NCLEX Leadership Questions (300 Questions)

NCLEX Leadership Questions: 300

1. An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:

A. 2 to 5 g of a simple carbohydrate.
B. 10 to 15 g of a simple carbohydrate.
C. 18 to 20 g of a simple carbohydrate.
D. 25 to 30 g of a simple carbohydrate.

2. A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which “related-to” phrase should the nurse add?

A. Related to bone demineralization resulting in pathologic fractures
B. Related to exhaustion secondary to an accelerated metabolic rate
C. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces
D. Related to tetany secondary to a decreased serum calcium level

3. Nurse Joey is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he’s impotent and says he’s concerned about its effect on his marriage. In planning this client’s care, the most appropriate intervention would be to:

A. Encourage the client to ask questions about personal sexuality.
B. Provide time for privacy.
C. Provide support for the spouse or significant other.
D. Suggest referral to a sex counselor or other appropriate professional.

4. during a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise?

A. At least once a week
B. At least three times a week
C. At least five times a week
D. Every day

5. Nurse Oliver should expect a client with hypothyroidism to report which health concerns?

A. Increased appetite and weight loss
B. Puffiness of the face and hands
C. Nervousness and tremors
D. Thyroid gland swelling

6. A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect?

A. Dysuria
B. Leg cramps
C. Tachycardia
D. Blurred vision

7. A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, Nurse Richard would suspect which of the following disorders?

A. Diabetes mellitus
B. Diabetes insipidus
C. Hypoparathyroidism
D. Hyperparathyroidism

8. When caring for a male client with diabetes insipidus, Nurse Juliet expects to administer:

A. vasopressin (Pitressin Synthetic).
B. furosemide (Lasix).
C. regular insulin.
D. 10% dextrose.

9. The nurse is aware that the following is the most common cause of hyperaldosteronism?

A. Excessive sodium intake
B. A pituitary adenoma
C. Deficient potassium intake
D. An adrenal adenoma

10. A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating:

A. “The test needs to be repeated following a 12-hour fast.”
B. “It looks like you aren’t following the prescribed diabetic diet.”
C. “It tells us about your sugar control for the last 3 months.”
D. “Your insulin regimen needs to be altered significantly.”

11. Following a unilateral adrenalectomy, Nurse Betty would assess for hyperkalemia shown by which of the following?

A. Muscle weakness
B. Tremors
C. Diaphoresis
D. Constipation

12. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

A. antidiuretic hormone (ADH).
B. thyroid-stimulating hormone (TSH).
C. follicle-stimulating hormone (FSH).
D. luteinizing hormone (LH).

13. Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, Nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

A. Diabetic ketoacidosis
B. Thyroid crisis
C. Hypoglycemia
D. Tetany

14. For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?

A. Cool, clammy skin
B. Distended neck veins
C. Increased urine osmolarity
D. Decreased serum sodium level

15. When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, Nurse April is most likely to detect:

A. a blood pressure of 130/70 mm Hg.
B. a blood glucose level of 130 mg/dl.
C. bradycardia.
D. a blood pressure of 176/88 mm Hg.

16. A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

A. Infusing I.V. fluids rapidly as ordered
B. Encouraging increased oral intake
C. Restricting fluids
D. Administering glucose-containing I.V. fluids as ordered

17. A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, Nurse Noah expects to assess:

A. Trousseau’s sign.
B. Homans’ sign.
C. Hegar’s sign.
D. Goodell’s sign.

18. Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?

A. Fluid intake is less than 2,500 ml/day.
B. Urine output measures more than 200 ml/hour.
C. Blood pressure is 90/50 mm Hg.
D. The heart rate is 126 beats/minute.

19. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client’s hyperglycemia?

A. Acromegaly
B. Type 1 diabetes mellitus
C. Hypothyroidism
D. Deficient growth hormone

20. Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend:

A. Increasing saturated fat intake and fasting in the afternoon.
B. Increasing intake of vitamins B and D and taking iron supplements.
C. Eating a candy bar if lightheadedness occurs.
D. Consuming a low-carbohydrate, high protein diet and avoiding fasting.

