NUR 242 Exam 4 – Med-Surg Concepts – Complete
300-Question Practice Exam Galen College of Nursing
| 2026/2027 Academic Year
Section 1: Endocrine Disorders (Questions 1-50)
1. A client with diabetes mellitus has a blood glucose level of 55 mg/dL and
is conscious. What is the nurse's priority action?
A) Administer insulin
B) Give 15 g of fast-acting carbohydrate
C) Administer glucagon IM
D) Call the provider
Answer: B – The "rule of 15" for conscious hypoglycemia: give 15 g of fast-
acting carbohydrate (4 oz juice, 3-4 glucose tablets, 1 tbsp honey or sugar).
Recheck blood glucose in 15 minutes.
2. A client with hyperthyroidism is prescribed propylthiouracil (PTU). The
nurse should monitor for which adverse effect?
A) Agranulocytosis
B) Hyperglycemia
C) Weight gain
D) Bradycardia
Answer: A – PTU and methimazole can cause agranulocytosis (fever, sore
throat, infection). CBC should be monitored. Instruct the client to report
signs of infection immediately.
3. A client with diabetes mellitus has an HbA1c of 9.2%. The nurse
interprets this as:
A) Excellent control
B) Poor control over the past 2-3 months
,C) Acute hyperglycemia
D) Lab error
Answer: B – HbA1c reflects average blood glucose over 2-3 months. Target
is <7%. 9.2% indicates poor control requiring intervention.
4. A client with hyperthyroidism has exophthalmos. What nursing
intervention is most appropriate?
A) Apply artificial tears
B) Elevate the head of the bed
C) Tape the eyelids closed at night
D) All of the above
Answer: D – Exophthalmos (proptosis) causes dry eyes, photophobia, and
corneal irritation. Interventions include artificial tears, head elevation, and
taping eyelids closed at night if incomplete closure.
5. A client with diabetes mellitus is NPO for surgery. What should the nurse
do about the client's morning insulin?
A) Administer the full dose
B) Hold all insulin
C) Call the provider for an order
D) Administer half the dose
Answer: C – Insulin requirements change when NPO. The provider must
give a specific order for insulin adjustment.
6. A client with hypothyroidism is prescribed levothyroxine. The nurse
should teach the client to take this medication:
A) With food
B) On an empty stomach, 30-60 minutes before breakfast
C) At bedtime with a snack
D) With antacids
,Answer: B – Levothyroxine absorption is impaired by food, calcium, iron,
and antacids. It should be taken on an empty stomach with water.
7. A client with diabetes mellitus is prescribed metformin. The nurse should
instruct the client to:
A) Take on an empty stomach
B) Take with meals to reduce GI side effects
C) Expect weight gain
D) Avoid carbohydrates
Answer: B – Metformin commonly causes GI side effects (nausea,
diarrhea). Taking with meals reduces these effects.
8. A client with hyperthyroidism has a thyroid storm. Which finding is
expected?
A) Hypothermia
B) Bradycardia
C) Hyperthermia and tachycardia
D) Hypotension
Answer: C – Thyroid storm is a life-threatening emergency with
hyperthermia (fever >104°F), tachycardia (>140/min), agitation, and
delirium.
9. A client with diabetes mellitus is prescribed regular insulin at 7:30 AM.
The nurse should anticipate the peak effect at:
A) 8:00-9:00 AM
B) 9:30-11:30 AM
C) 1:00-3:00 PM
D) 5:00-7:00 PM
, Answer: B – Regular insulin has an onset of 30-60 minutes and peaks at 2-
4 hours (9:30-11:30 AM). The client is at highest risk for hypoglycemia
during the peak.
10. A client with hypothyroidism has myxedema coma. What is the priority
nursing intervention?
A) Airway and breathing
B) Administering levothyroxine IV
C) Warming the client gradually
D) Administering IV fluids
Answer: A – Myxedema coma is a medical emergency. Airway, breathing,
and circulation are the priority. Hypothermia requires gradual rewarming.
11. A client with diabetes mellitus is prescribed insulin glargine at bedtime.
The nurse should teach the client that this insulin:
A) Peaks in 4-6 hours
B) Has no pronounced peak
C) Should be mixed with regular insulin
D) Can be given IV
Answer: B – Insulin glargine (Lantus) is a long-acting, peakless insulin that
provides basal coverage for approximately 24 hours.
