NCLEX Endocrine Questions (1-7) Situation: Maria, 48 years old, is a known diabetic type 1. She has often consulted her internist for Situation: Maria, medication. She asks you if she can get well. 1. If Maria asks you what to take for medication for medication,, you would answer that she; a must try other alternati!e b could consult other doctors c can"t take a herbal medicine d has to follow doctor"s prescription 2. #ne party time, you saw Maria eating a big piece of cake. $s a concerned nurse you would tell her a it"s okay Maria, it"s party time anyway b why are you hard%headed Maria c Maria stop eating the cake d Maria, remember that you are taking medicine for diabetes 3. &he ne't morning Maria said she did not feel well, you would say a see your doctor once b come let me assess your health status c I told you so d ha!e your blood sugar checked 4. (pon checking, Maria was ha!ing hyperglycemia, you tell Maria to; a drink plenty of water b ha!e a good rest c take her prescribed insulin d see her doctor right away 5. &he 5. &he following are nursing inter!entions when administering insulin e'cept) a administer insulin at room temperature b rotate site of in*ection c aspirate cloudy insulin before clear insulin to combine in one syringe d shake insulin !ial gently to redistribute insulin particles 6. &o pre!ent lipodystrophy due to insulin in*ection, the nurse should do the following e'cept) a in*ect insulin at room temperature b rotate the site of in*ection c in*ect insulin between layer of fats and muscles d introduce insulin rapidly 7. $mong 7. $mong the topics you will include as priority in health teaching to Mario is) a nutrition and diet therapy b daily foot care c good e'ercise daily d pre!ention of complication
NCLEX Endocrine Questions: NS!E"S N# "$ "$%&NLE: %&NLE: 1) # % &he nurse must tell the patient to follow doctor"s prescription. &ype &ype 1 or insulin dependent +M I++M, is characteri-ed by lack of insulin production so that the patient would reuire insulin in*ection throughout life. $t present, this is the only a!ailable treatment of I++M. 2) # 3) # % the most common problem of diabetics is related to their sugar control which could be hypoglycemia or hyperglycemia. &he initial response of the nurse to complaint of not feeling well by the patient would be to check the patient"s blood sugar le!el. 4) C % the most important management for hyperglycemia is to take insulin. /yperglycemia occurs when insulin is not enough to transport glucose from the blood to the cells causing blood glucose to rise to abnormal le!els. 0ommon causes of hyperglycemia are) •
inadeuate insulin in*ection
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skipping insulin in*ection
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increased insulin need) pregnancy, trauma, trauma, surgery, infection, stress, puberty
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insulin resistance due to the presence of insulin antibodies
In the absence of glucose, fat stores are mobili-ed as an alternate source of energy. &he end product fats metabolism, howe!er, howe!er, are ketone bodies. $s more and more fats are burned, more ketone bodies are produced. etones, then, accumulate because the body cannot e'crete them in the same speed as they are being produced resulting to ketoacidosis. etoacidosis is the most common complication of hyperglycemia. 5) C % insulin is administered at room temperature to pre!ent lipodystrophy and minimi-e discomfort. It is important to rotate sites of insulin in*ection in order to a!oid tissue d amage. &he instructions to the patient regarding site for insulin in*ection are) •
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do not use the same site more than once in one month a!oid areas abo!e muscles that will be used for e'ercise 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 e!en rate of absorption change in*ection area until the whole site has been used. Sites for in*ection should be spaced about one inch apart. &his is in order to a!oid sudden changes in absorption rate the areas of absorption are the abdomen fastest absorption, deltoid, upper thigh and the hip
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pressure may be applied o!er the site but do not massage after in*ection as this will alter absorption rate.
%nsu'in Storae %nstructions: •
unopened !ials should be refrigerated
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opened !ials can be stored at room temperature
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prefilled syringes can be stored for up to 2 weeks in the refrigerator with the needles pointing upward to pre!ent 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
i*in %nsu'in: •
two types of insulin is usually recommended to diabetic patient"s in order to achie!e a more effecti!e diabetic control. Insulin may be mi'ed so that the patient will only one ha!e in*ection. 3atient instructions regarding insulin mi'ing are)
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do not mi' human and animal insulin
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3/ and 35I insulin can be mi'ed only with regular insulin
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6ente insulin may be mi'ed with each other but it is not recommended to mi' it with regular, 3/ or 35I insulin. withdraw clear or regular insulin first before cloudy insulin to pre!ent contaminating the clear insulin with the cloudy insulin gently rotate cloudy insulin before withdrawing the drug from the !ial. 7'perts now belie!e that it is alright to shake insulin !ials in order to mi' insulin thoroughly.
