Chapter 43: Musculoskeletal System Introduction

1. A nurse questions an older patient about the age-related changes she has experienced in her
connective tissue, which have lessened her mobility. What do these changes most commonly
include? (Select all that apply.)
a. Loss of bone mass, which may cause fragile bones
b. Decline in muscle mass, causing loss of strength
c. Bony deposits in the joints, causing pain and altered movement
d. Loss of cartilage, causing more friction in joints
e. Diminished energy, causing decreased activity

1.A 51-year-old professional tennis instructor is newly diagnosed with osteoarthritis. What is the
nurse’s best explanation to the patient when asked what this diagnosis means? a. Presence of
antibodies in the synovial fluid
b. Dislocation of the patella over the tibia
c. Degeneration of articular cartilage
d. Body’s autoimmune response
2. A nurse explains to a patient with rheumatoid arthritis that the drug leflunomide (Arava) is a
disease-modifying antirheumatic drug (DMARD). What is the action of this medication?
a. Retards the progress of the disease
b. Builds new bone
c. Decreases inflammation
d. Increases flexibility
3. A nurse is caring for a patient with osteoarthritis. What is the best recommendation by the nurse to
this patient to control chronic pain?
a. Administer analgesics only when needed.
b. Administer analgesics as prescribed on a routine basis.
c. Plan activities with no rest periods to complete the activities quickly.
d. Wear high-heeled shoes to keep the body in alignment.
4. An older patient with osteoarthritis complains of stomach discomfort and shortness of breath after
years of taking aspirin for pain relief. What change in pain control medication would be most
appropriate for the home health care nurse to suggest?
a. Nonsteroidal anti-inflammatory drugs (NSAIDs)
b. Oral corticosteroids
c. Mild exercise
d. Warm baths
5. A home health care nurse is visiting a patient after a total hip replacement. What should the nurse
include when teaching the patient how to protect the new joint?
a. Put an extension on the toilet seat.
b. Keep the legs crossed when at rest.
c. Frequently change positions from side to side.
d. Slowly pull the knee to the chest twice a day to stretch the hip abductors.
6. After a knee replacement, an 87-year-old patient rejects the use of the continuous passive motion
(CPM) machine, saying, “I did not march when I was a child, and I am not marching now.” What
benefits of CPM should the nurse point out to encourage patient use?
a. Decrease in pain
b. Increase in circulation in the new joint
c. Increase in leg strength
d. Increase in flexibility for the new joint
7. What do connective tissue diseases affect?
a. Bones, ligaments, cartilage, and tendons
b. Bones, ligaments, and tendons
c. Spurs, ligaments, cartilage, and tendons
d. Tendons, cartilage, and tophi
8. Which patient is most likely to develop a connective tissue disease?
a. A teenage girl who swims
b. A 30-year-old woman who plays tennis
c. A 35-year-old male golfer
d. A 40-year-old male computer analyst
9. Which is true regarding connective tissue function?
a. Helps provide a source of storage for calcium
b. Stores hormones in the pores of bone tissue
c. Controls the distribution of minerals
d. Provides protection to body parts
10. Which characteristic should a nurse recognize as diagnostic of rheumatoid arthritis?
a. Absence of pain
b. Symmetric bilateral joint swelling
c. Evening stiffness that improves with activity
d. Increased appetite
11. A patient asks why systemic glucocorticoid medications are used as the last choice for the treatment
of rheumatoid arthritis. What is the nurse’s most informative reply? a. “The other drugs are just as
effective and work in similar ways.”
b. “They are used as a last choice or for short periods because they have many side effects.”
c. “Those drugs are given three or four times daily, which is more difficult for
patients to remember.”
d. “A higher incidence of vomiting occurs with prolonged use.”

12. A nurse, in conjunction with a patient, establishes a plan to treat the pain associated with arthritis.
What is the most effective strategy?
13. a. Avoid exercise to spare painful joints.
b. Use narcotics for pain relief.
c. Apply warm, moist compresses before doing activity.
d. Avoid assistive devices that encourage dependence.
14. What is the best physiologic reason for a patient with osteoporosis to maintain a regular exercise
regimen?
a. Involves the patient in her or his own care
b. Increases cardiac output
c. Promotes better mental health
d. Promotes bone formation and improves strength
15. A nurse is organizing a teaching plan for a patient with gout. What should the nurse caution this
patient he is at an increased risk for?
a. Kidney stones
b. Tophi
c. Visual disturbances
d. Facial lesions
16. A nurse is educating a patient with gout about a low-purine diet. Which food choice by the patient
would indicate the need for further teaching?
a. Pizza with pepperoni
b. Seafood platter with scallops and mussels
c. Chicken salad with nuts
d. Tuna sandwich with potato chips
17. A nurse is caring for a patient immediately after total knee replacement surgery. What assessment
requires priority?
a. Quality of pulses in the affected limb
b. Degree of nausea and vomiting
c. Understanding of the procedure
d. Amount of pain
18. Inadequate nutrition is the patient problem applicable to a patient with progressive systemic
sclerosis. What is the most important point for the nurse to teach this patient? a. Eat three large
meals spaced throughout the day.
b. Schedule rest periods to prevent overtiring.
c. Severe stress can trigger vasospasm.
d. Eat smaller, more frequent meals.
19. What instruction should a nurse include in a teaching plan for a patient with carpal tunnel
syndrome?
a. Anticoagulants and glucocorticoids
b. Methotrexate
c. Lubricating ointments
d. Splinting to prevent flexion and hyperextension
20. Two days after a total hip replacement, a patient is being discharged. Which statement indicates that
the patient understands the discharge teaching? a. “I can sit comfortably with my legs crossed.”
b. “I will ask my husband to tie my shoes for me.”
c. “I am glad I won’t have to use that bulky pillow between my legs at night.”
d. “My straight dining room chair will be helpful when I do the hip flexion exercises.”
ANS: B
21. What action would best benefit the patient diagnosed with bursitis of the shoulder?
a. Lifting a 5-lb weight as a daily exercise
b. Walking the fingers of the affected arm up the wall
c. Splinting the affected arm to keep the shoulder immobile
d. Performing gentle push-ups on the floor
1. What are the goals of therapy for patients with rheumatic arthritis? (Select all that apply.)
a. Decrease inflammation.
b. Balance activity and rest.
c. Promote adaptation to limitations.
d. Plan frequent periods of bed rest.
e. Supply patient education and support.
2. What actions would be best for patients with osteoarthritis to seek the assistance of physical
therapy? (Select all that apply.)
a. Isotonic exercises
b. Moist heat application
c. Instruction with a transcutaneous electrical nerve stimulation (TENS) unit
d. Measures to increase range of motion
e. Measures to increase strength
 3. What signs of progressive systemic sclerosis does the anonym CREST represent? (Select all that
apply.)
a. Calcinosis
b. Rash
c. Esophageal dysfunction
d. Sore joints
e. Telangiectasis

