1.

Glucose is an important molecule in a cell because it is primarily used for:

a. Extraction of energy
b. Synthesis of protein

c. Building of genetic material

d. Formation of cell membranes

2. Knowing that gluconeogenesis helps to maintain blood levels, a nurse should:

a. Document weight changes because of fatty acid mobilization
b. Evaluate patients sensitivity to low room temperature because of decreased adipose tissue
insulation
c. Protect the patient from the sources of infection because of decreased cellular protein deposits
d. Do all of the above
3. What is the basic underlying pathology of diabetes mellitus?
a. A disruption of the cellular glycolytic pathway
b. An inability of the liver to catabolize glycogen
c. A failure to synthesize and/or utilize insulin
d. An inhibition of the conversion of protein to amino acid
4. A clients blood gases reflect diabetic acidosis. The nurse should expect:
a. Increased pH
b. Decreased PO2

c. Increased PCO2
d. Decreased HCO3

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

a. 100mg/dl
b. 126mg/dl

c. 200mg/dl
d. 180mg/dl

6. Which test results should the nurse check to ascertain how well the client is managing her diabetes
mellitus overall?
a. Blood glucose level
b. Glucose tolerance test

c. Glycosylated haemoglobin
d. Radioimunnoassay of insulin

7. A parent asks the nurse why home blood glucose monitoring is being recommended for her child
with diabetes. The nurse should base the explanation on which of the following?
a. It is a less expensive method of testing
b. It is an easier method of testing
c. Children are better able to manage the diabetes
d. Children have a greater sense of control over the diabetes
8. A client has developed diabetes mellitus type 1 and no longer produces insulin. What cells of the
pancreas have become dysfunctional?
a. Beta cells
b. Alpha cells

c. Acinar cells
d. Kupffer cells

9. The nurse is discussing the treatment regimen for a client newly diagnosed with Type 1 Diabetes
Mellitus. During the discussion of insulin administration, the client asks the nurse, Why cant I just
take a pill like my friend does? Which of the following statement indicates the client understands
the nurses explanation?
a. My body does not produce insulin; therefore I must receive the injections.
b. I will be on insulin for a short while, and then I can take the pills.
c. The pills are not as effective as the insulin injections.
d. When my body starts making insulin again, I can stop taking the injections.
10. The mother of an 11 year old child with IDDM asks why her child cannot avoid all those shots and
take pills as her uncle does. Which of the following is the nurses best reply?
a. the pills work with an adult pancreas only
b. the drugs affect fat and protein metabolism, not sugar
c. Your child needs insulin replaced, and the oral hypoglycemics only add to an existing supply of
insulin

d. Perhaps when your child is older the pancreas will produce its own insulin, and then your child
can take oral hypoglycemics
11. The nurse knows that a client newly diagnosed with insulin-dependent diabetes (Type I) will require
further teaching when which of the following statements is made?
a. I will notify my healthcare provider if my glucose levels run higher or lower than target range.
b. I will take my insulin as prescribed, and I will not miss a dose.
c. I will not take my insulin if I am sick and cannot eat.
12. During a routine check-up, an insulin-dependent diabetic has his glycosylated haemoglobin
checked. The results indicate a level of 11%. Based on this result, what teaching should the nurse
emphasize?
a. Rotation of injection sites
b. Insulin mixing and preparation

c. Daily blood sugar monitoring

d. Regular high protein diet

13. The nurse is caring for a woman at 37 weeks gestation. The client was diagnosed with insulindependent diabetes mellitus at age 7. The client states, I am so thrilled that I will be breastfeeding
my baby. Which of the following responses by the nurse is best?
a. You will probably need less insulin while you are breastfeeding.
b. You will need to initially increase your insulin after the baby is born.
c. You will be able to take an oral hypoglycemic instead of insulin after the baby is born.
d. You will probably require the same dose of insulin than you are now taking.
14. Clinical manifestations associated with a diagnoses of type 1 DM include all of the following except:
a. Hypoglycaemia
b. Hyponatremia

c. Ketonuria
d. Polyphagia

15. What is the physiologic basis for the polyuria manifested by individuals with untreated diabetes
mellitus?
a. Inadequate secretion of antidiuretic hormone (ADH)
b. Early-stage renal failure causing a loss of urine concentrating capacity
c. Chronic stimulation of the detrusor muscle by the ketone bodies in the urine
d. Hyper osmolarity of the extracellular fluids secondary to hyperglycemia
16. Which of the following chronic complications is associated with diabetes?
a. Dizziness, dyspnea on exertion, and coronary artery disease
b. Retinopathy, neuropathy, and coronary artery disease
c. Leg ulcers, cerebral ischemic events, and pulmonary infarcts
d. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrythmias
17. Clinical nursing assessment for a patient with microangiopathy who has manifested impaired
peripheral arterial circulation includes all of the following except:
a. Integumentary inspection for the presence of brown spots on the lower extremities
b. Observation for paleness of the lower extremities
c. Observation for blanching of the feet after the legs are elevated for 60 seconds
d. Palpation for increased pulse volume in the arteries of the lower extremities
18. A 67-year old client with non-insulin dependent diabetes should be instructed to contact the outpatient clinic immediately if the following findings are present
a. Temperature of 37.5 degrees Celsius with painful urination
b. An open wound on their heel
c. Insomnia and daytime fatigue
d. Nausea with 2 episodes of vomiting
19. Nausea Mrs. Moore, 62-year-old, with diabetes is in the emergency department. She stepped on a
sharp sea shell while walking barefoot along the beach. Mrs. Moore did not notice that the object
pierced the skin until later that evening. What problem does the client most probably have?
a. Nephropathy
b. Macroangiopathy

c. Carpal tunnel syndrome

d. Peripheral neuropathy

20. At a senior citizens meeting, a nurse talks with a client who has diabetes mellitus type 1. Which
statement by the client during the conversation is most predictive of a potential for impaired skin
integrity?