6) C % lipodystrophy occurs when tissue changes occur due to repeated insulin in*ection. It can be in form of hypertrophy or atrophy. &he tissue affected feels hard under the skin and it is often caused by using the same site for in*ection repeatedly and with po rcine and beef insulin.
easures to +re,ent 'i+odstro+ inc'ude: •
rotate site of in*ection
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in*ect insulin at room temperature
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if it de!elops, do not use the site o at least months to allow it to heal
$o /ini/i0e disco/ort:
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a!oid in*ecting air bubbles
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do not change direction of the needle once it is inside the skin
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do not in*ect insulin straight out of the refrigerator
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don"t use dull needle
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wait until alcohol has dried completely before in*ecting
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penetrate the skin uickly with the needle. $spiration is not a routine
%nsu'in sou'd e inected at te sucutaneous tissue . In*ecting it in the muscle will increase absorption rate and can lead to fluctuations in the blood glucose le!el. It is in*ected at 9: degree angle. If the patient is !ery thin. It is in*ected at 4 degree angle to a!oid the needle reaching the muscle layer. 7) % the most important aspect of health teaching to diabetics is regarding their nutrition and diet therapy. Nutrition and #iet $era+ or #iaetics: •
a!oid fasting as it causes hypoglycemia
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a!oid feasting as it causes hyperglycemia
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eat before e'ercising to pre!ent hypoglycemia
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ha!e a bedtime snack especially if taking insulin snacks to pre!ent hypoglycemia while asleep
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distribute food intake to small meals a day to maintain blood sugar le!el and pre!ent sudden surges in blood sugar alcohol affects blood sugar stress, an'iety and illness affect blood sugar le!el and insulin reuirements may need to be ad*usted
$eac +atient tat co/+ared to ats and +rotein carodrates a,e te reatest i/+act on 'ood suar. •
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carbohydrates should pro!ide between :< and :< of the daily caloric intake comple' carbohydrates found in whole grains and !egetables are preferred o!er those found in starch%hea!y foods, such as pastas because they are longer to digest causing glucose from these type of carbs to be released slowly in the blood pre!enting a sudden rise in serum glucose le!el. simple sugars, either as sucrose or fructose, increases blood glucose le!els uickly, and pro!ides no other nutrients
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a!oid food with high glycemic inde'. =lycemic inde' refers to how uickly a food can raise blood glucose. >oods that raise blood glucose uickly ha!e high glycemic inde' such as simple sugars and starches. >oods with low glycemic inde' include high fiber foods such a s insoluble fiber found in wheat bran, whole grains, seeds, nuts, legumes, and fruit and !egetable peels and soluble fiber found in dried beans, oat bran, barley, apples, citrus fruits, and potatoes.
rotein sou'd +ro,ide 12 to 2 o ca'ories •
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fish is probably the best source of protein for heart protection as it can help lower blood pressure, triglyceride le!els, and tendency for blood clots, and the risk for stroke soy is rich in both soluble and insoluble fiber, omega%2 fatty acids, and pro!ides all essential proteins. Soybeans also contain natural compounds that may reduce 6+6 harmful cholesterol and triglycerides and increase /+6 beneficial cholesterol. &he best sources are soy products tofu, soymilk or whole soy protein
$!oid harmful fats such as saturated fats and trans fatty acids to maintain normal cholesterol le!els. Saturated fats are mostly found on animal products, including meat and dairy products. &rans fatty acids are manufactured fats which are used at stabili-ing polyunsaturated oils to pre!ent them from becoming rancid and to keep them solid at room temperature. =ood fats include polyunsaturated fats that are found in safflower, sunflower, corn, and cottonseed oils and fish; and monosaturated fats found in oli!e, canola, and peanut oils and in most nuts. Some studies ha!e reported that replacing carbohydrates with monosaturated fats impro!es glucose control after meals and reduces triglycerides in people with type ? diabetes.
