form of medication?”
[ ] 3. “Have you had digestive disorders in the past?”
[ ] 4. “Is there a possibility you could be pregnant?”
19. Because propylthiouracil (Propyl-Thyracil) can cause
agranulocytosis, the nurse advises the client to notify the
physician if which problem occurs?
[ ] 1. Persistent sore throat
[ ] 2. Occasional heart palpitations
[ ] 3. Fatigue on exertion
[ ] 4. Prolonged bleeding with trauma
After diagnostic testing, a client with Graves’ disease
is informed that it is necessary to undergo a subtotal
thyroidectomy. The physician prescribes potassium iodide
(Lugol’s solution) 4 gtt P.O. to be taken for 10 days before
the scheduled surgery.
20. When the nurse teaches the client how to self-administer
potassium iodide (Lugol’s solution), which instruction
is most appropriate?
[ ] 1. Swallow the drug quickly.
[ ] 2. Take the drug before meals.
[ ] 3. Dilute the drug in fruit juice.
[ ] 4. Chill the drug before taking it.
The client asks the nurse to explain the purpose of the
preoperative drug therapy.
21. Which response by the nurse about potassium iodide
(Lugol’s solution) is correct?
[ ] 1. It fi rms the gland so it is easily removed.
[ ] 2. It decreases the postoperative recovery time.
[ ] 3. It decreases the risk of postoperative bleeding.
[ ] 4. It eliminates the need for hormone replacement.
22. Preoperatively, which information is most important
to teach the client before the subtotal thyroidectomy?
[ ] 1. Techniques for changing positions
[ ] 2. Reasons for performing leg exercises
[ ] 3. The necessity for daily dressing changes
[ ] 4. Postoperative use of the incentive spirometer
23. To prepare for potential postoperative complications
related to the thyroidectomy, which item is necessary to
keep at the client’s bedside?
[ ] 1. Dressing change kit
[ ] 2. Tracheostomy tray
[ ] 3. Ampule of epinephrine
[ ] 4. Mechanical ventilator
After surgery, the client is returned to the nursing unit in
stable condition.
24. In which position should the client be maintained
after the subtotal thyroidectomy?
[ ] 1. Supine
[ ] 2. Sims’
[ ] 3. Semi-Fowler’s
[ ] 4. Recumbent
25. Postoperatively, the nurse should consult the physician
before encouraging the client who has undergone a
subtotal thyroidectomy to perform which activity?
[ ] 1. Forced coughing
[ ] 2. Deep breathing
[ ] 3. Ambulating
[ ] 4. Dangling legs
26. Which intervention is most appropriate to add to the
client’s care plan when monitoring for incisional bleeding
after a subtotal thyroidectomy?
[ ] 1. Observe for signs of hypovolemic shock.
[ ] 2. Assess for dampness at the back of the client’s neck.
[ ] 3. Remove the dressing to directly inspect the wound.
[ ] 4. Weigh all gauze dressings before and after changing.
27. Which assessment technique is most appropriate
when checking for laryngeal nerve damage in a client who
has had a thyroidectomy?
[ ] 1. Turning the client’s head from side to side
[ ] 2. Observing the client swallowing
[ ] 3. Looking for tracheal deviation
[ ] 4. Asking the client to say “Ah”
28. The nurse should assess for hypocalcemia based on
which client statements after a subtotal thyroidectomy?
Select all that apply.
[ ] 1. “I feel like I could vomit.”
[ ] 2. “My lips feel numb and tingly.”
[ ] 3. “Light seems to bother my eyes.”
[ ] 4. “I feel weak when I walk.”
[ ] 5. “I have cramps in my legs.”
[ ] 6. “I feel like my throat is constricting.”
Because the client is exhibiting signs and symptoms
of hypocalcemia after surgery, the nurse assesses for
Chvostek’s sign.
29. Place an X in the area of the head that the nurse
should assess to determine a positive or negative
Chvostek’s sign.
A day after a client undergoes subtotal thyroidectomy, the
nurse suspects that the client is developing clinical manifestations
related to thyroid crisis.
30. Which signs and symptoms related to thyroid crisis
require immediate notifi cation of the physician? Select all
that apply.
[ ] 1. High fever
[ ] 2. Falling blood pressure
[ ] 3. Regular noisy respirations
[ ] 4. Hand spasms
[ ] 5. Heart palpitations
[ ] 6. Decreased urine output
Based on the client’s clinical presentation, a diagnosis of
thyroid crisis is made.
31. Which nursing interventions are most appropriate at
this time? Select all that apply.
[ ] 1. Take the client’s vital signs at least every hour.
[ ] 2. Assess Trousseau’s sign every shift.
[ ] 3. Limit the client’s activity.
[ ] 4. Administer antipyretics per order.
[ ] 5. Encourage a diet high in iodized salt.
