MED SURG III FINAL EXAM / NSG233 FINAL EXAM 2025/2026
COMPLETE VERIFIED QUESTIONS
ENDOCRINE DISORDERS (1-12)
1. A patient with hyperthyroidism is taking propylthiouracil (PTU). Which finding
indicates the medication is effective?
A) Increased heart rate
B) Weight loss
C) Increased body weight
D) Heat intolerance
Answer: C
Rationale: PTU reduces thyroid hormone production. Weight gain, decreased HR,
and improved heat tolerance indicate effectiveness.
2. A nurse is teaching a patient with newly diagnosed type 1 diabetes about
insulin administration. Which statement by the patient indicates
understanding?
A) "I will store my insulin in the freezer."
B) "I can draw up the NPH insulin first, then the regular insulin."
C) "I should rotate injection sites to prevent lipohypertrophy."
D) "I only need to check my blood sugar once a day."
Answer: C
Rationale: Site rotation prevents lipohypertrophy, which causes erratic insulin
absorption. Insulin should not be frozen; clear (regular) is drawn before cloudy
(NPH).
3. A patient with diabetic ketoacidosis (DKA) has a blood glucose of 480 mg/dL
and potassium of 5.5 mEq/L. Which action should the nurse take first?
A) Administer IV potassium
B) Start regular insulin IV drip
,C) Give sodium bicarbonate
D) Infuse normal saline 0.9%
Answer: D
Rationale: Fluid resuscitation with normal saline is the priority to correct
dehydration and improve tissue perfusion. Insulin can wait briefly; potassium of
5.5 is high, so potassium is not given yet.
4. A patient with hypothyroidism is admitted with confusion, hypothermia, and
bradycardia. What is the priority intervention?
A) Administer levothyroxine IV
B) Apply active external warming
C) Give oral glucose
D) Obtain thyroid function tests
Answer: A
Rationale: These are signs of myxedema coma. IV levothyroxine is life-saving.
Active warming can cause vasodilation and shock; rewarm passively.
5. A patient with Cushing's syndrome is being discharged. Which instruction is
most important?
A) Monitor for weight loss
B) Avoid infection and injury
C) Increase dietary potassium
D) Take medications at bedtime
Answer: B
Rationale: Cushing's causes immunosuppression and poor wound healing.
Patients are at high risk for infection and fractures.
6. A patient with Addison's disease reports nausea, weakness, and dizziness.
Blood pressure is 80/50. Which action should the nurse take first?
A) Administer oral hydrocortisone
B) Start IV normal saline
,C) Give IV potassium chloride
D) Draw a cortisol level
Answer: B
Rationale: Hypotension suggests an adrenal crisis. IV fluids restore volume first,
followed by IV hydrocortisone. Potassium is often high in Addison's, not low.
7. A nurse is administering IV insulin to a patient with hyperosmolar
hyperglycemic state (HHS). Which finding requires immediate intervention?
A) Serum glucose decreasing from 600 to 400 mg/dL
B) Serum potassium of 3.2 mEq/L
C) Urinary output of 40 mL/hr
D) Patient reports thirst
Answer: B
Rationale: Insulin drives potassium into cells, worsening hypokalemia (3.2 is low).
Cardiac arrhythmias can occur. Potassium should be repleted before or with
insulin.
8. A patient with type 2 diabetes is prescribed metformin. Which instruction is
most important?
A) Take the medication on an empty stomach
B) Report muscle pain or weakness
C) Expect weight gain as a side effect
D) Monitor for hyperglycemia after meals
Answer: B
Rationale: Muscle pain/weakness may indicate lactic acidosis, a rare but serious
metformin complication. Metformin is taken with meals to reduce GI upset.
9. A patient after thyroidectomy develops tingling around the mouth and
muscle twitching. What is the nurse's priority action?
A) Administer IV levothyroxine
B) Check the surgical site for bleeding
, C) Give IV calcium gluconate
D) Apply oxygen via nasal cannula
Answer: C
Rationale: Tingling and twitching suggest hypocalcemia from accidental
parathyroid removal/damage. IV calcium gluconate is the emergent treatment.
10. A patient with syndrome of inappropriate antidiuretic hormone (SIADH) has
a serum sodium of 120 mEq/L. Which intervention is most appropriate?
A) Restrict oral fluids to 800 mL/day
B) Administer 3% saline IV push
C) Encourage salty foods
D) Give furosemide 40 mg IV
Answer: A
Rationale: Fluid restriction is first-line for mild to moderate SIADH. Hypertonic
saline is reserved for severe symptoms (seizures, coma). Rapid correction risks
osmotic demyelination.
11. A patient with diabetes insipidus (DI) has a urine output of 600 mL/hr.
Which medication does the nurse anticipate?
A) Hydrochlorothiazide
B) Desmopressin (DDAVP)
C) Spironolactone
D) Metformin
Answer: B
Rationale: Desmopressin is synthetic ADH, replacing the missing hormone in
central DI. HCTZ is used for nephrogenic DI.
12. A patient taking levothyroxine reports palpitations, anxiety, and weight loss.
What is the nurse's best action?
