SUCCEED REVIEW CENTER

NOVEMBER 2014 SIMULATED NLE

DAY 2, AM SESSION
PREPARED BY: DR. ERIC TACLAWAN
Situation: Pain management is an essential skill that all nurses are expected to possess. Foremost in a nurses attitude is to advance
and promote optimal nursing care for people affected by pain by promoting best nursing practice.
1. The nurse consults with the primary physician of a client who is experiencing continuous, severe pain. In planning for the clients
treatment, the nurse is aware of the principles of pain management and that it is appropriate to expect treatment to include:
A. Focusing on intramuscular administration of analgesics
B. Waiting for pain to become more intense before administering opioids
C. Administering opioid with nonopioid analgesics for severe pain experiences
D. Administering large doses of opioids initially to clients who have not taken the medications previously.
2. When assessing the intensity of the pain, the nurse should:
A. Ask about what precipitates the pain
B. Question the client about the location of the pain
C. Offer the client a pain scale to objectify the information
D. Use open-ended questions to find out about the sensation
3. The client tells the nurse about a burning sensation in the epigastric area. The nurse should describe this type of pain as:
A. Referred

C. Deep visceral

B. Radiating

D. Superficial or cutaneous

4. The nurse tells the client that the urinary catheter insertion may feel uncomfortable. This is most accurately an example of:
A. Distraction

C. Anticipatory teaching

B. Reducing pain perception

D. Self-care maintenance

5. Nurses working with clients in pain need to recognize and avoid common misconceptions and myths about pain. In regards to the
pain experience, which of the following is correct?
A. The client is the best authority on the pain experience.
B. Chronic pain is mostly psychological in nature.
C. Regular use of analgesics leads to drug addition
D. The amount of tissue damage is accurately reflected in the degree of pain perceived.
6. Situation: The Illness-Wellness Continuum describes how wellbeing is more than simply an absence of illness, but also incorporates
the individual's mental and emotional health. It has been used to highlight how, even in the absence of physical disease, an
individual can suffer from depression, anxiety or other conditions indicating a lack of wellness
7. This form of medicine has focused primarily on the illness side of the continuum, treating people with symptoms of disease, and is
known as:
A. Western

C. Osteopathic

B. Holistic

D. Complementary and alternative

8. An openness to and respect for cultural and ethnic differences in values, customs, and practices describes which of the following
terms?
A. Racism

B. Acculturation

C. Ethnocentrism

D. Ethnosensitivity

9. Acupuncture, chiropractic, therapeutic massage, relaxation techniques, and herbal remedies are various forms of this type of
approach to medicine.
A. Allopathic

C. Osteopathic

B. Holistic

D. Complementary and alternative

10. In this type of study, researchers randomly assign matched participants to either a treatment group or a control group and apply a
treatment to the first and a placebo to the second
A. Double blind

C. Prospective

B. Retrospective

D. Experimental

11. Economic, social, cultural, and physical conditions that contribute to or detract from the health of individuals and communities are
known as the
A. Social determinants of health

C. Perceived benefits of health

B. Ecological factors in health

D. Community factors in health

E.

F. Situation: Epidemiology examines the distribution and source of a disease in a population.

Understanding epidemiology and disease transmission is vital to nursing care.
G.

12. Studies that produce basic estimates of the rates of disorder in a general population and its subgroups is:
A. Qualitative epidemiology

C. Experimental epidemiology

B. Analytic epidemiology

D. Descriptive epidemiology

13. The number of new cases that occur within a specific population within a defined time interval is:
A. Point Prevalence

C. Period prevalence

B. Incidence

D. Lifetime Prevalence

14. In biomedical research survival analysis is typically used to evaluate

A. Incidence of a disease

C. Life expectancy

B. Point Prevalence

D. Lifetime Prevalence

15. A systematic method for continuous monitoring of diseases in a population, in order to be able to detect changes in disease
patterns and then to control them is:
A. Conditional probability

C. Prevalence

B. Screening

D. Surveillance

16. In epidemiology research, If the relative risk is greater than 1.0, the group with the suspected risk factor:
A. Have a lower incidence rate of the disorder.

