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2025 - 2026 NURS 618 ADVANCED
PATHOPHYSIOLOGY EXAM 3|50 QUESTIONS AND
ANSWERS|ALREADY GRADED A+
The nurse administers levothyroxine to a client with hypothyroidism. Which data indicate(s) that the drug is effective?
- Increase in T3 and T
- Decrease in heart rate
- Increase in TSH
- Decrease in urine output
- Decrease in periorbital edema a. 1,2,3,4, b. 1,2, c. 2,3, d. 1,2,3, e. 1, e. 1, A client with hyperparathyroidism presented to the hospital with flank pain. Which should be included in the client's plan of care? a. Strain all urine to see if kidney stones will pass in the urine b. Assess vital signs and call the respiratory therapist to draw blood for arterial blood gases c. Check blood for T3, T4, and TSH d. Draw blood to check for serum sodium and potassium a. Strain all urine to see if kidney stones will pass in the urine The nurse prepares to administer 3 units of insulin subcutaneously to a client with a blood glucose level of 250 mg/dL. Which procedure is correct? a. Using one syringe, add the regular insulin into the syringe and then add the NPH insulin.
b. Using one syringe, first insert air into the regular vial and then insert air into the NPH vial c. Avoid combining the two insulins because incompatibility could cause an adverse reaction d. Administer regular insulin subcutaneously and then give the NPH IV to prevent a separate stick a. Using one syringe, add the regular insulin into the syringe and then add the NPH insulin. An elderly client with long-term type 2 diabetes mellitus is seen in the clinic for a routine health assessment. To determine if the client is experiencing any long- term complications of diabetes, which assessments should the nurse obtain?
- Sensation in feet and legs
- Serum creatinine and blood urea nitrogen
- Visual acuity
- Signs of respiratory tract infection
- Skin condition of lower extremities a. 1,3, b. 1,2,3,4, c. 1,2,3, d. 2,4, e. 1,2,3, e. 1,2,3, A client who has a history of hypothyroidism was initially admitted with lethargy and confusion. Which additional findings warrants the most immediate action by the nurse? a. Hematocrit of 30% b. Facial puffiness c. Cold and dry skin d. Continued remarkable decline in level of consciousness d. Continued remarkable decline in level of consciousness
The nurse in the emergency department is caring for a client with type 1 diabetes mellitus in diabetic ketoacidosis (DKA). Which action should the nurse take first? a. Give a potassium supplement b. Check serum electrolyte levels c. Administer NPH insulin IV d. Administer sodium bicarbonate e. Start an IV infusion of normal saline e. Start an IV infusion of normal saline The nurse administers regular insulin (human), 8 units subcutaneously, to a client at 8.00 am, 30 minutes before his breakfast. At what time is the client most at risk for a hypoglycemic reaction? a. 9:00am b. 4:00pm c. 10:30am d. 1:00pm e. 11:00pm c. 10:30am When is the most important time to check blood glucose level? a. at HS (hours sleep=bedtime) b. after food c. during acute illness d. before exercise c. during acute illness The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? a. To treat tetany
b. To treat thyroid storm c. To stimulate release of parathyroid hormone d. To prevent cardiac irritability a. To treat tetany The nurse is preparing to give Dextrose 50% in water (DS0W) 50 mL IV to a client with insulin shock who has an IV with 5% Dextrose in water (DSW) and total parenteral nutrition (TPN) being infused. Which of the following demonstrates that the nurse understands proper administration of D50W? a. Dilute dextrose 50% in one (1) liter NS and infuse it into the client using an IV pump b. Give D5W from the current IV infusion by pushing a bolus of 5mL 10 times using the push pause method to make 50mL of D50W c. Push undiluted dextrose 50% slowly through the current infusing IV d. Mix dextrose 50% in 50mL of IV normal saline to piggyback for a volume of 100mL and infuse it into the client as secondary IV using an IV pump e. Ask the pharmacy to add Dextrose 50% to the TPN and infuse it into the client using an IV pump c. Push undiluted dextrose 50% slowly through the current infusing IV The nurse is preparing for a client's postoperative return to the unit after a parathyroidectomy procedure. The nurse should ensure that which piece of medical equipment is most important to be kept at the client's bedside? a. intermittent gastric suction device b. cardiac monitor c. tracheotomy set d. underwater seal chest drainage system c. tracheotomy set
- Palpitations
- Kussmaul respirations
- Lightheadedness
- Fruity breath odor a. 1,2, b. 2,3,4, c. 1,2,3, d. 3,4,5, e. 2,3, e. 2,3, The nurse teaches a class on foot care for clients diagnosed with diabetes mellitus. Which instructions should the nurse include in the class?