a. I give my insulin to myself in my thighs

b. Sometimes when I put my shoes on I dont know where my toes are
c. Here are my up and down glucose readings that I wrote on my calendar
d. if I bathe more than once a week my skin feels too dry
21. Nurse Tina notes that the client has decreased tactile sensation in both feet among one of her
diabetic patients. What is the nurses best first action?
a. Review the diet of the patient
c. Examine the clients feet for signs of
b. Test sensory perception in the clients
injury
hands
d. Encourage insulin injections
22. The following interventions are performed when an injury occurs to the foot of a diabetic client
except:
a. Wash the area with mild soap and
water
b. Call health care provider

c. Cover with a wet sterile dressing with

adhesive
d. Wear white cotton socks

23. Which of the following nursing interventions should be implemented when performing foot care to a
patient with DM?
a. Inspect the feet carefully and daily for calluses, corns, blisters, abrasions, redness, and nail
abnormalities
b. Bathe the feet daily in hot water
c. Use lanolin, nivea cream, or other cream moisturizers especially between the toes to prevent
maceration
d. Wear well-fitting, compressive shoes and socks-long enough, wide enough, soft, supple and
high-heeled
24. A nurse preparing a teaching plan for a client with diabetes mellitus regarding proper foot care.
Which instruction is included in the plan?
a. Soak feet in hot water
b. Apply moisturizer lotion to dry feet but not in between the toes
c. Always have a podiatrist cut your toenails; never cut them yourself
d. Avoid using mild soap on the feet
25. Ernest had DM for 20 years. He is admitted to the hospital with dry gangrene of the right toe. When
the nurse is working with the client, what information is most important to ascertain?
a. His age when DM developed
b. His understanding of hygienic skin measures
c. His technique in administering insulin
d. His willingness to look at, touch, or talk about his gangrene foot
26. When assessing a gangrenous toe, the nurse least likely expects which of the following?
a. Intense pain in affected area
b. Extension of the metatarsal
c. Changes in skin temperature of both feet
d. His willingness to look at, touch, or talk about his gangrenous foot
27. The physician orders sodium hypochlorite and boric acid (Dakins solution) for a gangrene lesion
and petroleum jelly for the adjoining healthy skin. Which of the following best describes their
actions?
a. Dakins solution is an anti-inflammatory agent; petroleum jelly is an anti-absorbent agent
b. Dakins solution debrides the wound; petroleum jelly protects the healthy tissue
c. Dakins solution dries out the lesion; petroleum jelly lubricates the surrounding tissue
d. Dakins solution cleanses the wound; petroleum jelly moisturizes the skin
28. Mr. Smith is scheduled for an above-the-knee amputation. After the surgery he was transferred to
the nursing care unit. The nurse assigned to him knows that 72 hours after the procedure the client
should be positioned properly to prevent contractures. Which of the following is the best position to
the client?
a. Sidelying, alternating left and right
c. Lying on abdomen several times daily
sides
d. Supine with stump elevated at least 30
b. Sitting in a reclining chair twice a day
degrees
29. A client complains of some discomfort after a below knee amputation. Which action by the nurse is
appropriate to do initially?
a. Conduct guided imagery or distraction

b. Ensure that the stump is elevated for the initial day

c. Wrap the stump snugly in an elastic bandage
d. Administer opioid narcotics as ordered
30. An amputee client will be taught to use crutches until he can manage with prosthesis
independently. Which of the following crutch-walking instructions would be INCORRECT?
a. Extend the arms while holding weights to strengthen the triceps
b. The crutches should be 16 inches less than the clients total height
c. The axillary bars on the crutches should support the clients weight
d. None of the above
31. The nurse is teaching a client who is taking insulin about the signs of hyperglycemia. The signs of
hyperglycemia include:
a. Kaussmauls breathing
b. Excessive hunger

c. Dry, flaky skin

d. High blood pressure

32. A client with DM demonstrates acute anxiety when first admitted for the treatment of
hyperglycemia. The most appropriate intervention to decrease the clients anxiety would be to:
a. Administer sedative
b. Make sure the client knows all the correct medical terms to understand what is happening
c. Ignore the signs and symptoms of anxiety so that they will soon disappear
d. Convey empathy, trust and respect toward the client
33. Manifestations of hypoglycaemia include which of the following?
a. Lethargy
b. Confusion

c. Nausea and vomiting

d. Shaky feeling and dizziness

34. A client with Type 1 DM calls the nurse to report recurrent episodes of hypoglycaemia while
exercising. Which statement by the client indicates an inadequate understanding of the peak action
of NPH insulin and exercise?
a. The best time for me to exercise is every afternoon
b. The best time for me to exercise is after I eat
c. The best time for me to exercise is after breakfast
d. The best time for me to eat is before bedtime
35. A nurse is caring for a client with Type DM. which client complaint would alert the nurse of the
presence of a possible hypoglycemic reaction?
a. Hot, dry skin
b. Muscle cramps

