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NCLEX-RN Practice Quiz Test Bank #11 -100% CORRECT ANSWERS
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NCLEX-RN Practice Quiz Test Bank #11 (75Questions)
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
Incorrect
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.
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-associated
hypercalcemia are known to have cancer, or cancer is readily
detectable on initial evaluation, and PTH levels will be
suppressed.
, 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.
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. 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?
A. A diet high in grains.
B. A diet with adequate caloric intake.
C. A high protein diet.
D. A restricted sodium diet.
Incorrect
Correct Answer: D. A restricted sodium diet.
A patient with Addison’s disease requires normal dietary sodium to
prevent excess fluid loss. Do not reduce salt in the diet. The client may
need to add extra salt to his food during hot and humid weather or
after exercise to replace salt lost through sweating. Do not use salt
substitutes.
Option A: Addison’s disease is a rare condition. It develops when
the adrenal glands, which are located above the kidneys, do not
make enough of certain hormones. These hormones are
important for normal body function. They help the body cope with
stress, hold salt and water, and maintain blood pressure. The
client should include complex carbohydrates in his diet, including
grains.
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.
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 versus restricting.
3. 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?
A. Anesthesia reaction
B. Hyperglycemia
C. Hypoglycemia
D. Diabetic ketoacidosis
Incorrect
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 of glycemic control, nature
and extent of surgical procedure, and available expertise.
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.
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.
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. 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?
A. Bowel perforation
B. Viral gastroenteritis
C. Colon cancer
D. Diverticulitis
Incorrect
Correct Answer: A. Bowel perforation
Bowel perforation is the most serious complication of fiberoptic
colonoscopy. Important signs include progressive abdominal pain,
fever, chills, and tachycardia, which indicate advancing peritonitis.
Bowel perforation results from insult or injury to the mucosa of the
bowel wall resulting from a violation of the closed system. This exposes
the structures within the peritoneal cavity to gastrointestinal contents.
Patients presenting with abdominal pain and distension, especially in
the appropriate historical setting, must be evaluated for this entity as
delayed diagnosis can be life-threatening due to the risk of developing
infections such as peritonitis.
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