21. An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, Nurse Libby prepares to take emergency action to prevent the potential complication of:

A. Thyroid storm.
B. Cretinism.
C. myxedema coma.
D. Hashimoto’s thyroiditis.

22. A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client:

A. prefers to take insulin orally.
B. has type 2 diabetes.
C. has type 1 diabetes.
D. is pregnant and has type 2 diabetes.

23. When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description?

A. sulfisoxazole (Gantrisin)
B. mexiletine (Mexitil)
C. prednisone (Orasone)
D. lithium carbonate (Lithobid)

24. After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the following would the nurse expect the physician to do?

A. Initiate insulin therapy.
B. Switch the client to a different oral antidiabetic agent.
C. Prescribe an additional oral antidiabetic agent.
D. Restrict carbohydrate intake to less than 30% of the total caloric intake.

25. During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should include which statement?

A. “The head of your bed must remain flat for 24 hours after surgery.”
B. “You should avoid deep breathing and coughing after surgery.”
C. “You won’t be able to swallow for the first day or two.”
D. “You must avoid hyper extending your neck after surgery.”

26. Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client with Cushing’s syndrome, the nurse would expect to find:

A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in the trunk and dorsocervical area.
D. Weight gain in arms and legs.

27. A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide?

A. “Administer desmopressin while the suspension is cold.”
B. “Your condition isn’t chronic, so you won’t need to wear a medical identification bracelet.”
C. “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.”
D. “You won’t need to monitor your fluid intake and output after you start taking desmopressin.”

28. Nurse Wayne is aware that a positive Chvostek’s sign indicate?

A. Hypocalcaemia
B. Hyponatremia
C. Hypokalemia
D. Hypermagnesemia

29. In a 29-year-old female client who is being successfully treated for Cushing’s syndrome, nurse Lyzette would expect a decline in:

A. Serum glucose level.
B. Hair loss.
C. Bone mineralization.
D. Menstrual flow.

30. A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin?

A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.
B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.
D. It regulates the threshold for water reabsorption in the kidneys.

31. Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Vince should expect the doses:

A. Onset to be at 2 p.m. and its peak to be at 3 p.m.
B. Onset to be at 2:15 p.m. and its peak to be at 3 p.m.
C. Onset to be at 2:30 p.m. and its peak to be at 4 p.m.
D. Onset to be at 4 p.m. and its peak to be at 6 p.m.

32. A female client with Cushing’s syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?

A. Depression
B. Neuropathy
C. Hypoglycemia
D. Hyperthyroidism

33. Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?

A. Tetany
B. Hemorrhage
C. Thyroid storm
D. Laryngeal nerve damage

34. After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?

A. Primary hypothyroidism
B. Graves’ disease
C. Thyrotoxicosis
D. Euthyroidism

35. Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?

A. Tetanic contractions
B. Neck vein distention
C. Weight loss
D. Polyuria

36. A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:

A. phentolamine (Regitine).
B. methyldopa (Aldomet).
C. mannitol (Osmitrol).
D. felodipine (Plendil).

37. A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client’s hypertension is caused by excessive hormone secretion from which of the following glands?

A. Adrenal cortex
B. Pancreas
C. Adrenal medulla
D. Parathyroid

38. Nurse Troy is aware that the most appropriate for a client with Addison’s disease?

A. Risk for infection
B. Excessive fluid volume
C. Urinary retention
D. Hypothermia

39. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client’s need for additional teaching when the client states:

A. “If I have hypoglycemia, I should eat some sugar, not dextrose.”
B. “The drug makes my pancreas release more insulin.”
C. “I should never take insulin while I’m taking this drug.”
D. “It’s best if I take the drug with the first bite of a meal.”

40. A female client whose physical findings suggest a hyper pituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, Nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize?