[ ] 6. Make sure I.V. calcium gluconate is available.
32. At the beginning of thyroid replacement therapy after
a thyroidectomy, the nurse must monitor the client closely
for side effects. Which fi ndings would the nurse expect
to detect if the client is receiving more thyroid hormone
replacement than required? Select all that apply.
[ ] 1. Hyperglycemia
[ ] 2. Tachycardia
[ ] 3. Insomnia
[ ] 4. Hirsutism
[ ] 5. Tremors
[ ] 6. Hypertension
Nursing Care of Clients with Disorders of
the Parathyroid Glands
A client who develops a benign parathyroid tumor manifests
signs of hyperparathyroidism.
33. When the nurse reviews the client’s history, which
assessment fi nding is closely associated with the client’s
diagnosis?
[ ] 1. Nightly leg cramps
[ ] 2. Recurrent kidney stones
[ ] 3. Loose bowel movements
[ ] 4. Excessive energy level
The nursing assistant assigned to this client asks why the
care plan indicates that the client is at risk for falls and
injury.
34. Which is the best explanation by the nurse concerning
an effect of hyperparathyroidism?
[ ] 1. The inability to maintain balance
[ ] 2. The risk of developing seizures
[ ] 3. Fainting when changing positions
[ ] 4. Pathologic bone fractures
The client has three of the four lobes of the parathyroid
gland surgically removed.
35. After the client returns from surgery and resumes
eating, the nurse should encourage the client to eat foods
from which food group?
[ ] 1. Bread and cereals
[ ] 2. Milk and cheese
[ ] 3. Meat and seafood
[ ] 4. Fruit and vegetables
A client diagnosed with hypoparathyroidism develops tetany
and comes to the emergency department for treatment.
36. Which I.V. medication can the nurse expect the physician
to order to treat the client’s condition?
[ ] 1. Calcium gluconate
[ ] 2. Ferrous sulfate
[ ] 3. Potassium chloride
[ ] 4. Sodium bicarbonate
Nursing Care of Clients with Disorders of
the Adrenal Glands
The nurse is caring for a client with a disorder of the
adrenal glands.
37. Place an X where the adrenal glands are located in the
diagram below.
The nurse cares for a client with Addison’s disease.
38. Which characteristic fi ndings would the nurse expect to
assess in a client with Addison’s disease? Select all that apply.
[ ] 1. Salt craving
[ ] 2. Skin blemishes
[ ] 3. Moon-shaped face
[ ] 4. Bronzed skin
[ ] 5. Hypoglycemia
[ ] 6. Weight loss
39. Which nursing assessment is most helpful in evaluating
the status of a client with Addison’s disease?
[ ] 1. Blood pressure
[ ] 2. Bowel sounds
[ ] 3. Breath sounds
[ ] 4. Heart sounds
The client’s care plan indicates that the nurse should
assist the client in selecting foods that are good sources of
sodium as part of the treatment for Addison’s disease.
40. If the following foods are available, which one should
the nurse recommend?
[ ] 1. Graham crackers
[ ] 2. Cheddar cheese
[ ] 3. Raw carrots
[ ] 4. Canned fruit
The nurse documents that the client has recurrent episodes
of hypoglycemia.
41. If a regular diet is ordered, which between-meal
snack should the nurse offer to help regulate the client’s
blood glucose level?
[ ] 1. Lemonade and peanuts
[ ] 2. Cola and potato chips
[ ] 3. Coffee and a muffi n
[ ] 4. Milk and crackers
42. Because this client is at risk for developing addisonian
crisis, which is also known as acute adrenal insuffi
ciency and adrenal crisis, a life-threatening condition,
what should the nurse instruct the client to avoid?
[ ] 1. Stress-producing situations
[ ] 2. Consuming alcoholic beverages
[ ] 3. Eating complex carbohydrates
[ ] 4. Getting too little sleep
43. A client with Addison’s disease is admitted to the
hospital with a history of nausea and vomiting for the past
3 days. The registered nurse (RN) administers methylprednisolone
(Solu-Medrol), a glucocorticoid, intravenously.
Which nursing action is most important for the licensed
practical nurse (LPN) to implement in the client’s plan of
care?
[ ] 1. Glucometer measurements
[ ] 2. Intake and output volumes
[ ] 3. Daily weights
[ ] 4. Frequent oral care
A 38-year-old client is hospitalized after developing symptoms
that resemble those of Cushing’s syndrome. The nurse
completes admission documentation.
44. Based on the client’s condition, which fi ndings will
the nurse most likely document after completing the initial
physical assessment? Select all that apply.
[ ] 1. The client has very thin legs.
[ ] 2. The client looks emaciated.
[ ] 3. The client has bulging eyes.
[ ] 4. The client’s skin is pale.
[ ] 5. The client has bruising.
