Exam 3 Practice Answers

DISCLAIMER: These questions are from numerous NCLEX sources which will be listed
at the end. There is a good chance that the same style of questions might appear on the
exam but please be mindful that the answer found here may NOT be the exact same
answer found on the exam. Proceed with caution. Good luck and happy studying!

Exam 3 Practice Answers
1. A client with Type 1 diabetes mellitus is admitted to an acute care facility with
diabetic ketoacidosis. To correct this acute diabetic emergency, which measure
should the health care team take first?
Answer: A – Initiate fluid replacement therapy
Rationale: The health care team first initiates fluid replacement therapy to
prevent or treat circulatory collapse caused by severe dehydration. Although
diabetic ketoacidosis results from insulin deficiency, the client must have an
adequate fluid volume before insulin can be administered; otherwise, the drug
won’t circulate throughout the body effectively. Therefore, insulin administration
follows fluid replacement therapy. Determining and correcting the cause of
diabetic ketoacidosis are important steps, but the client’s condition must be
stabilized first to prevent life-threatening complications.
2. A client with Addison’s disease comes to the clinic for a follow-up visit. When
assessing this client, the nurse should stay alert for signs and symptoms of:
Answer: D – Sodium and potassium abnormalities
Rationale: In Addison’s disease, a form of adrenocortical hypofunction,
aldosterone secretion is reduced. Aldosterone promotes sodium conservation and
potassium excretion. Therefore, aldosterone deficiency increases sodium
excretion, predisposing the client to hyponatremia, and inhibits potassium
excretion, predisposing the client to hyperkalemia. Because aldosterone doesn’t
regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency
doesn’t affect levels of these electrolytes directly.
3. The nurse obtains a fingerstick glucose level of 45 mg/dl from a client newly
diagnosed with diabetes mellitus. The client is alert and oriented, and the client’s
skin is warm and dry. How should the nurse intervene?
Answer: C – Obtain a repeat fingerstick glucose level
Rationale: The nurse should recheck the fingerstick glucose level to verify the
original result because the client isn’t exhibiting signs of hypoglycemia. The
nurse should give the client milk and a graham cracker with peanut butter or a
glass of orange juice only after confirming the low glucose level. It isn’t
necessary to notify the physician or to obtain a serum glucose level at this time.

4. A patient is prescribed levothyroxine (Synthroid) daily. What is the most
important instruction to teach for administration of this drug?
Answer: C – Call the doctor immediately at the onset of palpitations or
nervousness
Rationale: Levothyroxine (Synthroid) increases the metabolic rate of body
tissues. Some serious side effects include cardiovascular collapse, dysrhythmias,
and tachycardia. Because of these side effects, clients should be instructed not to
take the medication if their pulse is greater than 100 beats/min and to notify their
provider of headaches, nervousness, chest pain, palpitations, or any unusual
symptoms.
5. A client with severe head trauma sustained in a car accident is admitted to the
intensive care unit. Thirty-six hours later, the client’s urine output suddenly rises
above 200 mL/hour, leading the nurse to suspect diabetes insipidus. Which
laboratory findings support the nurse’s suspicion of diabetes insipidus?
Answer: D – Below-normal urine osmolality level, above-normal serum
osmolality level
Rationale: In diabetes insipidus, excessive polyuria causes dilute urine, resulting
in a below-normal urine osmolality level. At the same time, polyuria depletes the
body of water, causing dehydration that leads to an above-normal serum
osmolality level. For the same reasons, diabetes insipidus doesn’t cause abovenormal urine osmolality or below-normal serum osmolality levels.
6. A new diabetic is learning to administer his insulin. He receives 10U of NPH and
12U of regular insulin each morning. Which of the following statements reflects
understanding of the nurse’s teaching?
Answer: A – “When drawing up my insulin, I should draw up the regular insulin
first.”
Rationale: Regular insulin should be drawn up before the NPH. They can be
given together, so there is no need for two injections, making answer D incorrect.
Answer B is obviously incorrect, and answer C is incorrect because it certainly
does matter which is drawn first: Contamination of NPH into regular insulin will
result in a hypoglycemic reaction at unexpected times.
7. A 60-year-old diabetic is taking glyburide (Diabeta) 1.25 mg daily to treat Type II
diabetes mellitus. Which statement indicates the need for further teaching?
Answer: C – “I often skip dinner because I don’t feel hungry.”
Rationale: The client should be taught to eat his meals even if he is not hungry, to
prevent a hypoglycemic reaction. Answers A, B, and D are incorrect because they
indicate knowledge of the nurse’s teaching.