C. Is having no relationship with the risk factor.

B. Have a higher incidence rate of the disorder.

D. Does not have any risk at all

E. Situation: Pharmacological therapeutics cannot be overlooked in the practice of nursing because of the numerous benefits
derived from it. It provides better understanding to the use of drugs, precautions to be taken as nurses so that the use of drugs
gives maximum benefit and minimum harm.
17. When a drug is given at a constant rate, the generally accepted time to reach steady state (plateau) is:
A. 1 plasma half-life
C. 3 plasma half-life
B. 2 plasma half-life
D. 5 plasma half-life

18. Glucose-6-phosphate dehydrogenase (G6PD) activity is important to the integrity of the:

A. Red blood cells
C. Platelets
B. White blood cells
D. Mast cells
19. The drug used in acetaminophen overdose is:
A. Physostigmine

C. Acetyl salicylic acid

B. Flumazenil

D. Acetylcysteine

20. The drug used as an antidote to anticholinergic poisoning is:

A. Atropine

C. Physostigmine

B. Pyridoxine

D. Deferoxamine

21. Severe lead poisoning is treated with:

A. Succimer

B. Naloxone

C. Pyridoxine

D. Atropine

E.

F. Situation: Perioperative nursing includes those activities performed by the professional registered nurse in the preoperative,
intraoperative and postoperative phases of surgery. Perioperative nurses work in hospital surgical departments, ambulatory
surgery, clinics and physicians' offices. They work closely with the surgical patient, family members and other health-care
professionals to help plan, implement and evaluate treatment.
22. A client arrives at the clinic for a routine physical examination. During the examination, the nurse performs as otoscopic
examination. Which finding would nurse expect as normal?
A. Pale optic disk
C. Positive red reflex
B. Pearly gray tympanic membrane
D. Tactile fremitus
23. An adult client has the following laboratory results: white blood cells 6,300/ mm3; platelets 250,000 mm3; serum sodium 140 meq/L;
serum potassium 6 meq/L. Which condition is present?
A. Leukocytosis
C. Hyperkalemia
B. Thrombocytopenia
D. Hypernatremia
24. Which instruction is most important to provide when discharging a client from the emergency department following penetrating foot
injury?
A. Call the health care provider at the first signs of any red streaks appearing on the foot or leg
B. Refrain from crossing the legs at the knee or ankle
C. Avoid smoking until the entire wound is no longer open to the air
D. Watch for signs and symptoms of anaphylaxis from the tetanus toxoid
25. Which statement best explains the scientific rationale for performing urinary catheterization on a client following an abdominal
hysterectomy if she is unable to void within 8 hours?
A. Temporary atony may result from surgical manipulation in the area
B. The bladder is removed along with the uterus
C. Infection from surgery interferes with the clients ability to void
D. Surgically induced menopause impairs the client urinary function
26. Following a thyroidectomy, the client experiences hemorrhage. The nurse would prepare for which emergency intervention?
A. I.V administration of calcium
C. Creation of a tracheostomy
B. Insertion of an oral airway
D. I.V administration of thyroid hormone
E.

F. Situation: The nursing process is an integral part of patient care in the perioperative setting and includes performing a nursing
assessment. For perioperative nurses, this assessment differs from those performed on the patient in a medical-surgical unit
and requires some alterations to the formal nursing process that can challenge new perioperative nurses. One reason for this
difference is due to the brief time a perioperative nurse has contact with a conscious patient.
27. After obtaining 3 L of fluid from a client via parecentesis, the nurse would be alert for which complication?
A. Respiratory distress
C. Bleeding from the site
B. Encephalopathy
D. Vascular collapse
28. Open glove method is preferred to use except:
A. Intravenous cutdown or administering of spinal anesthesia
B. In the emergency department when donning sterile gloves for suturing lacerations
C. Changing a glove during an operation
D. When donning gloves for procedures requiring gown
29. It is the resection of the half of the colon and a segment of the terminal ileum and their mesenteries.
A. Colostomy
C. Transverse colectomy
B. Hemicolectomy
D. Ileostomy
30. Correction of a drooping upper eyelid is termed as
A. Correction of entropion
C. Excision of chalazion
B. Canthotomy
D. Blepharaptosis repair
31. Which topic would be most important to include in the postoperative teaching for the client scheduled for a vaginal hysterectomy?
A. Pelvic muscle strengthening exercises
C. Availability of support persons
B. Lower-extremity exercises and deep breathing
D. Use of a bedpan and call light
E.

