NCLEX Endocrine Questions

NCLEX Endocrine Questions (1-7) Situation: Maria, 48 years old, is a known diabetic type 1. She has often consulted her internist for medication. She asks you if she can get well.1. If Maria asks you what to take for medication, you would answer that she;

a) must try other alternativeb) could consult other doctorsc) can't take a herbal medicined) has to follow doctor's prescription

2. One party time, you saw Maria eating a big piece of cake. As a concerned nurse you would tell her

a) it's okay Maria, it's party time anywayb) why are you hard-headed Mariac) Maria stop eating the caked) Maria, remember that you are taking medicine for diabetes

3. The next morning Maria said she did not feel well, you would say

a) see your doctor onceb) come let me assess your health statusc) I told you sod) have your blood sugar checked

4. Upon checking, Maria was having hyperglycemia, you tell Maria to;

a) drink plenty of waterb) have a good restc) take her prescribed insulind) see her doctor right away

5. The following are nursing interventions when administering insulin except:

a) administer insulin at room temperatureb) rotate site of injectionc) aspirate cloudy insulin before clear insulin to combine in one syringed) shake insulin vial gently to redistribute insulin particles

6. To prevent lipodystrophy due to insulin injection, the nurse should do the following except:

a) inject insulin at room temperatureb) rotate the site of injectionc) inject insulin between layer of fats and musclesd) introduce insulin rapidly

7. Among the topics you will include as priority in health teaching to Mario is:

a) nutrition and diet therapyb) daily foot carec) good exercise dailyd) prevention of complication

NCLEX Endocrine Questions: ANSWERS AND RATIONALE:

1) D- The nurse must tell the patient to follow doctor's prescription. Type 1 or insulin dependent DM (IDDM), is characterized by lack of insulin production so that the patient would require insulin injection throughout life. At present, this is the only available treatment of IDDM.

2) D

3) D- the most common problem of diabetics is related to their sugar control which could be hypoglycemia or hyperglycemia. The initial response of the nurse to complaint of not feeling well by the patient would be to check the patient's blood sugar level.

4) C- the most important management for hyperglycemia is to take insulin. Hyperglycemia occurs when insulin is not enough to transport glucose from the blood to the cells causing blood glucose to rise to abnormal levels. Common causes of hyperglycemia are:

inadequate insulin injection skipping insulin injection increased insulin need: pregnancy, trauma, surgery, infection, stress, puberty insulin resistance due to the presence of insulin antibodies

In the absence of glucose, fat stores are mobilized as an alternate source of energy. The end product fats metabolism, however, are ketone bodies. As more and more fats are burned, more ketone bodies are produced. Ketones, then, accumulate because the body cannot excrete them in the same speed as they are being produced resulting to ketoacidosis. Ketoacidosis is the most common complication of hyperglycemia.

5) C- insulin is administered at room temperature to prevent lipodystrophy and minimize discomfort.It is important to rotate sites of insulin injection in order to avoid tissue damage. The instructions to the patient regarding site for insulin injection are:

do not use the same site more than once in one month avoid areas above muscles that will be used for exercise during the day or where heat will be

applied as it will cause more rapid absorption the abdomen is the site because of it's more rapid and even rate of absorption change injection area until the whole site has been used. Sites for injection should be spaced

about one inch apart. This is in order to avoid sudden changes in absorption rate the areas of absorption are the abdomen (fastest absorption), deltoid, upper thigh and the hip pressure may be applied over the site but do not massage after injection as this will alter

absorption rate.

Insulin Storage Instructions:

unopened vials should be refrigerated opened vials can be stored at room temperature prefilled syringes can be stored for up to 3 weeks in the refrigerator with the needles pointing

upward to prevent suspended particles from clogging the needle insulin should not be left in the car or checked in airline baggage because of potential changes in

temperature

Mixing Insulin:

two types of insulin is usually recommended to diabetic patient's in order to achieve a more effective diabetic control. Insulin may be mixed so that the patient will only one have injection. Patient instructions regarding insulin mixing are:

do not mix human and animal insulin NPH and PZI insulin can be mixed only with regular insulin Lente insulin may be mixed with each other but it is not recommended to mix it with regular, NPH

or PZI insulin. withdraw clear or regular insulin first before cloudy insulin to prevent contaminating the clear

insulin with the cloudy insulin gently rotate cloudy insulin before withdrawing the drug from the vial. Experts now believe that it

is alright to shake insulin vials in order to mix insulin thoroughly.

