GALEN NUR 242 – MEDICAL-SURGICAL
NURSING EXAM 4 PRACTICE TEST BANK 100
QUESTIONS WITH VERIFIED ANSWERS &
DETAILED RATIONALES 2025/2026 EDITION
A+ GRADE PREPARATION
SECTION 1: ENDOCRINE DISORDERS (QUESTIONS 1-20)
1. A patient with hyperthyroidism (Graves disease) presents with
weight loss, heat intolerance, and tachycardia. The underlying
pathophysiology is:
A) Autoantibodies stimulating the TSH receptor
B) Thyroid gland destruction
C) Pituitary adenoma
D) Iodine deficiency
Rationale: Graves disease is an autoimmune disorder caused by
antibodies that stimulate the TSH receptor, leading to thyroid
hyperfunction. This results in increased thyroid hormone production
and the hypermetabolic symptoms of hyperthyroidism.
2. A patient with hypothyroidism presents with weight gain, cold
intolerance, and fatigue. Laboratory findings show elevated TSH
and low T4. This indicates:
A) Primary hypothyroidism
B) Secondary hypothyroidism
,C) Tertiary hypothyroidism
D) Euthyroid sick syndrome
Rationale: In primary hypothyroidism, the thyroid gland is
dysfunctional, resulting in low T4. The pituitary responds by increasing
TSH production in an attempt to stimulate the thyroid. Elevated TSH
with low T4 is diagnostic of primary hypothyroidism.
3. A patient with hyperthyroidism is prescribed methimazole. Which
teaching is essential?
A) "Take this medication with food."
B) "This medication will increase your energy levels right away."
C) "Report any sore throat or fever immediately."
D) "You can stop this medication once you feel better."
Rationale: Methimazole can cause agranulocytosis (dangerously low
WBC count). Sore throat and fever are signs of infection that must be
reported immediately.
4. A patient with hypothyroidism is prescribed levothyroxine. Which
instruction is correct?
A) "Take with food to reduce stomach upset."
B) "Take on an empty stomach, 30-60 minutes before breakfast."
C) "Take with calcium supplements for better absorption."
D) "Take at bedtime with a snack."
Rationale: Levothyroxine should be taken on an empty stomach 30-60
minutes before breakfast for optimal absorption. Calcium and iron
supplements interfere with absorption.
5. A patient with type 1 diabetes has autoimmune destruction of
pancreatic beta cells, leading to:
,A) Insulin deficiency
B) Insulin resistance
C) Glucagon deficiency
D) Somatostatin excess
Rationale: Type 1 diabetes results from autoimmune destruction of
pancreatic beta cells, leading to absolute insulin deficiency. This
requires exogenous insulin for survival. Type 2 diabetes involves
insulin resistance with relative insulin deficiency.
6. A patient with type 2 diabetes has hyperglycemia due to:
A) Absolute insulin deficiency
B) Insulin resistance with relative insulin deficiency
C) Glucagon deficiency
D) Autoimmune beta cell destruction
Rationale: Type 2 diabetes is characterized by insulin resistance
(target cells fail to respond to insulin) combined with relative insulin
deficiency (the pancreas cannot produce enough insulin to overcome
resistance). Obesity and genetic factors are major risk factors.
7. A patient with diabetes has a blood glucose of 55 mg/dL and is
confused. Which action should the nurse take first?
A) Administer 15 g of rapid-acting carbohydrate (e.g., glucose
tablets, juice)
B) Administer insulin
C) Call the healthcare provider
D) Check for ketones in the urine
Rationale: A blood glucose of 55 mg/dL indicates hypoglycemia. The
priority is to treat with 15 g of rapid-acting carbohydrate and recheck
, glucose in 15 minutes. The patient is conscious but confused, so oral
glucose is appropriate.
8. A patient with diabetes is prescribed insulin. Which statement
indicates correct understanding of insulin administration?
A) "I should always use the same injection site."
B) "I should rotate injection sites to prevent lipohypertrophy."
C) "Insulin can be stored at room temperature for up to 6 months."
D) "I can mix all types of insulin in the same syringe."
Rationale: Rotating injection sites prevents lipohypertrophy (fatty
lumps) and ensures consistent insulin absorption. Sites should be
rotated within the same anatomical region.
9. A patient with diabetes insipidus is expected to have which
finding?
A) Polyuria and polydipsia with dilute urine
B) Polyuria and polydipsia with concentrated urine
C) Oliguria and edema
D) Hypertension and bradycardia
Rationale: Diabetes insipidus results from deficient ADH, causing the
kidneys to excrete large volumes of dilute urine (polyuria), leading to
excessive thirst (polydipsia) and risk of dehydration.
10. A patient with syndrome of inappropriate antidiuretic hormone
(SIADH) has which finding?