Situation: &he nurse is meeting with the parents of 11 year old Irish, who has recently been diagnosed with insulin dependent mellitus I++M. 8. Irish has been hospitali-ed for the past 2 days. /is physiologic condition has been stabili-ed and he is now on subcutaneous in*ections of insulin. In de!eloping 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 illness b fluid !olume deficit related to hypoglycemia c altered nutrition less than body reuirements, related to insulin deficiency d compromised family coping related to newly diagnosed illness 9. Irish"s parents stated that they really do not understands e'actly what this disease is. Ahich of the following is the best way to e'plain I++M to them@ a I++M is an inborn error in metabolism that makes the child unable to burn, fatty acids without insulin supplement b I++M is a genetic disorder that makes the child unable to metaboli-e protein without insulin supplements. c I++M is a deficiency in the secretions of insulin by the pancreas, which makes the child unable to metaboli-e carbohydrates without insulin supplements d I++M is a deficiency in the secretions of the insulin by the gallbladder, which makes the child unable to metaboli-e carbohydrates without insulin 1. &he mother of Irish is preparing a mi'ed dose of insulin. &he nurse is satisfied with the mother"s performance when she) a draws insulin from bottle of clear insulin first
b draws insulin from the bottle of delayed acting insulin first c fills both syringes with the prescribed insulin dosage then shake the bottle !igorously d withdraws the delayed action insulin before withdrawing the short acting insulin 11. Irish complains of nausea, !omiting, diaphoresis and headache. Ahich of the following nursing inter!entions should the nurse carry out f irst@ a withhold the client"s ne't insulin in*ection b test the client"s blood glucose le!el c administer tylenol acetaminophen as ordered d offer fruit *uice, gelatin and chicken bouillon 12. &he nurse should not instruct Irish mother that after in*ection of fast acting insulin at B in the morning, Irish should a!oid e'ercising and any strenuous acti!ity. a around 9 to 11am b after 4 hours c between 8am and 9am d in the afternoon after taking lunch 13. &he nurse also teaches Irish regarding the relationship of her diet, e'ercise and insulin reuirements. Ahich of the following statements below is wrong information that the nurse should not gi!e Irish@ a Irish should eat a snack before playing !olleyball during 3.7 b Irish should always wear her medic%alert band or I+ c Irish should go to school clinic to let the nurse gi!e her insulin shots when its time for her medication d Irish should always carry a prefilled insulin syringe in her bag with instructions 14. $fter four months, Irish was brought to the emergency room because she fainted in school during her 3.7. class. &he nurse should monitor which of the following tests to e!aluate the o!er%all therapeutic compliance of diabetic patient with normal serum hemoglobin@ a glycosylated hemoglobin b fasting blood glucose c ketone le!els d routine serum chemistry profile
NS!E"S N# "$%&NLE 8) % the most appropriate diagnosis at this point would be knowledge deficit. &he parents must be made aware of the nature of their child"s illness and the principles of care in order to ensure treatment compliance. 6etter C and 0 is inappropriate as the child"s condition is already stable. &here is no e!idence 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 1) % the clear or regular insulin should be withdrawn first before the cloudy insulin or the intermediate insulin 11)
% the first action to take would be to assess the blood glucose le!el of the p atient to find out if the symptoms are due to abnormal glucose le!el or other causes. :%9:mgD1::ml fasting blood sugar :%1:mgD1::ml before meals 14:%or less mgD1::ml one hour after meals if hyperglycemic % gi!e insulin if hypoglycemic % orange *uice, sugar, candy 12) % the child should a!oid e'ercising during peak hours of insulin action in order to p re!ent hypoglycemia. 3eak action regular insulin occurs after ?%4 hours after administration. >or the other types of insulin) •
short actingDregular clear % ?%4 hours
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intermediateDlenteD3/ cloudy % 8%1? hours
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long%actingDultralente cloudy % 18%?4 hours
13) C % starting 9 years old, a child has already de!eloped enough finger de'terity 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 in*ect her own insulin, the child need not go to the school clinic. $nother important instruction to Irish is to a!oid in*ecting insulin in her arm during 3.7. days when she plays !olleyball. 7'ercise increases absorption of insulin. She should, then in*ect it in her abdomen. If Irene is runner, it would not be ad!isable to in*ect it her thigh. It is important for the child to eat a carbohydrate snack before engaging in sports as e'ercise increases glucose utili-ation and make her hypoglycemic 0arrying a medic alert band or I+ and prefilled syringe with instructions are important in cases of emergency. 14) % the glycosylated hemoglobin shows the patients b lood glucose le!el during the last three months so iti s the best test that would reflect the patient"s compliance to therapy and her glucose control. >asting blood glucose reflects only the current glucose control etone appears in the urine when blood glucose le!els e'ceed ?:: mg"dl Eoutine serum chemistry is not necessary in assessing the therapeutic compliance of a diabetic patient. NCLEX Endocrine Questions 15. Ahich of the following should the nurse include in the discharge instructions to be gi!en to a client on continuous insulin infusion through insulin pump@ a change needle site e!ery ? to 2 days b check blood sugar le!el daily c push button on the de!ice to self%administer insulin after each meal d the machine gi!es continuous small doses of insulin, so there is no need to check blood sugar le!els 16. $ client with diabetes mellitus is self%administering 3/ insulin from a !ial kept at room temperature. &he client asks a nurse about the length of time an unrefrigerated !ial of insulin will remain its potency.