[ ] 6. The client’s scalp hair is thin.
The nurse develops the care plan and documents an
expected outcome that states, “The client will be free of
infection during the hospital stay.”
45. Based on the nurse’s understanding of this disease
process, for what reasons is the expected outcome justifi
ed? Select all that apply.
[ ] 1. The client is at risk for skin breakdown related to
thinning of the skin and edema.
[ ] 2. Wound healing is prolonged in clients with this
disorder.
[ ] 3. The immunosuppressive effects of the disorder
mask symptoms of infection.
[ ] 4. The client is at risk for aspiration pneumonia
related to laryngeal nerve damage.
[ ] 5. The client’s admission white blood cell count is
elevated.
[ ] 6. The client’s admission temperature is within
normal limits.
The physician orders a 24-hour urine collection to aid in
the diagnosis of Cushing’s syndrome.
46. The nurse is most accurate in telling the client that the
urine collection will begin when?
[ ] 1. With the client’s next voiding
[ ] 2. After the client’s next voiding
[ ] 3. After drinking a pitcher of water
[ ] 4. With the fi rst voiding in the morning
47. Which statement is correct concerning the collection
of urine for a 24-hour specimen?
[ ] 1. The volume of each voiding is measured and
recorded.
[ ] 2. The urine is placed in a container of preservative.
[ ] 3. Each voiding is taken immediately to the laboratory.
[ ] 4. The client voids directly into the specimen container.
After the health care team meets to discuss the client’s
nursing needs, the nursing diagnosis “Disturbed body
image” is added to the care plan.
48. The best rationale for adding this nursing diagnosis
to the care plan in the case of a female is that females with
Cushing’s syndrome typically experience which physiologic
effect?
[ ] 1. Masculine characteristics
[ ] 2. Heavy menstrual fl ow
[ ] 3. Extreme weight loss
[ ] 4. Large, pendulous breasts
Diagnostic tests confi rm that the client’s adrenal glands are
producing excessive amounts of adrenocortical hormones.
49. When the nurse explains the disorder to the client’s
spouse, it is accurate to stress that the client is also likely
to experience which effect?
[ ] 1. Anxiety and occasional panic attacks
[ ] 2. Depression and suicidal tendencies
[ ] 3. Impulsiveness and poor self-control
[ ] 4. Forgetfulness and memory changes
The physician orders a low-sodium diet to help treat the
client’s Cushing’s syndrome.
50. Which action by the nurse provides the best data for
monitoring the client’s therapeutic response to sodium
restriction?
[ ] 1. Monitoring sodium intake
[ ] 2. Measuring pedal edema
[ ] 3. Assessing skin turgor
[ ] 4. Weighing the client
51. Which nursing interventions are most appropriate
for managing the basic needs of a client with Cushing’s
syndrome? Select all that apply.
[ ] 1. Have the client sleep on a convoluted (egg-crate)
foam mattress.
[ ] 2. Ambulate the client at frequent intervals.
[ ] 3. Advise the client to ask for assistance when
getting up.
[ ] 4. Offer high-carbohydrate nourishment.
[ ] 5. Check the client frequently for suicidal ideation.
[ ] 6. Instruct the client to wear loose-fi tting clothing.
Eventually, the client undergoes a bilateral adrenalectomy
to correct Cushing’s syndrome.
52. To detect complications of surgery in the immediate
postoperative period, which assessment component is most
important for the nurse to monitor?
[ ] 1. Blood pressure
[ ] 2. Urine output
[ ] 3. Temperature
[ ] 4. Specifi c gravity
53. Which documentation fi nding provides the best indication
that the client has successfully avoided an adrenal
(addisonian) crisis after surgery?
[ ] 1. Urine output is approximately 2,000 mL/day.
[ ] 2. The client’s pedal edema has lessened.
[ ] 3. Capillary blood glucose level is within normal
limits.
[ ] 4. Vital signs are within preoperative ranges.
54. Based on the knowledge that clients with Cushing’s
syndrome heal slowly, which nursing measure is most
appropriate during the client’s postoperative period?
[ ] 1. Monitoring infusion of I.V. antibiotics
[ ] 2. Removing tape toward the incision site
[ ] 3. Increasing the client’s dietary protein intake
[ ] 4. Covering the wound with gauze
55. Which statement provides the best evidence that the
client who has undergone a bilateral adrenalectomy understands
the postoperative course?
[ ] 1. “I should avoid people with infectious diseases.”
[ ] 2. “I need to limit my fl uid intake to 1 quart per day.”
[ ] 3. “My appearance will never be the same as it was
before.”
[ ] 4. “No other treatment is necessary after I recover
from surgery.”
Nursing Care of Clients with Pancreatic
Endocrine Disorders
A 23-year-old client manifests symptoms of hyperinsulinism.
