COMPLETE VERIFIED QUESTIONS MED SURG III FINAL EXAM /
NSG233 FINAL EXAM 2025/2026
ENDOCRINE DISORDERS (1-10)
1. A patient with hyperthyroidism is prescribed methimazole. Which adverse
effect requires immediate discontinuation?
A) Mild rash on the chest
B) Nausea with breakfast
C) Fever and sore throat
D) Headache and fatigue
Answer: C
Rationale: Fever and sore throat suggest agranulocytosis, a life-threatening
adverse effect of methimazole/PTU. Immediate CBC and holding the medication
are required.
2. A patient with type 1 diabetes is found unconscious. A fingerstick glucose
reads "HIGH" (>600 mg/dL). Which additional finding suggests hyperosmolar
hyperglycemic state (HHS) rather than DKA?
A) Serum ketones positive
B) Kussmaul respirations
C) Serum osmolality 350 mOsm/kg
D) Fruity breath odor
Answer: C
Rationale: HHS has extreme hyperosmolality (>320), minimal ketones, and no
Kussmaul respirations. DKA has ketones and acidosis.
3. A patient with Addison's disease is taking prednisone and fludrocortisone.
Which statement indicates understanding of fludrocortisone?
A) "I will stop this medication if I feel better"
B) "This medication replaces my body's aldosterone"
,C) "I should take it only when I am stressed"
D) "It will cause me to lose weight"
Answer: B
Rationale: Fludrocortisone is a mineralocorticoid that replaces aldosterone,
regulating sodium and potassium. It is taken daily, not stopped abruptly.
4. A patient with pheochromocytoma is scheduled for surgery. Which finding is
most consistent with this diagnosis?
A) Orthostatic hypotension
B) Episodic severe hypertension with headache and sweating
C) Persistent bradycardia
D) Weight gain and constipation
Answer: B
Rationale: Pheochromocytoma causes episodic catecholamine release →
paroxysmal hypertension, severe headache, palpitations, and diaphoresis.
5. A patient with hypothyroidism reports taking levothyroxine with a glass of
milk and a calcium supplement. What should the nurse teach?
A) "Continue taking them together to reduce stomach upset"
B) "Take levothyroxine on an empty stomach 1 hour before meals"
C) "Milk and calcium improve levothyroxine absorption"
D) "Take levothyroxine only at bedtime with a snack"
Answer: B
Rationale: Calcium and dairy products impair levothyroxine absorption. It should
be taken on an empty stomach 30-60 minutes before food or other medications.
6. A patient with diabetes mellitus has a hemoglobin A1c of 10.5%. What is the
nurse's priority intervention?
A) Increase insulin doses immediately
B) Teach about medication adherence and blood sugar monitoring
,C) Schedule a follow-up appointment in 6 months
D) Start a low-carbohydrate diet
Answer: B
Rationale: Elevated A1c indicates poor glycemic control over 3 months. Teaching
and reinforcement of adherence are priority before assuming medication changes
alone.
7. A patient with Cushing's syndrome has a moon face, buffalo hump, and
purple striae. Which complication requires priority monitoring?
A) Hypoglycemia
B) Hyperkalemia
C) Infection
D) Weight loss
Answer: C
Rationale: Cushing's causes immunosuppression (hypercortisolism). Patients are
at high risk for opportunistic infections. Hyperglycemia, hypokalemia, and weight
gain are also common.
8. A patient after thyroidectomy has stridor and difficulty breathing. What is the
priority action?
A) Apply oxygen via mask
B) Prepare for emergency tracheostomy
C) Check calcium level
D) Administer IV levothyroxine
Answer: B
Rationale: Stridor post-thyroidectomy suggests laryngeal nerve damage or
tracheal obstruction. Emergency airway management (tracheostomy) may be
needed. Oxygen alone is insufficient.
9. A patient with SIADH is on fluid restriction. The patient asks for something to
drink. Which beverage is most appropriate?
, A) Large glass of water
B) Cup of black coffee
C) Small cup of ice chips
D) Can of diet soda
Answer: C
Rationale: Ice chips count as fluid but are often allowed in small amounts to
relieve thirst. Caffeine (coffee/diet soda) has mild diuretic effect but still
contributes to fluid intake.
10. A patient with diabetes insipidus (central) is started on desmopressin
(DDAVP). Which finding indicates the medication is effective?
A) Urine output increases to 500 mL/hr
B) Serum sodium decreases from 155 to 140 mEq/L
C) Weight increases by 3 kg in 24 hours
D) Urine specific gravity is 1.002
Answer: B
Rationale: Desmopressin reduces urine output and increases water reabsorption
→ serum sodium normalizes. Weight gain indicates fluid retention; urine specific
gravity should increase (>1.005).
CARDIAC DISORDERS (11-20)
11. A patient with heart failure (HF) is taking furosemide and enalapril. Which
finding indicates the enalapril dose may be too high?
A) Potassium 3.8 mEq/L
B) Blood pressure 90/55 with dizziness
C) Dry cough
D) Urine output 50 mL/hr
Answer: B
Rationale: Enalapril (ACE inhibitor) can cause hypotension, especially with
diuretics. Dizziness and low BP suggest the dose needs adjustment.