c. Anorexia
d. Tremors

36. Mr. Park is 32-year-old, a badminton player and has a type 1 diabetes mellitus. After the game, the
client complains of diaphoresis and light-headedness. The client asks the nurse how to avoid this
reaction. The nurse will recommend to:
a. Allow plenty of time after the insulin injection and before beginning the match
b. Eat a carbohydrate snack before and during the badminton match
c. Drink plenty of fluids before, during, and after bed time
d. Take insulin just before starting the badminton match
37. Nurse Jim is providing dietary instructions to a male client with hypoglycaemia. To control
hypoglycemic episodes, the nurse should recommend:
a. Increasing the saturated fat intake and fasting in the afternoon
b. Increasing the 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 avoid fasting
38. A 26 year old man comes to the emergency room with complaints of nausea, vomiting, and
abdominal pain. He is a Type 1 Diabetic. Four days earlier, he reduced his insulin dose when flu
symptoms prevented him from eating. The nurse performs an assessment of the patient which
reveals poor skin turgor, dry mucous membranes, and fruity breath odor. The nurse should be alert
for which of the following problems?
a. Hypoglycaemia

b. Viral illness

c. Ketoacidosis

d. Hyperglycemic hyperosmolar
nonketotic coma

39. A client with a diagnosis of DKA is being treated in the ER. Which finding would nurse expect to note
as confirming the diagnosis?
a. Elevated blood glucose level and low plasma bicarbonate
b. Decreased urine output
c. Increased respirations and increase in pH
d. Comatose state
40. In the acute phase of the situation above, the priority nursing action is to prepare to:
a. Administer regular insulin
intravenously
b. Administer 5% dextrose intravenously
c. Correct the acidosis
d. Apply an ECG monitor

41. If the patients DKA progresses, which of the following symptoms might the nurse see?
a. Kussmauls respirations and a fruity odor on the breath
b. Shallow respirations and severe abdominal pain
c. Decreased respirations and increased urine output
d. Cheyne-stokes respirations and foul-smelling urine
42. A male client has just been diagnosed with DM Type 1. When teaching the client and family how
diet and exercise affect insulin requirements, Nurse Joy should include which guideline?
a. Youll need more insulin when you exercise or increase your food intake
b. Youll need less insulin when you exercise or reduce your food intake
c. Youll need less insulin when you increase your food intake
d. Youll need more insulin when you exercise or decrease your food intake
43. The insulin that would be administered in patients with DKA is:
a. Human NPH Insulin
b. Human Regular insulin

c. Insulin lispro injection

d. Insulin glargine injection

44. Which instruction about insulin administration should nurse Kate give to a client?
e. Always follow the same order when drawing the different insulins into the syringe
f. Shake the vials before withdrawing the insulin
g. Store unopened vials of insulin in the freezer at temperatures well below freezing
h. Discard the intermediate-acting insulin if it appears cloudy
45. A nurse provides instructions to a client newly diagnosed with Type 1 Dm. the nurse recognizes
accurate understanding of measures to prevent DKA when the client states:
a. I will stop taking my insulin if Im too sick to eat
b. I will decrease my insulin dose during times of illness
c. I will notify my physician if my blood glucose level is greater than 250mg/dL
d. I will adjust my insulin dose according to the level of glucose in my urine
46. Which of the following causes of HHNS is most common?
a. Insulin overdose
b. Removal of adrenal gland

c. Undiagnosed, untreated
hyperpituitarism
d. Undiagnosed, untreated DM

47. A client is brought to the emergency room in an unresponsive state, and a diagnosis of
hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. The nurse would prepare
immediately initiate which of the following anticipated physicians orders?
a. 100 units of NPH insulin
b. Endotracheal intubation

c. IV replacement of sodium bicarbonate

d. IV infusion of normal saline

48. A nurse performs physical assessment on a client with DM 2. Findings include a fasting blood
glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a BP of 140/80. Which
finding would be of most concern of the nurse?
a. Pulse
b. BP

c. Respiration
d. Temperature

49. Which action should you suggest to the client who has difficulty controlling hypoglycaemia to
REDUCE rate of insulin absorption from the site?
a. Massage the injection site
b. Exercise within an hour of administration
c. Inject into the muscle instead of subcutaneously
d. Using refrigerated insulin without warming it to room temperature
50. Hypoglycemia followed by rebound hyperglycemia is seen in:
a. Somogyi effect
b. dawn phenomenon
c. diabetic ketoacidosis (DKA)
d. hyperosmolar hyperglycemic nonketosis syndrome (HHNKS)
51. While examining the oral cavity of a client, the nurse detects a fruity odor to the clients breath. The
nurse should do which of the following?
a. Instruct to use mouthwash after meals
b. Instruct client on good oral hygiene

c. Document the finding as the only

action
d. Notify physician

52. The nurse practitioner would expect which manifestation as a side effect of Metformin?
a. GI upset
b. Photophobia

c. Hyperglycemia
d. Skin eruptions

53. The client with Type 1 DM is switching from an animal-source regular insulin to a synthetically
derived human regular insulin. What precaution should you explain?