A) Increase the levothyroxine dose
B) Hold the next dose and notify the provider
COMPLETE VERIFIED QUESTIONS
ENDOCRINE DISORDERS (1-12)
1. A patient with hyperthyroidism is taking propylthiouracil (PTU). Which finding
indicates the medication is effective?
A) Increased heart rate
B) Weight loss
C) Increased body weight
D) Heat intolerance
Answer: C
Rationale: PTU reduces thyroid hormone production. Weight gain, decreased HR,
and improved heat tolerance indicate effectiveness.
2. A nurse is teaching a patient with newly diagnosed type 1 diabetes about
insulin administration. Which statement by the patient indicates
understanding?
A) "I will store my insulin in the freezer."
B) "I can draw up the NPH insulin first, then the regular insulin."
C) "I should rotate injection sites to prevent lipohypertrophy."
D) "I only need to check my blood sugar once a day."
Answer: C
Rationale: Site rotation prevents lipohypertrophy, which causes erratic insulin
absorption. Insulin should not be frozen; clear (regular) is drawn before cloudy
(NPH).
3. A patient with diabetic ketoacidosis (DKA) has a blood glucose of 480 mg/dL
and potassium of 5.5 mEq/L. Which action should the nurse take first?
A) Administer IV potassium
B) Start regular insulin IV drip
,C) Give sodium bicarbonate
D) Infuse normal saline 0.9%
Answer: D
Rationale: Fluid resuscitation with normal saline is the priority to correct
dehydration and improve tissue perfusion. Insulin can wait briefly; potassium of
5.5 is high, so potassium is not given yet.
4. A patient with hypothyroidism is admitted with confusion, hypothermia, and
bradycardia. What is the priority intervention?
A) Administer levothyroxine IV
B) Apply active external warming
C) Give oral glucose
D) Obtain thyroid function tests
Answer: A
Rationale: These are signs of myxedema coma. IV levothyroxine is life-saving.
Active warming can cause vasodilation and shock; rewarm passively.
5. A patient with Cushing's syndrome is being discharged. Which instruction is
most important?
A) Monitor for weight loss
B) Avoid infection and injury
C) Increase dietary potassium
D) Take medications at bedtime
Answer: B
Rationale: Cushing's causes immunosuppression and poor wound healing.
Patients are at high risk for infection and fractures.
6. A patient with Addison's disease reports nausea, weakness, and dizziness.
Blood pressure is 80/50. Which action should the nurse take first?
A) Administer oral hydrocortisone
B) Start IV normal saline
,C) Give IV potassium chloride
D) Draw a cortisol level
Answer: B
Rationale: Hypotension suggests an adrenal crisis. IV fluids restore volume first,
followed by IV hydrocortisone. Potassium is often high in Addison's, not low.
7. A nurse is administering IV insulin to a patient with hyperosmolar
hyperglycemic state (HHS). Which finding requires immediate intervention?
A) Serum glucose decreasing from 600 to 400 mg/dL
B) Serum potassium of 3.2 mEq/L
C) Urinary output of 40 mL/hr
D) Patient reports thirst
Answer: B
Rationale: Insulin drives potassium into cells, worsening hypokalemia (3.2 is low).
Cardiac arrhythmias can occur. Potassium should be repleted before or with
insulin.
8. A patient with type 2 diabetes is prescribed metformin. Which instruction is
most important?
A) Take the medication on an empty stomach
B) Report muscle pain or weakness
C) Expect weight gain as a side effect
D) Monitor for hyperglycemia after meals
Answer: B
Rationale: Muscle pain/weakness may indicate lactic acidosis, a rare but serious
metformin complication. Metformin is taken with meals to reduce GI upset.
9. A patient after thyroidectomy develops tingling around the mouth and
muscle twitching. What is the nurse's priority action?
A) Administer IV levothyroxine
B) Check the surgical site for bleeding
, C) Give IV calcium gluconate
D) Apply oxygen via nasal cannula
Answer: C
Rationale: Tingling and twitching suggest hypocalcemia from accidental
parathyroid removal/damage. IV calcium gluconate is the emergent treatment.
10. A patient with syndrome of inappropriate antidiuretic hormone (SIADH) has
a serum sodium of 120 mEq/L. Which intervention is most appropriate?
A) Restrict oral fluids to 800 mL/day
B) Administer 3% saline IV push
C) Encourage salty foods
D) Give furosemide 40 mg IV
Answer: A
Rationale: Fluid restriction is first-line for mild to moderate SIADH. Hypertonic
saline is reserved for severe symptoms (seizures, coma). Rapid correction risks
osmotic demyelination.
11. A patient with diabetes insipidus (DI) has a urine output of 600 mL/hr.
Which medication does the nurse anticipate?
A) Hydrochlorothiazide
B) Desmopressin (DDAVP)
C) Spironolactone
D) Metformin
Answer: B
Rationale: Desmopressin is synthetic ADH, replacing the missing hormone in
central DI. HCTZ is used for nephrogenic DI.
12. A patient taking levothyroxine reports palpitations, anxiety, and weight loss.
What is the nurse's best action?
A) Increase the levothyroxine dose
B) Hold the next dose and notify the provider