Chapter 45: Fractures

1. Two days after surgery for a crushed pelvis, a certified nursing assistant (CNA) reports that the
patient is complaining of a shortness of breath and is demonstrating signs of confusion and
restlessness. What should a nurse suspect, from these signs alone, that the patient has developed?
a. Impending shock
b. Fat embolus
c. Anxiety
d. Neurovascular compromise
2. What should a nurse teach an older patient with a newly casted Colles fracture?
a. Apply cool compresses to the cast.
b. Let the hand and arm dangle to increase the drainage.
c. Keep the hand immobile to reduce swelling.
d. Move the shoulders to reduce contractures.
3. A patient who has osteomyelitis after multiple fractures inquires what the physician meant when he
said that surgery would follow the antibiotic therapy. What is the nurse’s most helpful reply to
explain why this surgery will be performed?
a. To remove dead bone
b. To close the open draining wound
c. To close the area with casting material
d. To amputate
4. A patient with a crushed forearm cannot get pain relief with opioid medications. The injury is
swollen, cool, and cyanotic, with weak distal pulses. What should the nurse suspect?
a. Compartment syndrome
b. Overwhelming infection
c. Fat embolus
d. Osteomyelitis
5. A patient who sustained a simple fracture of the left fibula 7 days earlier asks in what stage of bone
healing he might be. What stage of healing should the nurse relay to the patient?
a. Hematoma formation
b. Ossification
c. Callus formation
d. Fibrocartilage formation
6. Which assessment is of the greatest concern to a nurse when caring for a patient just admitted with a
pelvic fracture?
a. Pain level rating of 8 on a scale of 1 to 10
b. No urinary output for 8 hours
c. Evidence of bruising along the patient’s hips and buttocks
d. Complaints of the need for back care from resting in bed

7. An older woman falls down at church and immediately complains of severe pain in her left hip.
Which observation is recognized as the cardinal sign of a fractured hip?
a. Shortened left leg compared with the right
 b. Downward curled toes
c. Internal rotation of the left leg
d. Hematoma on the left hip

8. A patient has just had a plaster of Paris upper extremity cast placed because of a fractured radius.
Which statement indicates that the patient understands the discharge teaching related to cast care?
a. “When I get home, I will remove some of the padding if it feels tight so my fingers don’t swell.”
b. “When I get home, I will wrap the cast in plastic so it will conserve the heat.”
c. “When I get home, I will use a spoon handle to scratch inside if my arm itches.”
d. “When I get home, I am going to rest in bed with my arm elevated above my heart.”
9. What special precaution should a nurse implement when assisting with the application of a short
arm plaster cast?
a. Dampen the skin to make the stockinette adhere.
b. Tape the arm before applying the stockinette.
c. Smooth the stockinette to prevent a pressure ulcer.
d. Roll the stockinette tightly above and below the margins of the cast.
10. An older patient who sustained a fractured hip and femur in a motor vehicle accident is to be in
Russell traction for several weeks. What should be the focus of care for the nurse?
a. Offering frequent distractions
b. Encouraging nutrition
c. Offering pain relief
d. Preventing deep vein thrombosis (DVT)
11. A 78-year-old retired teacher with a history of osteoporosis has fallen in her bathroom and sustained
a subcapital femoral fracture. She is scheduled for an open reduction and internal fixation (ORIF)
procedure in the morning. Which type of traction will most likely be implemented?
a. Bryant
b. Buck
c. Pelvic
d. Crutchfield tongs
12. A nurse is told that a patient has a compound comminuted fracture. What characteristic of the bone
in this type of fracture causes the nurse to be concerned?
a. It is bent but not completely broken, and the bent piece protrudes through the skin.
b. It is compressed, and bone pieces protrude through the skin.
c. It is twisted, and the fragments are separated.
d. It is broken into two or more pieces, and bone fragments protrude through the skin.
13. A patient with bilateral avascular necrosis of the hips is to walk with crutches using a four-point gait
for 6 weeks after her bone decompression surgeries. Which statement would indicate that the patient
understands this technique?
a. “The axillary bars on the crutches should support my weight when I walk.”
b. “I will move both crutches and then swing my legs to the crutches—2 and 2 equals
4!”
c. “I will move my right crutch and then my left leg and then the left crutch and my right leg.”
d. “I will move both crutches and then swing my legs through the crutches together.”
14. What action should a nurse implement when caring for a patient diagnosed with a compound
fracture?
a. Limit narcotics for 8 hours after surgery.
b. Monitor the patient’s respirations every hour.
c. Assess for pulses distal to the injury.
d. Verify that the patient is not allergic to sulfa.
15. Assistive devices such as canes, crutches, and walkers are used for people who need to limit weight-
bearing activities on joints. Which statement by a nurse best illustrates an understanding of the
appropriate use of these devices?
a. “Canes provide minimal support and balance and are carried on the unaffected side.”
b. “When using a cane, slide it as you go to decrease the arm strain.”
c. “A three-point gait is used when walking with a walker.”
d. “When using crutches, the unaffected leg goes down the steps first.”
16. Which patient is most appropriate for a nurse to refer to home health care?
a. A married man with a laundry room on the first floor
b. A single woman with a bedroom in a rooming house
c. A student living in a college dormitory but going home to stay with parents
d. A woman staying with her daughter and son-in-law at their one-story home
17. What should a nurse who is documenting and reporting the signs and symptoms of an infection
underneath a cast include in the medical record?
a. Elevated temperature
b. Tingling and decreased sensation
c. Full pulses and absence of pain
d. Swelling and diminished motor function
18. Which patient problem has the highest priority after surgery for the open reduction and external
fixation of an ankle?
a. Potential activity intolerance
b. Potential for infection
c. Immobility
d. constipation
19. A patient in a full body cast (spica) complains of nausea and abdominal distention. What potential
complication should a licensed vocational nurse (LVN) suspect?
a. Constipation
b. Compartment syndrome
c. Cast syndrome
d. Shock
20. An older adult patient is at risk for constipation after sustaining a pelvic fracture. Which nutritional
suggestion by the nurse is most appropriate?
a. Select food with high sodium content.
b. Avoid foods high in dietary fiber.
c. While immobilized, drink at least 2 to 3 L of fluids daily.
d. Include milk products at every meal.
21. Which finding should produce the most concern when performing pin care for a patient with an
external fixator?
a. Crusts around the pin
b. Serous drainage on the dressing
c. Purulent drainage
d. Absence of pain
22. Which assessment is considered abnormal when a nurse performs a neurovascular assessment on a
patient in skeletal traction?
a. Delayed capillary refill
b. Bilateral equal pulses
c. Absence of pain and swelling
23. What action should a nurse implement when dealing with the weights that are applying traction to a
patient?
 a. Remove them to pull the patient up in bed.
b. Hold them while the patient is changing positions in bed.
c. Hold them for a few minutes if the patient complains of pain.
d. Allow them to hang freely.
24. Which is true about a greenstick fracture?
a. Line of the fracture goes across the bone in right angles to the longitudinal axis.
b. Periosteum is not torn away from the bone.
c. Fracture is incomplete, and one side is bent.
d. Fracture occurred in one of the long bones of the body.
25. A patient with a fractured pelvis says that she will not ambulate because of pain. What should a
nurse inform the patient can be prevented with early ambulation?
a. Back injury
b. DVT
c. Callus formation
d. Disuse syndrome
1. To what can delayed union of a fracture be attributed? (Select all that apply.)
a. Inadequate immobilization
b. Hormone replacement therapy
c. Long-term use of corticosteroids
d. Infection
e. Poor nutrition
2. Which characteristics are present when crutches are properly fitted? (Select all that apply.)
a. The axilla piece is 3 to 4 fingerbreadths below the axilla.
b. They fit close to the axilla for secure support.
c. They are measured and adjusted when the patient is in the tripod position.
d. Adjusted hand grips allow for a 45-degree flexion of the elbow.
e. They are padded so patient can bear weight on the axilla piece when ambulating.
1. A nurse uses a diagram to show the process of a fractured bone healing. (Arrange the
options in the appropriate sequence. Do not separate answers with a space or punctuation.
Example: ABCD.) a. Ossification
b. Hematoma
c. Fibrocartilage
d. Consolidation
e. Callus

