Endocrine NCLEX Questions (76-80)

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76. A client with a diagnosis of Cushing's syndrome is undergoing a dexamethasone suppression test. The nurse plans to implement which steps during this test?

a ) collect a 24-hour urine specimen to measure serum cortisol levels
b) administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning
c) draw blood samples before and after exercise to evaluate the effect of exercise on serum cortisol levels
d) administer an injection of adrenocorticotropic hormone (ACTH) 30 minutes before drawing blood to measure serum cortisol levels


77. The nurse is caring for a client with type 1 diabetes mellitus. Which of the following laboratory results would indicate a potential complication associated with this disorder?

a) ketonuria
b) potassium: 4.2 mEq
c) blood glucose: 112 mg/dL
d) blood urea nitrogen (BUN): 18 mg/dL

78. Endocrine NCLEX Questions about the nurse who is employed in a diabetes mellitus clinic is caring for a client on insulin pump therapy. Which statement by the client indicates that a knowledge deficit exists regarding insulin pump therapy?

a) if my blood glucose is elevated, I can bolus myself with additional insulin as ordered
b) I'll need to check my blood glucose before meals in case I need a premeal insulin anymore
c) I still need to follow a diet and exercise plan even though I don't inject myself daily anymore
d) now that I have this pump, I don't have to worry about insulin reactions or ketoacidosis ever happening again

79. A client with Grave's disease has exopthalmos and is experiencing photophobia. Which of the following nursing interventions would best assist the client with this problem?

a) obtain dark glasses for the client
b) lubricate the eyes with tap water every 2 to 4 hours
c) administer methimazole (Tapazole) every 8 hours around the clock
d) instruct the client to avoid straining or heavy lifting because this can increase eye pressure

80. The nurse is completing a health history on a client with diabetes mellitus who has been taking insulin for many years. At present the client states that he is experiencing periods of hypoglycemia followed by periods of hyperglycemia. The most likely cause for this occurrence is which of following?

a) eating snacks between meals
b) initiating the use of the insulin pump
c) injecting insulin at a site of lipodystrophy
d) adjusting insulin according to blood glucose levels





Endocrine NCLEX Questions
Answers and Rationale

76) B

- The dexamethasone suppression test is performed to evaluate the function of the adrenal cortex. The procedure for this test is to administer 1 mg of dexamethasone at 11:00 PM to suppress ACTH formation and then to obtain 8:00 AM serum cortisol levels on the following day.

77) A

- Ketonuria is an abnormal finding in the client with diabetes mellitus indicating ketosis. Ketosis is a metabolic effect from the lack of insulin on fat metabolism and occurs in type 1 diabetes mellitus. It is associated with the severe complication of diabetic ketoacidosis (hyperglycemia, ketosis, and acidosis). Options B, C, and D are all normal laboratory findings.

78) D

- Endocrine NCLEX Questions Rationale: Hypoglycemic reactions can occur if there is an error in calculating the insulin dose or if the pump malfunctions. Ketoacidosis can occur if too little insulin is used or if there is an increase in metabolic need. The pump does not have a built-in blood glucose monitoring feedback system, so the client is subject to the usual complications associated with insulin administration without the use of a pump. Options A, B, and C are accurate regarding the use of the insulin pump.

79) A

- Medical therapy for Graves' disease does not help alleviate the clinical manifestation of exophthalmos. Because photophobia (light intolerance) accompanies this disorder, dark glasses are helpful in alleviating the problem. Tap water, which is hypotonic, could actually cause more swelling around the eye because it could pull fluid into the interstitial space. In addition, the client is at risk for developing an eye infection because the solution is not sterile. Methimazole inhibits the synthesis of thyroid hormone and is used to treat hyperthyroidism but will not alleviate exophthalmos or photophobia. There is no need to avoid straining with exophthalmos.

80) C

- Lipodystrophy, specifically lipohypertrophy, involves swelling of the fat at the site of repeated injections. This can interfere with the absorption of insulin, resulting in erratic blood glucose levels. Because the client has been on insulin for many years, this is the most likely cause of poor control. Options A, B, and D are appropriate techniques to use in order to regulate blood glucose levels.