12. A client with Cushing's syndrome has a moon face and buffalo hump.
The nurse should monitor for:
A) Hyperglycemia
B) Hypotension
C) Hypokalemia
D) Weight loss
300-Question Practice Exam Galen College of Nursing
| 2026/2027 Academic Year
Section 1: Endocrine Disorders (Questions 1-50)
1. A client with diabetes mellitus has a blood glucose level of 55 mg/dL and
is conscious. What is the nurse's priority action?
A) Administer insulin
B) Give 15 g of fast-acting carbohydrate
C) Administer glucagon IM
D) Call the provider
Answer: B – The "rule of 15" for conscious hypoglycemia: give 15 g of fast-
acting carbohydrate (4 oz juice, 3-4 glucose tablets, 1 tbsp honey or sugar).
Recheck blood glucose in 15 minutes.
2. A client with hyperthyroidism is prescribed propylthiouracil (PTU). The
nurse should monitor for which adverse effect?
A) Agranulocytosis
B) Hyperglycemia
C) Weight gain
D) Bradycardia
Answer: A – PTU and methimazole can cause agranulocytosis (fever, sore
throat, infection). CBC should be monitored. Instruct the client to report
signs of infection immediately.
3. A client with diabetes mellitus has an HbA1c of 9.2%. The nurse
interprets this as:
A) Excellent control
B) Poor control over the past 2-3 months
,C) Acute hyperglycemia
D) Lab error
Answer: B – HbA1c reflects average blood glucose over 2-3 months. Target
is <7%. 9.2% indicates poor control requiring intervention.
4. A client with hyperthyroidism has exophthalmos. What nursing
intervention is most appropriate?
A) Apply artificial tears
B) Elevate the head of the bed
C) Tape the eyelids closed at night
D) All of the above
Answer: D – Exophthalmos (proptosis) causes dry eyes, photophobia, and
corneal irritation. Interventions include artificial tears, head elevation, and
taping eyelids closed at night if incomplete closure.
5. A client with diabetes mellitus is NPO for surgery. What should the nurse
do about the client's morning insulin?
A) Administer the full dose
B) Hold all insulin
C) Call the provider for an order
D) Administer half the dose
Answer: C – Insulin requirements change when NPO. The provider must
give a specific order for insulin adjustment.
6. A client with hypothyroidism is prescribed levothyroxine. The nurse
should teach the client to take this medication:
A) With food
B) On an empty stomach, 30-60 minutes before breakfast
C) At bedtime with a snack
D) With antacids
,Answer: B – Levothyroxine absorption is impaired by food, calcium, iron,
and antacids. It should be taken on an empty stomach with water.
7. A client with diabetes mellitus is prescribed metformin. The nurse should
instruct the client to:
A) Take on an empty stomach
B) Take with meals to reduce GI side effects
C) Expect weight gain
D) Avoid carbohydrates
Answer: B – Metformin commonly causes GI side effects (nausea,
diarrhea). Taking with meals reduces these effects.
8. A client with hyperthyroidism has a thyroid storm. Which finding is
expected?
A) Hypothermia
B) Bradycardia
C) Hyperthermia and tachycardia
D) Hypotension
Answer: C – Thyroid storm is a life-threatening emergency with
hyperthermia (fever >104°F), tachycardia (>140/min), agitation, and
delirium.
9. A client with diabetes mellitus is prescribed regular insulin at 7:30 AM.
The nurse should anticipate the peak effect at:
A) 8:00-9:00 AM
B) 9:30-11:30 AM
C) 1:00-3:00 PM
D) 5:00-7:00 PM
, Answer: B – Regular insulin has an onset of 30-60 minutes and peaks at 2-
4 hours (9:30-11:30 AM). The client is at highest risk for hypoglycemia
during the peak.
10. A client with hypothyroidism has myxedema coma. What is the priority
nursing intervention?
A) Airway and breathing
B) Administering levothyroxine IV
C) Warming the client gradually
D) Administering IV fluids
Answer: A – Myxedema coma is a medical emergency. Airway, breathing,
and circulation are the priority. Hypothermia requires gradual rewarming.
11. A client with diabetes mellitus is prescribed insulin glargine at bedtime.
The nurse should teach the client that this insulin:
A) Peaks in 4-6 hours
B) Has no pronounced peak
C) Should be mixed with regular insulin
D) Can be given IV
Answer: B – Insulin glargine (Lantus) is a long-acting, peakless insulin that
provides basal coverage for approximately 24 hours.
12. A client with Cushing's syndrome has a moon face and buffalo hump.
The nurse should monitor for:
A) Hyperglycemia
B) Hypotension
C) Hypokalemia
D) Weight loss