F. Situation: The nurse is caring for several patients with cardiac disease. Among these cardiac diseases, valvular abnormalities
comprise a good proportion of them. Knowledge of the symptomatology and pathophysiology of these diseases is essential for
the nurse to be able to deliver the best care for the patients.
32. What is the most common cause of mitral stenosis?
A. IV drug use
C. COPD
B. Rheumatic fever
D. Atherosclerosis
33. Dyspnea, fatigue, increased pulmonary artery pressure, and decreased cardiac output are indicative of
A. MI
C. Left sided valve damage
B. Right sided valve damage
D. JVD
34. Atrial fibrillation is a common symptom that only occurs with
A. Mitral stenosis
C. Aortic stenosis
B. Mitral regurgitation
D. Aortic regurgitation
35. A client with mitral stenosis is scheduled for mitral valve replacement. Which condition may arise as a complication of mitral
stenosis?
A. Pulmonary hypertension
C. MI
B. Left-sided heart failure
D. Left ventricular hypertrophy
36. It is also considered a back flow. The valve does not close properly and blood backflows through the valve. This disorder is also
known as:
A. Stenosis
C. Regurgitation
B. Valve Prolapse
D. Mitral Valve Prolapse
E.

F. Situation: Peripheral vascular disease is a chronic progressive disease. Nursing intervention is aimed at primary prevention
through risk factor modification. Quality patient care will be facilitated through the development of an individualized plan of care.
An essential element to consider in promoting successful nursing intervention is collaboration of the nurse and patient when
developing the plan of care. Overall goals of care for a patient with PVD include promotion of circulation, relief of pain, and
prevention of tissue damage or infection.
37. A client is admitted to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, the
nurse formulates interventions with which goal in mind?
A. Decreasing blood pressure and increasing mobility
B. Increasing blood pressure and reducing mobility
C. Stabilizing the heart rate and blood pressure and easing anxiety
D. Increasing blood pressure and monitoring fluid intake and output
38. The most important factor in regulating the caliber of blood vessels, which determines resistance to flow, is:
A. Hormonal secretion
C. The influence of circulating chemicals
B. Independent arterial wall activity.
D. The sympathetic nervous system
39. With peripheral arterial insufficiency, leg pain during rest can be reduced by:
A. Elevating the limb above heart level
B. Lowering the limb so it is dependent
C. Massaging the limb after application of cold compresses
D. Placing the limb in a plane horizontal to the body
40. Buergers disease is characterized by all of the following except:
A. Arterial thrombosis formation and occlusion
B. Lipid deposits in the arteries
C. Redness or cyanosis in the limb when it is dependent
D. Venous inflammation and occlusion
41. A significant cause of venous thrombosis is:
1. Altered blood coagulation
2. Stasis of blood
3. Vessel wall injury
A) All of the above
C) 2 and 3 only
B) 1 and 2 only
D) 1 only
E)
F) Situation: The physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests
are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic
heart valves, or myocardial infarction.
42. Which test is used to determine a client's response to oral anticoagulant drugs?
A. Bleeding time
C. Prothrombin time (PT)
B. Platelet count
D. Partial thromboplastin time (PTT)
43. The nurse administers basic cardiac life support to a client in cardiac arrest. Which action does the nurse perform?
A. Assessing the patency of the airway
B. Administering I.V. medications
C. Administering a countershock of 200 joules
D. Breathing for the client after inserting an endotracheal (ET) tube
44. All are key manifestations of endocarditis
1. Janeway's lesion
3. Dry, nonproductive cough
2. Fever
4. Systemic embolization
A) 1, 2, 3
B) 2, 3, 4
C) 1, 2, 4
D) 1, 2, 3, 4
45. All are assessment findings of pericarditis EXCEPT?
1. Ankle edema
3. Friction rubs
2. Substernal pain
4. Elevated WBC count
A) 1, 2, 3
B) 2, 3, 4
C) 1, 2, 4
D) 1, 2, 3, 4
46. What is the best way to treat cardiac tamponade?
A. Diuertics
C. Pericardiocentesis
B. Chest tube
D. Paracentesis
E.