8. When caring for a client who’s being treated for hyperthyroidism, it’s important
to:
Answer: C – Balance the client’s periods of activity and rest
Rationale: A client with hyperthyroidism needs to be encouraged to balance
periods of activity and rest. Many clients with hyperthyroidism are hyperactive
and complain of feeling very warm. Consequently, it’s important to keep the
environment cool and to teach the client how to manage his physical reactions to
heat. Clients with hypothyroidism – not hyperthyroidism – complain of being
cold and need warm clothing and blankets to maintain a comfortable temperature.
They also receive thyroid replacement therapy, often feel lethargic and sluggish,
and are prone to constipation. The nurse should encourage clients with
hypothyroidism to be more active to prevent constipation.
9. The nurse is assessing a client with Cushing’s syndrome. Which observation
should the nurse report to the physician immediately?
Answer: B – An irregular apical pulse
Rationale: Because Cushing’s syndrome causes aldosterone overproduction,
which increases urinary potassium loss, the disorder may lead to hypokalemia.
Therefore, the nurse should immediately report signs and symptoms of
hypokalemia, such as an irregular apical pulse, to the physician. Edema is an
expected finding because aldosterone overproduction causes sodium and fluid
retention. Dry mucous membranes and frequent urination signal dehydration,
which isn’t associated with Cushing’s syndrome.
10. A client is brought to the emergency department in an unresponsive state, and a
diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse would
immediately prepare to initiate which anticipated health care provider’s
prescription.
Answer: C – Intravenous infusion of normal saline
Rationale: The primary goal of treatment in hyperglycemic hyperosmolar state
(HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte
deficiency. Intravenous fluid replacement is similar to that administered in
diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline.
Regular insulin, not NPH insulin, would be administered. The use of sodium
bicarbonate to correct acidosis is avoided because it can precipitate a further drop
in serum potassium levels. Intubation and mechanical ventilation are not required
to treat HHS.
11. An external insulin pump is prescribed for a client with diabetes and the client
asks the nurse about the functioning of the pump. The nurse bases the response
on which information about the pump?