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Endocrine NCLEX Questions (71-75)

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71. A client undergoes a thyroidectomy and the nurse monitors the client for signs of damage to the parathyroid glands postoperatively. Which of the following findings would indicate damage to the parathyroid glands?

a) neck pain
b) hoarseness
c) respiratory distress
d) tingling around the mouth

72. A nurse is conducting a health history on a client with hyperparathyroidism. Which of the following questions asked of the client would elicit information about this condition?

a) do you have tremors in your hands?
b) are you experiencing pain in your joints?
c) have you had problems with diarrhea lately?
d) do you notice any swelling in your legs at night?

73. A client is admitted to the hospital in metabolic acidosis caused by diabetic ketoacidosis (DKA). The nurse prepares to administer which of the following medications as a primary initial treatment for this problem?

a) potassium
b) regular insulin
c) calcium gluconate
d) sodium bicarbonate

74. A client with Cushing's syndrome is being instructed by the nurse on follow-up care. Which statement by the client would indicate a need for further instructions?

a) I should avoid contact sports
b) I should check my ankles for swelling
c) I need to avoid foods high in potassium
d) I need to check my blood glucose regularly

75. A client with hyperaldosteronism is being treated with spironolactone (Aldactone)> Which of the following indicates to the nurse that the medication is effective?

a) a decrease in blood pressure
b) a decrease in sodium excretion
c) a decrease in body metabolism
d) a decrease in plasma potassium





Endocrine NCLEX Questions
Answers and Rationale

71) D

- The parathyroid glands can be damaged or their blood supply impaired during thyroid surgery. Hypocalcemia and tetany result when parathyroid hormone (PTH) levels decrease. The nurse monitors for complaints of tingling around the mouth or of the toes or fingers and muscular twitching because these are signs of calcium deficiency. Additional later signs of hypocalcemia are positive Chvostek's and Trousseau's signs. Hoarseness and neck pain are expected findings postoperatively. Respiratory distress indicates a complication but is not a sign of damage to the parathyroid glands.

72) B

- Hyperparathyroidism causes an oversecretion of parathyroid hormone (PTH), which causes excessive osteoblast growth and activity within the bones. When bone reabsorption is increased, calcium is released from the bones into the blood, causing hypercalcemia. The bones suffer demineralization as a result of calcium loss, leading to bone and joint pain, and pathological fractures. Options A and C relate to assessment of hypoparathyroidism. Option D is unrelated to hyperparathyroidism.

73) B

- The primary treatment for any acid-base imbalance is the treatment of the underlying disorder that caused the problem. In this case, the underlying cause of the metabolic acidosis is anaerobic metabolism caused by the lack of the ability by the body to use circulating glucose. The administration of insulin corrects this problem. Potassium may be added to the treatment regimen if serum potassium levels indicate it is necessary. Options C and D would not be used in the treatment of this disorder.

74) C

- Hypokalemia is a common characteristic of Cushing's syndrome, and the client is instructed to consume foods high in potassium. Clients also experience activity intolerance, osteoporosis, and frequent bruising. Excess fluid volume results from water and sodium retention. Hyperglycemia is caused by an increased cortisol secretion.

75) A

- Aldactone antagonizes the effect of aldosterone and decreases circulating volume by inhibiting tubular reabsorption of sodium and water. Thus, it produces a decrease in blood pressure. It increases the excretion of sodium and water and increases potassium retention. It has no effect on body metabolism.


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Endocrine System Questions and Answers (66-70)

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66. The nurse is caring for a client who is scheduled for an adrenalectomy. The nurse plans to administer which medication in the preoperative period to prevent Addison's crisis?

a) prednisone (deltasone)orally
b) fludrocortisone (Florinef) subcutaneously
c) spironolactone (Aldactone) intramuscularly
d) methiprednisolone sodium succinate (Solu-Medrol) intravenously

67. The nurse is preparing a client with Graves' disease to receive radioactive iodine therapy. The nurse tells the client which of the following about the therapy?

a) following the initial dose, subsequent treatments must continue lifelong
b) the radioactive iodine is designed to destroy the entire thyroid gland with just one dose
c) it takes 6 to 8 weeks after treatment to experience relief from the symptoms of the disease
d) the high levels of radioactivity prohibit contact with family for 4 weeks after initial treatment

