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NCLEX-RN Exam Pack Set 11
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(75 Questions & Answers
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Updated 2022)
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1. 1. Question
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A patient is admitted to the hospital with a diagnosis of primary
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hyperparathyroidism. A nurse checking the patient’s lab results
la
would expect which of the following changes in laboratory
tz
findings?
sh
Sp
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o A. Elevated serum calcium
la
sh
o B. Low serum parathyroid hormone (PTH)
Sp
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o C. Elevated serum vitamin D
la
tz
o D. Low urine calcium
sh
Sp
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Correct Answer: A. Elevated serum calcium
la
The parathyroid glands regulate the calcium level in the blood. In
hyperparathyroidism, the serum calcium level will be elevated. A
sh
Sp
normal PTH in the presence of hypercalcemia is considered
ne
inappropriate and still consistent with PTH-dependent
la
hypercalcemia. PTH levels should be very low in those patients
tz
with PTH-independent hypercalcemia. A comprehensive clinical
sh
Sp
evaluation complemented by routine laboratory and radiologic
ne
studies should be sufficient to establish a diagnosis of primary
hyperparathyroidism in a patient with persistent hypercalcemia
la
and an elevated serum level of parathyroid hormone.
sh
o Option B: Parathyroid hormone levels may be high or
Sp
normal but not low. Patients with primary
ne
hyperparathyroidism and other causes of PTH-
a
dependent hypercalcemia often have frankly elevated
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levels of PTH, while some will have values that fall
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Sp
within the reference range for the general population.
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It is uncommon for clinically occult malignancies to
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cause hypercalcemia. Most patients with malignancy-
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Sp
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Sp
, ne
sh
associated hypercalcemia are known to have cancer,
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or cancer is readily detectable on initial evaluation,
la
and PTH levels will be suppressed.
tz
o Option C: Parathyroid hormone levels may be high or
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Sp
normal but not low. The body will lower the level of
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vitamin D in an attempt to lower calcium.
o Option D: Urine calcium may be elevated, with
la
calcium spilling over from elevated serum levels. This
sh
may cause renal stones. A review of previous medical
Sp
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records can often be of significant value in
establishing the cause of hypercalcemia. Most patients
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with hyperparathyroidism have persistent or
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sh
intermittent hypercalcemia for many years before a
Sp
definitive diagnosis is established.
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2. Question
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A patient with Addison’s disease asks a nurse for nutrition and
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Sp
diet advice. Which of the following diet modifications is not
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recommended?
la
tz
sh
o A. A diet high in grains.
Sp
ne
o B. A diet with adequate caloric intake.
la
sh
o C. A high protein diet.
Sp
ne
o D. A restricted sodium diet.
la
tz
Correct Answer: D. A restricted sodium diet.
sh
Sp
A patient with Addison’s disease requires normal dietary sodium
ne
to prevent excess fluid loss. Do not reduce salt in the diet. The
la
client may need to add extra salt to his food during hot and
humid weather or after exercise to replace salt lost through
sh
Sp
sweating. Do not use salt substitutes.
ne
o Option A: Addison’s disease is a rare condition. It
a
develops when the adrenal glands, which are located
tz
above the kidneys, do not make enough of certain
l
sh
Sp
hormones. These hormones are important for normal
ne
body function. They help the body cope with stress,
hold salt and water, and maintain blood pressure. The
la
sh
Sp
la
Sp
, ne
sh
client should include complex carbohydrates in his
ne
diet, including grains.
la
o Option B: A high protein diet is recommended for the
tz
client with Addison’s disease. The adrenal fatigue diet
sh
Sp
aims to stabilize blood sugar and balance cortisol
ne
levels by limiting sugar while increasing the intake of
protein, healthy fats, veggies, and whole grains.
la
Healthy fats and high-quality proteins slow the blood
sh
sugar rollercoaster and promote stable blood sugar
Sp
levels throughout the day.
ne
o Option C: Adequate caloric intake is recommended.
la
Refined carbohydrates quickly break down into sugar
tz
sh
after you ingest them, which causes a spike in blood
Sp
sugar followed by a steep decline. The diet
ne
discourages foods that are inflammatory or hard to
la
digest and may contribute to gut health issues. The
adrenal fatigue diet is more about eating more foods
sh
Sp
that make the client feel good and nourish the body
ne
versus restricting.
la
3. Question
tz
sh
A patient with a history of diabetes mellitus is in the second
Sp
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postoperative day following cholecystectomy. She has
complained of nausea and isn’t able to eat solid foods. The nurse
la
enters the room to find the patient confused and shaky. Which of
sh
the following is the most likely explanation for the patient’s
Sp
symptoms?