a. Human insulin should only be administered in the umbilical area

b. Do not mix human regular insulin with any other type of insulin
c. Adjustments in insulin timing may be needed with human insulin
d. You may notice the need to increase the dose to achieve the same level of glucose control
54. Insulin forces which of the following electrolytes out of the plasma and into the cells?
a. Calcium
b. Magnesium

c. Phosphorus
d. Potassium

55. 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 pm, the client has a capillary glucose level of 250mg/dl for which he receives 8 U of
regular insulin. Nurse Charlene should expect the doses:
a. Onset to be at 2pm and its peak at
3pm
b. Onset to be at 2:15pm and its peak to
be at 3pm

c. Onset to be at 2:30pm and its peak at

4pm
d. Onset to be at 4 pm and its peak to be
at 6pm

56. The nurse teaches the diabetic client about NPH and regular insulin. Which statement indicates that
the client understood the instructions?
a. Ill draw up NPH insulin first
b. I must keep the insulin in the
refrigerator

c. Ill draw up the regular insulin first

d. Exercise will slow down the
absorption of insulin

57. The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer
these drugs in 1 syringe. Identify the steps in this procedure by listing them in priority order.
1. Inject air equal to NPH dose into NPH vial
2. Invert regular insulin bottle and withdraw regular insulin dose
3. Inject air equal to regular dose into regular insulin bottle
4. Invert NPH vial and withdraw NPH dose
a. 1-2-3-4
b. 1-4-3-2

c. 1-4-2-3
d. 1-3-2-4

58. Rotation sites for insulin injection should be separated from one another by 2.5cm or 1 inch and
should be used only every:
a. Third day
b. Week

c. 2-3 weeks
d. 2-4 weeks

59. What is the best reason for the nurse in instructing the client to rotate injection sites for insulin?
a. Lipodystrophy can result and is extremely painful
b. Poor rotation technique can cause superficial haemorrhaging
c. Lipodystrophic areas can result, causing erratic insulin absorption rates from these
d. Injection sites can never be reused
60. A client is taking NPH insulin daily every morning. The nurse instructs the client that the most
common time for a hypoglycemic reaction to occur is:
a. 2 to 4hours after administration
b. 4 to 12 hours after administration

c. 12 to 16 hours after administration

d. 18 to 24 hours after administration

61. An 11 year old boy has recently been diagnosed with diabetes. The nurses teaching plan for daily
injections should be based on which of the following?
a. The parents do not need to learn the procedure
b. He is old enough to give most of his own injections
c. Self-injections will be possible when he is closer to adolescence
d. He can learn about self-injections when he is able to reach all injection sites
62. An external insulin pump is prescribed for a client with diabetes mellitus. The client asks Eddie
about the function of the pump. He bases the response on the information that the pump:
a. is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn
releases the insulin into the bloodstream.
b. is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific
intervals
c. continuously infuses small amounts of NPH insulin into the bloodstream while regularly
monitoring blood glucose levels
d. gives a small continuous dose of regular insulin, and the client can self-bolus with an additional
dosage from the pump prior to each meal.

63. A 23-year old patient has history of IDDM. The patient takes NPH insulin 30 u q AM. The nurse
knows that patients taking NPH insulin should eat a snack at which of the following times of day in
order to avoid a hypoglycemic reaction?
a. Mid-morning
b. Mid-afternoon

c. Early evening
d. Before bedtime

64. A client newly diagnosed with DM has been stabilized with insulin injections daily. A nurse prepares
a discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the
following concept?
a. Increase the amount of insulin prior to unusual exercise
b. Acetone in the urine will signify a need for insulin
c. Always keep insulin vials refrigerated
d. Systematically rotate insulin injection sites
65. The only type of insulin that may be given IV is:
a. rapid-acting
b. zinc

c. NPH
d. Humalog

66. When a patient with DM is being treated with sulfonylurea and uses alcohol, what reaction would
you anticipate?
a. Bradycardic episode
b. Hyperglycemic episode

c. Vomiting, dizziness
d. Edema

67. A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing
diagnosis would be:
a. High risk for deficient fluid volume
b. Deficient knowledge: disease process and treatment
c. Imbalanced nutrition: less than body requirements
d. Disabled family coping: compromised
68. Which among the following findings would strongly indicate possible cirrhosis?
a. Dry skin
c. Peripheral edema
b. Hepatomegaly
d. Pruritus
69. Hepatic fat accumulation in a 55-year old male is usually a result of which type of cirrhosis?
a. Biliary
c. Postnecrotic
b. Metabolic
d. Laennecs
70. A client with cirrhosis may have alterations in which of the following laboratory values?
a. Carbondioxide level
c. Prothrombin time (PT)
b. pH
d. White Blood Cell Count (WBC)
71. Which among the following clients is most likely to acquire hepatitis?
a. A child with a bacterial infection
c. A client with metastasis of liver cancer
b. A client with dysfunction of the biliary
d. An adult with varicella zoster
system
72. In reviewing the possible causes of Hepatitis A in a 22-year old male, which of the following would
be the most likely factor?
a. Contact with blood in his profession as a policeman
b. Receiving a blood transfusion during surgery
c. Eating shrimp at the local pub
d. Admitting to be sexually active
73. A concerned mother doesnt understand how her child acquired Hepatitis A, when he was perfectly
healthy up to a week ago. One characteristic of Hepatitis A that may help her to understand is that
Hepatitis A has:
a. An incubation period of 60 to 180 days
c. A positive carrier state
b. A fecal-oral mode of transmission
d. A sexual mode of transmission
74. A 65-year-old female with a history of hepatic encephalopathy is hospitalized for pneumonia and
dehydration. When she complains to the nurse about the small portions of meat ordered by the
dietitian, the best response would be:
a. ask your doctor about it in the morning
b. I will call and order larger portions for you
c. The amount of meat on your tray is dictated by certain blood test results
d. Your protein is being limited, but you can have more food from another group
75. A client is admitted to the unit with complaints of malaise, nausea and vomiting, anorexia, and
headaches. The lab work shows abnormal electrolytes and elevated aspartate aminotransferase
(AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP); Hepatitis B surface antigen
(HBsAG) is present. The nurse would assume the client has:
a. Hepatitis A
c. Cirrhosis
b. Hepatitis B
d. Pancreatitis