&he most appropriate response to the client is which of the following@ a two weeks b one month c two months d si' months 17. Ahich of the following is the appropriate initial action by the nurse when preparing insulin administration@ a in*ecting air into the regular insulin b withdrawing the cloudy insulin first before the clear insulin c in*ecting air into the cloudy insulin but withdrawing the clear insulin first d withdrawing the clear insulin and cloudy insulin in separate syringes 18. &he client with insulin%dependent diabetes mellitus I++M has been brought to the emergency room. Ahat should the nurse watch for if blood p/ is B.?8 a lactic acidosis b ketoacidosis c metabolic alkalosis d respiratory acidosis 19. $ client has been diagnosed to ha!e $+e %% diaetes /e''itus. She e'periences hypoglycemia. $fter recei!ing a glass of orange *uice, what should the nurse gi!e ne't@ a peanut butter sandwich b 1 tablespoon sugar c 1 cup skim milk d a cup chocolate drink 2. Ahich of the following laboratory test best indicate compliance of the diabetic client and insulin therapy@ a ?%hour postprandial blood glucose b fasting blood glucose c glycosylated hemoglobin d oral glucose tolerance test
NCLEX Endocrine Questions: NS!E"S N# "$%&NLE 15) % insulin lowers blood sugar le!els. Insulin pump gi!es small doses of insulin continuously and the patient can bolus himself before each meal.
16) % insulin, when stored at room temperature is potent for 2: days 1 month. 17) C % this action ensures pre!ention of contamination of the rapid%acting insulin. In case of emergency +$, rapid effect of the clear insulin is maintained. In*ecting air into the cloudy insulin will promote easy aspiration of the medication, once the syringe already contains the clear insulin. 18) % ketoacidosis is characteri-ed by low blood p/. &ype I diabetic clients are prone to ketoacidosis. 19) % orange *uice pro!ides uick source of glucose; slices of bread pro!ide sustained supply of glucose. &his will be followed with skim milk as source of protein, to inhibit breakdown of fats. &his in turn, pre!ents ketoacidosis. 2) C % glycosylated hemoglobin /b$1c is the best indicator of diabetic control. It reflects blood glucose le!el for the past 2 t: 4 mthNCLEX Endocrine Questions 21. $ diabetic client asks a nurse if bacon is allowed in the diet. Ahich nursing response is most appropriate@ a bacon is much too high in fats b bacon is not allowed c one strip of bacon may be eaten if you eliminate 1 teaspoon of butter d bacon may be eaten if you eliminate one meat from the diet 22. &he client with congesti!e heart disease is diagnosed to ha!e diabetes mellitus +M. Ahich of the following medications should not be administered by the n urse to this client@ a capoten captopril b lano'in digo'in c inderal propranolol d calan !erapamil 23. &he client has been diagnosed to ha!e type ? d iabetes mellitus. Ahich of the following are correct statements about type ? +M. Select all that apply a managed by diet and e'ercise b prone ot diabetic ketoacidosis c prone to //0 hyperglycemic hyperosmolar % nonketotic coma d managed by #/$ oral hypoglycemic agents e reuires lifelong insulin therapy f onset is before age 2: years g with absolute deficiency of insulin 24. &he diabetic client is ha!ing ketoacidosis. Ahich of the following is the appropriate initial nursing action@
a start an intra!enous glucose b administer insulin per IF c gi!e a glass of orange *uice d gi!e a cup of skim milk 25. &he client has been diagnosed to ha!e I++M non%insulin dependent diabetes mellitus. Ahich of the following signs and symptoms characteri-e the disease@ Select all that apply. a occurs after 2: years of age b obesity c reuires lifetime insulin in*ection d can be controlled by diet, e'ercise, and drug e prone to diabetic ketoacidosis f e'perience weight loss g may reuire insulin in case of stress, surgery, pregnancy
NCLEX Endocrine Questions: NS!E"S N# "$%&NLE 21) C % bacon is fat and may be e'changed with fat component in the diet, e.g. butter. 7'change 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 +M. 23) C # % these are characteristics of type II +M. &he other choices describe type I +M. 24) % ketoacidosis is characteri-ed by se!ere hyperglycemia. &he emergency management of ketoacidosis is regular insulinDIF. 25) # and ; % all of these describes I++M.o 4 months.
NCLEX Endocrine Questions (26-3) 26. &he following are characteristics of type I +M. Select all that apply a the client is thin b it reuires lifelong insulin c the client may take sulfonylureas d the client is at risk to de!elop diabetic ketoacidosis e onset of the disease is after 2: years of age f there is insulin secretion, but the body"s demands are increased
27. &he following are signs and symptoms that indicate hyperglycemia in a client with diabetes mellitus. Select all that apply a ele!ated blood sugar le!el b cold, clammy skin c increased urination d tremors e deep, rapid respiration f e'cessi!e thirst g metabolic acidosis 28. &he client has been diagnosed to ha!e I++M. Ahich order should you uestion@ a propranolol b insulin in*ection c acetaminophen d diltia-em 29. &he nurse is assessing a pregnant client with type I diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. &he nurse determines that teaching is needed if the client makes which statement@ a I will need to increase my insulin dosage during the first 2 months of pregnancy b my insulin dose will likely need to be increased during the second and third trimester c episodes of hypoglycemia are more likely to occur during the first 2 months of pregnancy d my insulin needs should return to normal within B to 1: days after birth if I am bottle%feeding 3. $n adolescent client with type I diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Ahich assessment findings should the nurse e'pect to note@ a sweating and tremors b hunger and hypertension c cold, clammy skin and irritability d fruity breath and decreasing le!el of consciousness
NCLEX Endocrine Questions: NS!E"S N# "$%&NLE 26) # % these are the characteristic of type I +M. 27) C E < ; % these are signs and symptoms of hyperglycemia. 28) % propranolol, a beta%adrenergic blocker causes hypoglycemia. It is contraindicated among diabetic clients. 29) % insulin needs decrease in the first trimester because of increase insulin production by the pancreas and increased peripheral sensiti!ity to insulin. &he statements in option C, 0, and + are accurate and signify that the client understands control of he r diabetes during pregnancy.