F. Situation: respiratory nurses are engaged in the holistic care of patients with lung diseases, with the aim of maintaining the
highest nursing standards, while working in collaboration with others members of healthcare team. Specialist nurses work in
various setting and in addition to providing care, they are often involved in preventive programmes.
47. An elderly client with pneumonia may appear with which of the following symptoms first?
A. Altered mental status and dehydration
C. Hemoptysis and dyspnea
B. fever and chills
D. Pleuritic chest pain and cough
48. Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows pneumonia to develop?
A. Atelectasis
C. Effusion
B. Bronchiectasis
D. Inflammation

49. An 18-year-old client is brought to the E.R. Hes tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a
nonproductive cough. He recently had a cold. From his history, the client may have which of the following?
A. Acute asthma
C. Chronic obstructive pulmonary disease (COPD)
B. Bronchial pneumonia
D. Emphysema
50. A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick
sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions?
A. Adult respiratory distress syndrome (ARDS)
C. Chronic obstructive bronchitis
B. Asthma
D. Emphysema
51. Its highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for
which of the following reasons?
A. All clients are recommended to have these vaccines
B. These vaccines produce bronchodilation and improve oxygenation.
C. These vaccines help reduce the tachypnea these clients experience
D. Respiratory infections can cause severe hypoxia and possibly death in these clients.
52.

53. Situation: There is a need to reduce symptoms, exacerbations and improve quality of life for patients with respiratory diseases.
Across the world, increasing numbers of nurses are adopting the prescribing role and can potentially enhance service provision.
Evidence suggests improved quality of care and efficiencies occur when nurses adopt the prescribing role.
54. A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. Hes tachypneic, with a prolonged
expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for
breathing. This client has symptoms of which of the following respiratory disorders?
A. ARDS
C. Chronic obstructive bronchitis
B. Asthma
D. Emphysema
55. Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema?
A. It enhances cardiovascular fitness.
C. It reduces the number of acute attacks.
B. It improves respiratory muscle strength.
D. It worsens respiratory function and is discouraged.
56. A 69-year-old client appears thin and cachectic. Hes short of breath at rest and his dyspnea increases with the slightest exertion.
His breath sounds are diminished even with deep inspiration. These signs and symptoms fit which of the following conditions?
A. ARDS
C. Chronic obstructive bronchitis
B. Asthma
D. Emphysema
57. Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of the following topics?
A. How to have his wife learn to listen to his lungs with a stethoscope.
B. How to increase his oxygen therapy.
C. How to treat respiratory infections without going to the physician.
D. How to recognize the signs of an impending respiratory infection.
58. A client with emphysema should receive only 1 to 3 L/minute of oxygen, if needed, or he may lose his hypoxic drive. Which of the
following statements is correct about hypoxic drive?
A. The client doesnt notice he needs to breathe.
B. The client breathes only when his oxygen levels climb above a certain point.
C. The client breathes only when his oxygen levels dip below a certain point.
D. The client breathes only when his carbon dioxide level dips below a certain point.
59.

60. Situation: Chronic disease (CD), the main reason why people seek healthcare in the developed world, encompasses a set of
progressive and long-term medical conditions including respiratory diseases such as asthma and chronic obstructive pulmonary
disease. Around 300 million individuals are affected by asthma and 10% of adults aged over 40 years have COPD across the world.
Asthma and COPD are both treatable conditions, the aim of which, whatever the severity, is to minimize and manage symptoms.
Despite this, many patients experience high levels of symptoms, poor quality of life, and exacerbations that are a common cause of
emergency hospital admissions.
61. A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to note
on assessment of this client?
A. Increased oxygen saturation with exercise
C. A hyperinflated chest on x-ray film
B. Hypocapnia
D. A widened diaphragm noted on chest x-ray film
62. Which of the following additional assessment data should immediately be gathered to determine the status of a client with a
respiratory rate of 4 breaths/minute?
A. Arterial blood gas (ABG) and breath sounds
C. Breath sounds and reflexes
B. Level of consciousness and a pulse oximetry value.
D. Pulse oximetry value and heart sounds
63. Which of the following treatment goals is best for the client with status asthmaticus?
A. Avoiding intubation
C. Improving exercise tolerance
B. Determining the cause of the attack
D. Reducing secretions
64. Which of the following respiratory disorders is most common in the first 24 to 48 hours after surgery?
A. Atelectasis
C. Pneumonia
B. Bronchitis
D. Pneumothorax
65. A client has started a new drug for hypertension. Thirty minutes after he takes the drug, he develops chest tightness and becomes
short of breath and tachypneic. He has a decreased level of consciousness. These signs indicate which of the following conditions?
A. Asthma attack
C. Respiratory failure
B. Pulmonary embolism
D. Rheumatoid arthritis
E.