76. The physical assessment of a 55-year-old female with end-stage cirrhosis reveals a protuberant
abdomen with bulging flanks and dullness to the dependent side while lying on the right. The
appropriate terminology for documentation of this assessment is:
a. Fluid overload
c. Ascites
b. Malnutrition
d. Distention
77. The physical assessment findings of spider angiomas, palmar erythema, peripheral edema, ascites
and change in mental status are consistent with which of the following disorders?
a. Cholelithiasis
c. Cirrhosis
b. Cholecystitis
d. Pancreatitis
78. When providing discharge teaching to the client with chronic cirrhosis, his wife asks the nurse to
explain why there is so much emphasis on bleeding precautions. Which of the following provides
the most appropriate response?
a. The liver affected by cirrhosis is unable to produce clotting factors
b. The low protein diet will result in reduced clotting factors
c. The increased production of bile decreases clotting factors
d. The required medications reduce clotting factors
79. Which among the following statements is true regarding viral hepatitis infection?
a. Hepatitis B is transmitted by the fecal-oral route
b. Hepatitis A is a sexually transmitted disease
c. The posticteric phase follows jaundice and lasts several weeks
d. Hepatitis D has a slow onset
80. When explaining the rationale for the use of lactulose (Chronulac) syrup to the client with chronic
cirrhosis, the nurse would use which of the following statements?
a. Chronulac syrup reduces constipation, which is a frequent complaint with cirrhosis
b. Chronulac syrup suppresses the metabolism of ammonia and aids in its elimination through the
feces
c. Chronulac syrup helps reverse cirrhosis of the liver
d. Chronulac syrup can be taken intermittently to reduce side effects
81. A client is admitted with possible liver cancer. Which of the tests below would be the most
confirming diagnosis?
a. Abdominal ultrasound
c. Alpha-fetoprotein markers
b. Abdominal flat plate X-ray
d. Computed tomography (CT) scan
Situation: Nurse Nelly is assessing Mr. Shick who is in the early stages of cirrhosis of the liver.
82. Which early sign would Nurse Nelly anticipates finding?
a. Peripheral edema
c. Anorexia
b. Ascites
d. Jaundice
83. What diet should be implemented for Mr. Shick who is in the early stages of cirrhosis?
a. High calorie, high carbohydrate
c. Low fat, low protein
b. High protein, low fat
d. High carbohydrate, low sodium
84. Mr. Shick complains that his skin always feels itchy and that he scratches himself raw while he
sleeps. Nurse Nelly should recognize that the itching is the result of which abnormality associated
with cirrhosis?
a. Folic acid deficiency
c. Increased bilirubin level
b. Prolonged prothrombin time
d. Hypokalemia
85. Few days after, Mr. Shick is developing ascites. Nurse Nelly should recognize that the pathologic
basis for the development of ascites in clients with cirrhosis is portal hypertension and:
a. an excess serum Na level
c. a decreased flow of hepatic lymph
b. an increased metabolism of aldosterone
d. a decreased serum albumin level
86. Which of the following health promotion activities would be appropriate for Nurse Nelly to suggest
to his client add to the daily routine at home?
a. Supplement the diet with multivitamins
c. Take a sleeping pill at bedtime
b. Limit daily alcohol intake
d. Limit contact with people
Situation: Nurse Rihanna together with her colleagues at San Lazaro Hospital is conducting a community
education on how to prevent the transmission of hepatitis.
87. Which of the following types of hepatitis is considered to be primarily a sexually transmitted
disease?
a. Hepatitis A
c. Hepatitis C
b. Hepatitis B
d. Hepatitis D
88. Nurse Rihanna knows that during the icteric phase of viral hepatitis, the client will exhibit which of
the following symptoms?
a. Tarry stools
c. Shortness of breath
b. Yellowed sclera
d. Light, frothy urine
89. Which of the following precautions would Nurse Rihanna and her colleagues indicate as essential
when caring for clients with Hepatitis A?
a. Gowning when entering a clients room
b. Wearing a mask when providing care