2. Arrange the process of stair climbing with crutches in the correct sequence: (Arrange the
options in the appropriate sequence. Do not separate answers with a space or punctuation.
Example: ABCD.)
a. Body weight is supported with crutches.
b. Crutches are moved to the next step.
c. The affected leg moves to the next step.
d. The unaffected leg is moved to the next step.
e. Body weight is transferred to the unaffected leg.

ANS:
ADEBC
Chapter 46: Amputations

1. A nurse is aware that a patient who is having his leg amputated is also having a prosthesis fitted
during at the same time as the surgery. Which fact should the preoperative teaching plan include?
 a. Extra preoperative medications will be needed.
b. A rigid dressing will be applied to accommodate the prosthesis.
c. A series of temporary prostheses will be put in place before the permanent one.
d. Wiring the residual limb will be needed to ensure acceptance of the prosthesis.
2. A patient asks when he should expect to be up and walking after his below-the-knee amputation.
When should the nurse assure him that most people with amputations can fully bear weight? a. 3
weeks
b. 1 month
c. 6 weeks
d. 3 months
3. A nurse is conducting a safety seminar and reminds the audience that upper extremity amputations
are most frequently caused by trauma. Which population has the highest incidence of this type of
amputation? a. School-aged girls
b. School-aged boys
c. Young men
d. Young women
 An 80-year-old man with diabetes has had vascular problems with his feet and lower legs for 10
years and is scheduled for a left below-the-knee amputation. Which remark by the patient
indicates an understanding of the procedure?
a. “I am glad this amputation will end my diabetic problems.”
b. “After they have hacked my leg, I won’t be able to drive.”
c. “If this heals well, how long until I get a prosthesis?”
d. “I hate that my left knee is going to be useless without a foot.”
4. What routine preoperative diagnostic tests are appropriate for a patient anticipating a below-the-
knee amputation?
a. Pulse volume recording and white blood cell (WBC) count
b. Cardiac catheterization and WBC count
c. Pulse volume recording and radiographic images
d. Thermography and cardiac catheterization
5. Where is the limb severed with an elbow disarticulation?
a. Just above the elbow joint
b. Just below the elbow joint
c. Between the shoulder and elbow
d. Through the elbow joint
6. A patient with peripheral vascular disease (PVD) and diabetes asks what he can do to help prevent
an amputation. What is the best response of the nurse?
a. “There is not really anything you can do to help.”
b. “Stopping smoking would help prevent vasoconstriction.”
c. “You will not need to check your blood glucose levels.”
d. “It is important to eat big meals so your body can heal.”
7. Why is a closed amputation usually performed?
a. To create a weight-bearing residual limb
b. To alleviate the effects of trauma
c. To allow infection to heal and drain
d. To treat a limb with gangrene
8. What controls the movement with a myoelectrically controlled prosthesis?
a. Patient’s muscle movement and the prosthesis
b. Battery-operated muscles implanted in the prosthesis
c. Motion-sensing mechanism that swings the prosthesis forward
d. Internal computer chip in the prosthesis
9. A patient who had a below-the-knee amputation 24 hours earlier is complaining of burning pain in
his left foot. Which intervention is most appropriate for the nurse to implement? a. Remind the
patient that it is only phantom pain.
b. Medicate the patient with the prescribed pain remedy.
c. Remind him that such sensations will go away in a few weeks.
d. Distract the patient with conversation.
10. During the admission of a patient scheduled for an amputation, a patient relates that she is a
practicing Orthodox Jew. What arrangements are appropriate for the nurse to make for this patient?
a. A veil should cover the amputated part.
b. A rabbi must be present for the surgery.
c. The amputated part should be buried.
d. A family member should be present to read the Torah.
11. What is an appropriate outcome for a patient with feelings of anxiety related to a perceived threat of
disability?”
a. Comfort is increased; verbalized pain is less.
 b. Anxiety is relieved; the patient verbalizes concern related to disability.
c. Grief is resolved; the patient expresses an acceptance of loss.
d. Residual limb is cleaned; no exudate, redness, or edema is observed.
12. What is the greatest danger in the early postoperative period after an amputation? a. Infection
b. Hemorrhage
c. Pain
d. Edema
13. A nurse is caring for a patient who has undergone replantation of a body part. What might the saliva
of leeches be used to treat in this patient? a. Inadequate arterial blood flow
b. Venous insufficiency
c. Venous congestion
d. Increased arterial blood flow
14. A patient who amputated his thumb in a lawnmower accident hands the emergency
department nurse his thumb in a glass jar. What is the best action for the nurse to implement?
a. Place the thumb in a baggie with iced lactated Ringer solution.
b. Wrap the thumb in plastic wrap and place it on ice.
c. Leave the thumb in the jar and place it in the refrigerator.
d. Wrap the thumb in a cloth saturated with normal saline and place it in a baggie.
15. A patient who has a below-the-elbow prosthesis shows the home health care nurse the residual limb,
which is red, edematous, and warm to touch. What should the nurse instruct this patient to do?
a. Apply soothing lotion to the residual limb before replacing the prosthesis.
b. Dampen the prosthetic limb sock to hydrate and cool the residual limb.
c. Pad the socket with lamb’s wool and replace the prosthesis.
d. Leave the prosthesis off and notify physician.
16. A child comes to the school nurse with his index finger partially amputated and hanging by a shred
of skin and muscle. What is the best action by the nurse? a. Flush the hand with warm water and
wrap it in a towel.
b. Carefully cut the skin holding the finger and wrap the finger and hand in a clean towel.
c. Pinch the finger to stop the bleeding and take the child to the hospital.
d. Wrap the hand and finger securely and place it on an ice water–filled plastic bag.
17. What nursing action should be implemented in the postoperative care for a patient with replantation
of the right thumb?
a. Decreasing the temperature of the room to 70 F
b. Elevating the hand but keeping it below the level of the heartOffering coffee, tea, or cola to
help increase fluid intake
c. Placing an antiembolus sleeve on the right arm
18. A nurse is caring for a patient with a recent below-the-knee amputation. What should the nurse
recommend to this patient to prevent the loss of calcium and protein?
a. Drink 1 to 2 L of fluid daily.
b. Ingest at least four milk products each day.
c. Ambulate 30 minutes a day.
d. Take vitamin supplements daily.