3) # /yperglycemia occurs with diabetic ketoacidosis. Signs of hyperglycemia include fruity breath and a decreasing le!el of consciousness. /unger can b e a sign of hypoglycemia or hyperglycemia, but hypertension is not a sign of diabetic ketoacidosis. Instead, hypotension occurs because of a decrease in blood !olume related to the dehydrated state that occurs during diabetic ketoacidosis. 0old, clammy skin, irritability, sweating, and tremors are all signs of hypoglycemia.
&n'ine Nursin ractice $est=E*a/ aout Endocrine (31-35) Situation: Miss 7leanor is a ? year old woman who is being treated in the endocrine clinic for adult% onset My'edema. 31. Ahile taking a nursing history, the nurse should e'pect Miss 7leanor to assess) a facial puffiness b intolerance to heat c e'opthalmus d heart palpitations 32. &he physician has ordered serum thyro'ine &4 concentration and serum cholesterol test. Ahich finding should the nurse e'pect@ a decreased serum &4 and decreased serum cholesterol b decreased serum &4 and increased serum cholesterol c increased serum &4 and increased serum cholesterol d increased serum &4 and increased serum cholesterol 33. Ahich of the following manifestations does the nurse e'pect in a client with my'edema@ a increased heart rate b edema c weight loss d intolerance to heat 34. Ahich of the following are most important to monitor in a client who had undergone total thyroidectomy@ a pulse and temperature b serum electrolyte le!els c weight and food intake d hoarseness of the !oice and ability to swallow 35. Ahich of the following should be included when gi!ing health teachings to a client with hyperthyroidism. a wear long%slee!ed clothing b use artificial tears to the eyes as necessary c increase fibers in the diet d take medications with milk
NS!E"S N# "$%&NLE 31) - >+otroidis/ 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) •
Cretinis/ % hypothyroidism in infants and young children
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>+otroidis/ ?itout /*ede/a % mild degree of thyroid failure in older children and adult
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>+otroidis/ ?it /*ede/a % se!ere degree of thyroid failure or hypothyroidism in adults
Manifestations of hypothyroidism are associated with the slowing of the metabolic rate and include) •
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3atient"s with my'edema e'hibits nonpitting edema in connecti!e tissues all o!er the body, including the face which appears puffy and the tongue which is enlarged. &he edema is due to accumulation of mucoprotein and water retention. ;oiter % enlargement of the thyroid gland may or may not be p resent. =oiter occurs from e'cessi!e stimulation of &S/ from the pituitary because of continuous deficient or lack thyro'ine. /ypothyroidism caused by lack of &S/ does not cause goiter. Cradycardia, hypotension, dysrrhythmias, enlarged heart $pathy, slow and slurred speech, lethargy
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+ecreased heat production%sensiti!ity to cold
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+ecreased nutrient reuirements) poor appetite
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+ecreased sweat and sebaceous gland function) dry scaly skin
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$ltered protein, fat and carbohydrate metabolism) weight gain edema slow wound healing, decreased blood glucose, hypoalbuminemia +ecreased erythropoietin production) anemia
32) - >+otroidis/ is due to deficient thyro'ine hormone so naturally serum &4 will be below normal. &hyro'ine regulates fat or lipid metabolism. +eficiency in thyro'ine will result in slow metabolic acti!ity resulting in slowing of lipid metabolism which increases serum cholesterol and triglyceride le!els making the patient at risk for atherosclerosis and cardiac disorders. anae/ent: 1. 3re!ention % pre!ention of iodine deficiency 2. Eeplacement therapy throughout life a. #rus used:
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Sodium 6%thyro'ineDle!othyro'ine Synthroid, 6e!oid
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Sodium 6%triidothyro'ine 0ytomel, &rionine
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Synthetic combination of &2 and &4 7uthroid, thyrolar
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atural combination of &2 and &4 e'tract
. aor Side Eects: •
Inadeuate treatment % show recurrenceDpersistence of signs of hypothyroidism
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7'cessi!e treatment % show signs of hyperthyroidism
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&oo fast increase in drug dose % angina, palpitations, tachycardia
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Cone loss and decreased bone density
c. +uring initiation of therapy % patient is seen by physician e!ery ?%4 weeks until condition is stable and then thyroid therapy is monitored annually. 3. Nursin Care: •
$cti!ity Intolerance % limit acti!ity to patient"s tolerance. If patient de!elops tachycardia or chest pain, stop acti!ity
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0onstipation % increase fiber and fluids
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/ypothermia % maintain comfortable en!ironmental temperature, use blankets as necessary
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(se freuent stimulation at dusk and nightfall % use nightlights to pre!ent confusion
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maintain safe en!ironment
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promote positi!e body image % educate about re!ersible body changes
4. Surer % may be performed for large goiters especially if it causes dysphagia, chocking sensation, inspiratory stridor, hoarseness and positi!e 3emberton"s sign ele!ation of arms results in di--iness and syncope caused by pressure on !eins that !enous return from the head.