6) C- lipodystrophy occurs when tissue changes occur due to repeated insulin injection. It can be in form of hypertrophy or atrophy. The tissue affected feels hard under the skin and it is often caused by using the same site for injection repeatedly and with porcine and beef insulin.

Measures to prevent lipodystrophy include:

rotate site of injection inject insulin at room temperature if it develops, do not use the site o at least 6 months to allow it to heal

To minimize discomfort:

avoid injecting air bubbles do not change direction of the needle once it is inside the skin do not inject insulin straight out of the refrigerator don't use dull needle wait until alcohol has dried completely before injecting penetrate the skin quickly with the needle. Aspiration is not a routine

Insulin should be injected at the subcutaneous tissue. Injecting it in the muscle will increase absorption rate and can lead to fluctuations in the blood glucose level. It is injected at 90 degree angle. If the patient is very thin. It is injected at 45 degree angle to avoid the needle reaching the muscle layer.

7) A- the most important aspect of health teaching to diabetics is regarding their nutrition and diet therapy.

Nutrition and Diet Therapy for Diabetics:

avoid fasting as it causes hypoglycemia avoid feasting as it causes hyperglycemia eat before exercising to prevent hypoglycemia have a bedtime snack especially if taking insulin snacks to prevent hypoglycemia while asleep distribute food intake to 6 small meals a day to maintain blood sugar level and prevent sudden

surges in blood sugar alcohol affects blood sugar stress, anxiety and illness affect blood sugar level and insulin requirements may need to be

adjusted

Teach patient that compared to fats and protein, carbohydrates have the greatest impact on blood sugar.

carbohydrates should provide between 50% and 60% of the daily caloric intake complex carbohydrates found in whole grains and vegetables are preferred over those found in

starch-heavy foods, such as pastas because they are longer to digest causing glucose from these type of carbs to be released slowly in the blood preventing a sudden rise in serum glucose level.

simple sugars, either as sucrose or fructose, increases blood glucose levels quickly, and provides no other nutrients

avoid food with high glycemic index. Glycemic index refers to how quickly a food can raise blood glucose. Foods that raise blood glucose quickly have high glycemic index such as simple sugars and starches. Foods with low glycemic index include high fiber foods such as insoluble fiber found in wheat bran, whole grains, seeds, nuts, legumes, and fruit and vegetable peels and soluble fiber found in dried beans, oat bran, barley, apples, citrus fruits, and potatoes.

Protein should provide 12% to 20% of calories

fish is probably the best source of protein for heart protection as it can help lower blood pressure, triglyceride levels, and tendency for blood clots, and the risk for stroke

soy is rich in both soluble and insoluble fiber, omega-3 fatty acids, and provides all essential proteins. Soybeans also contain natural compounds that may reduce LDL (harmful cholesterol) and triglycerides and increase HDL (beneficial cholesterol). The best sources are soy products (tofu, soymilk) or whole soy protein

Avoid harmful fats such as saturated fats and trans fatty acids to maintain normal cholesterol levels.Saturated fats are mostly found on animal products, including meat and dairy products.Trans fatty acids are manufactured fats which are used at stabilizing polyunsaturated oils to prevent them from becoming rancid and to keep them solid at room temperature.Good fats include polyunsaturated fats that are found in safflower, sunflower, corn, and cottonseed oils and fish; and monosaturated fats found in olive, canola, and peanut oils and in most nuts. Some studies have reported that replacing carbohydrates with monosaturated fats improves glucose control after meals and reduces triglycerides in people with type 2 diabetes.

Situation: The nurse is meeting with the parents of 11 year old Irish, who has recently been diagnosed with insulin dependent mellitus (IDDM).