19. What are late signs of hemorrhage in the postoperative period after an amputation?
a. Restlessness and increased respirations
b. Cyanosis and hypotension
c. Confusion and seizures
20. The verbalization of microvascular precautions is a criterion for measuring the achievement of
which outcome?
 a. Adequate circulation in the replanted limb
b. Pain relief
c. Patient knowledge of therapeutic measures
d. Adjustment to change in appearance and function
21. Which postoperative observation must be reported to the physician immediately?
a. Brownish-red drainage on the dressing, which is damp
b. Respirations of 20 breaths/min
c. Pulse of 72 beats/min
d. Bright-red bleeding
22. A home health care nurse suspects a neuroma in a patient who had an above-the-knee amputation 1
month earlier. Which complaint by the patient led the nurse to suspect a neuroma?
a. Area of swelling and bruising on distal portion of residual limb
b. Prickling sensation over residual limb
c. Sharp severe pain in the residual limb
d. Area of numbness on distal portion of residual limb
23. Which action should a nurse implement to diminish swelling of the residual limb in the
postoperative period after an above-the-knee amputation? a. Elevate the foot of the bed on blocks.
b. Elevate the residual limb on pillows.
c. Elevate the head of the bed 15 degrees.
1. Which major situational occurrences might lead to amputations? (Select all that apply.)
a.Trauma
b.Disease
c.Tumors
d. Congenital defects
e. Carelessness
2 What is a closed amputation designed to do? (Select all that apply.)
a.Prepare a weight-bearing limb.
b. Cover the stump with tissue and muscle.
c. Place sutures immediately over the bone.
d. Be staged to closure.
e. Be immediately ready for a prosthesis.
3 How should a nurse modify a teaching plan for an older adult who has had an above-the-knee
amputation? (Select all that apply.) a. Offer smaller units of information at a time.
b. Increase time for learning.
c. Place less emphasis on chronic health problems.
d. Clarify the reality of phantom pain.
e. Include frequent repetition.
TOP: Upper Body Training KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
Chapter 47: Endocrine System Introduction

1. A patient is receiving the medication octreotide (Sandostatin) as a treatment for acromegaly. What
should the nurse explain regarding this medication? a. It reverses the effects of acromegaly.
b. It should be given on a daily basis by injection.
c. It increases insulin secretion causing hypoglycemia.
d. It suppresses the growth hormone.
ANS: D
2. Which instruction should a nurse provide when a patient starts taking a saturated solution of
potassium iodide (SSKI)?
a. Sip medication through a straw to prevent tooth staining.
 b. Double the dose if a dose is missed.
c. Expect excessive salivation.
d. Take before meals.

3. Which significant need should be included in instructions to a patient scheduled for a thyroid scan
(123I)?
a. Provide a special container to collect urine for the next 24 hours.
b. Wear a protective apron to shield him or her from radiation for the next 24 hours.
c. Request that visitors keep a distance of at least 6 feet away for the next 24 hours.
d. Do not consume iodine for one week before the test..
 4. A patient asks about his laboratory test, which showed a high level of thyroid-stimulating hormone
(TSH) and a low level of T4. What is the most accurate explanation?
a. “It means that you have an inconsistency in your thyroid tests, and you will need more testing.”
b. “I am sorry. You will have to ask your physician about your laboratory results. We are not
allowed to discuss them.”
c. “The TSH is sending a message to your thyroid gland to increase production, but your
thyroid isn’t producing enough hormone.”
d. “That means that you will have to go on hormone therapy for the rest of your life.”
5. A patient has been given an antithyroid drug called methimazole. What appropriate nursing
implementations should be included?
a. Using special radioactive precautions for her urine for the first 24 hours
b. Monitoring her vital signs and withholding the medications if her pulse is greater than 100
beats/min
c. Teaching her to watch for and report any signs and symptoms of hypothyroidism or
infections
d. Keeping her on a low-calorie, low-protein diet
6. An older patient with hypothyroidism asks why her daily dose of thyroid hormone, which she has
taken for 15 years, has been reduced. What is nurse’s best rationale when explaining what the
decreased dose is related to?
a. Improved efficacy of the thyroid preparation
b. Age-related reduction in metabolic rate
c. Drug-related hypertrophy of the thyroid
d. Changes in your diet and activity level

MULTIPLE RESPONSE

1. A nurse makes a list of symptoms that a patient who is taking methimazole (Tapazole), a
thionamide drug, should report. What should this list include? (Select all that apply.) a. Becoming
pregnant
a. Jaundice
b. Blood in the stool
c. Rash
d. Urine retention
2. What are the common age-related changes in the endocrine system? (Select all that apply.)
a. Diminished response to antidiuretic hormone (ADH).
b. Decline in growth hormone (GH) production.
c. Reduction in protein synthesis.
d. Decreased risk for hypothyroidism.
e. Decline in cortisol secretion.

Chapter 48: Pituitary and Adrenal Disorders

1. What should preoperative teaching for a patient scheduled for a transsphenoidal hypophysectomy
include that the patient should do postoperatively? a. Avoid sneezing.
b. Drink through a straw.
c. Cough forcefully.
d. Wash mouth out with peroxide.
2. What hormone causes the features of a patient with acromegaly?
a. Prolactin
 b. Growth hormone
c. Thyroid-stimulating hormone
d. Adrenocorticotropic hormone
3. What are the classic symptoms of diabetes insipidus (DI)?
a. Diuresis, dehydration, and thirst
b. Dizziness, hypertension, and excitability
c. Stress incontinence, vomiting, and edema
d. Bradycardia, insomnia, and muscle cramps
4. A patient states that he is confused because the physician told him that his diabetes insipidus (DI) is
nephrogenic. What should the nurse state when describing the difference between nephrogenic DI
and neurogenic DI?
a. Nephrogenic DI will eventually resolve without medication.
b. Nephrogenic DI requires the nasal spray lypressin.
c. Nephrogenic DI does not respond to ADH.
d. Nephrogenic DI will require dialysis.
5. A 14-year-old adolescent male patient has been diagnosed with Addison disease. Which effect of
Addison disease should this patient be aware of? a. He will not develop pubic hair.
b. He will grow a heavy beard.
c. He will become bald at an early age.
d. He will have enlarged joints.
What is the cardinal indication of a pheochromocytoma?
a. Significant hypertension
b. Extreme nausea
c. Abdominal pain
d. Edema in the legs

6. A nurse is caring for a patient diagnosed with Addison disease. Which signs and symptoms should
lead the nurse to suspect an adrenal crisis? a. Hypertension and abdominal pain
b. Confusion and tachycardia
c. Bradycardia and nausea
d. Widening pulse pressure and shortness of breath
7. A nurse includes in the discharge plan for a patient with Addison disease, “Potential for injury.”
What should measures to deal with this include? a. Arranging for uncluttered floor space
b. Rising slowly from a lying position
c. Keeping the room well lit
d. Providing instructions in the use of a walker
8. What should a nurse include when planning education to a patient with Addison disease?
a. Discontinue hormonal replacement therapy if the patient becomes nauseated or has diarrhea.
b. Decrease medication if the patient is under stress or is being treated for an infection.
c. Wear a medical alert tag and carry emergency dexamethasone.
d. Begin a vigorous exercise program to overcome weakness and muscle wasting.
9. A patient with long-term asthma develops Cushing syndrome. What is the cause of this condition?
a. Taking corticosteroids for many years
b. Abruptly withdrawing cortisone therapy
c. Lacking ACTH, related to the pituitary gland
d. Poorly functioning adrenal glands
10. Which findings are expected when assessing a patient with Cushing syndrome?
a. Edema of the trunk, extremities, and face
b. Wasting of the abdomen with thick, calloused skin
 c. Excess adipose tissue in the trunk, slender extremities, and moon face
d. High levels of potassium and low levels of sodium, weakness, and wasting
11. Which statement by a patient diagnosed with Cushing syndrome leads a nurse to conclude that
teaching has been effective?
a. “I know I should add salt to everything I eat.”
b. “I make a point to avoid excessive exposure to sun.”
c. “I avoid being exposed to anyone with an infection.”
d. “I am careful to wear well-fitting shoes.”
12. A nurse is assessing a patient with Simmonds cachexia. What symptom should the nurse anticipate
the patient will exhibit? a. High body temperature
b. Ruddy complexion
c. Silky body hair
d. Muscle wasting