56. In response to a question about timing of symptoms
during the nursing history, when is the client most likely to
describe that symptoms typically occur?
[ ] 1. After fasting more than 6 hours
[ ] 2. About 2 hours after eating a meal
[ ] 3. Late in the evening, before bedtime
[ ] 4. Early in the morning, before breakfast
A glucose tolerance test is ordered to determine if the
client has functional hypoglycemia.
57. Which instruction by the nurse concerning the test
procedure is most accurate?
[ ] 1. “You need to eat a large meal just before the test.”
[ ] 2. “Bring a voided urine specimen to the laboratory.”
[ ] 3. “You can drink coffee or tea in the morning before
the test.”
[ ] 4. “You will be given a sweetened drink before the
test.”
58. To reduce or eliminate the symptoms that a client
with functional hypoglycemia experiences, it is best for the
nurse to recommend eating fi ve or six small meals containing
which nutrient?
[ ] 1. Simple sugars
[ ] 2. Complete proteins
[ ] 3. Complex carbohydrates
[ ] 4. Unsaturated fats
59. Which of the following provides the best evidence
that the dietary measures to control functional hypoglycemia
are therapeutic?
[ ] 1. The client experiences fewer incidences of weakness
and tremors.
[ ] 2. The client experiences fewer incidences of thirst
and dry mouth.
[ ] 3. The client experiences fewer incidences of muscle
spasms and fatigue.
[ ] 4. The client experiences fewer incidences of hunger
and abdominal cramps.
A nurse participates in a community-wide screening
to identify adults who may have undiagnosed diabetes
mellitus.
60. If the screening includes a measurement of postprandial
blood glucose, the nurse is correct in explaining that
blood will be drawn at which time?
[ ] 1. Approximately 2 hours before breakfast
[ ] 2. Approximately 2 hours after a meal
[ ] 3. Approximately 2 hours before bedtime
[ ] 4. Approximately 2 hours after fasting
61. Which statement indicates that a client with an
elevated 2-hour postprandial blood glucose level understands
the signifi cance of the screening test?
[ ] 1. “I need to eat less frequently.”
[ ] 2. “I need to stop eating candy.”
[ ] 3. “I need to consult my physician.”
[ ] 4. “I need to begin taking insulin.”
62. Which signs and symptoms are most appropriate for
the nurse to investigate when screening adults who have
come to have their blood glucose tested?
[ ] 1. Diarrhea, anorexia, and weight gain
[ ] 2. Constipation, weight loss, and thirst
[ ] 3. Polycholia, polyemia, and polyplegia
[ ] 4. Polyuria, polydipsia, and polyphagia
After the screening test, one client is referred to a physician
for additional follow-up. Further diagnostic tests
confi rm that the client has type 2 diabetes mellitus.
63. When given the news, the client denies the diagnosis
and becomes angry, stating there has been a mistake in the
tests. Which nursing action is most appropriate at this time?
[ ] 1. Emphasizing the importance of treatment
[ ] 2. Reassuring the client that the disease is easily
managed
[ ] 3. Explaining that many people live with diabetes
[ ] 4. Listening as the client expresses current feelings
The client with newly diagnosed type 2 diabetes mellitus is
referred to the diabetes clinic for teaching.
64. When the client asks the nurse why regular exercise
is recommended for diabetic clients, the best answer is that
exercise tends to facilitate which positive outcome?
[ ] 1. Regular exercise helps to control weight.
[ ] 2. Regular exercise helps to decrease appetite.
[ ] 3. Regular exercise helps to reduce blood glucose levels.
[ ] 4. Regular exercise helps to improve circulation to
the feet.
A dietitian explains how to use the American Diabetes
Association exchange list.
65. Which statement by the client provides the best
evidence that the client understands the principle of an
exchange list for meal planning?
[ ] 1. “I can eat one serving from each category on the
exchange list per day.”
[ ] 2. “Measured amounts of food in each category are
equal to one another.”
[ ] 3. “The number of servings from the exchange list is
unlimited.”
[ ] 4. “I need to use the exchange list to determine the
nutrition in food.”
66. The nurse knows the diabetic client understands
what “free” foods on the exchange list means if the client
excludes which one of the following from a meal plan?
[ ] 1. Iced tea
[ ] 2. Flavored water
[ ] 3. Light beer
[ ] 4. Club soda
The physician prescribes glyburide (DiaBeta) orally for
the client to treat diabetes.
68. When the client asks why a diabetic relative cannot
take insulin orally, what is the best answer?
[ ] 1. Insulin is inactivated by digestive enzymes.
[ ] 2. Insulin is absorbed too quickly in the stomach.
[ ] 3. Insulin is irritating to the gastric mucosa.
[ ] 4. Insulin is incompatible with many foods.
69. The diabetic client tells the nurse that breakfast is
always skipped. Which response by the nurse is most
appropriate?