8. Irish has been hospitalized for the past 3 days. His physiologic condition has been stabilized and he is now on subcutaneous injections of insulin. In developing a plan of care for Irish and his family, which of the following would be the most appropriate nursing diagnosis?

a) parent knowledge deficit related to newly diagnosed illnessb) fluid volume deficit related to hypoglycemiac) altered nutrition less than body requirements, related to insulin deficiencyd) compromised family coping related to newly diagnosed illness

9. Irish's parents stated that they really do not understands exactly what this disease is. Which of the following is the best way to explain IDDM to them?

a) IDDM is an inborn error in metabolism that makes the child unable to burn, fatty acids without insulin supplementb) IDDM is a genetic disorder that makes the child unable to metabolize protein without insulin supplements.c) IDDM is a deficiency in the secretions of insulin by the pancreas, which makes the child unable to metabolize carbohydrates without insulin supplements

d) IDDM is a deficiency in the secretions of the insulin by the gallbladder, which makes the child unable to metabolize carbohydrates without insulin

10. The mother of Irish is preparing a mixed dose of insulin. The nurse is satisfied with the mother's performance when she:

a) draws insulin from bottle of clear insulin firstb) draws insulin from the bottle of delayed acting insulin firstc) fills both syringes with the prescribed insulin dosage then shake the bottle vigorouslyd) withdraws the delayed action insulin before withdrawing the short acting insulin

11. Irish complains of nausea, vomiting, diaphoresis and headache. Which of the following nursing interventions should the nurse carry out first?

a) withhold the client's next insulin injectionb) test the client's blood glucose levelc) administer tylenol (acetaminophen) as orderedd) offer fruit juice, gelatin and chicken bouillon

12. The nurse should not instruct Irish mother that after injection of fast acting insulin at 7 in the morning, Irish should avoid exercising and any strenuous activity.

a) around 9 to 11amb) after 4 hoursc) between 8am and 9amd) in the afternoon after taking lunch

13. The nurse also teaches Irish regarding the relationship of her diet, exercise and insulin requirements. Which of the following statements below is wrong information that the nurse should not give Irish?

a) Irish should eat a snack before playing volleyball during P.Eb) Irish should always wear her medic-alert band or IDc) Irish should go to school clinic to let the nurse give her insulin shots when its time for her medicationd) Irish should always carry a prefilled insulin syringe in her bag with instructions

14. After four months, Irish was brought to the emergency room because she fainted in school during her P.E. class. The nurse should monitor which of the following tests to evaluate the over-all therapeutic compliance of diabetic patient with normal serum hemoglobin?

a) glycosylated hemoglobinb) fasting blood glucosec) ketone levelsd) routine serum chemistry profile

ANSWERS AND RATIONALE

8) A- the most appropriate diagnosis at this point would be knowledge deficit. The parents must be made aware of the nature of their child's illness and the principles of care in order to ensure treatment compliance. Letter B and C is inappropriate as the child's condition is already stable. There is no evidence that family coping is compromised and it is too early to tell if the family is not coping well to the newly diagnosed illness of Irish.

9) C

10) A- the clear or regular insulin should be withdrawn first before the cloudy insulin or the intermediate insulin

11) B- the first action to take would be to assess the blood glucose level of the patient to find out if the symptoms are due to abnormal glucose level or other causes.

60-90mg/100ml fasting blood sugar60-105mg/100ml before meals140-or less mg/100ml one hour after mealsif hyperglycemic - give insulinif hypoglycemic - orange juice, sugar, candy

12) A- the child should avoid exercising during peak hours of insulin action in order to prevent hypoglycemia. Peak action regular insulin occurs after 2-4 hours after administration. For the other types of insulin:

short acting/regular (clear) - 2-4 hours

intermediate/lente/NPH (cloudy) - 8-12 hours

long-acting/ultralente (cloudy) - 18-24 hours

13) C- starting 9 years old, a child has already developed enough finger dexterity to handle a syringe and thus can be taught how to administer her own insulin. If the nurse will see that Irish can and is willing to inject her own insulin, the child need not go to the school clinic. Another important instruction to Irish is to avoid injecting insulin in her arm during P.E. days when she plays volleyball. Exercise increases absorption of insulin. She should, then inject it in her abdomen. If Irene is runner, it would not be advisable to inject it her thigh.It is important for the child to eat a carbohydrate snack before engaging in sports as exercise increases glucose utilization and make her hypoglycemicCarrying a medic alert band or ID and prefilled syringe with instructions are important in cases of emergency.

14) A- the glycosylated hemoglobin shows the patients blood glucose level during the last three months so iti s the best test that would reflect the patient's compliance to therapy and her glucose control.Fasting blood glucose reflects only the current glucose controlKetone appears in the urine when blood glucose levels exceed 200 mg'dlRoutine serum chemistry is not necessary in assessing the therapeutic compliance of a diabetic patient.