A. “You must lie flat for 24 hours after surgery.”
B. “You must avoid coughing, sneezing, and blowing your nose.”
C. “You must restrict your fluid intake.”
D. “You must report ringing in your ears immediately.”

41. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide?

A. “Be sure to take glipizide 30 minutes before meals.”
B. “Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.”
C. “You won’t need to check your blood glucose level after you start taking glipizide.”
D. “Take glipizide after a meal to prevent heartburn.”

42. For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client?

A. They contain exudates and provide a moist wound environment.
B. They protect the wound from mechanical trauma and promote healing.
C. They debride the wound and promote healing by secondary intention.
D. They prevent the entrance of microorganisms and minimize wound discomfort.

43. When instructing the female client diagnosed with hyperparathyroidism about diet, Nurse Gina should stress the importance of which of the following?

A. Restricting fluids
B. Restricting sodium
C. Forcing fluids
D. Restricting potassium

44. Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?

A. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
B. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
C. Body image disturbance related to weight gain and edema
D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

45. A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder?

A. Serum potassium level
B. Serum sodium level
C. Arterial blood gas (ABG) values
D. Serum osmolarity

46. A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline?

A. “You’ll need more insulin when you exercise or increase your food intake.”
B. “You’ll need less insulin when you exercise or reduce your food intake.”
C. “You’ll need less insulin when you increase your food intake.”
D. “You’ll need more insulin when you exercise or decrease your food intake.”

47. Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon?

A. Oral anticoagulants
B. Anabolic steroids
C. Beta-adrenergic blockers
D. Thiazide diuretics

48. Which instruction about insulin administration should Nurse Kate give to a client?

A. “Always follow the same order when drawing the different insulins into the syringe.”
B. “Shake the vials before withdrawing the insulin.”
C. “Store unopened vials of insulin in the freezer at temperatures well below freezing.”
D. “Discard the intermediate-acting insulin if it appears cloudy.”

49. Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:

A. I.M. or subcutaneous glucagon.
B. I.V. bolus of dextrose 50%.
C. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
D. 10 U of fast-acting insulin.

50. For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek’s sign and Trousseau’s sign because they indicate which of the following?

A. Hypocalcaemia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia

51)  Knowing that gluconeogenesis helps to maintain blood levels, a nurse should:

1. Document weight changes because of fatty acid mobilization

2. Evaluate the patient’s sensitivity to low room temperatures because of decreased adipose tissue insulation

3. Protect the patient from sources of infection because of decreased cellular protein deposits

4. Do all of the above

52. Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except:

1. Hypoglycemia

2. Hyponatremia

3. Ketonuria

4. Polyphagia

53. The lowest fasting plasma glucose level suggestive of a diagnosis of DM is:

1. 90mg/dl

2. 115mg/dl

3. 126mg/dl

4. 180mg/dl

54. Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every:

1. Third day

2. Week

3. 2-3 weeks

4. 2-4 weeks

55. A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:

1. Blurred vision

2. Diaphoresis

3. Nausea

4. Weakness

56. Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except:

1. Integumentary inspection for the presence of brown spots on the lower extremities

2. Observation for paleness of the lower extremities

3. Observation for blanching of the feet after the legs are elevated for 60 seconds

4. Palpation for increased pulse volume in the arteries of the lower extremities

57. The nurse expects that a type 1 diabetic may receive ____ of his or her morning dose of insulin preoperatively:

1. 10-20%

2. 25-40%

3. 50-60%

4. 85-90%

58. Albert, a 35-year-old insulin dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of:

1. 1130 and 1330

2. 1330 and 1930

3. 1530 and 2130

4. 1730 and 2330

59. A bedtime snack is provided for Albert. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of:

1. 6-8 hours

2. 10-14 hours

3. 16-20 hours

4. 24-28 hours

60. Albert refuses his bedtime snack. This should alert the nurse to assess for:

1. Elevated serum bicarbonate and a decreased blood pH.

2. Signs of hypoglycemia earlier than expected.

3. Symptoms of hyperglycemia during the peak time of NPH insulin.

4. Sugar in the urine

61. A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is:

1. 2-4 hours after administration

2. 6-14 hours after administration

3. 16-18 hours after administration

4. 18-24 hours after administration

62. An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:

1. Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal.

2. Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals.

3. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream.

4. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

63. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis?

1. Elevated blood glucose level and a low plasma bicarbonate

2. Decreased urine output

3. Increased respirations and an increase in pH

4. Comatose state

64. A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client’s anxiety would be to:

1. Administer a sedative

2. Make sure the client knows all the correct medical terms to understand what is happening.

3. Ignore the signs and symptoms of anxiety so that they will soon disappear

4. Convey empathy, trust, and respect toward the client.

65. A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be:

1. High risk for deficient fluid volume

2. Deficient knowledge: disease process and treatment

3. Imbalanced nutrition: less than body requirements

4. Disabled family coping: compromised.

66. A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to:

1. Administer regular insulin intravenously

2. Administer 5% dextrose intravenously

3. Correct the acidosis

4. Apply an electrocardiogram monitor.

67. A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse?

1. Pulse

2. BP

3. Respiration

4. Temperature

68. A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise?

1. “The best time for me to exercise is every afternoon.”

2. “The best time for me to exercise is right after I eat.”

3. “The best time for me to exercise is after breakfast.”

4. “The best time for me to exercise is after my morning snack.”

69.  A client with diabetes mellitus visits a health care clinic. The client’s diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia?

1. Prednisone (Deltasone)

2. Atenolol (Tenormin)

3. Phenelzine (Nardil)

4. Allopurinol (Zyloprim)

70.  Glucose is an important molecule in a cell because this molecule is primarily used for:

1. Extraction of energy

2. Synthesis of protein

3. Building of genetic material

4. Formation of cell membranes.

71. When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse’s priority is to provide:

1. Oxygen

2. Carbohydrates

3. Fluid replacement

4. Dietary instruction

72. The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply.

1. Thirst

2. Palpitations

3. Diaphoresis

4. Slurred speech

5. Hyperventilation

73. When a client is in diabetic ketoacidosis, the insulin that would be administered is:

1. Human NPH insulin

2. Human regular insulin

3. Insulin lispro injection

4. Insulin glargine injection

74. The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says:

1. “I need to rub my forearm vigorously until warm before testing at this site.”

2. “The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.”

3. “I have to make sure that my current glucose monitor can be used at an alternate site.”

4. “Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels.”

75. Which adaptations should the nurse caring for a client with diabetic ketoacidosis expect the client to exhibit? Select all that apply:

1. Sweating

2. Low PCO2

3. Retinopathy

4. Acetone breath

5. Elevated serum bicarbonate

76. All of the following statements about Hashimoto's disease are true accept:
a. Many patients are entirely asymptomatic
b. Not all patients become hypothyroid
c. Most cases of obesity are attributable to Hashimoto's disease
d. Hypothyroidism may be subclinical

77. The most common benign tumor of the pituitary gland is a:
a. Glioma
b Prolactinoma
c. Carcinoid tumor
d. Islet cell tumor

.

78.12. Symptoms of polycystic ovarian syndrome (PCOS) may include all of the following except:
a. Pelvic pain
b. Acne, oily skin, and dandruff
c. Infertility
d. Weight Loss

79. Women with PCOS are at increased risk for all of the following except:
a. Pregnancy
b. Diabetes
c. Cardiovascular disease
d. Metabolic syndrome

80. All of the following organs may be affected by multiple endocrine neoplasia type 1 except:
a. Parathyroid glands
b. Kidneys
c. Pancreas and Duodenum
d. Pituitary gland

81. What is the treatment for hyperparathyroidism?
a. Synthetic thyroid hormone
b. Desiccated thyroid hormone
c. Surgical removal of the glands
d. Calcium and phosphate

82. The most common causes of death in people with cystic fibrosis is:
a. Dehydration
b. Opportunistic infection
c. Lung cancer
d. Respiratory failure