c. Assigning the client in a private room

d. Wearing gloves when giving direct care
90. Nurse Rihanna is developing a teaching plan for a client with Hepatitis A. Which of the following
instructions is appropriate?
a. Spray the house to eliminate infected insects
b. Tell family members to try to stay away from the client
c. Tell the family members to wash their hands frequently
d. Disinfect clothing and eating utensils
91. After the community education, a client approached Nurse Rihanna and expressed feelings of
isolation as a result of having hepatitis. What would be Nurse Rihannas best response?
a. Dont Worry. Its normal to feel that way.
b. Your friends are probably afraid of contracting hepatitis from you.
c. Im sure youre imagining that!
d. Tell me more about your feelings of isolation.
Situation : Mr. Gibson, 60 year old, is admitted to the hospital with cirrhosis. He has history of alcoholism
and hepatitis B.
92. What should Nurse Ashanti expect to find on his initial laboratory results?
a. hypernatremia
c. elevated serum albumin
b. elevated ALT
d. leukocytosis
93. Mr. Gibson is scheduled for a liver biopsy. What is your priority of care for this patient?
a. monitor for bleeding
c. controlling blood pressure
b. encouraging increased activity
d. providing nutritional support
94. What life threatening complication will result when the liver is destroyed due to hepatitis B and up
to the development of chronic hepatitis?
a. portal hypertension
c. liver failure
b. esophageal varices
d. hepatic encephalopathy
95. What instruction about diet modification should Nurse Ashanti give to Mr. Gibson?
a. increase fluid intake
d. encourage to eat dairy products and
b. avoid canned and processed food
poultry
c. eat food reach in protein
96. Mr. Gibson asks Nurse Ashanti why he has edema. Nurse Ashanti would use which of the following
statements to explain how edema results from pathophysiologic changes in cirrhosis?
a. The edema occurs because your liver produces fewer proteins that help draw fluid into the
bloodstream
b. The high osmotic pressure of proteins in your blood pushes fluid into the body tissues
c. The kidneys are able to filter less fluid, so the body cannot excrete it as urine very easily
d. Your body is metabolizing sex hormones more quickly, leading to fluid retention
Situation: Nurse Shaggy is the staff nurse on duty in the Medical Floor. He is caring for clients with
hepatobiliary disorders. Health teaching is his primary role for the quick recovery of his clients.
97. Ms. Demeanor has jaundice. Nurse Shaggys most appropriate comfort measure to implement is:
a. Offer hot beverages frequently
b. Encourage taking a hot bath or shower
c. Keep the air temperature at approximately 68 to 70 degrees F
d. Suggest the use of alcohol based skin lotion
98. When teaching Mr. Gabrielle with hepatitis A about infection control, Nurse Shaggy explains that he
is most infectious to others at which of these times?
a. 7 days exposure
c. 10 days before the onset of symptoms
b. 2 months after exposure
d. 14 days after symptoms begin
99. Mr. Foxx who has ascites and peripheral edema is at risk for impaired skin integrity. Which of the
following intervention would be implemented to prevent skin breakdown?
a. ROM exercises every 4 hours
c. Massage of the abdomen once a shift
b. Use of alternating air pressure mattress
d. Elevation of the lower extremities
100.
A male client with liver dysfunction reports that his gums bleed spontaneously. In addition,
Nurse Shaggy notes small hemorrhagic lesions on his face. Nurse Shaggy recognizes that the client
needs nutritional vitamin:
a. D
c. A
d. K
b. E

Recipe for success: Study while others are sleeping; work while others are loafing; prepare while others
are playing; and dream while others are wishing. -- William A. Ward

1. A client admitted with pheochromocytoma. The nurse assesses the clients blood pressure
frequently. This is based on the knowledge that pheochromocytoma of the adrenal medulla releases
excessive amounts of:
a. Renin
b. Aldosterone

c. Catecholamines
d. Glucocorticoids

2. The most important nursing intervention during the medical and surgical treatment of the patient
with a pheochromocytoma is
a. administering IV fluids
b. monitoring blood pressure
c. monitoring I&O and daily weights

d. administering B-adrenergic blocking agents

3. A nurse is caring for a client with pheochromocytoma. The client asks for a snack and something
warm to drink. The most appropriate choice for this client to meet nutritional need would be which
of the following?
a. Graham crackers and warm milk
b. Toast with peanut butter and cocoa
c. Crackers with cheese and tea
d. Vanilla wafers and coffee with cream and sugar
4. The following interventions are implemented for a patient with Pheochromocytoma to reduce
anxiety except:
a. Remain with the patient during acute episodes of hypertension
b. Ensure bed rest and elevate head of bed at 45-degree angle during sever hypertension
c. Instruct patient about use of sedatives and relaxation exercises
d. Reduce environmental stressors by providing a calm, quiet environment, restrict visitors
5. A catecholamine-secreting neoplasm associated with hyperfunction of the adrenal medulla. It may
appear wherever chromaffin cells are located; most are found in the adrenal medulla
a. Addisons disease
c. Primary aldosteronism
b. Cushings syndrome
d. Pheochromocytoma
6. The nurse is performing an admission assessment on a client admitted with a diagnosis of
pheochromocytoma. The nurse assesses for major symptoms associated with pheochromocytoma
when the nurse:
a. Tests the clients urine for glucose
c. Palpates the skin for its temperature
b. Obtains the clients weight
d. Takes the clients blood pressure
7. The primary feature of pheochromocytomas effect on blood pressure is:
a. Systolic hypertension
b. Diastolic hypertension
c. Hypertension that is resistant to treatment with drugs
d. Widening pulse pressure
8. Priority nursing management of the client with pheochromocytoma would include which of the
following?
a. Monitoring blood pressure
c. Monitoring neurological status
b. Monitoring urine output
d. Monitoring serum glucose levels
9. The client with pheochromocytoma is scheduled for surgical resection of the tumor in the adrenal
medulla. The nurse monitors the client postoperatively for which of the following potential
complications?
a. Orthostatic hypotension
c. Hypoglycaemia
b. Haemorrhage
d. Hypertensive crisis
Miss Anna Marie is admitted to the hospital because of easy fatigability for the past few months. After a
series of examinations, a diagnosis of hyperthyroidism was confirmed.
10. As assessment was made. The least symptom she would experience is:
a. Fine tremors of the hands
b. Hyperactive

c. Palpitation
d. Drowsiness

11. A client newly diagnosed of hypothyroidism is placed on Levothyroxine 0.1 mg PO daily. Follow-up
should include:
a. Weekly CBC monitoring
b. The client should come back in 4-6 weeks
c. The client should have weekly determination of levothyroxine levels
d. Client should have monthly CBC to rule out agranulocytosis
12. Iodine solution may cause which of the following effect?
a. Yellow eyes
b. Staining of teeth

c. Loss of teeth
d. Graying of hair

13. Before a post- thyroidectomy client returns to her room from the OR, the nurse plans to set up
emergency equipment, which should include:
a. A crash cart with bed board
b. A tracheostomy set and oxygen

c. An airway and rebreathing mask

d. Two ampules of sodium bicarbonate

14. 8 hours post thyroidectomy, the nurse assesses the patient for laryngeal nerve damage by:
a. Asking the patient to hyperextend the kneed and palpating for hematoma or edema
b. Asking the patient to state his name
c. Asking the patient to make small sips of water and observe if the patient can swallow without
difficulty