NCLEX Endocrine Questions

15. Which of the following should the nurse include in the discharge instructions to be given to a client on continuous insulin infusion through insulin pump?

a) change needle site every 2 to 3 daysb) check blood sugar level daily

c) push button on the device to self-administer insulin after each meald) the machine gives continuous small doses of insulin, so there is no need to check blood sugar levels

16. A client with diabetes mellitus is self-administering NPH insulin from a vial kept at room temperature. The client asks a nurse about the length of time an unrefrigerated vial of insulin will remain its potency. The most appropriate response to the client is which of the following?

a) two weeksb) one monthc) two monthsd) six months

17. Which of the following is the appropriate initial action by the nurse when preparing insulin administration?

a) injecting air into the regular insulinb) withdrawing the cloudy insulin first before the clear insulinc) injecting air into the cloudy insulin but withdrawing the clear insulin firstd) withdrawing the clear insulin and cloudy insulin in separate syringes

18. The client with insulin-dependent diabetes mellitus (IDDM) has been brought to the emergency room. What should the nurse watch for if blood pH is 7.28

a) lactic acidosisb) ketoacidosisc) metabolic alkalosisd) respiratory acidosis

19. A client has been diagnosed to have Type II diabetes mellitus. She experiences hypoglycemia. After receiving a glass of orange juice, what should the nurse give next?

a) peanut butter sandwichb) 1 tablespoon sugarc) 1 cup skim milkd) a cup chocolate drink

20. Which of the following laboratory test best indicate compliance of the diabetic client and insulin therapy?

a) 2-hour postprandial blood glucoseb) fasting blood glucosec) glycosylated hemoglobind) oral glucose tolerance test

NCLEX Endocrine Questions:ANSWERS AND RATIONALE

15) B- insulin lowers blood sugar levels. Insulin pump gives small doses of insulin continuously and the patient can bolus himself before each meal.

16) B- insulin, when stored at room temperature is potent for 30 days (1 month).

17) C- this action ensures prevention of contamination of the rapid-acting insulin. In case of emergency (DKA), rapid effect of the clear insulin is maintained. Injecting air into the cloudy insulin will promote easy aspiration of the medication, once the syringe already contains the clear insulin.

18) B- ketoacidosis is characterized by low blood pH. Type I diabetic clients are prone to ketoacidosis.

19) A- orange juice provides quick source of glucose; slices of bread provide sustained supply of glucose. This will be followed with skim milk as source of protein, to inhibit breakdown of fats. This in turn, prevents ketoacidosis.

20) C- glycosylated hemoglobin (HbA1c) is the best indicator of diabetic control. It reflects blood glucose level for the past 3 t0 4 mthNCLEX Endocrine Questions

21. A diabetic client asks a nurse if bacon is allowed in the diet. Which nursing response is most appropriate?

a) bacon is much too high in fatsb) bacon is not allowedc) one strip of bacon may be eaten if you eliminate 1 teaspoon of butterd) bacon may be eaten if you eliminate one meat from the diet

22. The client with congestive heart disease is diagnosed to have diabetes mellitus (DM). Which of the following medications should not be administered by the nurse to this client?

a) capoten (captopril)b) lanoxin (digoxin)c) inderal (propranolol)d) calan (verapamil)

23. The client has been diagnosed to have type 2 diabetes mellitus. Which of the following are correct statements about type 2 DM. Select all that apply

a) managed by diet and exerciseb) prone ot diabetic ketoacidosisc) prone to HHNC (hyperglycemic hyperosmolar - nonketotic coma)d) managed by OHA (oral hypoglycemic agents)e) requires lifelong insulin therapy

f) onset is before age 30 yearsg) with absolute deficiency of insulin

24. The diabetic client is having ketoacidosis. Which of the following is the appropriate initial nursing action?

a) start an intravenous glucoseb) administer insulin per IVc) give a glass of orange juiced) give a cup of skim milk

25. The client has been diagnosed to have NIDDM (non-insulin dependent diabetes mellitus). Which of the following signs and symptoms characterize the disease? Select all that apply.

a) occurs after 30 years of ageb) obesityc) requires lifetime insulin injectiond) can be controlled by diet, exercise, and druge) prone to diabetic ketoacidosisf) experience weight lossg) may require insulin in case of stress, surgery, pregnancy

NCLEX Endocrine Questions: ANSWERS AND RATIONALE

21) C - bacon is fat and may be exchanged with fat component in the diet, e.g. butter. Exchange food within the same food group.