33) % my'edema is manifested by h ypothyroidism. $, 0, and + are manifestations of hyperthyroidism 34) % thyroid crisis DstormDthyroidto'icosis is the most life%threatening postop complication of thyroid surgery. It is characteri-ed by hyperthermia and tachycardia. &herefore it is necessary to monitor the client"s pulse and temperature. 35)
% hyperthyroidism may cause e'opthalmos. &o pre!ent corneal ulceration, artificial tears will be instilled into the eyes as necessary. &he client usually de!elops diarrhea so, high f iber diet is not indicated. &he medication should not be taken with antacid. $ntacid inhibits absorption of anti thyroid drugs.
NCLEX Endocrine Questions (36-4) NCLEX Endocrine Questions 36. Ahich of the following assessment findings characteri-e thyroid storm@ a increased body temperature, decreased pulse, and increased blood pressure b increased body temperature, increased pulse, and increased blood pressure c increased body temperature, decreased pulse, and decreased blood pressure d increased body temperature, increased pulse, and decreased blood pressure 37. &he nurse is planning care for a client with hyperthyroidism. Ahich of the following nursing inter!entions are appropriate@ Select all that apply a instill isotonic eye drops as necessary b pro!ide se!eral, small, well%balanced meals c pro!ide rest periods d keep en!ironment warm e encourage freuent !isitors and con!ersation f weigh the client daily
38. $fter thyroidectomy, which of the following is the priority assessment to obser!e laryngeal ner!e damage@ a hoarseness of !oice b difficulty in swallowing c tetany d fe!er 39. $ home care nurse is teaching an adolescent with type I diabetes mellitus about insulin administration and rotation sites. Ahich statement, if made by the adolescent, would indicate effecti!e teaching@ a I need to use a different site for each insulin in*ection b I should use only my stomach and my thighs for in*ections c I need to use the same site for 1 month before rotating to another d I need to use one ma*or site for ? to 2 weeks before changing ma*or sites 4. $ 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. +iabetic ketoacidosis is diagnosed. $nticipating the plan of care, the nurse prepares to administer which intra!enous infusion@ a potassium b 3/ insulin c < de'trose d normal saline
NCLEX Endocrine Questions: NS!E"S N# "$%&NLE 36) % thyroid storm is characteri-ed by SS acti!ation. &hyroid hormones potentiate effects of cathecolamines epinephrineDnorepinephrine. &herefore, all !ital signs will be increased. 37) C and < % the client with hyperthyroidism may e'perience e'opthalmos. &his reuires instillation of eye drops to pre!ent dryness and ulceration of the cornea. &he client e'periences weight loss because of hypermetabolism. Se!eral, small, well%balanced meals are gi!en to impro!e nutritional status of the client and daily weights should be monitored. Aeight is the most ob*ecti!e indicator of nutritional status. &he client is usually e'hausted due to restlessness and agitation. >reuent rest periods help the client regain energy. 38) % laryngeal ner!e damage is manifested by se!ere hoarseness of !oice or Gwhispery !oiceG. 39) # % &o help decrease !ariations in absorption from day to day, the adolescent should use one ma*or site for in*ections for ? to 2 weeks before changing ma*or sites. &he in*ections are rotated to different locations within that ma*or site. #ptions $, C, and 0 are incorrect. 4) # % Eehydration is the initial step in resol!ing diabetic ketoacidosis. ormal saline is the initial IF rehydration fluid. 3/ insulin is ne!er administered by the IF route. +e'trose solutions are added to the treatment when the blood glucose le!el reaches an acceptable le!el. Intra!enously administered potassium may be reuired, depending on the potassium le!el, but would not be part of the initial treatment.