68. The nurse is preparing to care for a client returning from the operating room following a subtotal thyroidectomy. The nurse anticipates the need for which of the following items to be placed at the bedside?

a) hypothermia blanket
b) emergency tracheostomy kit
c) magnesium sulfate in a ready-to-inject vial
d) ampule of saturated solution of potassium iodide (SSKI)

69. The nurse is admitting a client with a diagnosis of myxedema to the hospital. The nurse performs which of the following that will provide data related to this diagnosis?

a) inspects facial features
b) auscultates lung sounds
c) percusses the thyroid gland
d) palpates the adrenal glands

70. A nurse is preparing postoperative discharge instructions for a client who had one adrenal gland removed. The nurse includes which of the following in the instructions?

a) the reason for maintaining a diabetic diet
b) teaching proper application of an ostomy pouch
c) instructions about early signs of a wound infection
d) the need for lifelong replacement of all adrenal hormones







Endocrine System Questions and Answers and Rationale

66) D

- A glucocorticoid preparation will be administered intravenously or intramuscularly in the immediate preoperative period to a client scheduled for an adrenalectomy. Methylprednisolone sodium succinate protects the client from developing acute adrenal insufficiency (Addison's crisis) that occurs as a result of the adrenalectomy. Aldactone is a potassium-sparing diuretic. Prednisone is an oral corticosteroid. Fludrocortisone is a mineralocorticoid.

67) C

- Following treatment with radioactive iodine therapy, a decrease in thyroid hormone level should be noted, which would help alleviate symptoms. Relief of symptoms does not occur until 6 to 8 weeks after initial treatment. This form of therapy is not designed to destroy the entire gland; rather, some of the cells that synthesize thyroid hormone will be destroyed by the local radiation. The nurse needs to reassure the client and family that unless the dosage is extremely high, clients are not required to observe radiation precautions. The rationale for this is that the radioactivity quickly dissipates. Occasionally, a client may require a second or third dose, but treatments are not lifelong.

68) B

- Respiratory distress can occur following thyroidectomy as a result of swelling in the tracheal area. The nurse would ensure that an emergency tracheostomy kit is available. Surgery on the thyroid does not alter the heat control mechanism of the body. Magnesium sulfate would not be indicated because the incidence of hypomagnesemia is not a common problem post-thyroidectomy. SSKI is typically administered preoperatively to block thyroid hormone synthesis and release, as well as to place the client in a euthyroid state.

69) A

- Inspection of facial features will reveal the characteristic coarse features, presence of edema around the eyes and face, and the blank expression that are characteristic of myxedema. The assessment techniques in options B, C, and D will not reveal information related to the diagnosis of myxedema.

70) C

- A client who had a unilateral adrenalectomy will be placed on corticosteroids temporarily to avoid a cortisol deficiency. These medications will be gradually weaned in the postoperative period until they are discontinued. Also, because of the anti-inflammatory properties of corticosteroids produced by the adrenals, clients who undergo an adrenalectomy are at increased risk of developing wound infections. Because of this increased risk of infection, it is important for the client to know measures to prevent infection, early signs of infection, and what to do if an infection seems to be present. The client does not need to maintain a diabetic diet, and the client will not have an ostomy following this surgery.



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Endocrine System Questions and Answers (61-65)

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61. A client with Cushing's disease is being admitted to the hospital after a stab wound to the abdomen. The nurse places highest priority on which of the following nursing diagnoses developed for this client?

a) risk for infection
b) disturbed body image
c) ineffective health maintenance
d) risk for deficient fluid volume

62. A nurse is caring for a client with a diagnosis of Cushing's syndrome. The nurse plans which of these measures to prevent complications from this medical condition?

a) monitoring glucose level
b) encouraging daily jogging
c) monitoring epinephrine levels
d) encouraging visits form friends

63. A nurse notes on the cardiac monitor that a client with aldosteronism is experiencing a dysrhythmia. The nurse immediately assesses the client's:

a) peripheral pulses
b) intake and output
c) superficial reflexes
d) plasma potassium level

64. A client is admitted to the hospital with a diagnosis of Cushing's syndrome. The nurse monitors the client for which of the following that is most likely to occur in this client?