NSG233 FINAL EXAM 2025/2026
ENDOCRINE DISORDERS (1-10)
1. A patient with hyperthyroidism is prescribed methimazole. Which adverse
effect requires immediate discontinuation?
A) Mild rash on the chest
B) Nausea with breakfast
C) Fever and sore throat
D) Headache and fatigue
Answer: C
Rationale: Fever and sore throat suggest agranulocytosis, a life-threatening
adverse effect of methimazole/PTU. Immediate CBC and holding the medication
are required.
2. A patient with type 1 diabetes is found unconscious. A fingerstick glucose
reads "HIGH" (>600 mg/dL). Which additional finding suggests hyperosmolar
hyperglycemic state (HHS) rather than DKA?
A) Serum ketones positive
B) Kussmaul respirations
C) Serum osmolality 350 mOsm/kg
D) Fruity breath odor
Answer: C
Rationale: HHS has extreme hyperosmolality (>320), minimal ketones, and no
Kussmaul respirations. DKA has ketones and acidosis.
3. A patient with Addison's disease is taking prednisone and fludrocortisone.
Which statement indicates understanding of fludrocortisone?
A) "I will stop this medication if I feel better"
B) "This medication replaces my body's aldosterone"
,C) "I should take it only when I am stressed"
D) "It will cause me to lose weight"
Answer: B
Rationale: Fludrocortisone is a mineralocorticoid that replaces aldosterone,
regulating sodium and potassium. It is taken daily, not stopped abruptly.
4. A patient with pheochromocytoma is scheduled for surgery. Which finding is
most consistent with this diagnosis?
A) Orthostatic hypotension
B) Episodic severe hypertension with headache and sweating
C) Persistent bradycardia
D) Weight gain and constipation
Answer: B
Rationale: Pheochromocytoma causes episodic catecholamine release →
paroxysmal hypertension, severe headache, palpitations, and diaphoresis.
5. A patient with hypothyroidism reports taking levothyroxine with a glass of
milk and a calcium supplement. What should the nurse teach?
A) "Continue taking them together to reduce stomach upset"
B) "Take levothyroxine on an empty stomach 1 hour before meals"
C) "Milk and calcium improve levothyroxine absorption"
D) "Take levothyroxine only at bedtime with a snack"
Answer: B
Rationale: Calcium and dairy products impair levothyroxine absorption. It should
be taken on an empty stomach 30-60 minutes before food or other medications.
6. A patient with diabetes mellitus has a hemoglobin A1c of 10.5%. What is the
nurse's priority intervention?
A) Increase insulin doses immediately
B) Teach about medication adherence and blood sugar monitoring
,C) Schedule a follow-up appointment in 6 months
D) Start a low-carbohydrate diet
Answer: B
Rationale: Elevated A1c indicates poor glycemic control over 3 months. Teaching
and reinforcement of adherence are priority before assuming medication changes
alone.
7. A patient with Cushing's syndrome has a moon face, buffalo hump, and
purple striae. Which complication requires priority monitoring?
A) Hypoglycemia
B) Hyperkalemia
C) Infection
D) Weight loss
Answer: C
Rationale: Cushing's causes immunosuppression (hypercortisolism). Patients are
at high risk for opportunistic infections. Hyperglycemia, hypokalemia, and weight
gain are also common.
8. A patient after thyroidectomy has stridor and difficulty breathing. What is the
priority action?
A) Apply oxygen via mask
B) Prepare for emergency tracheostomy
C) Check calcium level
D) Administer IV levothyroxine
Answer: B
Rationale: Stridor post-thyroidectomy suggests laryngeal nerve damage or
tracheal obstruction. Emergency airway management (tracheostomy) may be
needed. Oxygen alone is insufficient.
9. A patient with SIADH is on fluid restriction. The patient asks for something to
drink. Which beverage is most appropriate?
, A) Large glass of water
B) Cup of black coffee
C) Small cup of ice chips
D) Can of diet soda
Answer: C
Rationale: Ice chips count as fluid but are often allowed in small amounts to
relieve thirst. Caffeine (coffee/diet soda) has mild diuretic effect but still
contributes to fluid intake.
10. A patient with diabetes insipidus (central) is started on desmopressin
(DDAVP). Which finding indicates the medication is effective?
A) Urine output increases to 500 mL/hr
B) Serum sodium decreases from 155 to 140 mEq/L
C) Weight increases by 3 kg in 24 hours
D) Urine specific gravity is 1.002
Answer: B
Rationale: Desmopressin reduces urine output and increases water reabsorption
→ serum sodium normalizes. Weight gain indicates fluid retention; urine specific
gravity should increase (>1.005).
CARDIAC DISORDERS (11-20)
11. A patient with heart failure (HF) is taking furosemide and enalapril. Which
finding indicates the enalapril dose may be too high?
A) Potassium 3.8 mEq/L
B) Blood pressure 90/55 with dizziness
C) Dry cough
D) Urine output 50 mL/hr
Answer: B
Rationale: Enalapril (ACE inhibitor) can cause hypotension, especially with
diuretics. Dizziness and low BP suggest the dose needs adjustment.
