NUR 155 Exam 4 – 25 NCLEX-Style Questions with Answers and Rationales
Section 1: Diabetes & Endocrine Disorders (Q1–Q8)
1. A patient with Type 2 diabetes is scheduled for a fasting blood glucose test. What instruction should the nurse give?
A. Eat a high-protein snack the night before
B. Avoid eating or drinking anything but water for 8 hours
C. Take insulin before the test
D. Avoid walking or exercising before the test
✅ Answer: B
Rationale: Fasting is required to assess baseline glucose levels accurately.
2. A nurse is caring for a patient with DKA. Which IV solution is initiated first?
A. D5W
B. 0.9% Normal Saline
C. Lactated Ringers
D. 0.45% Saline
✅ Answer: B
Rationale: Isotonic fluids (0.9% NS) are used first to treat dehydration in DKA.
3. Which symptom is common in both DKA and HHS?
A. Metabolic acidosis
B. Kussmaul respirations
C. Extreme hyperglycemia
D. Positive ketones
✅ Answer: C
Rationale: Both DKA and HHS involve very high glucose levels.
4. A patient with hyperthyroidism reports palpitations, weight loss, and heat intolerance. Which medication should the nurse anticipate?
A. Levothyroxine
B. Propylthiouracil (PTU)
C. Prednisone
D. Calcium gluconate
✅ Answer: B
Rationale: PTU reduces thyroid hormone levels in hyperthyroidism.
5. Which lab value supports a diagnosis of hypothyroidism?
A. High T3
B. High T4
C. Low TSH
D. High TSH
✅ Answer: D
Rationale: TSH is elevated when the thyroid is underactive.
6. Which condition is a complication of untreated hypothyroidism?
A. Thyroid storm
B. Myxedema coma
C. Diabetic ketoacidosis
D. SIADH
✅ Answer: B
Rationale: Myxedema coma is a life-threatening complication of severe hypothyroidism.
7. What is the priority intervention for a patient with Addisonian crisis?
A. Monitor for hypokalemia
B. Administer IV corticosteroids
C. Restrict fluids
D. Place in Trendelenburg position
✅ Answer: B
Rationale: Corticosteroids replace deficient cortisol during crisis.
8. Which sign indicates Cushing’s syndrome?
A. Moon face and buffalo hump
B. Weight loss and tremors
C. Heat intolerance
D. Bradycardia and hypotension
✅ Answer: A
Rationale: Excess cortisol leads to characteristic fat distribution.
Section 2: Renal & Electrolytes (Q9–Q16)
9. Which lab value would you expect in a patient with chronic kidney disease (CKD)?
A. Increased creatinine
B. Increased calcium
C. Decreased phosphate
D. Decreased potassium
✅ Answer: A
Rationale: Creatinine is elevated due to poor renal clearance.
10. Which symptom is most indicative of hyperkalemia?
A. Muscle cramping
B. Bradycardia
C. Seizures
D. Hypertension
✅ Answer: B
Rationale: Hyperkalemia affects cardiac conduction, leading to bradycardia and arrhythmias.
11. What is a key nursing consideration when caring for a dialysis patient?
A. Check BP only in the fistula arm
B. Auscultate for bruit and feel for thrill
C. Use the fistula for IV meds
D. Apply tight bandages over the site
✅ Answer: B
Rationale: Patency of a fistula is confirmed by bruit and thrill.
12. Which fluid imbalance is most concerning in renal failure?
A. Hypovolemia
B. Hypernatremia
C. Fluid overload
D. Dehydration
✅ Answer: C
Rationale: Kidneys cannot excrete excess fluid, risking pulmonary edema and HTN.
13. Which electrolyte abnormality is seen with SIADH?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypercalcemia
✅ Answer: B
Rationale: Water retention dilutes sodium, causing hyponatremia.
14. A client has a serum calcium of 6.8 mg/dL. What is the priority?
A. Monitor for constipation
B. Prepare to administer calcium gluconate
C. Restrict dairy intake
D. Encourage fluid intake
✅ Answer: B
Rationale: Calcium <8.5 is low; levels <7 can cause tetany and need IV replacement.
15. A patient with AKI reports fatigue and dyspnea. Which lab finding supports fluid retention?
A. BUN 15
B. Hematocrit 48%
C. Creatinine 1.0
D. Potassium 6.2
✅ Answer: D
Rationale: Hyperkalemia is common in AKI and contributes to cardiac and muscle symptoms.
16. What is the most dangerous symptom of hypocalcemia?
A. Tetany
B. Constipation
C. Bradycardia
D. Nausea
✅ Answer: A
Rationale: Tetany and laryngospasm can compromise breathing.
Section 3: Musculoskeletal & Neuro (Q17–Q25)
17. What is a priority action for a patient with a new plaster cast?
A. Cover the cast with a blanket
B. Keep the cast elevated and exposed to air
C. Insert objects inside for itching
D. Use a hairdryer on high heat
✅ Answer: B
Rationale: The cast should remain uncovered to dry properly and reduce swelling.
18. A patient with a fractured femur reports tingling and severe pain not relieved by meds. What should the nurse suspect?
A. Fat embolism
B. Infection
C. Compartment syndrome
D. Dislocation
✅ Answer: C
Rationale: Unrelieved pain and neurovascular compromise indicate compartment syndrome.
19. Which instruction is correct for a client with osteoporosis?
A. Increase caffeine intake
B. Limit weight-bearing activities
C. Take calcium and vitamin D
D. Avoid sunlight exposure
✅ Answer: C
Rationale: Calcium and vitamin D are vital for bone health.
20. A patient who had a stroke is unable to swallow. What is the best nursing action?
A. Encourage sips of water
B. Keep the patient NPO
C. Insert a nasogastric tube immediately
D. Suction the mouth every hour
✅ Answer: B
Rationale: To prevent aspiration, keep NPO until a swallow study is done.
21. A client with Parkinson’s disease is at risk for which complication?
A. Hyperactivity
B. Aspiration pneumonia
C. Hyperglycemia
D. Joint dislocation
✅ Answer: B
Rationale: Muscle rigidity and dysphagia increase aspiration risk.
22. A client with a seizure disorder has an aura. What should the nurse do first?
A. Administer lorazepam
B. Turn the client on their side
C. Call the provider
D. Restrain the client
✅ Answer: B
Rationale: Positioning prevents aspiration if the seizure occurs.
23. Which assessment finding indicates ICP after a head injury?
A. Hypotension
B. Hyperactivity
C. Unequal pupils and vomiting
D. Hypoglycemia
✅ Answer: C
Rationale: Classic signs of increased intracranial pressure.
24. What is a priority for a stroke patient with left-sided weakness?
A. Use bilateral restraints
B. Encourage self-ambulation
C. Place call bell on the right side
D. Provide low-protein diet
✅ Answer: C
Rationale: Place call bell on unaffected side for safety.
25. A client with multiple sclerosis is experiencing diplopia and weakness. What medication helps reduce symptom flare-ups?
A. Furosemide
B. Prednisone
C. Acetaminophen
D. Vancomycin
✅ Answer: B
Rationale: Corticosteroids help reduce inflammation in MS exacerbations.
