NCLEX Endocrine Questions (41-45)

NCLEX Endocrine Questions

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 infection
b) take in adequate fluids
c) prevent and recognize hypoglycemia
d) 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 water
b) avoid using a mild soap on the feet
c) apply a moisturizing lotion to dry feet but not between the toes
d) 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 intubation
b) 100 units of NPH insulin
c) intravenous infusion of normal saline
d) 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 intervals
b) continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels
c) is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream
d) 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 refrigerated
b) ketones in the urine signify a need for less insulin
c) increase the amount of insulin before unusual exercise
d) systematically rotate insulin injections within one anatomic site




NCLEX Endocrine Questions:
ANSWERS AND RATIONALE

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.



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