NCLEX Endocrine Questions (41-45) NCLEX Endocrine Questions 41. $ client with diabetes mellitus has a glycosylated hemoglobin le!el of 9<. Cased on this result, the nurse plans to teach the client about the need to) a a!oid infection b take in adeuate fluids c pre!ent and recogni-e hypoglycemia d pre!ent and recogni-e h yperglycemia 42. $ nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Ahich instruction is included in the plan@ a soak feet in hot water b a!oid using a mild soap on the feet c apply a moisturi-ing lotion to dry feet but not between the toes d always ha!e a podiatrist cut your toenails; ne!er cut them yourself
43. $ client is brought to the emergency room in an unresponsi!e state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. &he nurse would immediately prepare to initiate which of the following anticipated physician"s orders@
a endotracheal intubation b 1:: units of 3/ insulin c intra!enous infusion of normal saline d intra!enous infusion of sodium bicarbonate 44. $n e'ternal insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. &he nurse bases the response on the information that the pump) a is timed to release programmed doses of regular or 3/ insulin into the bloodstream at specific inter!als b continuously infuses small amounts of 3/ insulin into the bloodstream while regularly monitoring blood glucose le!els c is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream d gi!es 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. $ client newly diagnosed with diabetes mellitus has been stabili-ed with daily insulin in*ections. $ nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which of the following concepts@ a always keep insulin !ials refrigerated b ketones in the urine signify a need for less insulin c increase the amount of insulin before unusual e'ercise d systematically rotate insulin in*ections within one anatomic site
NCLEX Endocrine Questions: NS!E"S N# "$%&NLE 41) # % In the test result for glycosylated hemoglobin $1c, B< or less indicates good control, B< to 8< indicates fair control, and 8< or higher indicates poor control. &his test measures the amount of glucose that has become permanently bound to the red blood cells from circulating glucose. 7le!ations in the blood glucose le!el will cause ele!ations in the amount of glycosylation. &hus, the test is useful in identifying clients who ha!e periods of hyperglycemia that are undetected in other ways. 7le!ations indicate continued need for teaching related to the pre!ention of hyperglycemic episodes. 42) C % &he client is instructed to use a moisturi-ing lotion on the feet a nd to a!oid applying the lotion between the toes. &he client should be instructed not to soak the feet and should a!oid hot water to pre!ent burns. &he client may cut the toenails straight across and e!en with the toe itself and would consult a podiatrist if the toenails were thick or hard to cut or if !ision were poor. &he client should be instructed to wash the feet daily with a mild soap. 43) C % &he primary goal of treatment in hyperglycemic hyperosmolar nonketotic syndrome //S is to rehydrate the client to restore fluid !olume and to correct electrolyte deficiency. Intra!enous fluid replacement is similar to that administered in diabetic ketoacidosis +$ and begins with IF infusion of normal saline. Eegular insulin, not 3/ insulin, would be administered. &he use of sodium bicarbonate to correct acidosis is a!oided because it can precipitate a further drop in serum potassium le!els. Intubation and mechanical !entilation are not reuired to treat //S.
44) # % $n insulin pump pro!ides 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. Eegular insulin is used in an insulin pump. $n e'ternal pump is not attached surgically to the pancreas. 45) # % Insulin doses should not be ad*usted nor increased before unusual e'ercise. If ketones are found in the urine, it possibly may indicate the need for additional insulin. &o minimi-e the discomfort associated with insulin in*ections, insulin should be administered at room temperature. In*ection sites should be rotated systematically within one anatomic site
NCLEX Endocrine Questions (46-5) NCLEX Endocrine Questions 46. $ client with a diagnosis of diabetic ketoacidosis +$ is being treated in an emergency room. Ahich finding would a nurse e'pect to note as confirming this diagnosis@ a comatose state b decreased urine output c increased respiration and an increase in p/ d ele!ated blood glucose le!el and low plasma bicarbonate le!el 47. $ nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. &he client demonstrates an understanding of the teaching by stating that glucose will be taken if which of the following symptoms de!elops@ a polyuria b shakiness c blurred !ision d fruity breath odor
48. $ client with diabetes mellitus demonstrates acute an'iety when first admitted for the treatment of hyperglycemia. &he appropriate inter!ention to decrease the client"s an'iety is to) a administer a sedati!e b con!ey empathy, trust, and respect toward the client c ignore the signs and symptoms of an'iety so that they will soon disappear d make sure that the client knows all the correct medical terms to understand what is happening 49. $ nurse pro!ides instructions to a client newly diagnosed with type 1 diabetes mellitus. &he nurse recogni-es accurate understanding of measures to pre!ent diabetic ketoacidosis is when the client states) a I will stop taking my insulin if I"m too sick to eat b I will decrease my insulin dose during times of illness c I will ad*ust my insulin dose according to the le!el of glucose in my urine d I will notify my physician if my blood glucose le!el is higher than ?: mgDd6 5. $ client is admitted to a hospital with a diagnosis of diabetic ketoacidosis +$. &he initial blood glucose le!el was 9: mgDd6. $ continuous intra!enous infusion of regular insulin is intiated, along with intra!enous rehydration with normal saline. &he serum glucose le!el is now ?4: mgDd6. &he nurse would ne't prepare to administer which of the following@