22) C- inderal is a beta adrenergic blocker. It may cause hypoglycemia and is contraindicated in a client with DM.

23) A, C, D- these are characteristics of type II DM. The other choices describe type I DM.

24) B- ketoacidosis is characterized by severe hyperglycemia. The emergency management of ketoacidosis is regular insulin/IV.

25) A, B, D, and G- all of these describes NIDDM.o 4 months.

NCLEX Endocrine Questions (26-30) 26. The following are characteristics of type I DM. Select all that apply

a) the client is thin

b) it requires lifelong insulinc) the client may take sulfonylureasd) the client is at risk to develop diabetic ketoacidosise) onset of the disease is after 30 years of agef) there is insulin secretion, but the body's demands are increased

27. The following are signs and symptoms that indicate hyperglycemia in a client with diabetes mellitus. Select all that apply

a) elevated blood sugar levelb) cold, clammy skinc) increased urinationd) tremorse) deep, rapid respirationf) excessive thirstg) metabolic acidosis

28. The client has been diagnosed to have IDDM. Which order should you question?

a) propranololb) insulin injectionc) acetaminophend) diltiazem

29. The nurse is assessing a pregnant client with type I diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that teaching is needed if the client makes which statement?

a) I will need to increase my insulin dosage during the first 3 months of pregnancyb) my insulin dose will likely need to be increased during the second and third trimesterc) episodes of hypoglycemia are more likely to occur during the first 3 months of pregnancyd) my insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding

30. An adolescent client with type I diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note?

a) sweating and tremorsb) hunger and hypertensionc) cold, clammy skin and irritabilityd) fruity breath and decreasing level of consciousness


26) A, B, D- these are the characteristic of type I DM.

27) A, C, E, F, G- these are signs and symptoms of hyperglycemia.

28) A- propranolol, a beta-adrenergic blocker causes hypoglycemia. It is contraindicated among diabetic

clients.

29) A- insulin needs decrease in the first trimester because of increase insulin production by the pancreas and increased peripheral sensitivity to insulin. The statements in option B, C, and D are accurate and signify that the client understands control of her diabetes during pregnancy.

30) DHyperglycemia occurs with diabetic ketoacidosis. Signs of hyperglycemia include fruity breath and a decreasing level of consciousness. Hunger can be a sign of hypoglycemia or hyperglycemia, but hypertension is not a sign of diabetic ketoacidosis. Instead, hypotension occurs because of a decrease in blood volume related to the dehydrated state that occurs during diabetic ketoacidosis. Cold, clammy skin, irritability, sweating, and tremors are all signs of hypoglycemia.

Online Nursing Practice Test/Exam about Endocrine (31-35) Situation: Miss Eleanor is a 25 year old woman who is being treated in the endocrine clinic for adult-onset Myxedema.

31. While taking a nursing history, the nurse should expect Miss Eleanor to assess:

a) facial puffinessb) intolerance to heatc) exopthalmusd) heart palpitations

32. The physician has ordered serum thyroxine (T4) concentration and serum cholesterol test. Which finding should the nurse expect?

a) decreased serum T4 and decreased serum cholesterolb) decreased serum T4 and increased serum cholesterolc) increased serum T4 and increased serum cholesterold) increased serum T4 and increased serum cholesterol

33. Which of the following manifestations does the nurse expect in a client with myxedema?a) increased heart rateb) edemac) weight lossd) intolerance to heat

34. Which of the following are most important to monitor in a client who had undergone total thyroidectomy?

a) pulse and temperatureb) serum electrolyte levelsc) weight and food intaked) hoarseness of the voice and ability to swallow

35. Which of the following should be included when giving health teachings to a client with hyperthyroidism.

a) wear long-sleeved clothing

b) use artificial tears to the eyes as necessaryc) increase fibers in the dietd) take medications with milk

ANSWERS AND RATIONALE

31) A- Hypothyroidism is due to absence or deficiency in thyroid hormone that causes a decline in the metabolic rate. It is classified according to the time or life in which it occurs:

Cretinism - hypothyroidism in infants and young children Hypothyroidism without myxedema - mild degree of thyroid failure in older children and adult Hypothyroidism with myxedema - severe degree of thyroid failure or hypothyroidism in adults

Manifestations of hypothyroidism are associated with the slowing of the metabolic rate and include:

Patient's with myxedema exhibits nonpitting edema in connective tissues all over the body, including the face which appears puffy and the tongue which is enlarged. The edema is due to accumulation of mucoprotein and water retention.