13. A nurse making a care plan for a 10-year-old boy with hyperpituitarism identifies an altered body
image. What should the nurse relate this nursing diagnosis to? a. Lack of facial hair
b. Excessive height
c. Small genitalia
d. Skin eruptions on the face
14. What should a nurse include when caring for a patient after a hypophysectomy, during which the
entire pituitary was removed?
a. Maintaining strict intake and output fluids
b. Keeping the patient flat in bed for the first 24 hours
c. Withholding analgesics to assess the level of consciousness
d. Providing mouth care with thorough cleansing of the oral cavity
15. What can bring on an addisonian crisis?
a. Sudden atmospheric temperature change
b. Hyperglycemia
c. Infection
d. Change of altitude
16. A 6-foot, 2-inch, 16-year-old girl who is being treated for hyperpituitarism says, “I can’t stand it that
I look like a freak.” What is the nurse’s best response? a. “Gigantism is treatable.”
b. “Your height could help you be a basketball star or a model.”
c. “What is it about your height that makes you a freak?”
d. “Your height is something you will have to get used to.”
17. A patient with hypopituitarism must take medications for the rest of his or her life. What should the
patient teaching plan include?
a. “Constipation must be prevented because straining increases intracranial pressure.”
b. “You must become familiar with the signs and symptoms of inadequate or excessive
hormone replacement.”
c. “It is not necessary to wear a medical alert bracelet or necklace.”
d. “Your self-image is important. Take positive steps to improve your appearance.”
e.
18. Two days after a hypophysectomy a patient complains of a headache and nuchal rigidity.
What action should the nurse take based on these assessments?
a. Medicate with the prescribed analgesic.
b. Report suspected meningitis to the head nurse.
c. Closely monitor the patient’s blood pressure.
 d. Elevate the head of the bed to 45 degrees.
19. A nurse is caring for a patient with diabetes insipidus (DI). Which signs should the nurse report that
indicate a change in condition? a. Dropping blood pressure
b. Light clear urine
c. Moist mucous membranes
d. Excessive thirst
e. Large urine output
1. What symptoms should a nurse expect a patient with the diagnosis of SIADH to report during an
intake interview? (Select all that apply.) a. Headache
b. Hypotension
c. Weight gain
d. Muscle cramps
e. Weakness
2. An 18-year-old girl is diagnosed with adenoma of the pituitary gland. What signs of this
diagnosis should the nurse assess? (Select all that apply.) a. Cessation of menses
b. Milk production
c. Excess body hair
d. Excessive urine output
and Comfort
Chapter 49: Thyroid and Parathyroid Disorders