a) hypovolemia
b) hypoglycemia
c) mood disturbances
d) deficient fluid volume

65. The nurse is caring for a client scheduled for a bilateral adrenalectomy for treatment of an adrenal tumor that is producing excessive aldosterone (primary hyperaldosteronism). The nurse appropriately tells the client which of the following?

a) you will need to wear an abdominal binder after surgery
b) you will most likely need to undergo chemotherapy after surgery
c) you will need to take hormone replacements for the rest of your life
d) you will not require any special long-term treatment after surgery






Endocrine System Questions and Answers and Rationale

61) A

- The client with a stab wound has a break in the body's first line of defense against infection. The client with Cushing's disease is at great risk for infection caused by excess cortisol secretion, subsequent impaired antibody function, and decreased proliferation of lymphocytes. The client may also have an Ineffective health maintenance and Disturbed body image, but these are not the highest priority at this time. The client would be at risk for Excess fluid volume, not Deficient fluid volume, with Cushing's disease.

62) A

- In the client with Cushing's syndrome, increased levels of glucocorticoids can result in hyperglycemia and signs and symptoms of diabetes mellitus. Epinephrine levels are not affected. Clients experience activity intolerance related to muscle weakness and fatigue, therefore option B is incorrect. Visitors should be limited because of the client's impaired immune response.

63) D

- Aldosteronism can lead to hypokalemia, which in turn can cause life-threatening dysrhythmias. Options A, B, and C are not immediate priorities for this client.

64) C

- When Cushing's syndrome develops, the normal function of the glucocorticoids becomes exaggerated and the classic picture of the syndrome emerges. This exaggerated physiological action can cause mood disturbances, including memory loss, poor concentration and cognition, euphoria, and depression. It can also cause persistent hyperglycemia along with sodium and water retention, producing edema and hypertension.

65) C

- The major cause of primary hyperaldosteronism is an aldosterone-secreting tumor called an aldosteronoma. Surgery is the treatment of choice. Clients undergoing a bilateral adrenalectomy will need permanent replacement of adrenal hormones. Options A, B, and D are inaccurate.



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Endocrine System Questions and Answers (66-70)

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Endocrine System Questions and Answers (56-60)

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56. A nurse is preparing to care for a client following parathyroidectomy. The nurse plans care anticipating which postoperative order?

a) maintain the endotracheal tube for 36 hours
b) take a rectal temperature only until discharge
c) ensure that intravenous calcium preparations are available
d) place the client in a flat position with the head and neck immobilized

57. While a client with myxedema is being admitted to the hospital, the client reports having experienced a lack of energy, cold intolerance, and puffiness around the eyes and face. The nurse knows that these symptoms are caused by a lack of production of which hormone(s)

a) luteinizing hormone (LH)
b) adrenocorticotropic hormone (ACTH)
c) triiodothyronine (T3) and thyroxine (T4)
d) prolactin (PRL) and growth hormone (GH)

58. A 33-years old female is admitted to the hospital with a suspected diagnosis of grave's disease. Which symptom related to the client's menstrual cycle would the client likely report?

a) amenorrhea
b) metrorrhagia
c) menorrhagia
d) dysmenorrha

59. A client with diabetes mellitus has a blood glucose level of 644 mg/dL. The nurse interprets that this client is most at risk of developing which type of acid-base imbalance?

a) metabolic acidosis
b) metabolic alkalosis
c) respiratory acidosis
d) respiratory alkalosis

60. The home care nurse is developing a plan of care for an older client with diabetes mellitus who has gastroenteritis. In order to maintain food and fluid intake to prevent dehydration, the nurse plans to:

a) offer water only until the client is able to tolerate solid foods
b) withhold all fluids until vomiting has ceased for at least 4 hours
c) encourage the client to take 8 to 12 ounces of fluid every hour while awake
d) maintain a clear liquid diet for at least 5 days before advancing to solids to allow inflammation of the bowel to dissipate






Endocrine System Questions and Answers Rationale

56) C

- Hypocalcemia is a potentially life-threatening complication following parathyroidectomy, and the nurse should ensure that intravenous calcium preparations are readily available. Semi-Fowler's position is the position of choice to assist in lung expansion and prevent edema. Rectal temperatures are not required. Tympanic temperatures can be taken. The client will not necessarily have an endotracheal tube.