Answer: D – Gives a small continuous dose of short-duration insulin
subcutaneously, and the client can self-administer a bolus with an additional dose
from the pump before each meal
Rationale: An insulin pump provides a small continuous dose of short-duration
(rapid or short-acting) insulin subcutaneously throughout the day and night, and
the client can self-administer a bolus with an additional dose from the pump
before each meal as needed. Short-duration insulin is used in an insulin pump.
An external pump is not attached surgically to the pancreas.
12. A client is admitted to an emergency department, and a diagnosis of myxedema
coma is made. Which action would the nurse prepare to carry out initially?
Answer: B – Maintain a patent airway
Rationale: The initial nursing action would be to maintain a patent airway.
Oxygen would be administered, followed by fluid replacement, keeping the client
warm, monitoring vital signs, and administering thyroid hormones by the
intravenous route.
13. A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes
of hypoglycemia with exercising. Which statement by the client indicates an
adequate understanding of the peak action of NPH insulin and exercise?
Answer: C - “The best time for me to exercise is mid-to-late afternoon.”
Rationale: A hypoglycemic reaction may occur in response to increased exercise.
Clients should avoid exercise during the peak time of insulin. NPH insulin peaks
at 4 to 12 hours; therefore, afternoon exercise takes place during the peak of the
medication. Options 1, 2, and 4 do not address peak action times.
14. A client is diagnosed with syndrome of inappropriate antidiuretic hormone
secretion (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and
urine specific gravity 1.030. Which nursing intervention would help prevent
complications associated with SIADH?
Answer: C – Elevating the client’s head of bed to 90 degrees
Rationale: Excessive release of antidiuretic hormone (ADH) disturbs fluid and
electrolyte balance in SIADH. The excessive ADH causes an inability to excrete
dilute urine, retention of free water, expansion of extracellular fluid volume, and
hyponatremia. Symptomatic treatment begins with restricting fluids to 800
mL/day. Vasopressin is administered to clients with diabetes insipidus, a
condition in which circulating ADH is deficient. Elevating the head of the bed
decreases vascular return and decreases atrial-filling pressure, which increases
ADH secretion worsening the client’s condition. The client’s sodium is low and,
therefore, shouldn’t be restricted.

15. The nurse is caring for a postoperative parathyroidectomy client. Which client
complaint would indicate that a life-threatening complication may be developing,
requiring notification of the health care provider immediately?
Answer: A – Laryngeal stridor
Rationale: During the postoperative period, the nurse carefully observes the
client for signs of hemorrhage, which causes swelling and compression of
adjacent tissue. Laryngeal stridor is a harsh, high-pitched sound heard on
inspiration and expiration; stridor is caused by compression of the trachea, leading
to respiratory distress. Stridor is an acute emergency situation that requires
immediate attention to avoid complete obstruction of the airway. Options 2, 3,
and 4 do not identify signs of a life-threatening complication.
16. The nurse is providing discharge instructions to a client who has a Cushing’s
syndrome. Which client statement indicates that instructions related to dietary
management are understood?
Answer: B - “I should eat foods that have a lot of potassium in them.”
Rationale: A diet low in carbohydrates and sodium but ample in protein and
potassium is encouraged for a client with Cushing’s syndrome. Such a diet
promotes weight loss, reduction of edema and hypertension, control of
hypokalemia, and rebuilding of wasted tissue.
17. The nurse is caring for a client who is 2 days postoperative following an
abdominal hysterectomy. The client has a history of diabetes mellitus and has
been receiving regular insulin according to capillary blood glucose testing four
times a day. A carbohydrate-controlled diet has been prescribed but the client has
been complaining of nausea and is not eating. On entering the client’s room, the
nurse finds the client to be confused and diaphoretic. Which action is most
appropriate at this time?
Answer: B – Obtain a capillary blood glucose level and perform a focused
assessment
Rationale: Diaphoresis and confusion are signs of moderate hypoglycemia. A
likely cause of the client’s change in condition could be related to the
administration of insulin without the client eating enough food. However, an
assessment is necessary to confirm the presence of hypoglycemia. The nurse
would obtain a capillary blood glucose level to confirm the hypoglycemia and
perform a focused assessment to determine the extent and cause of the client’s
condition. Once hypoglycemia is confirmed, the nurse stays with the client and
asks the unlicensed assistive personnel (UAP) to obtain the appropriate
carbohydrate snack. A code is called if the client is not breathing or if the heart is
not beating.

