NSG 4100 Adult Health III | Comprehensive
Practice Exam 2 Practice Questions and well
verified answers real exam 2025\26
Topics: Endocrine Disorders, Immunological Disorders (HIV/AIDS), Renal/End-
Stage Renal Disease (ESRD), Neurological Disorders, and Perioperative Care for
related surgeries.
Endocrine Disorders (Adrenal, Pituitary, Thyroid, Pancreatic)
1. A patient presents with muscle weakness, hyperpigmentation of the knuckles and gums, weight
loss, and hypotension. Which of the following conditions is most consistent with these symptoms?
A. Cushing's syndrome
B. Addison's disease
C. Hyperaldosteronism
D. Pheochromocytoma
Answer: B. Addison's disease
Rationale: Hyperpigmentation is a classic sign of Addison's disease due to increased ACTH. The other
symptoms (weakness, weight loss, hypotension) align with adrenal insufficiency.
2. A patient with a history of chronic corticosteroid use for asthma is undergoing a left total knee
arthroplasty. The nurse should anticipate which of the following orders to manage the patient's
medication regimen during this physiologic stressor?
A. Withhold the corticosteroid 24 hours before surgery to promote healing.
B. Administer the usual dose of corticosteroid orally on the morning of surgery.
C. Administer a higher, parenteral dose of corticosteroids during the perioperative period.
D. Switch the patient from an oral to an inhaled corticosteroid.
Answer: C. Administer a higher, parenteral dose of corticosteroids during the perioperative period.
Rationale: Patients on chronic steroid therapy are at risk for adrenal crisis during stress (surgery). They
require "stress dose" steroids, typically IV, to mimic the body's natural cortisol surge.
3. A patient following a 24-hour urine collection for vanillylmandelic acid (VMA) to rule out
pheochromocytoma calls the clinic. Which instruction from the nurse is most important to emphasize
for the accuracy of this test?
A. "Save the first urine voided in the morning on the first day."
B. "You must consume a diet high in protein during the collection."
,C. "Avoid vanilla, coffee, and fruits for 2-3 days before and during the collection."
D. "Drink at least 3 liters of water per day to ensure an adequate sample."
Answer: C. "Avoid vanilla, coffee, and fruits for 2-3 days before and during the collection."
Rationale: VMA is a breakdown product of catecholamines. Certain foods (vanilla, coffee, fruit) can
interfere with the test results, causing false positives.
4. The nurse is providing discharge teaching for a patient who had a transsphenoidal hypophysectomy
(pituitary tumor removal). Which patient statement indicates a need for further teaching?
A. "I will need to take hormone replacements for the rest of my life."
B. "I should bend at the waist to tie my shoes instead of bending my knees."
C. "I will report any persistent drainage from my nose or a post-nasal drip."
D. "I must avoid blowing my nose and brushing my teeth for a couple of weeks."
Answer: B. "I should bend at the waist to tie my shoes instead of bending my knees."
Rationale: Patients must avoid bending at the waist, straining, or any activity that increases intracranial
pressure and could cause a CSF leak. They should bend at the knees.
5. A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is being treated with fluid
restriction and tolvaptan. Which laboratory finding indicates that the treatment is effective?
A. Serum sodium of 122 mEq/L
B. Serum sodium of 138 mEq/L
C. Urine specific gravity of 1.035
D. Decreased level of consciousness
Answer: B. Serum sodium of 138 mEq/L
*Rationale: SIADH causes hyponatremia due to water retention. Effective treatment should increase the
serum sodium level toward the normal range (135-145 mEq/L).*
6. A patient is admitted with diabetic ketoacidosis (DKA). The nurse reviews the admission orders.
Which order should the nurse question?
A. Initiate a continuous IV insulin infusion at 0.1 units/kg/hr.
B. Administer 1 liter of 0.9% normal saline over the first hour.
C. Administer potassium chloride 20 mEq IV push now.
D. Check blood glucose by fingerstick every hour.
Answer: C. Administer potassium chloride 20 mEq IV push now.
Rationale: IV push potassium is dangerous and can cause cardiac arrest. Potassium is always diluted and
infused via an IV pump. While potassium is often replaced in DKA, the route is critical.
7. A patient with hyperthyroidism is scheduled for a thyroidectomy. The nurse administers
propylthiouracil (PTU) and saturated solution of potassium iodide (SSKI) as ordered. What is the
primary reason for administering SSKI preoperatively?
A. To block the synthesis of new thyroid hormones.
B. To reduce the vascularity and size of the thyroid gland.
C. To provide a sedative effect and reduce patient anxiety.
D. To prevent postoperative hypocalcemia.
Answer: B. To reduce the vascularity and size of the thyroid gland.