57) C

- Although all of these hormones originate from the anterior pituitary, only T3 and T4 are associated with the client's symptoms. Myxedema results from inadequate thyroid hormone levels (T3 and T4). Low levels of thyroid hormone result in an overall decrease in the basal metabolic rate, affecting virtually every body system and leading to weakness, fatigue, and a decrease in heat production. A decrease in LH results in the loss of secondary sex characteristics. A decrease in ACTH is seen in Addison's disease. PRL stimulates breast milk production by the mammary glands, and GH affects bone and soft tissue by promoting growth through protein anabolism and lipolysis.

58) A

- Amenorrhea or a decreased menstrual flow is common in the client with Graves' disease. Dysmenorrhea, metrorrhagia, and menorrhagia are also disorders related to the female reproductive system; however, they do not manifest in the presence of Graves' disease.

59) A

- Diabetes mellitus can lead to metabolic acidosis. When the body does not have sufficient circulating insulin, the blood glucose level rises. At the same time, the cells of the body use all available glucose. The body then breaks down glycogen and fat for fuel. The by-products of fat metabolism are acidotic and can lead to the condition known as diabetic ketoacidosis. Options B, C, and D are incorrect.

60) C

- The client should be offered liquids containing both glucose and electrolytes. Small amounts of fluid may be tolerated, even when vomiting is present. The diet should be advanced as tolerated and include a minimum of 100 to 150 grams of carbohydrates daily. Offering water only and maintaining liquids for 5 days will not prevent dehydration but may promote it in this client.


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NCLEX Endocrine Questions 51-55

NCLEX Endocrine Questions

51. A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for:

a) relief of pain
b) signs of renal toxicity
c) signs and symptoms of hyperglycemia
d) signs and symptoms of hypothyroidism

52. A nurse develops a plan of care for a client with hyperparathyroidism who is receiving calcitonin salmon (Calcimar). Which of the following outcome criteria has the highest priority regarding this medication?

a) relief of pain
b) absence of side effects
c) achievement of normal serum calcium levels
d) verbalization of appropriate medication knowledge

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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

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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

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NCLEX Endocrine Questions (36-40)

NCLEX Endocrine Questions

36. Which of the following assessment findings characterize 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. The nurse is planning care for a client with hyperthyroidism. Which of the following nursing interventions are appropriate? Select all that apply

a) instill isotonic eye drops as necessary
b) provide several, small, well-balanced meals
c) provide rest periods
d) keep environment warm
e) encourage frequent visitors and conversation
f) weigh the client daily

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NCLEX Endocrine Questions (26-30)

26. The following are characteristics of type I DM. Select all that apply

a) the client is thin
b) it requires lifelong insulin
c) the client may take sulfonylureas
d) the client is at risk to develop diabetic ketoacidosis
e) onset of the disease is after 30 years of age
f) there is insulin secretion, but the body's demands are increased  

27. The following are signs and symptoms that indicate hyperglycemia in a client with diabetes mellitus. Select all that apply

a) elevated blood sugar level
b) cold, clammy skin
c) increased urination
d) tremors
e) deep, rapid respiration
f) excessive thirst
g) metabolic acidosis

28. The client has been diagnosed to have IDDM. Which order should you question?

a) propranolol
b) insulin injection
c) acetaminophen
d) diltiazem

29. The nurse is assessing a pregnant client with type I diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that teaching is needed if the client makes which statement?

a) I will need to increase my insulin dosage during the first 3 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 3 months of pregnancy
d) my insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding

30. An adolescent client with type I diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note?

a) sweating and tremors
b) hunger and hypertension
c) cold, clammy skin and irritability
d) fruity breath and decreasing level of consciousness





NCLEX Endocrine Questions:
ANSWERS AND RATIONALE

26) A, B, D
- these are the characteristic of type I DM.

27) A, C, E, F, G
- these are signs and symptoms of hyperglycemia.

28) A
- propranolol, a beta-adrenergic blocker causes hypoglycemia. It is contraindicated among diabetic clients.

