Endocrine NCLEX PN Practice Questions II
Ana Corona, MSN, FNP-C Nursing Instructor July 2007
A thirty five year old male has been an insulindependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect? A: Atherosclerosis B: Diabetic nephropathy C: Autonomic neuropathy D: Somatic neuropathy
Answer C is correct. Autonomic neuropathy can cause inability to urinate.
A patient’s chart indicates a history of hyperkalemia. Which of the following would you not expect to see with this patient if this condition were acute? A: Decreased HR B: Paresthesias C: Muscle weakness of the extremities D: Migraines
Answer D is correct. Answer choices A-C were symptoms of acute hyperkalemia
A patient’s chart indicates a history of ketoacidosis. Which of the following would you not expect to see with this patient if this condition were acute? A: Vomiting B: Extreme Thirst C: Weight gain
The client with a history of diabetes insipidus is admitted with polyuria. The priority intervention for this client is: Measure the urinary output Check the vital signs
. Which of the following tests is most likely to be performed first? A: Blood sugar check B: CT scan C: Blood cultures D: Arterial blood gases
Answer A is correct. the first response should be to check blood sugar levels. even on warm days. The male is sweaty and pale. and mental confusion. Weight loss would be expected
A 84 year-old male has been loosing mobility and gaining weight over the last 2 months. The patient also has the heater running in his house 24 hours a day. Which of the following tests is most likely to be performed? A: CBC (complete blood count) B: ECG (electrocardiogram) C: Thyroid function tests D: CT scan
Answer C is correct.
A 28 year old male has been found wandering around in a confused pattern.D: Acetone breath smell
Answer C is correct. polydipsia. Weight gain and poor temperature tolerance indicate something may be wrong with the thyroid function. With a history of diabetes.
therefore. making answer C incorrect. but the stem already says that the client has polyuria.
A client has had a unilateral adrenalectomy to remove a tumor. and specific gravity changes occur with other disorders. so answer A is incorrect.Encourage increased fluid intake Weigh the client
Answer B is correct. Temperature would be an indicator of infection. Measuring the urinary output is important. The loss of electrolytes would be reflected in the vital signs. and D are incorrect. answers B. Answer D is incorrect because weighing the client is not necessary at this time. The large amount of fluid loss can cause fluid and electrolyte imbalance that should be corrected. The client is receiving IV glucocorticoids (Solu-Medrol). Which of the following interventions would the nurse implement? Glucometer readings as ordered Intake/output measurements Sodium and potassium levels monitored Daily weights
. The remaining gland might have been suppressed due to the tumor activity.
A client with Addison's disease has been admitted with a history of nausea and vomiting for the past 3 days. decreased output would be a clinical manifestation but would take longer to occur than blood pressure changes. Encouraging fluid intake will not correct the problem. Blood pressure is the best indicator of cardiovascular collapse in the client who has had an adrenal gland removed. the most important measurement in the immediate post-operative period for the nurse to take is: Blood pressure Temperature Output Specific gravity
Answer A is correct. To prevent complications. C.
A 32-year-old mother of three is brought to the clinic. The tingling is due to low calcium levels. The client is complaining of tingling around the mouth and in the fingers and toes. and the client is wearing two sweaters. C. therefore. Hypertension occurs in thyroid storm and the drainage would occur in hemorrhage. The parathyroid glands are responsible for calcium production and can be damaged during a thyroidectomy. Answer B is not necessary at this time. so answers C and D are incorrect.8
Answer A is correct. The client is diagnosed with hypothyroidism. answer A is incorrect. and D are incorrect. sodium and potassium levels would be monitored when the client is receiving mineral corticoids. IV glucocorticoids raise the glucose levels and often require coverage with insulin. which would
. thus. The crash cart would be needed in respiratory distress but would not be the next action to take. Her pulse is 52. answers B. The decrease in pulse can affect the cardiac output and lead to shock. there is a weight gain of 30 pounds in 4 months.
A client had a total thyroidectomy yesterday. What would the nurses' next action be? Obtain a crash cart Check the calcium level Assess the dressing for drainage Assess the blood pressure for hypertension
Answer B is correct. Which of the following nursing diagnoses is of highest priority? Impaired physical mobility related to decreased endurance Hypothermia r/t decreased metabolic rate Disturbed thought processes r/t interstitial edema Decreased cardiac output r/t bradycardia
Answer D is correct. and daily weights is unnecessary.
" "I can save my dessert from supper for a bedtime snack." "I will eat a snack around three o'clock each afternoon. and weight loss. so a snack should be eaten at the expected peak time. Answer D is incorrect because there is no need to save the dessert until bedtime. NPH insulin peaks in 8–12 hours. The nurse's response is based on the knowledge that:
The physician has prescribed Novalog insulin for a client with diabetes mellitus. and D are incorrect. Novalog insulin onsets very quickly. so food should be available within 10–15 minutes of taking the insulin.Question 11
take precedence over the other choices. and C are incorrect.m. answers A. so it is incorrect. What would the nurse expect the admitting assessment to reveal? Bradycardia Decreased appetite Exophthalmos Weight gain
Answer C is correct.