[ ] 1. “If you drink a glass of milk and eat a breakfast
bar, that will be suffi cient for breakfast.”
[ ] 2. “You should eat each meal and snack at the same
time each day.”
[ ] 3. “If you skip breakfast, eat a high-calorie snack at
midmorning.”
[ ] 4. “Wait to take your medication until you eat your
fi rst meal of the day.”
After the client is discharged from the hospital, the
physician wants the client to continue to self-monitor the
response to the diet and medication management.
70. Which monitoring approach is best for the nurse to
recommend?
[ ] 1. Testing the urine with a chemical reagent strip
[ ] 2. Using a glucometer to check capillary blood
glucose levels
[ ] 3. Having laboratory personnel draw venous blood
samples
[ ] 4. Arranging for testing by a home health agency
Nurse
Emergency medical personnel bring a client who is lethargic
and confused to the emergency department. A tentative
diagnosis of type 1 diabetes mellitus and diabetic ketoacidosis
(DKA) is made.
71. Which assessment fi ndings would the nurse expect to
document if the client has DKA? Select all that apply.
[ ] 1. The client is hypertensive and tachycardic.
[ ] 2. The client is dyspneic and hypotensive.
[ ] 3. The client breathes noisily and smells of acetone.
[ ] 4. The client stares blankly and smells of alcohol.
[ ] 5. The client has warm, fl ushed skin and has vomited.
[ ] 6. The client complains of abdominal pain and is
thirsty.
The nurse documents that Kussmaul’s respirations were
detected during the initial assessment.
72. Which respiratory pattern is the best description of
the client’s breathing?
[ ] 1. Fast, deep, labored respirations
[ ] 2. Shallow respirations, alternating with apnea
[ ] 3. Slow inhalation and exhalation through pursed lips
[ ] 4. Shortness of breath with pauses
The nurse plans to monitor the client’s response to insulin
therapy closely with an electronic glucometer and instructs
the emergency department technician to take periodic
capillary blood glucose measurements.
73. Which techniques are correct when using an electronic
glucometer to monitor the client’s capillary blood
glucose level? Select all that apply.
[ ] 1. Clean the client’s fi nger with povidone-iodine
(Betadine).
[ ] 2. Take a set of vital signs before the test.
[ ] 3. Pierce the central pad of the client’s fi nger.
[ ] 4. Apply a large drop of blood to a test strip or area.
[ ] 5. Don gloves before piercing the client’s fi nger.
[ ] 6. Perform a quality control before the test.
After using the glucometer, the emergency department
technician reports to the nurse that the client’s capillary
blood glucose measures 498 mg/dL.
74. Based on the client’s blood glucose measurement, the
nurse immediately reevaluates the client. Which physician
orders should the nurse anticipate? Select all that apply.
[ ] 1. STAT serum blood glucose
[ ] 2. Intravenous regular insulin
[ ] 3. Vital signs every 2 hours
[ ] 4. A diet of six small, frequent meals
[ ] 5. Electronic glucometer measurements before meals
and at bedtime
[ ] 6. Continuous cardiac monitoring
After stabilization in the emergency department, the client
with diabetic ketoacidosis (DKA) is admitted to a stepdown
unit for further observation and treatment. After
several episodes of hyperglycemia, the physician orders
sliding-scale regular insulin administered subcutaneously
for the client.
75. How soon after administering the client’s dose of
regular insulin subcutaneously should the nurse assess for
signs of hypoglycemia?
[ ] 1. 5 minutes later
[ ] 2. 30 minutes later
[ ] 3. 6 hours later
[ ] 4. 10 hours later
76. The nurse teaches the client with newly diagnosed
diabetes mellitus about the signs and symptoms of hypoglycemia.
Which of the following should the nurse stress
in teaching? Select all that apply.
[ ] 1. Sleepiness
[ ] 2. Shakiness
[ ] 3. Thirst
[ ] 4. Hunger
[ ] 5. Diaphoresis
[ ] 6. Confusion
During the midmorning after receiving insulin, the client
reports feeling weak, shaky, and dizzy. The nurse asks the
nursing assistant to obtain a capillary blood glucose measurement
with a glucometer.
77. The nursing assistant reports to the nurse that the client’s
blood glucose reading is 58 mg/dL. What is the most
appropriate nursing action at this time?
[ ] 1. Administer the next scheduled dose of insulin.
[ ] 2. Give the client ¼ cup of sweet fruit juice.
[ ] 3. Report the client’s symptoms to the physician.
[ ] 4. Perform a complete head-to-toe assessment.
The client with type 1 diabetes mellitus must learn to combine
two insulins—regular and intermediate-acting—and
self-administer the injection before being discharged.
78. Which action is the best indication that the client
needs more practice in combining two insulins in one
syringe?