Goiter - enlargement of the thyroid gland may or may not be present. Goiter occurs from excessive stimulation of TSH from the pituitary because of continuous deficient or lack thyroxine. Hypothyroidism caused by lack of TSH does not cause goiter.

Bradycardia, hypotension, dysrrhythmias, enlarged heart Apathy, slow and slurred speech, lethargy Decreased heat production-sensitivity to cold Decreased nutrient requirements: poor appetite Decreased sweat and sebaceous gland function: dry scaly skin Altered protein, fat and carbohydrate metabolism: weight gain (edema) slow wound healing,

decreased blood glucose, hypoalbuminemia Decreased erythropoietin production: anemia

32) B- Hypothyroidism is due to deficient thyroxine hormone so naturally serum T4 will be below normal.

Thyroxine regulates fat or lipid metabolism. Deficiency in thyroxine will result in slow metabolic activity resulting in slowing of lipid metabolism which increases serum cholesterol and triglyceride levels making the patient at risk for atherosclerosis and cardiac disorders.

Management:

1. Prevention - prevention of iodine deficiency

2. Replacement therapy throughout lifea. Drugs used:

Sodium L-thyroxine/levothyroxine (Synthroid, Levoid) Sodium L-triidothyroxine (Cytomel, Trionine) Synthetic combination of T3 and T4 (Euthroid, thyrolar) Natural combination of T3 and T4 extract

b. Major Side Effects:

Inadequate treatment - show recurrence/persistence of signs of hypothyroidism Excessive treatment - show signs of hyperthyroidism Too fast increase in drug dose - angina, palpitations, tachycardia Bone loss and decreased bone density

c. During initiation of therapy - patient is seen by physician every 2-4 weeks until condition is stable and then thyroid therapy is monitored annually.

3. Nursing Care:

Activity Intolerance - limit activity to patient's tolerance. If patient develops tachycardia or chest pain, stop activity

Constipation - increase fiber and fluids Hypothermia - maintain comfortable environmental temperature, use blankets as necessary Use frequent stimulation at dusk and nightfall - use nightlights to prevent confusion maintain safe environment promote positive body image - educate about reversible body changes

4. Surgery - may be performed for large goiters especially if it causes dysphagia, chocking sensation, inspiratory stridor, hoarseness and positive Pemberton's sign (elevation of arms results in dizziness and syncope) caused by pressure on veins that venous return from the head.

33) B- myxedema is manifested by hypothyroidism. (A, C, and D are manifestations of hyperthyroidism)

34) A- thyroid crisis /storm/thyroidtoxicosis is the most life-threatening postop complication of thyroid surgery. It is characterized by hyperthermia and tachycardia. Therefore it is necessary to monitor the client's pulse and temperature.

35) B- hyperthyroidism may cause exopthalmos. To prevent corneal ulceration, artificial tears will be instilled into the eyes as necessary. The client usually develops diarrhea so, high fiber diet is not indicated. The medication should not be taken with antacid. Antacid inhibits absorption of anti thyroid drugs.

NCLEX Endocrine Questions (36-40) NCLEX Endocrine Questions

36. Which of the following assessment findings characterize thyroid storm?

a) increased body temperature, decreased pulse, and increased blood pressureb) increased body temperature, increased pulse, and increased blood pressurec) increased body temperature, decreased pulse, and decreased blood pressured) increased body temperature, increased pulse, and decreased blood pressure

37. The nurse is planning care for a client with hyperthyroidism. Which of the following nursing interventions are appropriate? Select all that apply

a) instill isotonic eye drops as necessaryb) provide several, small, well-balanced mealsc) provide rest periodsd) keep environment warme) encourage frequent visitors and conversationf) weigh the client daily