1. A physician ordered T3 and T4 tests for a young woman complaining of fatigue, weight gain, muscle
aches and pains, and constipation. Which laboratory test results will help confirm the diagnosis of
hypothyroidism? a. Both tests show decreases.
b. Both tests show increases.
c. The T3 test elevates, and the T4 test decreases.
d. The level of thyroxin rises and then falls back to subnormal levels.
2. A patient with a hyperthyroid complains of fatigue but still cannot get to sleep. What is the best
suggestion by the nurse?
a. Taking “cat naps” during the day
b. Adhering to a bedtime ritual
c. Drinking a cup of cocoa before bedtime
d. Performing mild prebedtime exercises
3. A patient with exophthalmos is distressed about her appearance and asks when it will go away.
What is the best response by the nurse? a. It is not reversible.
b. It can be disguised with sunglasses and makeup.
c. It usually subsides after medication for hyperthyroidism is started.
d. It can be minimized with plastic surgery to the eyelids.
4. A nurse is explaining Graves disease to a newly diagnosed patient. Which statement by the nurse
best clarifies the pathophysiologic changes of Graves disease?
a. “Your thyroid gland is not producing enough hormones; consequently, you will need replacement
therapy.”
b. “Your thyroid gland is overactive, but there are ways to treat it through medicine or surgery.”
c. “It’s an autoimmune disorder that has no satisfactory treatment.”
d. “Graves disease is a temporary disorder that will gradually subside.”
5. the patient’s color is poor, the pulse and respirations are rapid, and the patient feels warm to the
touch. The patient says that she feels frightened. What is the best initial implementation by the
nurse?
a. Tell her that there is nothing to be afraid of and stay to calm her.
b. Ask her if she would like pain medication.
c. Call the charge nurse; these are signs of a thyroid storm.
d. Get a tracheostomy set at the bedside.
6. What is the most appropriate nursing concern for the patient recently diagnosed with
hyperthyroidism? a. Hypothermia
b. Constipation
c. Disturbed body image
d. Disturbed sleep pattern
7. A patient, newly diagnosed with hypothyroidism, is anxious to begin her drug regimen. What
should the nurse’s instructions relative to hormone replacement include?
a. “Be certain that no dose is skipped.”
b. “Be sure and take these drugs just before bedtime.”
c. “Know the signs and symptoms of hyperthyroidism.”
d. “You will be able to notice the benefits of thyroid replacement therapy right away.”
8. What patient recommendation should a nurse include when preparing to present presurgical
teaching of a patient scheduled for a subtotal thyroidectomy?
a. Lie flat on her back for 24 hours to prevent undue strain on the suture line.
b. Be able to verbalize the signs and symptoms of thyroid crisis.
c. Demonstrate how to deep breathe and support her head during position changes.
d. Have a tube in her trachea to assist in breathing.
9. On returning from surgery after undergoing a thyroidectomy, a patient is alarmed about the large
tracheostomy tray on the bedside table. What is the nurse’s most reassuring response when the
patient asks why it is there?
a. “We have it there as a precautionary measure in the unlikely event that you have difficulty
breathing.”
b. “If you start bleeding, we’ll be able to take care of it right here at the bedside.”
c. “We have to keep it there in case of an emergency and the physician needs it.”
d. “It’s hospital policy to have it available for persons who are likely to have respiratory arrest.”
10. What is the appropriate action of the nurse when assessing for hemorrhage in a post-thyroidectomy
patient?
a. Assess upper chest for the patient positioned in high Fowler position.
b. Turn the patient to the side to check; the patient must be kept flat in the bed.
c. Lift up the neck dressing to assess for excessive bleeding.
d. Examine behind patient’s neck and upper back to assess for hemorrhage.
11. How do foods such as soybeans, turnips, and rutabagas affect people with thyroid disorders?
a. Suppress thyroid hormone.
b. Decrease the hypothermia of the person with hypothyroidism.
c. Supplement the diet of a person with hypothyroidism.
d. Counteract the effect of iodide therapy.
12. A nurse taking the blood pressure of a patient who had a total thyroidectomy 2 days earlier notes
that the patient’s hand goes into a carpopedal spasm. What should the nurse recognize this
movement as an indication of? a. Hyperkalemia, called the Allen sign
b. Hypernatremia, called the Hogan sign
c. Hypocalcemia, called the Trousseau sign
d. Hypokalemia, called the Chvostek sign
13. What action should a nurse implement to address dry skin in the patient with hypothyroidism?
a. Increase the frequency of bathing to get rid of dry skin.
b. Apply lotions and creams to help maintain moisture.
c. Increase activities to stimulate circulation in the skin.
d. Take antihistamines to prevent itching.
14. What action should a nurse implement to initiate the Chvostek sign?
a. Ask the patient to grimace and note if the facial response is symmetrical.
b. Inflate a blood pressure cuff to the systolic level and watch for a carpopedal spasm.
c. Tap the face over the facial nerve and watch for a spasm of the facial muscle.
d. Check the pupillary response to light and determine whether the pupil accommodates and reacts.
15. What symptoms should a nurse anticipate in the history of a patient with hyperparathyroidism?
a. Fatigue, hyperactive reflexes, muscle cramps, and twitching
b. Poor muscle tone, bone pain, urinary calculi, and fractures
c. Hunger, thirst, and urinary retention
d. Tachycardia, air hunger, and nervousness
16. What is the priority nursing concern for a patient with hyperparathyroidism?
a. Potential urinary obstruction
b. Decreased cardiac output
c. Potential for injury
d. Inadequate nutrition
 17. What is the nurse aware is happening when the patient with hypoparathyroidism complains of
fatigue and a lack of energy?
a. Hypertension is the cause of the fatigue.
b. Hypocalcemia has caused decreased cardiac output.
c. Dyspnea has sapped the patient’s energy.
d. Poor muscle tone makes any activity tiring.
18. Which intervention is necessary to assist a patient with hypothyroidism to understand how he can
live a full and normal life?
a. Teach the importance of taking antithyroid medication until it is no longer needed.
b. Encourage exercise to burn extra calories and maintain a normal weight.
c. Teach him to take care of energy needs through adequate nutrition.
d. Encourage treatment with thyroid replacement therapy.
1. Why are antithyroid medications provided presurgically to a patient with hyperthyroidism?
(Select all that apply.)
a. To decrease the level of hormone in the blood before surgery
b. To help reduce the risk of hemorrhage during surgery
c. To decrease the threat of a thyroid storm
d. To reduce exophthalmia
e. To increase weight
What should a nurse caring for a patient with hyperthyroidism include when developing a plan of
care? (Select all that apply.) a. Decreasing weight
b. Provision of a cool environment
c. Eye care
d. Nutritional support
e. Prevention of diarrhea
Chapter 50: Diabetes and Hypoglycemia
1. A nurse explains that type 1 diabetes mellitus is a disease in which the body does not produce
enough insulin. What is the reason that the blood glucose is elevated?
a. Prolonged elevation of stress hormone (cortisol, epinephrine, glucagon, growth hormone) levels
b. Malfunction of the glycogen-storing capabilities of the liver
c. Destruction of the beta cells in the pancreas
d. Insulin resistance of the receptor cells in the muscle tissue
2. A patient newly diagnosed with type 2 diabetes mellitus asks the nurse why she has to take a pill
instead of insulin. The nurse explains that in type 2 diabetes mellitus, the body still makes insulin.
What other information is pertinent for the nurse to relay?
a. Overweight and underactive people cannot simply use the insulin produced.
b. Metabolism is slowed in some people, so they have to take a pill to speed up their metabolism.
c. Sometimes the autoimmune system works against the action of the insulin.
d. The cells become resistant to the action of insulin. Pills are given to increase the sensitivity.
3. A patient tells a nurse that she eats “huge” amounts of food but stays hungry most of the time. What
should the nurse explain as the cause of hunger experienced by persons with type 1 diabetes?
a. Excess amount of glucose
b. Need for additional calories to correct the increased metabolism
c. Fact that the cells cannot use the blood glucose
d. Need for exercise to stimulate insulin secretion
4. What does the lack of insulin in patients with type 1 diabetes cause that increases the risk for
cardiovascular disorders?
a. High glucose levels that irritate and shrink the vessels
b. Inadequate metabolism of proteins, which causes ketosis
 c. Increased fatty acid levels
d. Increased metabolism of ketones, which causes hypertension
5. The self-care goal of a patient with diabetes is to keep the blood sugar within normal limits. What
causes hyperglycemia to occur?
a. Blood glucose levels rise, stimulating the production of insulin.
b. Insulin conversion of glycogen to glucose is inhibited.
c. The body responds to glucose-starved tissues by changing stored glycogen into glucose.
d. Glycogen is unable to be stored in the liver and muscles.
6. A young patient complains that diabetes is causing her to “have no life at all. It’s too hard.” What is
the most helpful response by the nurse? a. “Yes, you must make some sacrifices.”
b. “It’s hard, but with significant alterations in your lifestyle, you can live a long life.”
c. “What’s hard about exercise, diet, and medicine?”
d. “Let’s talk about what makes it so hard.”
ANS: D
Involving the patient in decisions about how she will cope with her diabetes will make the goals
more realistic and personal, which will give her a greater chance of success in meeting them.
7. When a patient with type 2 diabetes says, “Why in the world are they looking at my hemoglobin? I
thought my problem was with my blood sugar.” What should the nurse explain about the level of
hemoglobin A1c?
a. Shows how a high level of glucose can cause a significant drop in the hemoglobin level
b. Shows what the glucose level has done during the past 3 months
c. Indicates a true picture of the patient’s nutritional state
d. Reflects the effect of a high level of glucose on the ability to produce red blood cells (RBCs)
8. A patient with type 2 diabetes shows a blood sugar reading of 68 at 6 AM. What action should the
nurse implement based on the reading of 72 mg/dL? a. Notify the charge nurse of the reading.
b. Give regular insulin per a sliding scale.
c. Give him 8 oz of skim milk.
d. Administer the oral glucose tablet.
9. A nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that this is a life-
threatening condition. What will DKA result in?
a. Disorder of carbohydrates, fats, and proteins metabolism
b. Storage of glycogen, resulting in a severe shortage of glucose in the bloodstream
c. Dangerously elevated pH and bicarbonate levels in the blood
d. Severe hypoglycemia, which can result in coma and convulsions
10. A patient has been admitted to the hospital with the diagnosis of DKA. What vital signs should a nurse
anticipate that the patient will exhibit?
a. Temperature, 99 F; pulse, 62 beats/min; respirations, 16 breaths/min and shallow
b. Temperature, 98.6 F; pulse, 76 beats/min; respirations, 16 breaths/min and deep
c. Temperature, 98 F; pulse, 84 beats/min; respirations, 18 breaths/min and shallow
d. Temperature, 97.4 F; pulse, 110 beats/min; respirations, 26 breaths/min and deep
11. A home health care nurse is assessing a patient with type 1 diabetes who has been controlled for 6
months. The nurse is surprised and concerned about a blood glucose reading of 52 mg/dL. What action
by this patient most likely caused this episode of hypoglycemia?
a. Taking a new form of birth control pill this morning
b. Using large amounts of sugar substitute in her tea this morning
c. A 2-hour long exercise class at the spa this morning
d. Administering an insufficient dose of insulin this morning
12. As part of a teaching plan in preparation for discharge, a patient with type 1 diabetes needs guidelines
for exercise. Which guideline should be included?
a. Plan exercise so that it coincides with the peak action of insulin.
b. Insulin should be injected into the lower extremity before exercise because that site provides the
greatest absorption.
c. Exercise should be performed daily at the same time of day and at the same intensity.
d. Keep exercise at a minimum to conserve your energy.
13. A patient has come into the emergency department accompanied by a friend who states that the patient
had been acting very strangely and seems confused. The friend states that the patient has diabetes and
takes insulin. Which signs of hypoglycemia might the nurse assess?
a. Slow pulse rate and low blood pressure
b. Irritability, anxiety, confusion, and dizziness
c. Flushing, anger, and forgetfulness
d. Sleepiness, edema, and sluggishness
14. A patient has come to the physician’s office after finding out that her blood glucose level was 135
mg/dL. She states that she had not eaten before the test and was told to come and see her physician.
She asks the nurse if she has diabetes. What is the most accurate nursing response?
a. “Having a fasting serum glucose that high certainly indicates diabetes.”
b. “That test indicates that we need to perform more tests that are specific for diabetes.”
c. “How do you feel? Do you have any other signs of diabetes?”
d. “Do you have a family history of diabetes, stroke, or heart disease? We need to know
15. A nurse is formulating a teaching plan for a 22-year-old woman taking rosiglitazone (Avandia). What
should the nurse include information about in this plan to caution this patient?
a. Decreased effectiveness of her birth control pills
b. Excessive exposure to the sun
c. Sudden drop in blood pressure with dizziness
d. Possible severe diarrhea
16. A patient with type 1 diabetes has an insulin order for NPH insulin, 35 U, to be given at 0700. The
patient has also been instructed not to take anything by mouth (NPO) in preparation for laboratory
work that will not be drawn until 1000. What action should the nurse implement?
a. Give the insulin as ordered.
b. Give the insulin with a small snack.
c. Inform the charge nurse.
d. Hold the insulin until after the blood draw.
ANS: D
Holding the insulin to adhere to the NPO order is appropriate. The patient will not be getting food until
after the laboratory work; consequently, the insulin will not be needed until then. Giving the insulin as
ordered will create a possibility of hypoglycemia before the blood is drawn. Giving a snack to a
patient who is NPO is inappropriate.