F. Situation: Critically ill patients are diverse in terms of illness, but many experience electrolyte abnormalities or fluid imbalances
that can compromise their clinical status and adversely affect outcomes. These shifts in electrolytes and fluids can be attributed
to an underlying chronic disease state, an acute condition that manifests during the course of the patients hospitalization, or the
administration of certain medications. Monitoring and carefully managing electrolytes and fluid balance is an integral part of
assessing and caring for a critically ill patient.
66. The nurse evaluates who among the following patients to possibly have hypermagnesemia?
A. A patient who has chronic alcoholism and is taking Vitamin B
B. A patient who has hyperthyroidism and is taking biphosphonates
C. A patient who has renal failure and is taking antacids
D. A patient who has forward heart failure and is taking digoxin
67. The nurse is evaluating the serum laboratory results on the following four clients. Which of the following laboratory results is a
priority for the nurse to report first?
A. A patient with osteoporosis and a calcium level of 10.6 mg/dl
B. A patient with renal failure and a magnesium level of 2.6 mEq/L
C. A patient with bulimia and a potassium level of 3.4 mEq/L
D. A patient with dehydration and a sodium level of 149 mEq/L

68. The patient is admitted to a nursing unit from a long-term care facility with a hematocrit of 56% and a serum sodium level of 152
mEq/L. Which condition would be a cause for these findings?
A. Overhydration
C. Dehydration
B. Anemia
D. Renal Failure
69. The patient who has undergone an exploratory laparotomy and subsequent removal of a large intestinal tumor has a nasogastric
tube (NGT) in place and an IV running at 150 mL/hr via an IV pump. Which data should prompt the nurse of possible complications?
A. The pump keeps sounding an alarm that the high pressure has been reached
B. Intake is 1800 mL, NGT output is 550 mL, and Foley output 950 mL.
C. On auscultation, crackles and rales in all lung fields are noted
D. Patient has negative pedal edema and an increasing level of consciousness
70. The patient diagnosed with diabetes insipidus weighed 160 pounds when the daily weight was taken yesterday. This morning's
weight is 155.6 pounds. How much fluid has the client lost (in milliliters)?
A. 500 ml
B. 1000 ml
C. 2000 ml
D. 4400 ml
E.

F. Situation: Fluid and electrolyte balance play an important role in homeostasis, and critical care nurses assume a vital role in
identifying and treating the physiologic stressors experienced by critically ill patients that disrupt homeostasis. Just as too little or
too much of any one electrolyte can become a problem in maintaining a critically ill patients stability, imbalances in fluid
homeostasis can also present unique challenges for both the nurse and the patient.
71. The nurse writes the nursing problem of "fluid volume excess" (FVE). Which intervention should be included in the plan of care?
A. Change the IV fluid from 0.9% NS to D5W
C. Monitor blood glucose levels
B. Restrict the patient's sodium in the diet
D. Prepare the patient for hemodialysis
72. The patient is admitted with a serum sodium level of 110 mEq/L. Which nursing intervention should be implemented?
A. Encourage fluids orally
C. Administer antidiuretic hormone intranasally
B. Administer 10% saline solution IV Bolus
D. Place on seizure precautions.
73. The telemetry monitor technician notifies the nurse of the morning telemetry readings. Which client should the nurse assess first?
A. The client in normal sinus rhythm with a peaked T wave
B. The client diagnosed with atrial fibrillation with a rate of 100
C. The client diagnosed with a myocardial infarction who has occasional PVC
D. The client with a first-degree AV block and a rate of 92
74. The client post-thyroidectomy complains of numbness and tingling around the mouth and the tips of the fingers. Which intervention
should be implemented first?
A. Notify the health care provider immediately
B. Tap the cheek about two (2) centimeters anterior to the ear lobe
C. Check the serum calcium and magnesium levels
D. Prepare to administer calcium gluconate IVP
75. The client has received IV solutions for three (3) days through a 20-gauge IV catheter placed in the left cephalic vein. On morning
rounds the nurse notes the IV site is tender to palpation and a red streak has formed. Which action should the nurse implement first?
A. Start a new IV in the right hand
C. Complete an incident record
B. Discontinue the intravenous line
D. Place a warm washrag over the site
E.