d. Testing the patients gag and swallow reflex

15. To maintain skin integrity of a patient with hyperthyroidism, the following nursing interventions
should be instituted except:
a. Assess skin frequently to detect diaphoresis
b. Bathe frequently with cool water; change linens when damp
c. Use soap to prevent drying and use lubricant skin lotions over pressure points
d. Protect and relieve pressure from bony prominences while immobilized or while hypothermia
blanket is used
16. The doctor prescribed an anti-thyroid drug which would be:
a. Cytomel
b. Tapazole

c. Synthroid
d. Tagamet

17. Which of the following are possible actions of thyroid hormones?

a. decreases potency of anticoagulants
c. increases potency of anticoagulants
b. increases the effectiveness of digitalis
d. anti-inflammatory effect
18. A self-limiting, painful inflammation of the thyroid gland, usually associated with viral infections is:
a. Hashimotos thyroiditis
c. Chronic-progressive thyroiditis
b. Lymphocytic thyroiditis
d. Subacute thyroiditis
19. The nurse is obtaining a health history on a 36-year old female who reports an increase in appetite,
weight loss, intolerance to heat, and nervousness. On physical assessment, the client is noted to
have thin hair and moist skin. Based on this information, the nurse would suspect which of the
following?
a. Hypothyroidism
c. Hypoparathyroidism
b. Hyperthyroidism
d. Hyperparathyroidism
20. A client on antithyroid drug therapy presents palpitations and dry mouth. He as cough. What
medication would you discourage?
a. Benzocaine lozenge
c. Ibuprofen
b. Guaiafenessin
d. Pseudoepinephrine
21. When should PTU be given?
a. Only at bedtime
c. Every 2 hours
b. As a single dose
d. In divided doses around the clock
22. Lucy undergoes Subtotal Thyroidectomy for Graves Disease. In planning for the clients return from
the OR, the nurse would consider that in a subtotal thyroidectomy:
a. The entire thyroid gland is removed
b. A small part of the gland is left intact
c. One parathyroid gland is also removed
d. A portion of the thyroid and four parathyroid glands are removed
23. Which of the following are evidences of iodine toxicity?
a. Swelling of the buccal mucosa, excessive salivation, coryza, skin eruptions
b. Gum bleeding, drooling, inflammation of the tongue, skin discoloration
c. Decreased salivation, staining of the teeth, coryza, pruritus
d. Swelling of the gums, exophthalmos, brittle nails, dry skin and hair
24. A patient, after 3 months, was readmitted to the hospital for thyroidectomy. Prior to surgery, the
doctor prescribed Lugols solution. When administering this medication, the nurse should remember
the following consideration except:
a. Not to administer it for more than 10 days
b. Telling the patient to take it using a straw
c. Crushing the tablet then giving it with sweets to mask the metallic taste
d. Instructing the patient to report a brassy taste, sore gums and coryza
25. The primary reason why Lugols solution is administered prior to surgery is to:
a. Decrease thyroid (T3 and T4) hormone
c. Reduce metabolic rate
d. Provide store of thyroxine hormone after
secretion
b. Limit bleeding
surgery
26. A nurse taking care of a patient from the OR. You asked questions as soon as the patient regained
consciousness from thyroidectomy primarily to assess the evidence of:
a. Thyroid storm
c. Damage to the laryngeal nerve
b. Mediastinal shift
d. Hypocalcemia tetany
27. In contrast to hyperthyroidism, underproduction of thyroxin results in:
a. Graves disease
c. Cushings disease
b. Diabetes insipidus
d. Myxedema
28. A client with hypothyroidism is taking levothyroxine sodium (Synthroid), a thyroid replacement
hormone. Which of the following statements made by the client would indicate additional teaching
is required?
a. I know I will be on this medication for the rest of my life.
b. I dont eat excessive amounts of cabbage or spinach.
c. I take my Synthroid with food
d. I take my Synthroid in the mornings

29. The nurse is providing care to a client with myxedema coma. Priority nursing care would include
which of the following?
a. Measures to decrease body temperature
b. Measures to decrease heart rate
c. Measures to maintain airway, fluid and electrolyte balance, and cardiovascular status
d. Measure to decrease blood pressure
30. In collaboration with the dietician, what dietary modification should the nurse suggest for the client
with hyperthyroidism?
a. Decrease calories and proteins and increase carbohydrates
b. Eliminate carbohydrates and increase proteins and fats
c. Increase calories, proteins, and carbohydrates
d. No dietary modification is needed
31. Which statement made by the client alerts the nurse to the possibility of hypothyroidism?
a. My sister has thyroid problems
c. Food just doesnt taste good without a lot of
b. I seem to feel the heat more than
salt
other people
d. I am always tired, even when I get 10 or 12
hours of sleep
32. Which medication should the nurse be prepared to administer to a client with bradycardia as a
result of hypothyroidism?
a. Atropine sulfate
c. Propranolol
b. Levothyroxine sodium
d. Epinephrine
33. A client with exophthalmos as a result of Graves disease has expressed a desire for the
medications to hurry up and work so that my eyes will go down. The nurses response to the
client will be based on which of the following?
a. Reversal of exophthalmos occurs after a therapeutic level of the antithyroid medication is
achieved.
b. Reversal of exophthalmos occurs after treatment with ophthalmic medications.
c. Changes in the eyes as a result of Graves disease are not reversible, even after treatment of
the disease.
d. Exopthalmos as a result of Graves disease is only a temporary symptom, and should resolve
spontaneously.
34. A client is returning from a subtotal thyroidectomy for the treatment of hyperthyroidism. The
immediate priority in assessing this client would include which of the following?
a. Assess for respiratory distress
c. Assess neurological status
b. Asses fluid volume status
d. Assess for pain
35. Discharge teaching for the client with hypoparathyroidism should include which of the following
instructions:
a. use OTC vitamin D preparation
b. avoid strenuous ex ercises
c. supplement calcium intake