83. Untreated hyperthyroidism during pregnancy may result in all of the following except:
a. Premature birth and miscarriage
b. Low birth weight
c. Autism
d. Preeclampsia

84. Short stature and undeveloped ovaries suggest which of the following disorders:
a. Polycystic ovarian syndrome
b. Prolactinoma
c. Grave's disease
d. Turner syndrome

85. Endocrine disorders may be triggered by all of the following except:
a. Stress
b. Infection
c. Chemicals in the food chain and environment
d. Cell phone use

86. An analysis of data from the Women's Health Initiative questioned the use of which therapy to prevent heart disease?
a. Synthetic thyroid hormone
b. Oral contraceptives
c. Weight-loss drugs
d. Postmenopausal hormone replacement therapy

87. The parathyroid glands play a major role in regulating which substances?
A. Calcium and Phosphorus
B. Chloride and potassium
C. Potassium and calcium
D. Sodium and potassium a. Calcium and Phosphorus

88. The primary function of insulin is to:
A. Lower blood glucose levels
B. Produce melanin
C. regulate the body’s metabolic rate
D. stimulate release of digestive enzymes

89. A client is admitted to the hospital with a medical DX of hyperthyroidism. When taking a history which information would be most significant?
A. edema, intolerance to cold, lethargy
b. peri-orbital edema, lethargy mask like face
c. weight loss, intolerance to cold, muscle wasting
d. weight loss, intolerance to heat, exophthalmos

90. Which nursing action is most appropriate for a client in ketoacidosis?
a. admin of carbs
b. admin of IV fluids
c. applying cold compress
d. giving glucagon IV

91. The nurse smells a sweet fruity odor on the breath of a client admitted with DM. This odor may be associated with?
a. alcohol intoxication
b. insulin shock
c. ketoacidosis

92. A client asks what the purpose of the Hb A1c test is. The nurses best explanation would be that the test measures the average:
a. blood sugar lvl's over a 6-10 week period
b. hemoglobin lvl's over a 6 - 10 week period
c. protein lvl over a 3 month period
d. vanillylmandelic acid lvl's

93. Which of the following would be a nursing priority for a client just DX with Addison's disease?
a. avoiding unnecessary activity
b. encouraging client to wear a med alert tag
c. ensuring the client is adequately hydrated
d. explaining that the client will need lifelong hormone therapy

94. A nurse is caring for a client in the late stage of Ketoacidosis. The nurse notices that the clients’ breath has a characteristic fruity odor. Which of the following substances is responsible for the fruity smell in the breath?
a. iodine
b. acetone
c.alcohol
d. glucose

95. A nurse is caring for a client with Addison's disease. Which of the following nursing considerations should be employed when caring for this client?
a. avoid sodium in the clients diet
b. monitor and protect skin integrity
c. document the specific gravity of urine
d. monitor increases in blood pressure

96. A nurse is assigned to care for and monitor any complications in a 40 yr client with chronic diabetes. Which of the following is a macrovascular complication of diabetes?
a. neuropathy
b. retinopathy
c. nephropathy
d. Arteriosclerosis

97. A nurse is instructing a 50yr diabetic client about the steps to be followed for self admin of insulin. Which of the following instructions should be included in the client teaching?
a. instruct client to avoid injections to the abdomen
b. encourage client to always inject insulin in the same site
c. inform client about the type of syringe to use
d. encourage client to do active exercise after injection

98. A nurse is preparing a diet plan for a 50yr with simple goiter. Which of the following should be included in the client’s diet to decrease the enlargement of the thyroid gland?
a. iodine
b. sodium
c. potassium
d. calcium

99. A nurse is caring for a 60yr client affected with hypoparathyroidism. When checking the lab report, the nurse finds the clients’ calcium level was very low. Which of the following vitamins regulates the calcium level in the body?
a. A
b. D
c. E
d. K

100. A client presents to the emergency room with a history of Graves' disease. The client reports having symptoms for a few days, but has not previously sought or received any additional treatment. The client also reports having had a cold a few days back. Which of the following interventions would be appropriate to implement for this client, based on the history and current symptoms? Select all that apply.