F. Situation: The bodys acid-base balance depends on delicately balanced chemical reactions that require the ph of blood to
remain slightly alkaline within a normal range of 7.35-7.45. For normal cell function and metabolism, the bloods ph must stay
within this narrow range. A ph greater than 7.45 creates alkaline conditions and a ph lower than 7.35 is too acidic for the body.
The cause of acid-base imbalances is either respiratory or metabolic in origin.
76. A clients ABG results are as follows: pH: 7.16; PaCO2 60 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result
represents which of the following conditions?
A. Metabolic acidosis
C. Respiratory acidosis
B. Metabolic alkalosis
D. Respiratory alkalosis
77. A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg.
The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in
this condition?
A. Sodium level of 145 mEq/L
C. Magnesium level of 2.0 mg/L
B. Potassium level of 3.0 mEq/L
D. Phosphorus level of 4.0 mg/dl
78. A nurse reviews the arterial blood gas results of a patient and notes the following: pH 7.45; PCO2 30 mm Hg; and bicarbonate
concentration of 22 mEq/L. The nurse analyzes these results as indicating:
A. Metabolic acidosis, compensated.
C. Respiratory alkalosis, compensated.
B. Metabolic alkalosis, uncompensated.
D. Respiratory acidosis, compensated.
79. A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the
client is at risk for which acid-base disorder?
A. Respiratory acidosis
C. Metabolic acidosis
B. Respiratory alkalosis
D. Metabolic alkalosis
80. A nurse is caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base disorder?
A. Respiratory acidosis
C. Metabolic acidosis
B. Respiratory alkalosis
D. Metabolic alkalosis
E.

F. Situation: Nurses have been major contributor to the improvement in the quality of care provided to the people with diabetes.
The role of nurse in diabetes is to facilitate patient empowerment and self care in the management of their disease through
education and support. However the nurses need to be knowledgeable enough, must possess basic communication skills to be
comfortable and to be effective in their teachings. New findings related to diabetes are constantly emerging and the nurses need
to be aware and keep themselves up to date.
81. The nurse is caring for a patient whose blood glucose level is 55mg/dL. What is the likely nursing response?
A. Administer a glucagon injection

C. Administer 10-15 grams of a carbohydrate

B. Give a small meal

D. Give a small snack of high protein food

82. A client with type II diabetes is being educated about what to do if he catches the flu or a cold. What is something he should be
informed of?

A. Discontinue Metformin (glucophage)

C. Add 2-3 more snacks to diet

B. Expect hyperglycemia

D. Come into the hospital for monitoring

83. In educating a client about Type II Diabetes, what would be a proper explanation for poor wound healing?
A. High blood glucose damages capillaries
C. The pancreas fails to secrete the proper chemicals
B. Swings in blood sugar prevent proper clotting
D. Ketosis prevents proper healing
84. When does regular insulin generally have peak action after application?
A. 30-45 minutes
C. 1-2 hours
B. 45-60 minutes
D. 2-3 hours
85. The nurse is caring for a client who has normal glucose levels at bedtime, hypoglycemia at 2am and hyperglycemia in the morning.
What is this client likely experiencing?
A. Dawn phenomenon
C. An insulin spike
B. Somogyi effect
D. Excessive corticosteroids
E.