18. In the emergency department during initial assessment of a newly-admitted
patient with diabetes, the nurse discovers all of these findings. Which finding
should be reported to the health care provider immediately?
Answer: B – Rapid respiratory rate with deep inspirations
Rationale: Rapid, deep respirations (Kussmaul respirations) are symptomatic of
diabetic ketoacidosis (DKA). Hammer toe, as well as numbness and tingling, are
chronic complications associated with diabetes. Decreased sensitivity and
swelling (lipohypertrophy) occurs at the site of repeated insulin injections, and
treatment involves teaching the patient to rotate injection sites.
19. A patient with diabetes has hot, dry skin; rapid and deep respirations; and a fruity
odor to his breath. As charge nurse, you observe a newly-graduated RN
performing all the following patient tasks. Which one requires that you intervene
immediately?
Answer: B – Encouraging the patient to drink orange juice
Rationale: The signs and symptoms the patient is exhibiting are consistent with
hyperglycemia. The RN should not give the patient additional glucose. All of the
other interventions are appropriate for this patient. The RN should also notify the
provider at this time.
20. You are preceptor for a senior nursing student who will teach a diabetic patient
about self-care during sick days. For which statement by the student must you
intervene?
Answer: B - “Test your urine for ketones whenever your blood glucose level is
less than 240 mg/dL.”
Rationale: Urine ketone testing should be done whenever the patient’s blood
glucose is greater than 240 mg/dL. All of the other teaching points are
appropriate “sick day rules.” For dehydration, teaching should also include that if
the patient’s blood glucose is lower than her target range, she should drink fluids
containing sugar.
21. During the first 24 hours after a client diagnosed with Addisonian crisis, which
intervention should the nurse perform frequently?
Answer: C – Assess vital signs
Rationale: Because the client in Addisonian crisis is unstable, vital signs and
fluid and electrolyte balance should be assessed every 30 minutes until he’s
stable. Daily weights are sufficient when assessing the client’s condition. The
client shouldn’t have ketones in his urine, so there is no need to assess the urine
for their presence. Oral hydrocortisone isn’t administered during the first 24
hours in severe adrenal insufficiency.

22. The nurse is admitting a new client with a diagnosis of myxedema. During the
initial assessment, the nurse is most concerned when the client presents with
which findings?
Answer: D - Bradycardia and decreased intellectual function
Rationale: Myxedema is caused by hypothyroidism. Signs and symptoms of
hypothyroidism including slowing of the heart rate and decreased intellectual
functions, such as slurring speech, impaired memory, and inattentiveness.
Hypertension, weight loss, heat intolerance, emotional lability, and increased
appetite are all signs and symptoms of hyperthyroidism. Corneal ulcerations may
be seen in hyperthyroidism due to exophthalmos because edema behind the eye
may prevent eyelids from closing completely.
23. A client is scheduled for several tests. Which test should be performed after the
thyroid function tests?
Answer: D – Computed tomography scan of the head with contrast
Rationale: Constrast media contains iodine and can alter thyroid function test
results
24. A nurse is caring for a client with diabetes insipidus. Which laboratory value is
most important for the nurse to monitor?
Answer: D – Sodium
Rationale: Diabetes insipidus occurs as a result of decreased release of
antidiuretic hormone, which disturbs fluid and electrolyte balance, especially
sodium. Clients need to be closely monitored for hypernatremia.
25. The nurse is admitting a client who is diagnosed with untreated Cushing’s
syndrome. While performing the initial assessment, the nurse can expect to see
which of the following signs and symptoms?
Answer: A - Moon face and truncal obesity
Rationale: Overproduction of adrenocortical hormone results in redistribution of
fat, which manifests as a moon face, truncal obesity, and a buffalo hump. Weight
loss and heat intolerance indicate thyroid hormone overproduction. Changes in
skin texture and low body temperature indicate thyroid hormone underproduction.
Polyuria and dehydration indicate diabetic ketoacidosis.
26. The nurse administers tamsulosin (Flomax) to a client with benign prostatic
hyperplasia (BPH)? The nurse is aware that which of the following is a priority
assessment?
Answer: A – Voiding pattern
Rationale: The alpha-adrenergic blocker tamsulosin (Flomax) relaxes the smooth
muscle of the bladder neck and prostate, so the urinary voiding symptoms
(frequency, urgency, hesitancy) of BPH are reduced in many clients. These drugs

