NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS
WITH ANSWERS PLUS EXPLANATIONS A+ RATED
1. 1. Question
A patient is admitted to the hospital with a diagnosis of primary
hyperparathyroidism. A nurse checking the patient’s lab results
would expect which of the following changes in laboratory
findings?
o A. Elevated serum calcium
o B. Low serum parathyroid hormone (PTH)
o C. Elevated serum vitamin D
o D. Low urine calcium
Correct Answer: A. Elevated serum calcium
The parathyroid glands regulate the calcium level in the blood. In
hyperparathyroidism, the serum calcium level will be elevated. A normal
PTH in the presence of hypercalcemia is considered inappropriate and
still consistent with PTH-dependent hypercalcemia. PTH levels should be
very low in those patients with PTH-independent hypercalcemia. A
comprehensive clinical evaluation complemented by routine laboratory
and radiologic studies should be sufficient to establish a diagnosis of
primary hyperparathyroidism in a patient with persistent hypercalcemia
and an elevated serum level of parathyroid hormone.
o Option B: Parathyroid hormone levels may be high or
normal but not low. Patients with primary hyperparathyroidism
and other causes of PTH- dependent hypercalcemia often have
frankly elevated levels of PTH, while some will have values that
fall within the reference range for the general population. It is
uncommon for clinically occult malignancies to cause
hypercalcemia. Most patients with malignancy-
,NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS
WITH ANSWERS PLUS EXPLANATIONS A+ RATED
associated hypercalcemia are known to have cancer,
or cancer is readily detectable on initial evaluation,
and PTH levels will be suppressed.
o Option C: Parathyroid hormone levels may be high
or normal but not low. The body will lower the level
of vitamin D in an attempt to lower calcium.
o Option D: Urine calcium may be elevated, with
calcium spilling over from elevated serum levels. This
may cause renal stones. A review of previous
medical records can often be of significant value in
establishing the cause of hypercalcemia. Most
patients with hyperparathyroidism have persistent
or intermittent hypercalcemia for many years before
a definitive diagnosis is established.
• 2. Question
A patient with Addison’s disease asks a nurse for nutrition and
diet advice. Which of the following diet modifications is not
recommended?
o A. A diet high in grains.
o B. A diet with adequate caloric intake.
o C. A high protein diet.
o D. A restricted sodium diet.
Correct Answer: D. A restricted sodium diet.
A patient with Addison’s disease requires normal dietary sodium to prevent excess
o Option A: Addison’s disease is a rare condition. It develops when the ad
,NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS
WITH ANSWERS PLUS EXPLANATIONS A+ RATED
client should include complex carbohydrates in his
diet, including grains.
o Option B: A high protein diet is recommended for
the client with Addison’s disease. The adrenal
fatigue diet aims to stabilize blood sugar and balance
cortisol levels by limiting sugar while increasing the
intake of protein, healthy fats, veggies, and whole
grains. Healthy fats and high-quality proteins slow
the blood sugar rollercoaster and promote stable
blood sugar levels throughout the day.
o Option C: Adequate caloric intake is
recommended. Refined carbohydrates quickly
break down into sugar after you ingest them,
which causes a spike in blood sugar followed by a
steep decline. The diet discourages foods that are
inflammatory or hard to digest and may
contribute to gut health issues. The adrenal
fatigue diet is more about eating more foods that
make the client feel good and nourish the body
• 3. Question
A patient with a history of diabetes mellitus is in the second
postoperative day following cholecystectomy. She has
complained of nausea and isn’t able to eat solid foods. The nurse
enters the room to find the patient confused and shaky. Which of
the following is the most likely explanation for the patient’s
symptoms?
o A. Anesthesia reaction
o B. Hyperglycemia
o C. Hypoglycemia
o D. Diabetic ketoacidosis
Correct Answer: C. Hypoglycemia
A postoperative diabetic patient who is unable to eat is likely to
be suffering from hypoglycemia. The actual treatment
recommendations for a given patient should be individualized,
based on diabetes classification, usual diabetes regimen, state
, NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS
WITH ANSWERS PLUS EXPLANATIONS A+ RATED
glycemic control, nature and extent of surgical procedure, and
available expertise.
o Option A: An anesthesia reaction would not occur on
the second postoperative day. Anesthesia and surgery
cause a stereotypical metabolic stress response that
could overwhelm homeostatic mechanisms in patients
with pre-existing abnormalities of glucose metabolism.
The invariant features of the metabolic stress
response include release of the catabolic hormones
epinephrine, norepinephrine, cortisol, glucagons, and
growth hormone and inhibition of insulin secretion and
action.
o Option B: Confusion is a late sign of hyperglycemia.
Shakiness is not one of its symptoms. The
management approach in these categories of patients
always includes insulin therapy in combination with
dextrose and potassium infusion. Major surgery is
defined as one requiring general anesthesia of ?1 h. At
a minimum, blood glucose should be monitored before
and immediately after surgery in all patients. Those
undergoing extensive procedures should have hourly
glucose monitoring during and immediately following
surgery.
o Option D: Symptoms of DKA include excessive thirst,
frequent urination, abdominal pain, fruity-scented
breath, confusion, and shortness of breath. However,
shakiness is not a sign of DKA. The stress of surgery
itself results in metabolic perturbations that alter
glucose homeostasis, and persistent hyperglycemia is
a risk factor for endothelial dysfunction, postoperative
sepsis, impaired wound healing, and cerebral
ischemia. The stress response itself may precipitate
diabetic crises (diabetic ketoacidosis [DKA].
• 4. Question
A nurse assigned to the emergency department evaluates a
patient who underwent fiberoptic colonoscopy 18 hours
previously. The patient reports increasing abdominal pain, fever,
and chills. Which of the following conditions poses
the most immediate concern?