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la
tz
o A. Anesthesia reaction sh
Sp
ne
o B. Hyperglycemia
la
o C. Hypoglycemia
sh
Sp
ne
o D. Diabetic ketoacidosis
a
tz
Correct Answer: C. Hypoglycemia
l
sh
A postoperative diabetic patient who is unable to eat is likely to
Sp
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be suffering from hypoglycemia. The actual treatment
recommendations for a given patient should be individualized,
la
based on diabetes classification, usual diabetes regimen, state of
sh
Sp
la
Sp
, ne
sh
glycemic control, nature and extent of surgical procedure, and
ne
available expertise.
la
o Option A: An anesthesia reaction would not occur on
tz
the second postoperative day. Anesthesia and surgery
sh
Sp
cause a stereotypical metabolic stress response that
necould overwhelm homeostatic mechanisms in patients
with pre-existing abnormalities of glucose metabolism.
la
The invariant features of the metabolic stress
sh
response include release of the catabolic hormones
Sp
epinephrine, norepinephrine, cortisol, glucagons, and
ne
growth hormone and inhibition of insulin secretion and
la
action.
tz
o Option B: Confusion is a late sign of hyperglycemia.
sh
Sp
Shakiness is not one of its symptoms. The
ne
management approach in these categories of patients
la
always includes insulin therapy in combination with
dextrose and potassium infusion. Major surgery is
sh
Sp
defined as one requiring general anesthesia of ?1 h. At
ne
a minimum, blood glucose should be monitored before
and immediately after surgery in all patients. Those
la
tz
undergoing extensive procedures should have hourly
sh
glucose monitoring during and immediately following
Sp
surgery.
ne
o Option D: Symptoms of DKA include excessive thirst,
la
frequent urination, abdominal pain, fruity-scented
sh
breath, confusion, and shortness of breath. However,
Sp
shakiness is not a sign of DKA. The stress of surgery
ne
itself results in metabolic perturbations that alter
la
glucose homeostasis, and persistent hyperglycemia is
tz
a risk factor for endothelial dysfunction, postoperative
sh
Sp
sepsis, impaired wound healing, and cerebral
ne
ischemia. The stress response itself may precipitate
diabetic crises (diabetic ketoacidosis [DKA].
la
4. Question
sh
Sp
ne
A nurse assigned to the emergency department evaluates a
patient who underwent fiberoptic colonoscopy 18 hours
a
previously. The patient reports increasing abdominal pain, fever,
tz
l
sh
and chills. Which of the following conditions poses
Sp
the most immediate concern?
ne
la
sh
Sp
la
Sp
sh
NCLEX-RN Exam Pack Set 11
ne
(75 Questions & Answers
la
tz
sh
Sp
Updated 2022)
ne
la
1. 1. Question
sh
Sp
A patient is admitted to the hospital with a diagnosis of primary
ne
hyperparathyroidism. A nurse checking the patient’s lab results
la
would expect which of the following changes in laboratory
tz
findings?
sh
Sp
ne
o A. Elevated serum calcium
la
sh
o B. Low serum parathyroid hormone (PTH)
Sp
ne
o C. Elevated serum vitamin D
la
tz
o D. Low urine calcium
sh
Sp
ne
Correct Answer: A. Elevated serum calcium
la
The parathyroid glands regulate the calcium level in the blood. In
hyperparathyroidism, the serum calcium level will be elevated. A
sh
Sp
normal PTH in the presence of hypercalcemia is considered
ne
inappropriate and still consistent with PTH-dependent
la
hypercalcemia. PTH levels should be very low in those patients
tz
with PTH-independent hypercalcemia. A comprehensive clinical
sh
Sp
evaluation complemented by routine laboratory and radiologic
ne
studies should be sufficient to establish a diagnosis of primary
hyperparathyroidism in a patient with persistent hypercalcemia
la
and an elevated serum level of parathyroid hormone.
sh
o Option B: Parathyroid hormone levels may be high or
Sp
normal but not low. Patients with primary
ne
hyperparathyroidism and other causes of PTH-
a
dependent hypercalcemia often have frankly elevated
tz
l
levels of PTH, while some will have values that fall
sh
Sp
within the reference range for the general population.
ne
It is uncommon for clinically occult malignancies to
la
cause hypercalcemia. Most patients with malignancy-
sh
Sp
la
Sp
, ne
sh
associated hypercalcemia are known to have cancer,
ne
or cancer is readily detectable on initial evaluation,
la
and PTH levels will be suppressed.
tz
o Option C: Parathyroid hormone levels may be high or
sh
Sp
normal but not low. The body will lower the level of
ne
vitamin D in an attempt to lower calcium.
o Option D: Urine calcium may be elevated, with
la
calcium spilling over from elevated serum levels. This
sh
may cause renal stones. A review of previous medical
Sp
ne
records can often be of significant value in
establishing the cause of hypercalcemia. Most patients
la
with hyperparathyroidism have persistent or
tz
sh
intermittent hypercalcemia for many years before a
Sp
definitive diagnosis is established.
ne
2. Question
la
A patient with Addison’s disease asks a nurse for nutrition and
sh
Sp
diet advice. Which of the following diet modifications is not
ne
recommended?
la
tz
sh
o A. A diet high in grains.