don’t affect the size of the prostate, renal function, or production of metabolism of
testosterone.
27. The client with an ileal conduit will be using a resusable appliance at home. The
nurse should teach the client to clean the appliance routinely with which product?
Answer: B – Soap
Rationale: A reusable appliance should be routinely cleaned with soap and water
28. The client is scheduled for an intravenous pyelogram (IVP) to determine the
location of the renal calculi. Which of the following measures would be most
important for the nurse to include in pretest preparation?
Answer: C – Checking the client’s history for allergy to iodine
Rationale: A client scheduled for an IVP should be assessed for allergies to
iodine and shellfish. Clients with such allergies may be allergic to the IVP dye
and be at risk for an anaphylactic reaction. Adequate fluid intake is important
after the examination. Bladder spasms are not common during an IVP. Bowel
preparation is important before an IVP to allow visualization of the ureters and
bladder, but checking for allergies is most important.
29. A client is complaining of severe flank and abdominal pain. A flate plate of the
abdomen shows urolithiasis. Which intervention is important?
Answer: A – Strain all urine
Rationale: Urine should be strained for calculi and sent to the laboratory for
analysis. Fluid intake of 3 to 4 qt (3 to 4 L) per day is encouraged to flush the
urinary tract and prevent further calculi formation. Ambulation is encouraged to
help pass the calculi through gravity. A low-calcium diet is recommended to help
prevent the formation of calcium calculi.
30. The nurse is providing instruction about skin care at the stoma site for a client
with an ileal conduit. What is the most important information for the nurse to
provide?
Answer: C - Clean the skin around the stoma with mild soap and water and dry it
thoroughly
Rationale: Cleaning the skin around the stoma with mild soap and water and
drying it thoroughly helps keep the area clean from urine, which can irritate the
skin. Change the appliance in the early morning when urine output is less to
decrease the amount of urine in contact with the skin. The stoma should be
covered with a gauze pad and when changing the appliance to prevent seepage of
urine onto the skin. The faceplate or wafer of the appliance shouldn’t be more
than 3 mm larger than the stoma to reduce the skin area in contact with urine.
31. A client has a transurethral prostactectomy for benign prostatic hypertrophy and is
currently being treated with a continuous bladder irrigation. He’s complaining of

an increase in severity of bladder spasms. Which intervention should the nurse do
first?
Answer: D - Check for the presence of clots and make sure the catheter is
draining properly
Rationale: Blood cots and blocked outflow of the urine can increase spasms. The
irrigation shouldn’t be stopped as long as the catheter is draining because clots
will form. A belladonna and opium suppository should be given to relieve spasms
but only after assessment of the drainage. Oral analgesics should be given if the
spasms are unrelieved by the belladonna and opium suppository.
32. A client has returned from surgery with continuous bladder irrigation. The nurse
is aware that proper maintenance of a continuous bladder irrigation system
includes:
Answer: B - Regulating irrigant flow to maintain pink urine
Rationale: The irrigant should be infused at a rate fast enough to maintain pink
urine. Red urine indicates inadequate irrigation and possible clot formation.
Bladder distension shouldn’t occur as long as the system is draining properly and
no clots are obstructing the outflow of urine. Leakage of urine around the
catheter indicates the clot formation on the catheter tip, needing manual irrigation.
The irrigation should be stopped because of the potential for clot formation.
33. A client is diagnosed with prostate cancer. The physician is most likely to order
which test to monitor the client’s progress?
Answer: C - Prostate-specific antigen (PSA)
Rationale: The PSA test is used to monitor prostate cancer progression; higher
PSA levels indicate a greater tumor burden. Serum creatinine levels may suggest
blockage from an enlarged prostate. CBC is used to diagnose anemia and
polycythemia. Serum potassium levels identify hypokalemia and hyperkalemia.
34. A sterile urine specimen for culture and sensitivity has been ordered for a patient
who has an indwelling urinary catheter. How should the nurse obtain this
specimen?
Answer: A - Withdraw several millimeters of urine from the port on the
collection tubing, using a syringe and needle
Rationale: When it is necessary to collect a urine specimen from a patient with an
indwelling catheter, it should be obtained from the catheter itself using the special
port for specimens. A specimen from the collecting receptacle (drainage bag)
may not be fresh urine and could result in an inaccurate analysis. A patient’s
catheter would not be removed for the sole purpose of obtaining a urine specimen.