a ampule of :< de'trose b 3/ insulin subcutaneously c intra!enous fluids containing < de'trose d phenytoin +ilantin for the pre!ention of sei-ures
NCLEX Endocrine Questions: NS!E"S N# "$%&NLE 46) # % In +$, the arterial p/ is lower than B.2, plasma bicarbonate is lower than 1 m7D6, the blood glucose le!el is higher than ?: mgDd6, and ketones are present in the blood and urine. &he client would be e'periencing polyuria, and ussmaulHs respirations would be present. $ comatose state may occur if +$ is not treated, but coma would not confirm the diagnosis. 47) % Shakiness is a sign of hypoglycemia and would indicate the need for food or glucose. $ fruity breath odor, blurred !ision, and polyuria are signs of hyperglycemia. 48) % &he appropriate inter!ention is to address the clientHs feelings related to the an'iety. $dministering a sedati!e is not the most appropriate inter!ention. &he nurse should not ignore the clientHs an'ious feelings. $ client will not relate to medical terms, particularly when an'iety e'ists. 49) # % +uring illness, the client should monitor blood glucose le!els and should notify the physician if the le!el is higher than ?: mgDd6. Insulin should ne!er be stopped. In fact, insulin may need to be increased during times of illness. +oses should not be ad*usted without the physicianHs ad!ice and are usually ad*usted based on blood glucose le!els, not urinary glucose readings. 5) C % +uring management of +$, when the blood glucose le!el falls to ?: to 2:: mgDd6, the infusion rate is reduced and < de'trose is added to maintain a blood glucose le!el of about ?: mgDd6, or until the client reco!ers from ketosis. 3/ insulin is not used to treat +$. >ifty percent de'trose is used to treat hypoglycemia. 3henytoin +ilantin is not a usual treatment measure for +$.
NCLEX Endocrine Questions 51-55 NCLEX Endocrine Questions 51. $ physician has prescribed propylthiouracil 3&( for a client with hyperthyroidism and the nurse de!elops a plan of care for the client. $ priority nursing assessment to be included in the plan regarding this medication is to assess for) a relief of pain b signs of renal to'icity c signs and symptoms of hyperglycemia d signs and symptoms of hypothyroidism 52. $ nurse de!elops a plan of care for a client with hyperparathyroidism who is recei!ing calcitonin salmon 0alcimar. Ahich of the following outcome criteria has the h ighest priority regarding this medication@ a relief of pain
b absence of side effects c achie!ement of normal serum calcium le!els d !erbali-ation of appropriate medication knowledge
53. $ physician prescribes le!othyro'ine sodium Synthroid, :.1 mg orally daily, for a client with hypothyroidism. &he nurse will prepare to administer this medication) a in the morning to pre!ent insomnia b only when the client complains of fatigue and cold intolerance c at !arious times during the day to pre!ent tolerance from occurring d three times daily in eual doses of :. mg each to ensure consistent serum drug le!els 54. $ nurse is monitoring a client with diabetes insipidus and desmopressin acetate ++$F3 has been prescribed for the client. Ahich of the following outcomes reflects a therapeutic effect of this medication@ a decreased urine output b decreased blood pressure c urine osmolality lower than 1:: m#smDkg d serum osmolality higher than 2?: m#smDkg 55. $ nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Ahich of the following, if e'hibited in the client, would indicate hyperglycemia and warrant physician notification@ a polyuria b diaphoresis c hypertension d increased pulse rate
NCLEX EN#&C"%NE Q@ES$%&NS: NS!E"S N# "$%&NLE 51) # % 7'cessi!e dosing with propylthiouracil 3&( may con!ert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. &emporary administration of thyroid hormone may be reuired. 3ropylthiouracil is not used for pain and does not cause hyperglycemia or renal to'icity. 52) C % 0alcitonin can lower plasma calcium le!els in clients with hypercalcemia caused by hyperparathyroidism. &he therapeutic effect in this client situation would be a reduction in serum calcium le!els. #ptions $, C, and + are incorrect outcome criteria. 53) % 6e!othyro'ine Synthroid is a synthetic thyroid hormone that increases cellular metabolism. 6e!othyro'ine should be gi!en in the morning in a single dose to pre!ent insomnia and should be gi!en at the same time each day to maintain an adeuate drug le!el. &herefore, options C, 0, and + are incorrect. 54) % +esmopressin acetate ++$F3 is a synthetic form of antidiuretic hormone that causes increased reabsorption of water, with a resultant decrease in urine output. &he therapeutic response to ++$F3 would be a decrease in serum osmolality, because more fluid is retained, and an increase in urine
osmolality, because less fluid is e'creted. /ypotension may b e apparent with diabetes insipidus and blood pressure may increase as e'tracellular fluid !olume is restored. 55) % 0lassic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. #ptions C, 0, and + are not signs of hyperglycemia.