- "Wear closed-toe shoes.
- "Soak your feet in hot water twice a day."
- *Massage using lanolin lotion between your toes and remove corns and calluses after soaking your feet with warm water for one hour daily."
- "Cut toenails straight across and file the edges"
- "Pat feet dry gently. especially between the toes" a. 1,4, b. 1,2,3, c. 2,3, d. 2,3,4, e. 1,2,3,4, a. 1,4, The nurse is administering Ranitidine to a client diagnosed with peptic ulcer disease. Which statement supports the rationale for administering this medication?
a. It prevents the final transport of hydrogen ions into the gastric lumen b. It protects the ulcer from the destructive action of the digestive enzyme pepsin c. It blocks histamine 2 receptors controlling hydrochloric acid secretion by the parietal cells. d. It neutralizes the hydrochloric acid secreted by the stomach c. It blocks histamine 2 receptors controlling hydrochloric acid secretion by the parietal cells. A client returns to the nursing unit after undergoing an esophagogastroduodenoscopy (EGD). Which is the appropriate nursing intervention? a. Tell the client to report a sore throat immediately because it is a serious complication b. Withhold oral fluids until the client's sag reflex has returned c. Allow the client to have bathroom privileges d. Keep the client lying flat in bed in the supine position b. Withhold oral fluids until the client's sag reflex has returned A nurse is teaching clients with gastroesophageal reflux disease (GERD). Which should the nurse include in the teaching?
- Minimize avoid wearing tight clothing to decrease pressure/compression on the stomach
- Take fluids with rather than between meals
- Avoid milk products at night
- Take small frequent meals and snacks
- Avoid late-night snacking or meals
- Avoid chocolate, peppermint, coffee, tomato juice, orange juice a. 3,4,5,
A client is receiving an infusion of total parenteral nutrition (TPN) through a central line at 75ml/hr. The nurse responds to the client's IV pump alarm, which indicates that the bag is empty. The new TPN bag is not expected to arrive from the pharmacy for an hour. What is the most appropriate nursing action? a. Hang 0.9% normal saline until the new TPN bag arrives, then increase TPN to 150 ml/hr for 1 hour b. Hang 10% dextrose in water until new TPN bag arrives, then resume TPN at 75 ml/hr c. Hang lactated ringers until the new TPN bag arrives then resume TPN at 75ml/hr d. Hang Dextran in normal saline until the new TPN bag arrives, then resume TPN at 150 ml/hr b. Hang 10% dextrose in water until new TPN bag arrives, then resume TPN at 75 ml/hr The nurse is providing discharge teaching to a client newly diagnosed with ulcerative colitis. Which of the following statements by the client indicate that teaching has been effective?
- I need to avoid eating anything during exacerbation to rest my bowel
- I should ask my provider to prescribe a high dose of an antidiarrheal medication to treat my disease, manage the inflammation, and induce remission
- I should increase the consumption of fresh fruits and vegetables as they are very high in fiber, and avoid roast Turkey and canned veggies
- should take my Sulfasalazine "Asulfidine" after meals and take it with a full glass of water, and increase my fluid intake throughout the day.
- I should avoid consuming alcoholic beverages, caffeine, and tobacco because these are gastric irritants that stimulate the intestine.
a. 1,2, b. 1,2,3,4, c. 1,4, d. 2,3,4, e. 1,2,3, c. 1,4, The nurse will implement which nursing actions when caring for an overweight client recently diagnosed with a hiatal hernia?