A) Polyuria and polydipsia
B) Hyponatremia and fluid retention
C) Hypernatremia and dehydration
D) Hyperkalemia and acidosis
NURSING EXAM 4 PRACTICE TEST BANK 100
QUESTIONS WITH VERIFIED ANSWERS &
DETAILED RATIONALES 2025/2026 EDITION
A+ GRADE PREPARATION
SECTION 1: ENDOCRINE DISORDERS (QUESTIONS 1-20)
1. A patient with hyperthyroidism (Graves disease) presents with
weight loss, heat intolerance, and tachycardia. The underlying
pathophysiology is:
A) Autoantibodies stimulating the TSH receptor
B) Thyroid gland destruction
C) Pituitary adenoma
D) Iodine deficiency
Rationale: Graves disease is an autoimmune disorder caused by
antibodies that stimulate the TSH receptor, leading to thyroid
hyperfunction. This results in increased thyroid hormone production
and the hypermetabolic symptoms of hyperthyroidism.
2. A patient with hypothyroidism presents with weight gain, cold
intolerance, and fatigue. Laboratory findings show elevated TSH
and low T4. This indicates:
A) Primary hypothyroidism
B) Secondary hypothyroidism
,C) Tertiary hypothyroidism
D) Euthyroid sick syndrome
Rationale: In primary hypothyroidism, the thyroid gland is
dysfunctional, resulting in low T4. The pituitary responds by increasing
TSH production in an attempt to stimulate the thyroid. Elevated TSH
with low T4 is diagnostic of primary hypothyroidism.
3. A patient with hyperthyroidism is prescribed methimazole. Which
teaching is essential?
A) "Take this medication with food."
B) "This medication will increase your energy levels right away."
C) "Report any sore throat or fever immediately."
D) "You can stop this medication once you feel better."
Rationale: Methimazole can cause agranulocytosis (dangerously low
WBC count). Sore throat and fever are signs of infection that must be
reported immediately.
4. A patient with hypothyroidism is prescribed levothyroxine. Which
instruction is correct?
A) "Take with food to reduce stomach upset."
B) "Take on an empty stomach, 30-60 minutes before breakfast."
C) "Take with calcium supplements for better absorption."
D) "Take at bedtime with a snack."
Rationale: Levothyroxine should be taken on an empty stomach 30-60
minutes before breakfast for optimal absorption. Calcium and iron
supplements interfere with absorption.
5. A patient with type 1 diabetes has autoimmune destruction of
pancreatic beta cells, leading to:
,A) Insulin deficiency
B) Insulin resistance
C) Glucagon deficiency
D) Somatostatin excess
Rationale: Type 1 diabetes results from autoimmune destruction of
pancreatic beta cells, leading to absolute insulin deficiency. This
requires exogenous insulin for survival. Type 2 diabetes involves
insulin resistance with relative insulin deficiency.
6. A patient with type 2 diabetes has hyperglycemia due to:
A) Absolute insulin deficiency
B) Insulin resistance with relative insulin deficiency
C) Glucagon deficiency
D) Autoimmune beta cell destruction
Rationale: Type 2 diabetes is characterized by insulin resistance
(target cells fail to respond to insulin) combined with relative insulin
deficiency (the pancreas cannot produce enough insulin to overcome
resistance). Obesity and genetic factors are major risk factors.
7. A patient with diabetes has a blood glucose of 55 mg/dL and is
confused. Which action should the nurse take first?
A) Administer 15 g of rapid-acting carbohydrate (e.g., glucose
tablets, juice)
B) Administer insulin
C) Call the healthcare provider
D) Check for ketones in the urine
Rationale: A blood glucose of 55 mg/dL indicates hypoglycemia. The
priority is to treat with 15 g of rapid-acting carbohydrate and recheck
, glucose in 15 minutes. The patient is conscious but confused, so oral
glucose is appropriate.
8. A patient with diabetes is prescribed insulin. Which statement
indicates correct understanding of insulin administration?
A) "I should always use the same injection site."
B) "I should rotate injection sites to prevent lipohypertrophy."
C) "Insulin can be stored at room temperature for up to 6 months."
D) "I can mix all types of insulin in the same syringe."
Rationale: Rotating injection sites prevents lipohypertrophy (fatty
lumps) and ensures consistent insulin absorption. Sites should be
rotated within the same anatomical region.
9. A patient with diabetes insipidus is expected to have which
finding?
A) Polyuria and polydipsia with dilute urine
B) Polyuria and polydipsia with concentrated urine
C) Oliguria and edema
D) Hypertension and bradycardia
Rationale: Diabetes insipidus results from deficient ADH, causing the
kidneys to excrete large volumes of dilute urine (polyuria), leading to
excessive thirst (polydipsia) and risk of dehydration.
10. A patient with syndrome of inappropriate antidiuretic hormone
(SIADH) has which finding?
A) Polyuria and polydipsia
B) Hyponatremia and fluid retention
C) Hypernatremia and dehydration
D) Hyperkalemia and acidosis