Sp
ne
o B. A diet with adequate caloric intake.
la
sh
o C. A high protein diet.
Sp
ne
o D. A restricted sodium diet.
la
tz
Correct Answer: D. A restricted sodium diet.
sh
Sp
A patient with Addison’s disease requires normal dietary sodium
ne
to prevent excess fluid loss. Do not reduce salt in the diet. The
la
client may need to add extra salt to his food during hot and
humid weather or after exercise to replace salt lost through
sh
Sp
sweating. Do not use salt substitutes.
ne
o Option A: Addison’s disease is a rare condition. It
a
develops when the adrenal glands, which are located
tz
above the kidneys, do not make enough of certain
l
sh
Sp
hormones. These hormones are important for normal
ne
body function. They help the body cope with stress,
hold salt and water, and maintain blood pressure. The
la
sh
Sp
la
Sp
, ne
sh
client should include complex carbohydrates in his
ne
diet, including grains.
la
o Option B: A high protein diet is recommended for the
tz
client with Addison’s disease. The adrenal fatigue diet
sh
Sp
aims to stabilize blood sugar and balance cortisol
ne
levels by limiting sugar while increasing the intake of
protein, healthy fats, veggies, and whole grains.
la
Healthy fats and high-quality proteins slow the blood
sh
sugar rollercoaster and promote stable blood sugar
Sp
levels throughout the day.
ne
o Option C: Adequate caloric intake is recommended.
la
Refined carbohydrates quickly break down into sugar
tz
sh
after you ingest them, which causes a spike in blood
Sp
sugar followed by a steep decline. The diet
ne
discourages foods that are inflammatory or hard to
la
digest and may contribute to gut health issues. The
adrenal fatigue diet is more about eating more foods
sh
Sp
that make the client feel good and nourish the body
ne
versus restricting.
la
3. Question
tz
sh
A patient with a history of diabetes mellitus is in the second
Sp
ne
postoperative day following cholecystectomy. She has
complained of nausea and isn’t able to eat solid foods. The nurse
la
enters the room to find the patient confused and shaky. Which of
sh
the following is the most likely explanation for the patient’s
Sp
symptoms?
ne
la
tz
o A. Anesthesia reaction sh
Sp
ne
o B. Hyperglycemia
la
o C. Hypoglycemia
sh
Sp
ne
o D. Diabetic ketoacidosis
a
tz
Correct Answer: C. Hypoglycemia
l
sh
A postoperative diabetic patient who is unable to eat is likely to
Sp
ne
be suffering from hypoglycemia. The actual treatment
recommendations for a given patient should be individualized,
la
based on diabetes classification, usual diabetes regimen, state of
sh
Sp
la
Sp
, ne
sh
glycemic control, nature and extent of surgical procedure, and
ne
available expertise.
la
o Option A: An anesthesia reaction would not occur on
tz
the second postoperative day. Anesthesia and surgery
sh
Sp
cause a stereotypical metabolic stress response that
necould overwhelm homeostatic mechanisms in patients
with pre-existing abnormalities of glucose metabolism.
la
The invariant features of the metabolic stress
sh
response include release of the catabolic hormones
Sp
epinephrine, norepinephrine, cortisol, glucagons, and
ne
growth hormone and inhibition of insulin secretion and
la
action.
tz
o Option B: Confusion is a late sign of hyperglycemia.
sh
Sp
Shakiness is not one of its symptoms. The
ne
management approach in these categories of patients
la
always includes insulin therapy in combination with
dextrose and potassium infusion. Major surgery is
sh
Sp
defined as one requiring general anesthesia of ?1 h. At
ne
a minimum, blood glucose should be monitored before
and immediately after surgery in all patients. Those
la
tz
undergoing extensive procedures should have hourly
sh
glucose monitoring during and immediately following
Sp
surgery.
ne
o Option D: Symptoms of DKA include excessive thirst,
la
frequent urination, abdominal pain, fruity-scented
sh
breath, confusion, and shortness of breath. However,
Sp
shakiness is not a sign of DKA. The stress of surgery
ne
itself results in metabolic perturbations that alter
la
glucose homeostasis, and persistent hyperglycemia is
tz
a risk factor for endothelial dysfunction, postoperative
sh
Sp
sepsis, impaired wound healing, and cerebral
ne
ischemia. The stress response itself may precipitate
diabetic crises (diabetic ketoacidosis [DKA].
la
4. Question
sh
Sp
ne
A nurse assigned to the emergency department evaluates a
patient who underwent fiberoptic colonoscopy 18 hours
a
previously. The patient reports increasing abdominal pain, fever,
tz
l
sh
and chills. Which of the following conditions poses
Sp
the most immediate concern?
ne
la
sh
Sp
la
Sp
