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 alternative
b) could consult other doctors
c) can't take a herbal medicine
d) 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 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. The next 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) have your blood sugar checked

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

a) drink plenty of water
b) have a good rest
c) take her prescribed insulin
d) see her doctor right away

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

a) administer insulin at room temperature
b) rotate site of injection
c) aspirate cloudy insulin before clear insulin to combine in one syringe
d) 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 temperature
b) rotate the site of injection
c) inject insulin between layer of fats and muscles
d) introduce insulin rapidly

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

a) nutrition and diet therapy
b) daily foot care
c) good exercise daily
d) 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.


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NCLEX Endocrine Questions (8-14)

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