A 25-year-old client with Grave's disease is admitted to the unit. as stated in answer C. The client with hyperthyroidism will often exhibit tachycardia. therefore. Exophthalmos (protrusion of eyeballs) often occurs with hyperthyroidism. therefore.
A client with hypothyroidism asks the nurse if she will still need to take thyroid medication during the pregnancy. Which statement indicates that the client knows when the peak action of the insulin occurs? "I will make sure I eat breakfast within 10 minutes of taking my insulin. It may not be 3 p." "I will need to carry candy or some form of sugar with me all the time."
Answer A is correct. increased appetite. answers A. B. Answer B does not address a particular type of insulin.
Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy. C. Fetal growth is not arrested if thyroid medication is continued. the client should be taught to drink plenty of fluids and not void. the thyroid gland triples in size. and there is no need to withhold food for 8 hours. Therefore.
Answer B is correct. Fetal growth is arrested if thyroid medication is continued during pregnancy. It is more difficult to maintain thyroid regulation during pregnancy due to a slowing of metabolism. Preparation for an ultrasound includes: Increasing fluid intake Limiting ambulation Administering an enema Withholding food for 8 hours
Answer A is correct.
The nurse should visit which of the following clients first? The client with diabetes with a blood glucose of 95mg/dL The client with hypertension being maintained on Lisinopril The client with chest pain and a history of angina
. The client may ambulate. Answer C is incorrect because the thyroid function does not slow. and D are incorrect.There is no need to take thyroid medication because the fetus's thyroid produces a thyroid-stimulating hormone. Answer A is incorrect because there could be a need for thyroid medication during pregnancy. answers B.
A client with diabetes has an order for ultrasonography. This makes it more difficult to regulate thyroid medication. Before ultrasonography. During pregnancy. so answer D is incorrect. an enema is not needed.
Which statement indicates that the client knows when the peak action of the insulin occurs? "I will make sure I eat breakfast within 2 hours of taking my insulin. Answer D is incorrect.The client with Raynaud's disease
Answer C is correct." "I will eat a snack around three o'clock each afternoon." "I can save my dessert from supper for a bedtime snack. Answer B is untrue because NPH insulin is time released and does not usually cause sudden hypoglycemia. the nurse should: Assess the client for allergies Bolus the client with IV fluid Tell the client he will be asleep Insert a urinary catheter
. The client in answer B is maintained on blood pressure medication.
The physician has prescribed NPH insulin for a client with diabetes mellitus. The client in answer D is in no distress.
The physician has ordered a thyroid scan to confirm the diagnosis." "I will need to carry candy or some form of sugar with me all the time. The client with chest pain should be seen first because this could indicate a myocardial infarction. Before the procedure."
Answer C is correct. NPH insulin onsets in 90–120 minutes. The client in answer A has a blood glucose within normal limits. but the client should eat a bedtime snack. so answer A is incorrect. so a snack should be offered at that time. NPH insulin peaks in 8–12 hours.
gloves. The client will not have a bolus of fluid. and a mask should be used when caring for the client and hand washing is very important. Which statement is true regarding precautions for infections spread by contact? The client should be placed in a room with negative pressure.
A client hospitalized with MRSA (methicillin-resistant staph aureus) is placed on contact precautions. Infection requires skin-to-skin contact and is prevented by hand washing. C. so the client should be instructed to cover his nose and mouth when he sneezes or coughs. the nurse should wear the mask. so the client should wear a mask at all times.17
Answer A is correct. a gown. MRSA is spread by contact with blood or body fluid or by touching the skin of the client. and a gown. It is not necessary for the client to wear the mask at all times. The door should remain closed. so answer C is incorrect. so answers B.
The client has recently returned from having a thyroidectomy. A thyroid scan uses a dye. Gloves. and will not have a urinary catheter inserted. Infection requires close contact. It is cultured from the nasal passages of the client.
Answer D is correct. The client who has recently had a thyroidectomy is at risk for tracheal edema. so the client should be assessed for allergies to iodine. so answers A and B are incorrect. Transmission is highly likely. A padded
. The nurse should keep which of the following at the bedside? A tracheotomy set A padded tongue blade An endotracheal tube An airway
Answer A is correct. therefore. but a negative-pressure room is not necessary. the door may remain open. The client with MRSA should be placed in isolation. and D are incorrect. will not be asleep.
In assessing this patient for hypocalcemia. B. If the client experiences tracheal edema. Applying a BP cuff to upper arm. Tapping a finger on the supramandibular portion of the parotid cland and observing for twitching of the upper lip on the side opposite to the stimulation. and observing for carpopedal spasm. inflating it.
Answer C is correct. line is started and blood is drawn for laboratory studies. Chvostek's sign is elicited by: A. the endotracheal tube or airway will not correct the problem. D. so answers C and D are incorrect. Tapping over a branch of the facial nerve and observing for twitching of the upper lip on the ipsilateral (same) side as stimulation is considered a positive Chvostek's sign.