38. After thyroidectomy, which of the following is the priority assessment to observe laryngeal nerve damage?

a) hoarseness of voiceb) difficulty in swallowingc) tetanyd) fever

39. A home care nurse is teaching an adolescent with type I diabetes mellitus about insulin administration and rotation sites. Which statement, if made by the adolescent, would indicate effective teaching?

a) I need to use a different site for each insulin injectionb) I should use only my stomach and my thighs for injectionsc) I need to use the same site for 1 month before rotating to anotherd) I need to use one major site for 2 to 3 weeks before changing major sites

40. A child with type I diabetes mellitus is brought to an emergency room by the mother, who states that the child has been complaining of abdominal pain and has a fruity odor of the breath. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which intravenous infusion?

a) potassiumb) NPH insulinc) 5% dextrosed) normal saline


36) B- thyroid storm is characterized by SNS activation. Thyroid hormones potentiate effects of cathecolamines (epinephrine/norepinephrine). Therefore, all vital signs will be increased.

37) A, B, C, and F- the client with hyperthyroidism may experience exopthalmos. This requires instillation of eye drops to prevent dryness and ulceration of the cornea. The client experiences weight loss because of hypermetabolism. Several, small, well-balanced meals are given to improve nutritional status of the client and daily weights should be monitored. Weight is the most objective indicator of nutritional status. The client is usually exhausted due to restlessness and agitation. Frequent rest periods help the client regain energy.

38) A- laryngeal nerve damage is manifested by severe hoarseness of voice or "whispery voice". 39) D- To help decrease variations in absorption from day to day, the adolescent should use one major site for injections for 2 to 3 weeks before changing major sites. The injections are rotated to different locations within that major site. Options A, B, and C are incorrect.

40) D- Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level reaches an acceptable level. Intravenously administered potassium may be required, depending on the potassium level, but would not be part of the initial treatment.


41. A client with diabetes mellitus has a glycosylated hemoglobin level of 9%. Based on this result, the nurse plans to teach the client about the need to:

a) avoid infectionb) take in adequate fluidsc) prevent and recognize hypoglycemiad) prevent and recognize hyperglycemia

42. A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction is included in the plan?

a) soak feet in hot waterb) avoid using a mild soap on the feetc) apply a moisturizing lotion to dry feet but not between the toesd) always have a podiatrist cut your toenails; never cut them yourself

43. A client is brought to the emergency room in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which of the following anticipated physician's orders?

a) endotracheal intubationb) 100 units of NPH insulinc) intravenous infusion of normal salined) intravenous infusion of sodium bicarbonate

44. An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:

a) is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervalsb) continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levelsc) is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstreamd) gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose form the pump before each meal

45. A client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which of the following concepts?

a) always keep insulin vials refrigeratedb) ketones in the urine signify a need for less insulinc) increase the amount of insulin before unusual exercise

d) systematically rotate insulin injections within one anatomic site


41) D- In the test result for glycosylated hemoglobin A1c, 7% or less indicates good control, 7% to 8% indicates fair control, and 8% or higher indicates poor control. This test measures the amount of glucose that has become permanently bound to the red blood cells from circulating glucose. Elevations in the blood glucose level will cause elevations in the amount of glycosylation. Thus, the test is useful in identifying clients who have periods of hyperglycemia that are undetected in other ways. Elevations indicate continued need for teaching related to the prevention of hyperglycemic episodes.

42) C- The client is instructed to use a moisturizing lotion on the feet and to avoid applying the lotion between the toes. The client should be instructed not to soak the feet and should avoid hot water to prevent burns. The client may cut the toenails straight across and even with the toe itself and would consult a podiatrist if the toenails were thick or hard to cut or if vision were poor. The client should be instructed to wash the feet daily with a mild soap.

43) C- The primary goal of treatment in hyperglycemic hyperosmolar nonketotic syndrome (HHNS) 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 HHNS.

