NCLEX Endocrine Questions (46-50)

NCLEX Endocrine Questions

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 state
b) decreased urine output
c) increased respiration and an increase in pH
d) 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) polyuria
b) shakiness
c) blurred vision
d) 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 sedative
b) convey empathy, trust, and respect toward the client
c) ignore the signs and symptoms of anxiety so that they will soon disappear
d) 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 eat
b) I will decrease my insulin dose during times of illness
c) I will adjust my insulin dose according to the level of glucose in my urine
d) 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% dextrose
b) NPH insulin subcutaneously
c) intravenous fluids containing 5% dextrose
d) phenytoin (Dilantin) for the prevention of seizures




NCLEX Endocrine Questions:
ANSWERS AND RATIONALE

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.


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