F. Situation: Diabetes mellitus is a disease which can be very well controlled but at times can be life threatening if it is not properly
taken care of. Although there is no cure of this disease, but a great progress has been made in controlling and managing
diabetes. The nurse encounters patients of all ages with diabetes in all clinical settings including the outpatient and home
settings. Thus she is expected to plan, organize and coordinate care among the various health care providers and also is
expected to provide care and education and thus to promote the health and well being of all the diabetic patients.
86. What is NOT true of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) compared to diabetic ketoacidosis (DKA)?
A. HHNS is found mainly in Type II Diabetes
C. Both typically are treated with insulin
B. Both have high levels of hyperglycemia
D. In HHNS, blood pH tends to drop
87. 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?
A. Elevated blood glucose level and a low plasma bicarbonate
B. Decreased urine output
C. Increased respirations and an increase in pH
D. Comatose state
88. 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:
A. Administer regular insulin intravenously
C. Correct the acidosis
B. Administer 5% dextrose intravenously
D. Apply an electrocardiogram monitor.
89. . 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:
A. 2-4 hours after administration

C. 16-18 hours after administration

B. 6-14 hours after administration

D. 18-24 hours after administration

90. A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:
A. Blurred vision

C. Nausea

B. Diaphoresing

D. Weakness

E. Situation: Abnormalities of the pituitary gland are generally associated with hyper- or hyposecretion of its products. Diseases of
the pituitary gland, diseases of the hypothalamus, radiation therapy to the head or neck, trauma or tumour interfere with pituitary
function and thus the function of other trophic glands like the thyroid, adrenals and gonads. Patients with endocrine disorders
require nursing interventions to assist them to cope with the physical and emotional changes and also to prevent complications
involving other organs.
91. Acromegaly is most frequently diagnosed in:
A. Middle-aged adults

C. Children ages 2 to 5

B. Newborns

D. Adults age 65 and older

92. Grave's disease is:

A. The most common cause of hypothyroidism

C. The most common cause of hyperthyroidism

B. The most common cause of hyperparathyroidism

D. The most common cause of adrenal insufficiency

93. Symptoms of Grave's ophthalmopathy include which of the following:

1. Proptosis

3. Xerophthalmia

2. Lid lag

4. Ptosis

A) 1, 2, 3 only

B) 2 , 3, 4 only

C) 1 and 3 only

D) 1, 2, 3, 4

94. An ACTH stimulation test is commonly used to diagnose:

A. Grave's disease

C. Cystic fibrosis

B. Adrenal insufficiency and Addison's disease

D. Hashimoto's disease

95. Which of the following are symptoms of Cushing's syndrome

1. Severe fatigue and weakness

3. A protruding hump between the shoulders

2. Hypertension and elevated blood glucose

4. Hirsutism

A) 1, 2, 3

B) 2 and 3 only

C) 1 and 3 only

D) 1, 2, 3, 4

E)
F) Situation: In the nursing care for patients with endocrine disorders, the nurse is expected to apply knowledge of normal
anatomy, physiology, and assessments of the endocrine glands when providing nursing care for clients with endocrine
disorders. The nurse is also expected to identify diagnostic tests and to compare and contrast the manifestations of
disorders that result from hyperfunction and hypofunction of the glands.
96. Hashimoto's disease is:
A. Chronic inflammation of the thyroid gland
B. Diagnosed most frequently in Asian-Americans and Pacific Islanders
C. A form of hyperthyroidism
D. A rare form of hypothyroidism
97. The most common benign tumor of the pituitary gland is a:
A. Glioma
B. Prolactinoma

C. Carcinoid tumor
D. Islet cell tumor

98. 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

99. Short stature and undeveloped ovaries suggest which of the following disorders:
A. Polycystic ovarian syndrome
B. Prolactinoma

C. Grave's disease
D. Turner syndrome

100. Untreated hyperthyroidism during pregnancy may result in all of the following except:
A. Premature birth and miscarriage
C. Autism
B. Low birthweight
D. Preeclampsia
E. Situation: Nurses caring for clients with endocrine disorders are expected to explain the implications for medications prescribed
to treat disorders of the endocrine glands and to provide appropriate nursing care for the client before and after surgery.
101. 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
102. Following a unilateral adrenalectomy, the nurse would assess for hyperkalemia shown by which of the following?
A. Muscle weakness
C. Diaphoresis
B. Tremors
D. Constipation
103. Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, the nurse 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
C. Hypoparathyroidism
B. Hyperglycemia
D. Thyroid Storm
104. 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
C. bradycardia
B. a blood glucose level of 130 mg/dl
D. a blood pressure of 176/88 mm Hg.
105. 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, the nurse prepares to take
emergency action to prevent the potential complication of:
A. Thyroid Storm
C. Myxedema Coma
B. Cretinism
D. Hashimotos thyroiditis