[ ] 1. The client rolls the vial of intermediate-acting
insulin to mix it with its additive.
[ ] 2. The client instills air into both the fast-acting and
intermediate-acting insulin vials.
[ ] 3. The client instills the intermediate-acting insulin
into the vial of rapid-acting insulin.
[ ] 4. The client inverts each vial before withdrawing the
specifi ed amount of insulin.
79. When the client practices self-administration of the
insulin, which action is correct?
[ ] 1. Piercing the skin at a 30-degree angle
[ ] 2. Using a syringe calibrated in minims
[ ] 3. Using a 29-gauge needle on the syringe
[ ] 4. Rotating abdominal sites for each injection
The nurse implements a diabetes teaching plan in anticipation
of the client’s discharge.
81. Which statement indicates that the client has misunderstood
the nurse’s teaching?
[ ] 1. “I may need more insulin during times of stress.”
[ ] 2. “I may need more food when exercising strenuously.”
[ ] 3. “My insulin needs may change as I get older.”
[ ] 4. “My dependence on insulin may stop eventually.”
82. The nurse discusses the long-term effects of diabetes
mellitus with the client and realizes that the client needs
further teaching when the client identifi es which occurrence
as a complication of this disease?
[ ] 1. Blindness
[ ] 2. Stroke
[ ] 3. Renal failure
[ ] 4. Liver failure
83. When the client asks how to store an opened vial of
insulin, which answer by the nurse offers the most correct
instruction?
[ ] 1. The best place for storing insulin is in the bathroom,
close to the shower.
[ ] 2. The best place to store insulin is in the refrigerator.
[ ] 3. The best way to store insulin is at room temperature.
[ ] 4. The best place for storing insulin is in a warm
location but out of sunlight.
The nurse includes foot care as a component of diabetes
teaching.
84. Which statement by the client about foot care indicates
a need for further teaching?
[ ] 1. “I need to inspect my feet daily.”
[ ] 2. “I should soak my feet each day.”
[ ] 3. “I need to wear shoes whenever I’m not sleeping.”
[ ] 4. “I need to schedule regular appointments with the
podiatrist.”
After 3 months, the client returns for a follow-up appointment
with the physician to evaluate the progress of
s elf-care.
85. Which information is most important for the nurse
to elicit from the client to effectively evaluate compliance
with the prescribed therapy?
[ ] 1. The dosage and frequency of insulin
administration
[ ] 2. The client’s glucose monitoring records for the
past week
[ ] 3. The client’s weight and vital signs before the offi ce
interview
[ ] 4. The symptoms experienced in the past month
86. Which laboratory test is most important for the nurse
to monitor to determine how effectively the client’s diabetes
is being managed?
[ ] 1. Fasting blood glucose
[ ] 2. Blood chemistry profi le
[ ] 3. Complete blood count
[ ] 4. Glycosylated hemoglobin (HbA1c)
During the physician’s visit, the client reports researching
the use of insulin pumps on the Internet and wants to know
the possibility of being a candidate. After evaluating the
client and discussing the request, the physician asks the
nurse to provide instructions about management of the client’s
diabetes using a continuous insulin infusion pump.
87. The nurse teaches the client how the infusion pump
operates and correctly points out that the infusion is typically
administered in which location?
[ ] 1. In a vein within the nondominant hand
[ ] 2. In the muscular tissue of the thigh
[ ] 3. In the subcutaneous tissue of the abdomen below
the belt line
[ ] 4. In an implanted I.V. catheter threaded into the neck
The nurse cares for an older client who is insulin dependent
and lives in a long-term care facility.
88. When developing the client’s care plan, which intervention
is most appropriate to add?
[ ] 1. Encourage the client to use an electric razor.
[ ] 2. Tell the client to fi le rather than cut toenails.
[ ] 3. Make sure that the client receives mouth care twice
per day.
[ ] 4. Advise the client to use deodorant soap when bathing
89. The nurse has prepared 24 units of Humulin N insulin
for subcutaneous administration. Identify with an X the
preferred location for insulin administration to facilitate
rapid absorption.
90. Which sign is most suggestive that a client with type
2 diabetes is developing hyperosmolar hyperglycemic
nonketotic syndrome (HHNS)?
[ ] 1. The client’s serum glucose level is 650 mg/dL.
[ ] 2. The client’s urinary output is 3,000 mL/24 hours.
[ ] 3. The client’s skin is cool and moist.
[ ] 4. The client’s urine contains acetone.
A client with type 1 diabetes mellitus comes to the clinic
complaining of persistent bouts of nausea, vomiting,
and diarrhea for the past 4 days. The client has skipped
insulin injections because of not being able to eat or keep
anything down.
91. Which instruction should the nurse give the client
about insulin administration during periods of illness?
[ ] 1. Monitor blood glucose levels every 2 to 4 hours.