29) A
- insulin needs decrease in the first trimester because of increase insulin production by the pancreas and increased peripheral sensitivity to insulin. The statements in option B, C, and D are accurate and signify that the client understands control of her diabetes during pregnancy.

30) D
Hyperglycemia occurs with diabetic ketoacidosis. Signs of hyperglycemia include fruity breath and a decreasing level of consciousness. Hunger can be a sign of hypoglycemia or hyperglycemia, but hypertension is not a sign of diabetic ketoacidosis. Instead, hypotension occurs because of a decrease in blood volume related to the dehydrated state that occurs during diabetic ketoacidosis. Cold, clammy skin, irritability, sweating, and tremors are all signs of hypoglycemia.




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NCLEX Endocrine Questions (21-25)

NCLEX Endocrine Questions

21. A diabetic client asks a nurse if bacon is allowed in the diet. Which 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. The client with congestive heart disease is diagnosed to have diabetes mellitus (DM). Which of the following medications should not be administered by the nurse to this client?

a) capoten (captopril)
b) lanoxin (digoxin)
c) inderal (propranolol)
d) calan (verapamil)

23. The client has been diagnosed to have type 2 diabetes mellitus. Which of the following are correct statements about type 2 DM. Select all that apply

a) managed by diet and exercise
b) prone ot diabetic ketoacidosis
c) prone to HHNC (hyperglycemic hyperosmolar - nonketotic coma)
d) managed by OHA (oral hypoglycemic agents)
e) requires lifelong insulin therapy
f) onset is before age 30 years
g) with absolute deficiency of insulin

24. The diabetic client is having ketoacidosis. Which of the following is the appropriate initial nursing action?

a) start an intravenous glucose
b) administer insulin per IV
c) give a glass of orange juice
d) give a cup of skim milk

25. The client has been diagnosed to have NIDDM (non-insulin dependent diabetes mellitus). Which of the following signs and symptoms characterize the disease? Select all that apply.

a) occurs after 30 years of age
b) obesity
c) requires lifetime insulin injection
d) can be controlled by diet, exercise, and drug
e) prone to diabetic ketoacidosis
f) experience weight loss
g) may require insulin in case of stress, surgery, pregnancy




NCLEX Endocrine Questions:
ANSWERS AND RATIONALE

21) C - bacon is fat and may be exchanged with fat component in the diet, e.g. butter. Exchange 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 DM.

23) A, C, D
- these are characteristics of type II DM. The other choices describe type I DM.

24) B
- ketoacidosis is characterized by severe hyperglycemia. The emergency management of ketoacidosis is regular insulin/IV.

25) A, B, D, and G
- all of these describes NIDDM.


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NCLEX Endocrine Questions (15-20)

NCLEX Endocrine Questions

15. Which of the following should the nurse include in the discharge instructions to be given to a client on continuous insulin infusion through insulin pump?

a) change needle site every 2 to 3 days
b) check blood sugar level daily
c) push button on the device to self-administer insulin after each meal
d) the machine gives continuous small doses of insulin, so there is no need to check blood sugar levels

16. A client with diabetes mellitus is self-administering NPH insulin from a vial kept at room temperature. The client asks a nurse about the length of time an unrefrigerated vial of insulin will remain its potency. The most appropriate response to the client is which of the following?

a) two weeks
b) one month
c) two months
d) six months

17. Which of the following is the appropriate initial action by the nurse when preparing insulin administration?

a) injecting air into the regular insulin
b) withdrawing the cloudy insulin first before the clear insulin
c) injecting air into the cloudy insulin but withdrawing the clear insulin first
d) withdrawing the clear insulin and cloudy insulin in separate syringes

18. The client with insulin-dependent diabetes mellitus (IDDM) has been brought to the emergency room. What should the nurse watch for if blood pH is 7.28

a) lactic acidosis
b) ketoacidosis
c) metabolic alkalosis
d) respiratory acidosis

19. A client has been diagnosed to have Type II diabetes mellitus. She experiences hypoglycemia. After receiving a glass of orange juice, what should the nurse give next?

a) peanut butter sandwich
b) 1 tablespoon sugar
c) 1 cup skim milk
d) a cup chocolate drink

20. Which of the following laboratory test best indicate compliance of the diabetic client and insulin therapy?

a) 2-hour postprandial blood glucose
b) fasting blood glucose
c) glycosylated hemoglobin
d) oral glucose tolerance test




NCLEX Endocrine Questions:
ANSWERS AND RATIONALE

15) B
- insulin lowers blood sugar levels. Insulin pump gives small doses of insulin continuously and the patient can bolus himself before each meal.