DIF: Cognitive Level: Application REF: p. 986 OBJ: 8

TOP: Insulin with NPO Order KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

17. A patient comes to the diabetes clinic and confides to the nurse that she does not follow the diet
exchange program that she was given. What is the best response by the nurse? a. “The exchange
program is a carefully developed and very important program that allows you to take control of your
disease.”
b. “A lot of people have trouble with that program. You aren’t the first one to go off your diet.”
c. “We had better check your blood work to see what you’ve done to yourself.”
d. “Okay. Let’s talk about what you do eat and drink and how you manage your diabetes.”
18. A patient with type 1 diabetes asks why his 0700 insulin has been changed from NPH insulin to 70/30
premixed insulin. What is the best explanation by the nurse that explains about 70/30 insulin mixture?
a. It is absorbed more rapidly into the bloodstream.
b. It has no peak action time and lasts all day.
c. It makes insulin administration easier and safer.
d. It provides a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast.
19. What should a nurse include when drawing up a patient’s diabetes teaching plan?
a. Develop an exercise plan because regular exercise helps control blood glucose levels.
b. Monitor blood sugar levels only if not feeling well to ensure that the fingertips are not pricked too
much.
c. If nervousness, palpitations, or hunger is experienced, take a small dose (1 to 2 U) of regular insulin
and call the physician.
d. Use over-the-counter measures for any foot blisters, calluses, or wounds before seeking medical
help.
20. What has most likely occurred in a patient who has been diagnosed with endogenous hypoglycemia?
a. Taken an overdose of hypoglycemic drugs
b. Been following a very restricted fasting diet or is malnourished
c. Excessive secretion of insulin or an increase in glucose metabolism
d. Exercised unwittingly without replenishing needed fluids and nutrients
21. How long does it take for Humulin R 20 units to peak?
a. 15 minutes
b. 30 minutes
c. 1 hour
d. 2 hours

22. A nurse suspects that a patient with type 1 diabetes may be experiencing the Somogyi phenomenon.
What symptom supports this suspicion? a. Headache on awakening and enuresis
b. 6 AM blood sugar of 58 mg/dL and nausea
c. Abdominal pain and elevated blood pressure
d. Drowsiness and disorientation after eating
23. A patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS). The
blood glucose level is very high (880 mg/dL) on admission. The physician believes that the condition
is the result of large amounts of glucose solutions administered intravenously (IV) during renal
dialysis. What should the nurse anticipate that the patient would exhibit?
a. Fruity breath and a high level of ketones in her urine
b. Severe dehydration and hypernatremia caused by the hyperglycemia
c. Exactly the same symptoms and signs as DKA
d. Kussmaul respirations, nausea, and vomiting
1. What are functional causes of hypoglycemia? (Select all that apply.)
a. Dumping syndrome
b. Overdose of insulin
c. Addison disease
d. Prolonged muscular exercise
e. Chronic alcoholism
2. What should a teaching plan about foot care include for a patient with diabetes? (Select all that apply.)
a. Wash and carefully dry the feet every day.
b. Apply lotion between the toes.
c. Protect the feet from extreme temperatures.
d. Walk barefoot only indoors.
e. Buy shoes that are comfortable and supportive.
3. A teaching plan for a patient with diabetes is focused on smoking cessation and the control of
hypertension for the avoidance of microvascular complications. What are examples of microvascular
complications? (Select all that apply.) a. Macular degeneration
b. End-stage renal disease (ESRD)
c. Coronary artery disease (CAD)
d. Peripheral vascular disease (PVD)
e. Cerebrovascular accident (CVA)
4. How is the Whipple triad described? (Select all that apply.)
a. Symptoms of hypoglycemia are present.
b. Low blood glucose levels are documented when symptoms are present.
c. Symptoms can be reproduced with an injection of regular insulin, 10 units.
d. Muscular activity does not have any effect on blood glucose.
e. Symptoms improved when the blood glucose level rises.