*Rationale: Iodine solutions (SSKI, Lugol's solution) are given 10-14 days before surgery to inhibit
hormone release and decrease the vascularity and fragility of the gland, making surgery safer.*
, 8. A nurse is assessing a patient 12 hours after a thyroidectomy. The patient reports tingling in the
fingers and around the mouth. What is the nurse's priority action?
A. Administer the prescribed pain medication.
B. Check the patient's calcium level.
C. Place the patient in high-Fowler's position.
D. Have the patient speak to assess for hoarseness.
Answer: B. Check the patient's calcium level.
Rationale: Tingling (paresthesia) of the fingers and circumoral region is an early sign of hypocalcemia,
which can occur if the parathyroid glands were accidentally removed or damaged during surgery.
9. Which of the following assessment findings in a patient with syndrome of inappropriate antidiuretic
hormone (SIADH) requires immediate intervention?
A. Serum sodium of 130 mEq/L
B. Weight gain of 2 lbs in one day
C. Urine output of 80 mL/hr
D. New onset confusion and lethargy
Answer: D. New onset confusion and lethargy
Rationale: Rapidly dropping sodium levels lead to cerebral edema. Neurologic changes (confusion,
lethargy, seizures) are signs of severe, life-threatening hyponatremia requiring immediate intervention.
10. The nurse is providing dietary teaching for a patient with Cushing's syndrome. Which of the
following meal plans best reflects the patient's nutritional needs?
A. Low-calorie, low-carbohydrate, low-sodium
B. High-protein, high-calcium, low-sodium, low-carbohydrate
C. High-potassium, high-protein, low-sodium, low-calorie
D. Low-fat, low-cholesterol, high-fiber
Answer: C. High-potassium, high-protein, low-sodium, low-calorie
Rationale: Cushing's causes hyperglycemia (low-calorie/low-carb), hypertension (low-sodium), muscle
wasting (high-protein), and hypokalemia (high-potassium).
HIV/AIDS and Immunologic Disorders
11. A patient has a positive enzyme immunoassay (EIA) for HIV. What is the next step in confirming
the diagnosis?
A. Repeat the EIA test on a new blood sample.
B. Perform a Western blot test.
C. Order a CD4+ T-cell count.
D. Admit the patient for an AIDS-defining illness workup.
Answer: A. Repeat the EIA test on a new blood sample.
Rationale: Standard protocol is to repeat the EIA on the same sample. If it is positive again, a
confirmatory test like the Western blot is performed.
12. According to the CDC, which of the following laboratory values confirms a diagnosis of AIDS in a
patient who is HIV-positive?
A. Presence of HIV antibodies
Practice Exam 2 Practice Questions and well
verified answers real exam 2025\26
Topics: Endocrine Disorders, Immunological Disorders (HIV/AIDS), Renal/End-
Stage Renal Disease (ESRD), Neurological Disorders, and Perioperative Care for
related surgeries.
Endocrine Disorders (Adrenal, Pituitary, Thyroid, Pancreatic)
1. A patient presents with muscle weakness, hyperpigmentation of the knuckles and gums, weight
loss, and hypotension. Which of the following conditions is most consistent with these symptoms?
A. Cushing's syndrome
B. Addison's disease
C. Hyperaldosteronism
D. Pheochromocytoma
Answer: B. Addison's disease
Rationale: Hyperpigmentation is a classic sign of Addison's disease due to increased ACTH. The other
symptoms (weakness, weight loss, hypotension) align with adrenal insufficiency.
2. A patient with a history of chronic corticosteroid use for asthma is undergoing a left total knee
arthroplasty. The nurse should anticipate which of the following orders to manage the patient's
medication regimen during this physiologic stressor?
A. Withhold the corticosteroid 24 hours before surgery to promote healing.
B. Administer the usual dose of corticosteroid orally on the morning of surgery.
C. Administer a higher, parenteral dose of corticosteroids during the perioperative period.
D. Switch the patient from an oral to an inhaled corticosteroid.
Answer: C. Administer a higher, parenteral dose of corticosteroids during the perioperative period.
Rationale: Patients on chronic steroid therapy are at risk for adrenal crisis during stress (surgery). They
require "stress dose" steroids, typically IV, to mimic the body's natural cortisol surge.
3. A patient following a 24-hour urine collection for vanillylmandelic acid (VMA) to rule out
pheochromocytoma calls the clinic. Which instruction from the nurse is most important to emphasize
for the accuracy of this test?
A. "Save the first urine voided in the morning on the first day."
B. "You must consume a diet high in protein during the collection."
,C. "Avoid vanilla, coffee, and fruits for 2-3 days before and during the collection."
D. "Drink at least 3 liters of water per day to ensure an adequate sample."
Answer: C. "Avoid vanilla, coffee, and fruits for 2-3 days before and during the collection."
Rationale: VMA is a breakdown product of catecholamines. Certain foods (vanilla, coffee, fruit) can
interfere with the test results, causing false positives.