. Inflating a BP cuff on the upper arm or having the patient hyperventilate will both produce carpopedal spasm and are part of the diagnostic tests used to elicit Trousseau's sign. Applying a (BP) cuff to the upper arm.
A 17-year-old female model comes to your ER complaining of generalized cramps and numbness in her fingers. C. so answer B is incorrect." An I. Medical history is noncontributory.
Trousseau's sign can be elicited in the hypocalcemic patient by: A.V.5 mg/dl. When questioned. Tapping a finger on the skin above the supramandibular portion of the parotid gland and observing for twitching of the upper lip on same side as stimulation. inflating it. Having the patient hyperventilate (more than 30 breaths/minute) to produce carpopedal spasm resulting from respiratory alkalosis. Her serum calcium level is 5.tongue blade is used for seizures and not for the client with tracheal edema. B. A decrease in ionized calcium causes an increase in neuromuscular excitability. Tapping a finger on the skin above the supramandibular portion of the parotid gland and observing for twitching of the upper lip on side opposite stimulation. and observing for carpopedal spasm. she tells you that She has been on a high-protein diet for "about 6 weeks.
Tapping a finger on the supramandibular portion of the parotid gland and observing for twitching of the upper lip on the same side as stimulation. the myxedematous state results from the interstitial accumulation of a mucopolysaccharide substance that attracts water and produces water retention. Hypocalcemia
Answer A is correct. pulse. the hyponatremia is caused by dilution.) rectally. respirations. Therefore. Question next slide
The patient admitted with hypothyroid crisis (myxedema coma) would most likely have which of the following electrolyte abnormalities? A.
. Her daughter relates a history of "thyroid problem" and noncompliance with medical therapy. and a yellowish skin pigmentation is noted. Another method for producing this phenomenon is hyperventilation. D. inflating to the patient's systolic pressure.
A 71-year-old woman is transported to the ED because of fatigue and a change in mental status. (36 degrees C. The diagnosis of myxedema is made. owing to the hypometabolic state. periorbital edema is present. Hyponatremia B. and observing for carpopedal spasm. her temperature is 96. This usually is a result of inappropriate secretion of antidiuretic hormone (ADH).
Answer A is correct. Her BP is 110/74 mm Hg. Hyperglycemia D. 12 breaths/minute. Patients with myxedema coma suffer from hyponatremia.8 degrees F. in which the alkalotic state decreases serum calcium levels.C. Trousseau's sign is elicited by applying a BP cuff to the patient's arm. Hypoglycemia is also seen in myxedema coma. Hypernatremia C. Having the patient hyperventilate (more than 30 breaths/minute) to produce carpopedal spasm resulting from respiratory acidosis. Also. On physical examination. 48 beats/minute.
not IM injections.
Which medication is not an oral hypoglycemic agent? Glypizide (Glucotrol) Tolbutamide (Orinase)
. Steroid therapy causes GI disturbances with oral administration. Because sufficient muscle mass is necessary or acute injection of parental cortisol preparations. In addition.
Parental injections of cortisol for patients with addison’s disease should be injected: After the patient eats Deep into the deltoid Deep into the gluteal muscle Into the subcutaneous tissue
Answer C is correct. These hormones increase metabolic functions. Respiratory acidosis and CO2 narcosis are a result of lowered thyroxine (T4) and Tri-iodothyronine (T3) levels. Respiratory alkalosis without compensation C. The patient does not have to have food in the stomach before administration. thereby causing hypoventilation. tissue atrophy and pigmentation abnormalities. the nurse should inject them deep into the gluteal muscle. Cortisol should not be injected subC because it may cause sterile abscess. Metabolic alkalosis D. Respiratory alkalosis with compensation
Answer A is correct. metabolic acidosis may develop as hypoxia increases serum lactate levels.Question 23
Which of the following acid-base imbalances is most likely to occur in this patient? A. such as respiration. a decrease in T3 and T4 levels depresses respiratory function. Thus. Respiratory acidosis B.
. who found him unconscious on the floor. Assess the client for head trauma. Diazoxide (Hystat) are hypoglycemia agents. Chlorpropamide (diabinese). (sulfonyrlueas)
While reviewing a clients lab results. Hyperstat is a benzothiadiazide that causes hyperglycemia by inhibiting insulin secretions. Normal fasting blood sugar is 70-99
A. the nurse recognizes that a fasting glucose value of ________________ is within normal limits.
Answer A is correct. It is used to treat hypoglycemia by excessive insulin productions. Ask the coworker how long the client was unconscious.
A diabetic client is admitted to the ER by a coworker. A low blood sugar level is life threatening & must be corrected immediately. Contact the client's family and tell them to come to the hospital immediately. D. B. A nurse would first: Check the client's blood sugar level and start an IV infusion. 80 120 160 200
Answer A is correct. It is priority to assess the client's blood sugar level.Tolbutamide (Orinase). Glypizide (Glucotrol).Chlorpropamide (diabinese) Diazoxide (Hyperstat)
Answer D is correct.