[ ] 2. Eat candy or sugar frequently.
[ ] 3. Attempt to drink a high-calorie beverage every
hour.
[ ] 4. Test urine daily for protein.
92. During change of shifts, a nurse discovers that a
hospitalized client with diabetes received two doses of
insulin. After notifying the physician, which nursing
action is most appropriate?
[ ] 1. Completing an incident report
[ ] 2. Calling the intensive care unit (ICU)
[ ] 3. Performing frequent neurologic checks
[ ] 4. Monitoring the client’s blood glucose
*******************************************************************
From 1Saunders_Comprehensive_Review
Practice Questions
571. A client is brought to the emergency department
in an unresponsive state, and a diagnosis of
hyperglycemic hyperosmolar nonketotic syndrome
is made. The nurse would immediately
prepare to initiate which of the following anticipated
physician’s prescriptions?
1. Endotracheal intubation
2. 100 units of NPH insulin
3. Intravenous infusion of normal saline
4. Intravenous infusion of sodium bicarbonate
572. An external insulin pump is prescribed for a
client with diabetes mellitus and the client asks
the nurse about the functioning of the pump.
The nurse bases the response on the information
that the pump:
1. Is timed to release programmed doses of regular
or NPH insulin into the bloodstream at
specific intervals
2. Continuously infuses small amounts of NPH
insulin into the bloodstream while regularly
monitoring blood glucose levels
3. Is surgically attached to the pancreas and infuses
regular insulin into the pancreas, which in turn
releases the insulin into the bloodstream
4. Gives a small continuous dose of regular insulin
subcutaneously, and the client can selfadminister
a bolus with an additional dose
from the pump before each meal
573. A client with a diagnosis of diabetic ketoacidosis
(DKA) is being treated in an emergency department.
Which finding would a nurse expect to
note as confirming this diagnosis?
1. Comatose state
2. Decreased urine output
3. Increased respirations and an increase in pH
4. Elevated blood glucose level and low plasma
bicarbonate level
574. A nurse teaches a client with diabetes mellitus
about differentiating between hypoglycemia and
ketoacidosis. The client demonstrates an understanding
of the teaching by stating that a form
of glucose should be taken if which of the following
symptoms develops?
1. Polyuria
2. Shakiness
3. Blurred vision
4. Fruity breath odor
575. A client with diabetes mellitus demonstrates
acute anxiety when first admitted for the treatment
of hyperglycemia. The appropriate intervention
to decrease the client’s anxiety is to:
1. Administer a sedative.
2. Convey empathy, trust, and respect toward
the client.
3. Ignore the signs and symptoms of anxiety so
that they will soon disappear.
4. Make sure that the client knows all the correct
medical terms to understand what is happening.
576. A nurse provides instructions to a client newly
diagnosed with type 1 diabetes mellitus. The nurse
recognizes accurate understanding of measures to
prevent diabetic ketoacidosis when the client states:
1. “I will stop taking my insulin if I’m too sick
to eat.”
2. “I will decrease my insulin dose during times
of illness.”
3. “I will adjust my insulin dose according to the
level of glucose in my urine.”
4. “I will notify my physician if my blood glucose
level is higher than 250 mg/dL.”
577. A client is admitted to a hospital with a diagnosis
of diabetic ketoacidosis (DKA). The initial
blood glucose level was 950 mg/dL. A continuous
intravenous infusion of regular insulin is
initiated, along with intravenous rehydration
with normal saline. The serum glucose level is
now 240 mg/dL. The nurse would next prepare
to administer which of the following?
1. Ampule of 50% dextrose
2. NPH insulin subcutaneously
3. Intravenous fluids containing 5% dextrose
4. Phenytoin (Dilantin) for the prevention of
seizures
578. A nurse is monitoring a client newly diagnosed
with diabetes mellitus for signs of complications.
Which of the following, if exhibited in the client,
would indicate hyperglycemia and warrant physician
notification?
1. Polyuria
2. Diaphoresis
3. Hypertension
4. Increased pulse rate
579. A nurse is preparing a plan of care for a client
with diabetes mellitus who has hyperglycemia.
The priority nursing diagnosis would be:
1. Deficient knowledge
2. Deficient fluid volume
3. Compromised family coping
4. Imbalanced nutrition, less than body
requirements
580. A home health nurse visits a client with a diagnosis
of type 1 diabetes mellitus. The client relates a
history of vomiting and diarrhea and tells the
nurse that no food has been consumed for the
last 24 hours. Which additional statement by
the client indicates a need for further teaching?
1. “I need to stop my insulin.”
2. “I need to increase my fluid intake.”
3. “I need to monitor my blood glucose every 3
to 4 hours.”
4. “I need to call the physician because of these
symptoms.”