WITH ANSWERS PLUS EXPLANATIONS A+ RATED
1. 1. Question
A patient is admitted to the hospital with a diagnosis of primary
hyperparathyroidism. A nurse checking the patient’s lab results
would expect which of the following changes in laboratory
findings?
o A. Elevated serum calcium
o B. Low serum parathyroid hormone (PTH)
o C. Elevated serum vitamin D
o D. Low urine calcium
Correct Answer: A. Elevated serum calcium
The parathyroid glands regulate the calcium level in the blood. In
hyperparathyroidism, the serum calcium level will be elevated. A normal
PTH in the presence of hypercalcemia is considered inappropriate and
still consistent with PTH-dependent hypercalcemia. PTH levels should be
very low in those patients with PTH-independent hypercalcemia. A
comprehensive clinical evaluation complemented by routine laboratory
and radiologic studies should be sufficient to establish a diagnosis of
primary hyperparathyroidism in a patient with persistent hypercalcemia
and an elevated serum level of parathyroid hormone.
o Option B: Parathyroid hormone levels may be high or
normal but not low. Patients with primary hyperparathyroidism
and other causes of PTH- dependent hypercalcemia often have
frankly elevated levels of PTH, while some will have values that
fall within the reference range for the general population. It is
uncommon for clinically occult malignancies to cause
hypercalcemia. Most patients with malignancy-
,NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS
WITH ANSWERS PLUS EXPLANATIONS A+ RATED
associated hypercalcemia are known to have cancer,
or cancer is readily detectable on initial evaluation,
and PTH levels will be suppressed.
o Option C: Parathyroid hormone levels may be high
or normal but not low. The body will lower the level
of vitamin D in an attempt to lower calcium.
o Option D: Urine calcium may be elevated, with
calcium spilling over from elevated serum levels. This
may cause renal stones. A review of previous
medical records can often be of significant value in
establishing the cause of hypercalcemia. Most
patients with hyperparathyroidism have persistent
or intermittent hypercalcemia for many years before
a definitive diagnosis is established.
• 2. Question
A patient with Addison’s disease asks a nurse for nutrition and
diet advice. Which of the following diet modifications is not
recommended?
o A. A diet high in grains.
o B. A diet with adequate caloric intake.
o C. A high protein diet.
o D. A restricted sodium diet.
Correct Answer: D. A restricted sodium diet.
A patient with Addison’s disease requires normal dietary sodium to prevent excess
o Option A: Addison’s disease is a rare condition. It develops when the ad
,NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS
WITH ANSWERS PLUS EXPLANATIONS A+ RATED
client should include complex carbohydrates in his
diet, including grains.
o Option B: A high protein diet is recommended for
the client with Addison’s disease. The adrenal
fatigue diet aims to stabilize blood sugar and balance
cortisol levels by limiting sugar while increasing the
intake of protein, healthy fats, veggies, and whole
grains. Healthy fats and high-quality proteins slow
the blood sugar rollercoaster and promote stable
blood sugar levels throughout the day.
o Option C: Adequate caloric intake is
recommended. Refined carbohydrates quickly
break down into sugar after you ingest them,
which causes a spike in blood sugar followed by a
steep decline. The diet discourages foods that are
inflammatory or hard to digest and may
contribute to gut health issues. The adrenal
fatigue diet is more about eating more foods that
make the client feel good and nourish the body
• 3. Question
A patient with a history of diabetes mellitus is in the second
postoperative day following cholecystectomy. She has
complained of nausea and isn’t able to eat solid foods. The nurse
enters the room to find the patient confused and shaky. Which of
the following is the most likely explanation for the patient’s
symptoms?
o A. Anesthesia reaction
o B. Hyperglycemia
o C. Hypoglycemia
o D. Diabetic ketoacidosis
Correct Answer: C. Hypoglycemia
A postoperative diabetic patient who is unable to eat is likely to
be suffering from hypoglycemia. The actual treatment
recommendations for a given patient should be individualized,
based on diabetes classification, usual diabetes regimen, state
, NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS
WITH ANSWERS PLUS EXPLANATIONS A+ RATED
glycemic control, nature and extent of surgical procedure, and
available expertise.
o Option A: An anesthesia reaction would not occur on
the second postoperative day. Anesthesia and surgery
cause a stereotypical metabolic stress response that
could overwhelm homeostatic mechanisms in patients
with pre-existing abnormalities of glucose metabolism.
The invariant features of the metabolic stress
response include release of the catabolic hormones
epinephrine, norepinephrine, cortisol, glucagons, and
growth hormone and inhibition of insulin secretion and
action.
o Option B: Confusion is a late sign of hyperglycemia.
Shakiness is not one of its symptoms. The
management approach in these categories of patients
always includes insulin therapy in combination with
dextrose and potassium infusion. Major surgery is
defined as one requiring general anesthesia of ?1 h. At
a minimum, blood glucose should be monitored before
and immediately after surgery in all patients. Those
undergoing extensive procedures should have hourly
glucose monitoring during and immediately following
surgery.
o Option D: Symptoms of DKA include excessive thirst,
frequent urination, abdominal pain, fruity-scented
breath, confusion, and shortness of breath. However,
shakiness is not a sign of DKA. The stress of surgery
itself results in metabolic perturbations that alter
glucose homeostasis, and persistent hyperglycemia is
a risk factor for endothelial dysfunction, postoperative
sepsis, impaired wound healing, and cerebral
ischemia. The stress response itself may precipitate
diabetic crises (diabetic ketoacidosis [DKA].
• 4. Question
A nurse assigned to the emergency department evaluates a
patient who underwent fiberoptic colonoscopy 18 hours
previously. The patient reports increasing abdominal pain, fever,
and chills. Which of the following conditions poses
the most immediate concern?