A. Administer aspirin

B. Replace intravenous fluids

C. Induce shivering

D. Relieve respiratory distress

E. Administer a cooling blanket

101. Select the member of the healthcare team that is paired with one of the main functions of this team member.

A. Occupational therapist: Gait exercises

B. Physical therapist: The provision of assistive devices to facilitate the activities of daily living

C. Speech and language therapist: The treatment of swallowing disorders

D. Case manager: Ordering medications and treatments

102. The recommended daily caloric intake for sedentary older men, active adult women and children is:

A. 2400 calories

B. 1600 calories

C. 2800 calories

D. 2000 calories

103. Ill health, malnutrition, and wasting as a result of chronic disease are all associated with:

A. Surgical asepsis

B. Catabolism

C. Cachexia

D. Venous stasis

104. Select all the possible opportunistic infections that adversely affect HIV/AIDS infected patients.

A. Visual losses

B. Kaposi’s sarcoma

C. Wilms’ sarcoma

D. Tuberculosis

E. Peripheral neuropathy

F. Toxoplasma gondii

105. What can help reduce a patient’s anxiety and postsurgical pain?

A. Preoperative teaching

B. Preoperative checklist

C. Psychological counseling

D. Preoperative medication

106. Which disease decreases the metabolic rate?

A. Cancer

B. Hypothyroidism

C. Chronic obstructive pulmonary disease

D. Cardiac failure

107. When caring for an infant during cardiac arrests, which pulse must be palpated to determine cardiac function?

A. Carotid

B. Brachial

C. Pedal

D. Radial

108. The patient should be sitting when deep breathing and coughing because this position:

A. Is physically more comfortable for the patient

B. Helps the patient to support their incision with a pillow

C. Loosens respiratory secretions

D. Allows the patient to observe their area and relax

109. Which procedures necessitate the use of surgical asepsis techniques? Select all that apply.

A. Intramuscular medication administration

B. Central line intravenous medication administration

C. Donning gloves in the operating room

D. Neonatal bathing

E. Foley catheter insertion

F. Emptying a urinary drainage bag

110. What is the ultimate purpose and goal of performance improvement activities?

A. To increase efficiency

B. To contain costs

C. To improve processes

D. To improve policies

111. The primary difference between practical nursing licensure and a nursing certification in an area of practice is that nursing licensure is:

A. Insures competency and a nursing certification validates years of experience.

B. Mandated by the American Nurses Association and a nursing certification are not.

C. Is legally mandated by the states and a nursing certification is not.

D. Renewed every two years and a nursing certification is renewed every five years.

112. What intervention is the best to relieve constipation during pregnancy?

A. Increasing the consumption of fruits and vegetables

B. Taking a mild over-the-counter laxative

C. Lying flat on back when sleeping

D. Reduction of iron intake by half or more

113. You are the RN working on 2 easts with adult medical surgical patients. Your unit has been instructed to perform a horizontal evacuation of your patients because there is a fire on 1 east. Where will you evacuate your patients to?

A. 3 west

B. 3 east

C. 2 west

D. 1 west

114. Which electrolyte is essential for enzyme and neurochemical activities?

 A. Chloride

B. Magnesium

C. Potassium

D. Phosphate

115. Number the choices below to reflect the correct sequence for using a fire extinguisher:

A. Aim at the base of the fire (2)

B. Squeeze the handle (3)

C. Sweep back and forth (4)

D. Pull the pin (1)

116. As you are working you suspect that another licensed practical nurse is verbally and physically abusing a patient. What is the first thing that you will do?