d. avoid diuretics to minimize calcium

loss

36. A patient is admitted to the Endocrine unit. The patient states that he has recently lost 15 lbs over
two and one-half months, although there has been no change in his eating habits, and if anything,
his appetite has increased. The patient also complains of palpitations, and says that his eyes look
like they are going to pop out. Based on this data, the nurse can infer that this patient is most
likely exhibiting symptoms of:
a. Hyperparathyroidism
c. Hypothyroidism
b. Hyperthyroidism
d. Addisonian crisis
37. When caring for client in thyroid crisis, the nurse would question an order for:
a. IV fluid
c. Prophylthiouracil
b. Propanolol (Inderal)
d. A hyperthermia blanket
38. A client is suspected to develop tetany after subtotal thyroidectomy. Which of the following
symptoms might indicate tetany?
a. Tingling in the fingers
c. Tension on the suture lines
b. Pain in the hands and feet
d. Bleeding on the back of the dressing
39. On the second postoperative day after the subtotal thyroidectomy, the client tells the nurse that he
feels numbness and tingling around the mouth. What is the nurses best first action?
a. Offer mouth care
d. Document the finding as the only
b. Loosen the dressing
action
c. Notify the physician
40. A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50
mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication:
a. Should be taken in the morning
c. Must be stored in a dark container
b. May decrease the clients energy level
d. Will decrease the clients heart rate
41. A client was admitted to the emergency room and a diagnosis of myxedema coma is made. Which
action would the nurse prepare to carry out initially?

a. Warm the client

b. Administer fluid replacement

c. Maintain oxygenation
d. Administer thyroid hormone

42. The client with hyperthyroid symptoms is having hormone studies done to confirm the diagnosis.
Which set of values indicates non-Graves disease hyperthyroidism?
a. Elevated T3, elevated T4, high TSH levels
b. Elevated T3, normal T4, low TSH levels
c. Elevated T3, low T4, low TSH levels
d. Low T3, normal T4, high TSH levels
43. What is the priority nursing diagnosis for the client newly diagnosed with hyperthyroidism?
a. Decreased cardiac output related to tachycardia
b. Disturbed body image related to weight loss
c. Hyperthermia related to hypermetabolism
d. Fatigue related to energy depletion
44. The nurse is caring for a 45 year old patient who had a thyroidectomy 12 hours ago for treatment of
Graves disease. The nurse would be most concerned if which of the following was observed?
a. BP of 140/80 mmHg; RR of 16cpm; Oral Temp of 99 Degrees F
b. The patient supports his head and neck when turning his head to the right
c. The client spontaneously flexes his wrist when the blood pressure is obtained
d. The client is drowsy and complains of a sore throat
45. What are signs of thyroid crisis from Graves disease?
a. Weight gain to 155 lb with height of 5'8"
b. Heart rate 90 beats/min and respiratory rate 16 breaths/min
c. Hot and moist skin with protrusion of eyeballs
d. Constipation and amenorrhea
46. The client is receiving an antithyroid medication to treat hyperthyroidism. Which of the following
should be included in client education regarding the initiation of this therapy?
a. Increased need for sleep or not tolerating cold like you used to can occur when taking this
medication. If it does, notify your physician.
b. Nausea and vomiting are serious complication of the medication you are taking.
c. Take your pulse everyday, as you were taught. If it is too fast, call your doctor
d. This medication may cause dyspnea or vertigo. Notify your health care provider if this occurs.
47. Which clinical manifestation indicates to the nurse the treatment for the client with hypothyroidism
is effective?
a. The client is thirsty
b. The clients weight has been the same for 3 weeks
c. The clients total white blood cell count is 6000 cells/mm3
d. The client has had a bowel movement every day for 1 week
48. The client with hypothyroidism as a result of Hashimotos thyroiditis asks the nurse how long she
will have to take thyroid medication. What is the nurses best response?
a. You will need to take the thyroid medication until the goiter is completely gone
b. the thyroiditis will be cured with antibiotics, and then you will no longer need the thyroid
medication
c. you will need thyroid replacement hormone therapy for the rest of your life because thyroid
gland function will not return
d. When you thyroid function studies indicate a normal blood level of thyroid hormones, you will
be able to discontinue the medication
49. What is the priority nursing diagnosis for the client with hypothyroidism?
a. Hypothermia
b. Disturbed Body image
c. Disturbed thought process
d. Imbalanced Nutrition: More than Body Requirements

50. You see Mrs. Dizon in the clinic. She is 45 years old with a history of hypothyroidism and has been
treated with L-thyroxine 0.15mg daily. From your assessment of hypothyroidism, the following
nursing interventions are included except:
a. Encourage to increase fluid intake
b. Recommend low residue diet
c. Encourage increased mobility within the patients exercise tolerance
d. Monitor bowel function by recording frequency and consistency of stool
51. Instructions given to Mrs. Dizon include the following except:
a. The need to receive antithyroid therapy for the duration of her life
b. How and when to take medications
c. Signs and symptoms of insufficient and excessive medications, reinforce teaching by providing
written instructions
d. Energy conservation techniques and the need to increase activity
52.