4. The nurse is providing discharge teaching for a patient who had a transsphenoidal hypophysectomy
(pituitary tumor removal). Which patient statement indicates a need for further teaching?
A. "I will need to take hormone replacements for the rest of my life."
B. "I should bend at the waist to tie my shoes instead of bending my knees."
C. "I will report any persistent drainage from my nose or a post-nasal drip."
D. "I must avoid blowing my nose and brushing my teeth for a couple of weeks."
Answer: B. "I should bend at the waist to tie my shoes instead of bending my knees."
Rationale: Patients must avoid bending at the waist, straining, or any activity that increases intracranial
pressure and could cause a CSF leak. They should bend at the knees.
5. A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is being treated with fluid
restriction and tolvaptan. Which laboratory finding indicates that the treatment is effective?
A. Serum sodium of 122 mEq/L
B. Serum sodium of 138 mEq/L
C. Urine specific gravity of 1.035
D. Decreased level of consciousness
Answer: B. Serum sodium of 138 mEq/L
*Rationale: SIADH causes hyponatremia due to water retention. Effective treatment should increase the
serum sodium level toward the normal range (135-145 mEq/L).*
6. A patient is admitted with diabetic ketoacidosis (DKA). The nurse reviews the admission orders.
Which order should the nurse question?
A. Initiate a continuous IV insulin infusion at 0.1 units/kg/hr.
B. Administer 1 liter of 0.9% normal saline over the first hour.
C. Administer potassium chloride 20 mEq IV push now.
D. Check blood glucose by fingerstick every hour.
Answer: C. Administer potassium chloride 20 mEq IV push now.
Rationale: IV push potassium is dangerous and can cause cardiac arrest. Potassium is always diluted and
infused via an IV pump. While potassium is often replaced in DKA, the route is critical.
7. A patient with hyperthyroidism is scheduled for a thyroidectomy. The nurse administers
propylthiouracil (PTU) and saturated solution of potassium iodide (SSKI) as ordered. What is the
primary reason for administering SSKI preoperatively?
A. To block the synthesis of new thyroid hormones.
B. To reduce the vascularity and size of the thyroid gland.
C. To provide a sedative effect and reduce patient anxiety.
D. To prevent postoperative hypocalcemia.
Answer: B. To reduce the vascularity and size of the thyroid gland.
*Rationale: Iodine solutions (SSKI, Lugol's solution) are given 10-14 days before surgery to inhibit
hormone release and decrease the vascularity and fragility of the gland, making surgery safer.*
, 8. A nurse is assessing a patient 12 hours after a thyroidectomy. The patient reports tingling in the
fingers and around the mouth. What is the nurse's priority action?
A. Administer the prescribed pain medication.
B. Check the patient's calcium level.
C. Place the patient in high-Fowler's position.
D. Have the patient speak to assess for hoarseness.
Answer: B. Check the patient's calcium level.
Rationale: Tingling (paresthesia) of the fingers and circumoral region is an early sign of hypocalcemia,
which can occur if the parathyroid glands were accidentally removed or damaged during surgery.
9. Which of the following assessment findings in a patient with syndrome of inappropriate antidiuretic
hormone (SIADH) requires immediate intervention?
A. Serum sodium of 130 mEq/L
B. Weight gain of 2 lbs in one day
C. Urine output of 80 mL/hr
D. New onset confusion and lethargy
Answer: D. New onset confusion and lethargy
Rationale: Rapidly dropping sodium levels lead to cerebral edema. Neurologic changes (confusion,
lethargy, seizures) are signs of severe, life-threatening hyponatremia requiring immediate intervention.
10. The nurse is providing dietary teaching for a patient with Cushing's syndrome. Which of the
following meal plans best reflects the patient's nutritional needs?
A. Low-calorie, low-carbohydrate, low-sodium
B. High-protein, high-calcium, low-sodium, low-carbohydrate
C. High-potassium, high-protein, low-sodium, low-calorie
D. Low-fat, low-cholesterol, high-fiber
Answer: C. High-potassium, high-protein, low-sodium, low-calorie
Rationale: Cushing's causes hyperglycemia (low-calorie/low-carb), hypertension (low-sodium), muscle
wasting (high-protein), and hypokalemia (high-potassium).
HIV/AIDS and Immunologic Disorders
11. A patient has a positive enzyme immunoassay (EIA) for HIV. What is the next step in confirming
the diagnosis?
A. Repeat the EIA test on a new blood sample.
B. Perform a Western blot test.
C. Order a CD4+ T-cell count.
D. Admit the patient for an AIDS-defining illness workup.
Answer: A. Repeat the EIA test on a new blood sample.
Rationale: Standard protocol is to repeat the EIA on the same sample. If it is positive again, a
confirmatory test like the Western blot is performed.
12. According to the CDC, which of the following laboratory values confirms a diagnosis of AIDS in a
patient who is HIV-positive?
A. Presence of HIV antibodies