- Elevate the head of the hospital bed to approximately 30 degrees
- Instruct the client to avoid tobacco and caffeine
- Offer small frequent low-fat meals and encourage the client to lose weight
- Encourage the client to wear tight clothes and provide a girdle to reduce the hernia
- Teach the client to avoid lifting or straining a. 1,2, b. 1,2,3,4, c. 2,3,4, d. 1,2,3, e. 1,4, d. 1,2,3, The nurse is assessing a client who had an esophagogastroduodenoscopy (EGD) 2 hours ago. Which finding requires an immediate report to the health care provider? a. Temperature spike to 101.2F (38.4 C), an increase from 97.8 right after the EGD b. Sore throat when swallowing c. Blood pressure drop from 122/88mmHg to 106/72mmHg d. Gag reflex has not returned
A client calls the primary care clinic reporting diarrhea for 4 days and a low-grade fever and bloody stool. What instruction is most important for the nurse to give to the client? a. Instruct the client to take 2 tablets of Loperamide (Imodium) followed by 1 tablet after each loose stool b. Encourage the client to eat bulk forming foods such as whole grain bread c. Make an appointment for the client with the health care provider today d. Encourage rest, fluids, and acetaminophen for the fever c. Make an appointment for the client with the health care provider today The nurse assessing a client's pain would expect the client to make which statement when describing the abdominal pain associated with appendicitis? a. My pain is acute and excruciating in my right lower abdomen above my night hip b. My pain is an 8 out of 10 on my left side below my belly button and is radiating to left shoulder c. My pain is a burning sensation in my upper abdomen and is aggravated by fatty food d. My pain is intermittent in my abdomen and right shoulder a. My pain is acute and excruciating in my right lower abdomen above my night hip A student nurse asks why enteral (tube) feeding. rather than total parenteral nutrition (TPN), are being administered to a client with sepsis and respiratory failure. Which is the best response by the registered nurse? a. Enteral feeding have no complications, but TPN do have many complications
b. Enteral feedings provide higher calorie content, yet metabolic needs cannot usually be met adequately using TPN c. Enteral feeding maintain gut integrity and help prevent stress ulcers. d. Risk of hyperglycemia is lower with enteral feeding than with TPN c. Enteral feeding maintain gut integrity and help prevent stress ulcers. Which instructions should the nurse include when providing discharge teaching to a client with peptic ulcer disease due to Helicobacter pylori infection?
- Avoid foods that may cause epigastric distress such as spicy or acidic foods.
- It is best if you refrain from consuming alcohol products
- Report black tarry stools to your health care provider immediately
- Take your amoxicillin, clarithromycin, and omeprazole for the next 14 days
- You may take over the counter drugs such as aspirin if you have mild epigastric pain a. 1,2,3, b. 2,4, c. 1,2,3,4, d. 2,3,4, e. 1,3, a. 1,2,3, A client with a history of diverticular disease is being discharged home after being treated for an episode of acute diverticulitis. Which instructions should be included in the discharge teaching plan to reduce the risk of future episodes of acute exacerbation of diverticulosis?
- Drink plenty of fluids
- Exercise regularly
- Follow a low residue diet
- Include whole grains, fruits, and vegetables in the diet
- Increase intake of red meat and take opioids when complaining of abdominal pain
Healthcare workers must protect themselves against becoming infected with HIV. The Center for Disease Control has issued guidelines for healthcare workers in relation to protection from HIV. These guidelines include which recommendation? a. Freeze HIV blood specimens at - 70 F to kill the virus b. Place HIV positive clients in reverse isolation and limit visitors c. Conduct mandatory HIV testing of those who work with AIDS clients d. Follow standard precautions and wear gloves when coming in contact with the blood or body fluids of any client e. Place HIV positive clients in contact precautions d. Follow standard precautions and wear gloves when coming in contact with the blood or body fluids of any client A major disaster has been called, and the charge nurse on a medical unit must recommend to the medical discharge officer on rounds which clients to discharge. Which client should not be discharged? a. The client diagnosed with chronic angina pectoris who has been on new medication for 2 days b. The client diagnosed with COPD who has the following arterial blood gas (ABG) levels: pH, 7.34; PCO2, 55; HCO3, 28; Pa02, 89. c. The client with an infected leg wound who is receiving vancomycin VPB every 24 hours for methicillin-resistant Staphylococcus aureus (MRSA) infection d. The client diagnosed with deep vein thrombosis (DVT) who has had heparin discontinued and has been on warfarin (Coumadin) for 4 days c. The client with an infected leg wound who is receiving vancomycin VPB every 24 hours for methicillin-resistant Staphylococcus aureus (MRSA) infection A nurse is collecting data from a client who has been diagnosed with an allergy to latex. In determining the client's risk factors associated with the allergy, the nurse questions the client about an allergy to which food item?
