NUR 242 MEDICAL-SURGICAL NURSING III THIS
EXAM CONSIST OF COMPLEX CARE, ENDOCRINE
DISORDERS, RESPIRATORY FAILURE, CARDIAC
EMERGENCIES, AND PERIOPERATIVE
COMPLICATIONS QUESTIONS AND CORRECT
ANSWERS
Section 1: Endocrine Disorders (Diabetes Mellitus & Thyroid)
1. A nurse is caring for a client with type 1 diabetes mellitus who is found unresponsive, pale, and
diaphoretic. The client’s blood glucose reading is 45 mg/dL. Which action should the nurse take first?
A. Administer glucagon intramuscularly.
B. Recheck the blood glucose in 15 minutes.
C. Administer 15 grams of fast-acting carbohydrates orally.
D. Call the rapid response team.
Correct Answer: A. Administer glucagon intramuscularly.
Rationale: The client is unresponsive (altered mental status) with severe hypoglycemia. Oral
carbohydrates are contraindicated due to the risk of aspiration. Glucagon (IM or subcutaneous) is the
priority to raise blood glucose rapidly by stimulating glycogenolysis in an unresponsive patient.
2. A client with hyperthyroidism is scheduled for a thyroidectomy. The nurse notes that the client has
not received any antithyroid medication this morning. What is the priority nursing assessment?
A. Presence of a hoarse voice.
B. Blood pressure and heart rate.
C. Level of consciousness.
D. Surgical consent form.
, Correct Answer: B. Blood pressure and heart rate.
Rationale: Discontinuing antithyroid medications can precipitate a thyroid storm. The priority is to
assess for signs of sympathetic nervous system overdrive: tachycardia, hypertension, hyperthermia, and
mental status changes.
3. A nurse is providing discharge teaching to a client with hypothyroidism who is starting
levothyroxine (Synthroid). Which statement by the client indicates a need for further teaching?
A. "I will take this medication on an empty stomach in the morning."
B. "I will report any chest pain or palpitations to my provider."
C. "I can switch to a generic brand if it is cheaper at the pharmacy."
D. "It may take several weeks for me to feel the full effects of this drug."
Correct Answer: C. "I can switch to a generic brand if it is cheaper at the pharmacy."
Rationale: Levothyroxine has a narrow therapeutic index. Switching between brand and generic
formulations can cause significant fluctuations in serum levels. Patients should maintain consistency in
the brand/manufacturer unless directed by the provider.
4. A client with Cushing’s syndrome is admitted. Which assessment finding is consistent with this
diagnosis?
A. Bronze skin pigmentation and weight loss.
B. Truncal obesity, moon face, and purple striae.
C. Exophthalmos and tachycardia.
D. Heat intolerance and fine hair.
Correct Answer: B. Truncal obesity, moon face, and purple striae.
Rationale: Cushing’s syndrome (hypercortisolism) results in central obesity, a rounded "moon" face, thin
skin that bruises easily, and purple striae (stretch marks) due to protein breakdown.
5. A nurse is monitoring a client post-thyroidectomy. The client reports tingling in the fingers and
around the mouth. The nurse notes Chvostek’s sign. Which laboratory value should the nurse expect
to be abnormal?
A. Decreased serum sodium
B. Decreased serum calcium
C. Increased serum potassium
D. Increased serum glucose
EXAM CONSIST OF COMPLEX CARE, ENDOCRINE
DISORDERS, RESPIRATORY FAILURE, CARDIAC
EMERGENCIES, AND PERIOPERATIVE
COMPLICATIONS QUESTIONS AND CORRECT
ANSWERS
Section 1: Endocrine Disorders (Diabetes Mellitus & Thyroid)
1. A nurse is caring for a client with type 1 diabetes mellitus who is found unresponsive, pale, and
diaphoretic. The client’s blood glucose reading is 45 mg/dL. Which action should the nurse take first?
A. Administer glucagon intramuscularly.
B. Recheck the blood glucose in 15 minutes.
C. Administer 15 grams of fast-acting carbohydrates orally.
D. Call the rapid response team.
Correct Answer: A. Administer glucagon intramuscularly.
Rationale: The client is unresponsive (altered mental status) with severe hypoglycemia. Oral
carbohydrates are contraindicated due to the risk of aspiration. Glucagon (IM or subcutaneous) is the
priority to raise blood glucose rapidly by stimulating glycogenolysis in an unresponsive patient.
2. A client with hyperthyroidism is scheduled for a thyroidectomy. The nurse notes that the client has
not received any antithyroid medication this morning. What is the priority nursing assessment?
A. Presence of a hoarse voice.
B. Blood pressure and heart rate.
C. Level of consciousness.
D. Surgical consent form.
, Correct Answer: B. Blood pressure and heart rate.
Rationale: Discontinuing antithyroid medications can precipitate a thyroid storm. The priority is to
assess for signs of sympathetic nervous system overdrive: tachycardia, hypertension, hyperthermia, and
mental status changes.
3. A nurse is providing discharge teaching to a client with hypothyroidism who is starting
levothyroxine (Synthroid). Which statement by the client indicates a need for further teaching?
A. "I will take this medication on an empty stomach in the morning."
B. "I will report any chest pain or palpitations to my provider."
C. "I can switch to a generic brand if it is cheaper at the pharmacy."
D. "It may take several weeks for me to feel the full effects of this drug."
Correct Answer: C. "I can switch to a generic brand if it is cheaper at the pharmacy."
Rationale: Levothyroxine has a narrow therapeutic index. Switching between brand and generic
formulations can cause significant fluctuations in serum levels. Patients should maintain consistency in
the brand/manufacturer unless directed by the provider.
4. A client with Cushing’s syndrome is admitted. Which assessment finding is consistent with this
diagnosis?
A. Bronze skin pigmentation and weight loss.
B. Truncal obesity, moon face, and purple striae.
C. Exophthalmos and tachycardia.
D. Heat intolerance and fine hair.
Correct Answer: B. Truncal obesity, moon face, and purple striae.
Rationale: Cushing’s syndrome (hypercortisolism) results in central obesity, a rounded "moon" face, thin
skin that bruises easily, and purple striae (stretch marks) due to protein breakdown.
5. A nurse is monitoring a client post-thyroidectomy. The client reports tingling in the fingers and
around the mouth. The nurse notes Chvostek’s sign. Which laboratory value should the nurse expect
to be abnormal?
A. Decreased serum sodium
B. Decreased serum calcium
C. Increased serum potassium
D. Increased serum glucose