581. A nurse is caring for a client after hypophysectomy.
The nurse notices clear nasal drainage
from the client’s nostril. The initial nursing
action would be to:
1. Lower the head of the bed.
2. Test the drainage for glucose.
3. Obtain a culture of the drainage.
4. Continue to observe the drainage.
582. After several diagnostic tests, a client is diagnosed
with diabetes insipidus. A nurse performs an
assessment on the client, knowing that which
symptom is most indicative of this disorder?
1. Fatigue
2. Diarrhea
3. Polydipsia
4. Weight gain
583. A client is admitted to an emergency department,
and a diagnosis of myxedema coma is made.
Which action would the nurse prepare to carry
out initially?
1. Warm the client.
2. Maintain a patent airway.
3. Administer thyroid hormone.
4. Administer fluid replacement.
584. A nurse is caring for a client admitted to the
emergency department with diabetic ketoacidosis
(DKA). In the acute phase, the priority nursing
action is to prepare to:
1. Correct the acidosis.
2. Administer 5% dextrose intravenously.
3. Administer regular insulin intravenously.
4. Apply a monitor for an electrocardiogram.
585. 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?
1. “The best time for me to exercise is after I eat.”
2. “The best time for me to exercise is after
breakfast.”
3. “The best time for me to exercise is mid- to
late afternoon.”
4. “The best time for me to exercise is after my
morning snack.”
586. A nurse is completing an assessment on a client
who is being admitted for a diagnostic workup
for primary hyperparathyroidism. Which client
complaint would be characteristic of this
disorder?
1. Diarrhea
2. Polyuria
3. Polyphagia
4. Weight gain
587. A nurse is caring for a postoperative parathyroidectomy
client. Which client complaint would
indicate that a serious, life-threatening complication
may be developing, requiring immediate
notification of the physician?
1. Laryngeal stridor
2. Abdominal cramps
3. Difficulty in voiding
4. Mild to moderate incisional pain
588. A client is diagnosed with pheochromocytoma.
A nurse prepares a plan of care for the client;
while planning, the nurse understands that
pheochromocytoma is a condition that:
1. Causes profound hypotension
2. Is manifested by severe hypoglycemia
3. Is not curable and is treated symptomatically
4. Causes the release of excessive amounts of
catecholamines
589. A nurse is caring for a client with pheochromocytoma
who is scheduled for adrenalectomy. In the
preoperative period, the priority nursing action
would be to monitor:
1. Vital signs
2. Intake and output
3. Blood urea nitrogen results
4. Urine for glucose and ketones
590. A nurse is performing an assessment on a client
with pheochromocytoma. Which of the following
assessment data would indicate a potential
complication associated with this disorder?
1. A coagulation time of 5 minutes
2. A urinary output of 50 mL per hour
3. A blood urea nitrogen level of 20 mg/dL
4. A heart rate that is 90 beats/min and irregular
591. 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?
1. “Cushing’s disease results from an oversecretion
of insulin.”
2. “Cushing’s disease results from an undersecretion
of corticotropic hormones.”
3. “Cushing’s disease results from an undersecretion
of mineralocorticoid hormones.”
4. “Cushing’s disease results from an increased
pituitary secretion of adrenocorticotropic
hormone.”
592. 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 101 _ F, pulse of 88 beats/min,
respirations of 22 breaths/min, and blood pressure
of 100/72 mm Hg. Which finding would
be of most concern to the nurse?
1. Pulse
2. Respiration
3. Temperature
4. Blood pressure
593. 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?
1. “I take oral insulin instead of shots.”
2. “By taking these medications, I am able to eat
more.”
3. “When I become ill, I need to increase the
number of pills I take.”
4. “The medications I’m taking help release the
insulin I already make.”
594. A nurse is providing discharge instructions to a
client who has Cushing’s syndrome. Which client
statement indicates that instructions related to
dietary management are understood?
1. “I can eat foods that have a lot of potassium
in them.”
2. “I will need to limit the amount of protein in
my diet.”
3. “I am fortunate that I can eat all the salty
foods I enjoy.”
4. “I am fortunate that I do not need to follow
any special diet.”
595. The nurse is caring for a client who is 2 days
postoperative following an abdominal hysterectomy.
The client has a history of diabetes mellitus
and has been receiving regular insulin
according to capillary blood glucose testing four
times a day. A carbohydrate-controlled diet has
been prescribed but the client has been complaining
of nausea and is not eating. On entering
the client’s room, the nurse finds the client to be
confused and diaphoretic. Which action is
appropriate at this time?
1. Call a code to obtain needed assistance
immediately.
2. Obtain a capillary blood glucose level and
perform a focused assessment.
3. Stay with the client and ask the nursing assistant
to call the physician for a prescription for
intravenous 50% dextrose.
4. Ask the nursing assistant to stay with the client
while obtaining 15 to 30 g of a carbohydrate
snack for the client to eat.