a. Eggs b. Bananas c. Milk d. Yogurt b. Bananas Which statement indicates the female client with systemic lupus erythematosus (SLE) understands the discharge instructions? a. "I should not get pregnant because I have SLE" b. "I am going to enjoy all Christmas activities in the public park." c. I must avoid using hypoallergenic products, that produce fewer allergic reactions than other cosmetic products" d. "I should wear sunscreen with at least a 15 SPF" d. "I should wear sunscreen with at least a 15 SPF" The nurse provides home care instructions to a client with systemic lupus erythematosus and tells the client about methods to manage fatigue. Which statement by the client indicates a need for further instruction? a. "I should sit whenever possible to conserve my energy" b. "I should do some exercises, such as walking, when I am not fatigued" c. "I should avoid long periods of rest because it causes joint stiffness" d. "I should take hot baths because they are relaxing" d. "I should take hot baths because they are relaxing" The nurse is assisting in planning care for a client with a diagnosis of immunodeficiency and should incorporate which action as a priority in the plan? a. Encouraging discussion about lifestyle changes
c. Swelling in the genital area d. Swelling in the lower extremities b. Positive punch biopsy of the cutaneous lesions A client with acquired immunodeficiency syndrome (AIDS) is receiving ganciclovir. The nurse should take which priority action in caring for this client? a. Ensure that the client uses an electric razor for shaving. b. Administer the medication with an antacid. c. Monitor for signs of hyperglycemia. d. Administer the medication without food. a. Ensure that the client uses an electric razor for shaving. A client who has been receiving pentamidine intravenously now has a fever with a temperature of 102°F (38.9°C). Keeping in mind that the client has a diagnosis of acquired immunodeficiency syndrome (AIDS) and Pneumocystis jiroveci pneumonia, the nurse should interpret that this fever is most associated with which condition? a. Toxic nervous system effects from the medication b. Inadequate thermoregulation c. Insufficient medication dosing d. Infection caused by leukopenic effects of the medication d. Infection caused by leukopenic effects of the medication A client is diagnosed with stage I Lyme disease, and the nurse assesses the client for disease manifestations. Which should the nurse expect to note as the hallmark characteristic of this stage?
a. Neurological deficits b. Bull's eye appearance skin rash c. Enlarged and inflamed joints d. Arthralgias b. Bull's eye appearance skin rash The nursing instructor is reviewing the plan of care with a nursing student who is caring for a client with an altered immune system and the role of interferons is discussed. Which statement by the nursing student indicates a need for further teaching? a. "They are produced by several types of cells." b. "They have been effective to some degree in the treatment of melanoma." c. "They are effective against a wide variety of bacteria." d. "They are effective against a wide variety of viruses." c. "They are effective against a wide variety of bacteria." A client is suspected of having systemic lupus erythematosus (SLE). On reviewing the client's record, the nurse should expect to note documentation of which characteristic sign of SLE? a. Fever b. Elevated red blood cell count c. Fatigue d. Skin lesions as butterfly rash d. Skin lesions as butterfly rash A client is admitted to the hospital with a diagnosis of parasitic worms. After reviewing the client's complete blood cell (CBC) count, the nurse should expect an increased laboratory value for which cells?