A. Nothing because you are not certain that it is occurring

B. Nothing because you only suspect the abuse

C. Call the police or the security department

D. Report your suspicions to the charge nurse

117. Which of the following is the World Health Organization’s (WHO) definition of health?

A. The absence of all illness and disease

B. The absence of any comorbidity

C. A holistic state of wellbeing

D. A use of health promotion activities

118. Which nursing theorist believes that most patients are capable of performing self-care?

A. Dorothea Orem

B. Madeleine Leininger

C. Martha Rogers

D. Sister Callista Roy

119. What element is minimally assessed during a basic prenatal physical examination?

A. Palpation and auscultation of the abdomen

B. Examination of the anus and rectum

C. Urinalysis for glucose, protein and ketones

D. Visual assessment of cervix and vagina

120. A positive over-the-counter pregnancy test is considered a:

A. Possible sign of pregnancy.

B. Presumptive sign of pregnancy.

C. Probable sign of pregnancy.

D. Positive sign of pregnancy.

121. Select all of the signs and symptoms of hyperthyroidism.

A.      Thickened bodily hair

B.      Heat intolerance

C.      Constipation

D.     Insomnia

E.      Increased appetite

F.       Palpitations

G.     Cold skin

122. During which phase of the nursing process does data get collected and validated with the patient and/or family members by the nurse?

A. The implementation phase

B. The assessment phase

C. The evaluation phase

D. The planning phase

123. Which of the following is the best worded expected outcome?

A. “The nurse will provide for adequate hydration”

B. “The nurse will insure that the patient is safe”

C. “The patient will cough and deep breathe every two hours”

D. “The patient will value health”
 

124. What is a major difference between a problems oriented medical record and a source oriented medical record?

A. The problem oriented medical system has a centralized part of the chart for interdisciplinary progress notes and the source oriented medical record has separate areas for each profession’s progress notes.

B. The problem oriented medical system consists of narrative progress notes and the source oriented medical record uses SOAP.

C. The source oriented medical system uses charting by exception and the source oriented medical record system does not.

D. The source oriented medical system has a centralized part of the chart for interdisciplinary progress notes and the problem oriented medical record has separate areas for each profession’s progress notes.

125. Which of the following are necessary elements of malpractice? Select all that apply.

A. A breach of duty

B. An intentional act

C. A nonintentional act

D. Forseeability

E. Patient harm

F. Causation

126. Select the following fire emergency interventions in correct sequential order.

A. Pull the fire alarm. (2)

B. Contain the fire. (3)

C. Rescue patients in danger.(1)

D. Extinguish the fire. (4)

127. After your patient has been told that they have Cushing’s syndrome, the patient asks you what Cushing’s syndrome is. How would you respond to this patient’s question?

A. “Cushing’s syndrome is a type of irritable bowel syndrome.”

B. “Cushing’s syndrome is a disorder of the adrenal gland.”

C. “Cushing’s syndrome often occurs among patients who are getting radiation therapy.”

D. “Cushing’s syndrome often occurs among patients who are chemotherapy.”

128. You are preparing a sterile field for a operating room surgical procedure. When should you stop the preparation of this sterile field?

A. When you have placed a sterile item only 1 inch and not 2 inches from the edge of the sterile field

B. When you have completely finished the field. You cannot stop the set up until it is all done.

C. When you have accidentally poured a sterile liquid into a container that was on the sterile field

D. When you turn your upper body only away from the field because the surgeon calls your name

129. Avulsed teeth should be placed in:

A. Normal saline.

B. Cold water.

C. Milk.

D. Warm water.

130. You are working in a pediatric unit of the hospital and caring for a six year old boy who is hospitalized with cystic fibrosis and respiratory compromise. Which developmental task is the challenge for this boy at his age?

A. To cough, deep breathe and improve respiratory status

B. To establish industry and self confidence

C. To develop autonomy and self-control

D. To develop initiative and a sense of purpose

131. The embryonic period during pregnancy takes place from:

A. Weeks 1 to 12.

B Weeks 1 to 10.

C.Weeks 3 to 5.

D.Weeks 6 to 10.

132. Place these human needs