Chapter 56: Integumentary System Introduction

1. Displaying her hands, a patient asks, “Do you think my liver is OK? Look at all these liver spots!”
What is the most appropriate nursing response?
a. “The spots could mean something is wrong; I will make a note of it.”
b. “The spots are normal aging changes and have nothing to do with your liver.”
c. “Have you recently been exposed to hepatitis?”
d. “Don’t worry about them. They will fade during the winter.”
2. A confused patient has been restrained because of combativeness and hyperactivity. What skin
assessment may occur as a result of the restraints? a. Lentigines
b. Senile purpura
c. Senile angiomas
d. Seborrheic keratoses
3. What should a nurse ask about when taking the functional assessment of a patient with a skin
disorder?
a. A sore that is slow to heal
b. Unusual hair growth
c. Previous skin disorders
d. Exposure to chemicals or irritants
 4. A daughter of an older adult patient who has just returned from surgery is distressed about her father’s
pale, cold hands and feet. What is the best response by the nurse after covering the patient with an
extra blanket?
a. “Don’t be concerned. It is quite cold in the operating room. Your dad will be warm in a minute.”
b. “Older patients like your dad get a little shocky during surgery.”
c. “When patients have blood loss during surgery, superficial vessels close off temporarily,
resulting in cold extremities.”
d. “We are watching the disturbed circulation in your dad’s hands and feet very carefully.”

5. What information should a nurse provide to a patient with vitiligo receiving phototherapy?
a. “Expose yourself to the sun for several hours before treatment to acclimate the skin surface.”
b. “Wear protective clothing.”
c. “Wear loose clothing such as sleeveless T-shirts and shorts after the treatment.”
d. “Leave off sunglasses after treatment so your eyes can more quickly accommodate.”
6. A nurse is screening patients that the plastic surgeon is considering for phototherapy.
Which patient should the nurse exclude?
a. A 34-year-old woman with lupus erythematosus
b. A 5-year-old child with pneumonia
c. A 60-year-old man with a pacemaker
d. A 23-year-old woman who is 3 months’ pregnant
MULTIPLE RESPONSE
1. Which age-related skin changes should a nurse anticipate when performing a physical assessment
on an 80-year-old man? (Select all that apply.) a. Increased nasal hair
b. Flattened nails
c. Small macular lesions at the hairline
d. Increased hair on the helix of the ear
e. Presence of seborrheic keratosis
2. Which conditions can be improved with negative pressure therapy? (Select all that apply.) a.
Pressure ulcers
b. Skin grafts
c. Burns
d. Dehisced surgical wounds
e. Eczema
hysiological Integrity: Physiological Adaptation
Chapter 57: Skin Disorders

1. A nurse is caring for a patient with pruritus. Which implementation can the nurse perform without a
physician’s order?
a. Apply topical corticosteroids to affected areas.
b. Administer an antihistamine.
c. Apply lubricant to unbroken skin.
d. Bathe the patient in an oatmeal bath.
2. Which action should a nurse implement to make a patient with atopic dermatitis more comfortable?
a. Instruct the patient to wear loose clothing.
 b. Add alcohol to the bath water.
c. Provide a diet low in fat.
d. Increase the room temperature between 78 F and 80 F.
3. Which sign or symptom suggests that a patient with skin breakdown is developing a systemic
infection?
a. Lesion on the patient’s leg that is swollen and warm to the touch
b. Temperature that has risen to 101 F
c. Blood pressure that has risen from 126/84 to 130/86 mm Hg
d. Request by the patient for medication for severe itching
4. Which is an appropriate implementation for a patient with severe psoriasis who has an
altered self-concept?
a.Touching the patient often
a. Reassuring the patient of a quick remission
b. Reminding the patient to bathe often
c. Promptly administering medications as needed
3. A patient with severe psoriasis who is to be treated with the systemic drug methotrexate sodium
anxiously asks, “Is this cancer drug safe? Are there some side effects I need to know about?” What is
the best response by the nurse?
a. “Yes, methotrexate is used to treat cancer and psoriasis, and it has no severe side effects.”
b. “No, it is not a cancer drug, but you should ask your physician about concerns regarding
your therapy.”
c. “We use this drug to treat many kinds of patients, including patients with cancer. You will have
periodic blood tests.”
d. “I don’t know if it is used with patients with cancer, but the drug can be used when conditions are
as severe as yours.”

4. A family member of an older patient with severe dermatitis says, “I was always so careful to bathe
him every day. I guess I just wasn’t careful enough.” What is the best response by the nurse?
a.“Dermatitis is not caused by poor hygiene.”
a. “Don’t worry; we will bathe him thoroughly while he is here.”
b. “You will have a chance to do better when he is back at home.”
c. “You shouldn’t feel like the skin condition is your fault.”

5. A nurse is caring for an obese patient who has been bedridden for a long time and who has a high risk
for infection. Where is the best location for the nurse to assess for the moist red lesions of Candida
albicans?
 a. Scalp, behind the ears
b. Abdominal skinfolds
c. Shaft of the penis
d. Sacrum and bony prominences

6. What information is most essential for a nurse to gather when interviewing a young woman who is
taking the drug isotretinoin (Accutane) for acne? a. Usual weight
b. Family history of breast cancer
c. Current method of birth control
d. Drugs previously used
7. An excited mother of a teenage boy with severe acne furiously reports to the nurse, “I’ve told him a
thousand times he should bathe more often! I’ve kept after him about all that junk food he eats. I jump
on him when I see him squeezing his zits. I tried to get him to scrub his face three times a day!”
Which statement indicates the most likely cause of the boy’s acne?
a. Poor personal hygiene
b. Ingestion of junk food
c. Squeezing lesions
d. Need for facial scrubs
8. A patient who has undergone treatment for herpes simplex virus type 2 (HSV type 2) expresses relief
that she is cured. What should the nurse include in her teaching? a. Daily douches of Burow solution
are needed.
b. HSV is permanently cured by acyclovir (Zovirax).
c. Sexual partners are now safe from infection from her.
d. HSV lies dormant and can be triggered without any sexual contact.
9. An 80-year-old patient comes to the emergency department with extreme pain and itching in the hip
and leg and has herpetic vesicular lesions on the left hip. What should the nurse inquire about patient
exposure to? a. HSV, type 1
b. HSV, type 2
c. Smallpox
d. Chickenpox
10. A physician asks a nurse to take a smear from herpetic lesions in an older patient’s hip to diagnose the
disorder. What is the most probable test that will be performed?
a. Culture and sensitivity test to a bactericide
b. Tzanck test to test for viral culture
c. Complete blood count to assess the white blood count for response to a pathogen
d. Titration for the strength of the pathogen
11. How does cutaneous T-cell lymphoma differ from squamous cell and basal cell carcinomas?
a. Does not metastasize.
b. Has a cause unrelated to sun exposure.
c. Can be treated with radiation.
d. Can be treated topically.
12. A nurse is caring for an adult patient with extensive burns on the front of the trunk, including the
genitalia, and the fronts of both legs. How should the nurse document the burn size using the rule of
nines? a. 13%
b. 17%
c. 25%
d. 37%
13. Which assessment by an emergency department nurse most indicates that a burn patient might be at
risk for respiratory impairment? a. Burns on the face and neck
b. Respiration of 18 breaths/min
c. Flaring nares
d. Sooty sputum
14. What should a nurse be sure to frequently assess when caring for a burn patient with eschar formation
around an entire arm? a. Urine output
b. Pain level
c. Capillary refill
d. Breath sounds
15. During the first 24 hours after a burn, fluid replacement is the treatment priority. Which assessment
should alert the nurse that the fluid protocol is ineffective? a. Rectal temperature of 101 F
b. Urine output of 20 mL/hr
c. Crackles in the lower left lobe
d. Significant edema in the burn area