44) D - An insulin pump provides a small continuous dose of regular 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. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

45) D- Insulin doses should not be adjusted nor increased before unusual exercise. If ketones are found in the urine, it possibly may indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, insulin should be administered at room temperature. Injection sites should be rotated systematically within one anatomic site


46. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in an emergency room. Which finding would a nurse expect to note as confirming this diagnosis?

a) comatose stateb) decreased urine outputc) increased respiration and an increase in pHd) elevated blood glucose level and low plasma bicarbonate level

47. A nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and

ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which of the following symptoms develops?

a) polyuriab) shakinessc) blurred visiond) fruity breath odor

48. A client with diabetes mellitus demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The appropriate intervention to decrease the client's anxiety is to:

a) administer a sedativeb) convey empathy, trust, and respect toward the clientc) ignore the signs and symptoms of anxiety so that they will soon disappeard) make sure that the client knows all the correct medical terms to understand what is happening

49. A nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis is when the client states:

a) I will stop taking my insulin if I'm too sick to eatb) I will decrease my insulin dose during times of illnessc) I will adjust my insulin dose according to the level of glucose in my urined) I will notify my physician if my blood glucose level is higher than 250 mg/dL

50. A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of regular insulin is intiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which of the following?

a) ampule of 50% dextroseb) NPH insulin subcutaneouslyc) intravenous fluids containing 5% dextrosed) phenytoin (Dilantin) for the prevention of seizures


46) D- In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmaul’s respirations would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis.

47) B- Shakiness is a sign of hypoglycemia and would indicate the need for food or glucose. A fruity breath odor, blurred vision, and polyuria are signs of hyperglycemia.

48) B- The appropriate intervention is to address the client’s feelings related to the anxiety. Administering a sedative is not the most appropriate intervention. The nurse should not ignore the client’s anxious feelings. A client will not relate to medical terms, particularly when anxiety exists.

49) D- During illness, the client should monitor blood glucose levels and should notify the physician if the level is higher than 250 mg/dL. Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the physician’s advice and are usually adjusted based on blood glucose levels, not urinary glucose readings.

50) C- During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and 5% dextrose is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers from ketosis. NPH insulin is not used to treat DKA. Fifty percent dextrose is used to treat hypoglycemia. Phenytoin (Dilantin) is not a usual treatment measure for DKA.

NCLEX Endocrine Questions 51-55 NCLEX Endocrine Questions

51. A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for:

a) relief of painb) signs of renal toxicityc) signs and symptoms of hyperglycemiad) signs and symptoms of hypothyroidism

52. A nurse develops a plan of care for a client with hyperparathyroidism who is receiving calcitonin salmon (Calcimar). Which of the following outcome criteria has the highest priority regarding this medication?

a) relief of painb) absence of side effectsc) achievement of normal serum calcium levelsd) verbalization of appropriate medication knowledge

53. A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication:

a) in the morning to prevent insomniab) only when the client complains of fatigue and cold intolerancec) at various times during the day to prevent tolerance from occurringd) three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels

54. A nurse is monitoring a client with diabetes insipidus and desmopressin acetate (DDAVP) has been prescribed for the client. Which of the following outcomes reflects a therapeutic effect of this medication?

a) decreased urine outputb) decreased blood pressurec) urine osmolality lower than 100 mOsm/kgd) serum osmolality higher than 320 mOsm/kg

55. A nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which of the following, if exhibited in the client, would indicate hyperglycemia and warrant physician notification?

a) polyuriab) diaphoresisc) hypertensiond) increased pulse rate

NCLEX ENDOCRINE QUESTIONS:ANSWERS AND RATIONALE

51) D- Excessive dosing with propylthiouracil (PTU) may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity.

52) C- Calcitonin can lower plasma calcium levels in clients with hypercalcemia caused by hyperparathyroidism. The therapeutic effect in this client situation would be a reduction in serum calcium levels. Options A, B, and D are incorrect outcome criteria.

53) A- Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases cellular metabolism. Levothyroxine should be given in the morning in a single dose to prevent insomnia and should be given at the same time each day to maintain an adequate drug level. Therefore, options B, C, and D are incorrect.

54) A- Desmopressin acetate (DDAVP) is a synthetic form of antidiuretic hormone that causes increased reabsorption of water, with a resultant decrease in urine output. The therapeutic response to DDAVP would be a decrease in serum osmolality, because more fluid is retained, and an increase in urine osmolality, because less fluid is excreted. Hypotension may be apparent with diabetes insipidus and blood pressure may increase as extracellular fluid volume is restored.

55) A- Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Options B, C, and D are not signs of hyperglycemia.

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NCLEX Endocrine Questions