35. The nurse is providing discharge instructions for a client treated for acute
pyelonephritis. What is the most important information for the nurse to include?
Answer: B - Return for follow-up urine cultures
Rationale: The client needs to return for follow-up urine cultures because
bacteriauria may be present but asymptomatic. Intake of dairy products won’t
contribute to pyelonephritis. Antibiotics need to be taken for the full course of
therapy regardless of symptoms. Pyelonephritis typically recurs as a relapse or
new infection and frequently recurs within 2 weeks of completing therapy.
36. A client who will have his last chemotherapy cycle in 11 days becomes
neutropenic. The client understands his condition when he states:
Answer: A - “I’ll monitor my temperature frequently and go to the nearest
emergency department if my temperature rises above 100.4°F.”
Rationale: The client understands his neutropenic state when he states that he’ll
monitor his temperature frequently and go to the emergency department if his
temperature rises above 100.4°F. Neutropenic clients should avoid crowds, eating
fresh fruits and vegetables, and working in the garden – all of which place the
client at risk for infection.
37. A client received chemotherapy 24 hours ago. Which precautions are necessary
when caring for the client?
Answer: C - Wear personal protective equipment when handling blood, body
fluids, and feces
Rationale: Chemotherapy drugs are present in the waste and body fluids of
clients for 48 hours after administration. The nurse should wear personal
protective equipment when handling blood, body fluids, or feces. Gloves offer
minimal protection against exposure. The nurse should wear a face shield, gown,
and gloves when exposure to blood or body fluid is likely. Placing incontinence
pads in the regular trashcan and providing a urinal or bedpan don’t protect the
nurse caring for the client.
38. A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies
the lesion according to the TNM staging system as follows: TIS, N0, M0. What
does this classification mean?
Answer: B - Carcinoma in situ, no abnormal regional lymph nodes, and no
evidence of distant metastasis
Rationale: TIS, N0, M0 denotes carcinoma in situ, no abnormal regional lymph
nodes, and no evidence of distant metastasis. No evidence of primary tumor, no
abnormal regional lymph nodes, and no evidence of distant metastasis is classified
as T0, N0, M0. If the tumor and regional lymph nodes can’t be assessed and no
evidence of metastasis exists, the lesion is classified as TX, NX, M0. A
progressive increase in tumor size, no demonstrable metastasis of the regional

lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2,
T3, or T4; N0; and M1, M2, or M3.
39. After cancer chemotherapy, a client experiences nausea and vomiting. The nurse
should assign highest priority to which intervention?
Answer: C - Administering metoclopramide (Reglan) and dexamethasone
(Decadron) as prescribed.
Rationale: Administering an antiemetic, such as metoclopramide, and an antiinflammatory agent, such as dexamethasone, may reduce the severity of
chemotherapy-induced nausea and vomiting. This, in turn, helps prevent
dehydration, a common complication of chemotherapy. The other options are less
likely to achieve this outcome.
40. Which statement by a client undergoing external radiation therapy indicates the
need for further teaching?
Answer: D - “I will expose my family members to radiation.”
Rationale: The client undergoing external radiation therapy requires further
teaching when he voices a concern that he might expose his family to radiation.
Internal radiation, not external radiation, poses a risk to the client’s family. The
client requires no further teaching if he states that he should wash his skin with
mild soap and water, wear protective clothing when outside, and avoid using a
heathing pad.