16) B
- insulin, when stored at room temperature is potent for 30 days (1 month).

17) C
- this action ensures prevention of contamination of the rapid-acting insulin. In case of emergency (DKA), rapid effect of the clear insulin is maintained. Injecting air into the cloudy insulin will promote easy aspiration of the medication, once the syringe already contains the clear insulin.

18) B
- ketoacidosis is characterized by low blood pH. Type I diabetic clients are prone to ketoacidosis.

19) A
- orange juice provides quick source of glucose; slices of bread provide sustained supply of glucose. This will be followed with skim milk as source of protein, to inhibit breakdown of fats. This in turn, prevents ketoacidosis.

20) C
- glycosylated hemoglobin (HbA1c) is the best indicator of diabetic control. It reflects blood glucose level for the past 3 to 4 months.


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Online Nursing Practice Test/Exam about Endocrine (8-14)

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Situation: The nurse is meeting with the parents of 11 year old Irish, who has recently been diagnosed with insulin dependent mellitus (IDDM).

8. Irish has been hospitalized for the past 3 days. His physiologic condition has been stabilized and he is now on subcutaneous injections of insulin. In developing 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 volume deficit related to hypoglycemia
c) altered nutrition less than body requirements, related to insulin deficiency
d) compromised family coping related to newly diagnosed illness

9. Irish's parents stated that they really do not understands exactly what this disease is. Which of the following is the best way to explain IDDM to them?

a) IDDM is an inborn error in metabolism that makes the child unable to burn, fatty acids without insulin supplement
b) IDDM is a genetic disorder that makes the child unable to metabolize protein without insulin supplements.
c) IDDM is a deficiency in the secretions of insulin by the pancreas, which makes the child unable to metabolize carbohydrates without insulin supplements
d) IDDM is a deficiency in the secretions of the insulin by the gallbladder, which makes the child unable to metabolize carbohydrates without insulin

10. The mother of Irish is preparing a mixed dose of insulin. The 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 vigorously
d) withdraws the delayed action insulin before withdrawing the short acting insulin

11. Irish complains of nausea, vomiting, diaphoresis and headache. Which of the following nursing interventions should the nurse carry out first?

a) withhold the client's next insulin injection
b) test the client's blood glucose level
c) administer tylenol (acetaminophen) as ordered
d) offer fruit juice, gelatin and chicken bouillon

12. The nurse should not instruct Irish mother that after injection of fast acting insulin at 7 in the morning, Irish should avoid exercising and any strenuous activity.

a) around 9 to 11am
b) after 4 hours
c) between 8am and 9am
d) in the afternoon after taking lunch

13. The nurse also teaches Irish regarding the relationship of her diet, exercise and insulin requirements. Which of the following statements below is wrong information that the nurse should not give Irish?

a) Irish should eat a snack before playing volleyball during P.E
b) Irish should always wear her medic-alert band or ID
c) Irish should go to school clinic to let the nurse give her insulin shots when its time for her medication
d) Irish should always carry a prefilled insulin syringe in her bag with instructions

14. After four months, Irish was brought to the emergency room because she fainted in school during her P.E. class. The nurse should monitor which of the following tests to evaluate the over-all therapeutic compliance of diabetic patient with normal serum hemoglobin?

a) glycosylated hemoglobin
b) fasting blood glucose
c) ketone levels
d) routine serum chemistry profile





ANSWERS AND RATIONALE

8) A
- the most appropriate diagnosis at this point would be knowledge deficit. The parents must be made aware of the nature of their child's illness and the principles of care in order to ensure treatment compliance. Letter B and C is inappropriate as the child's condition is already stable. There is no evidence 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

10) A
- the clear or regular insulin should be withdrawn first before the cloudy insulin or the intermediate insulin

11) B
- the first action to take would be to assess the blood glucose level of the patient to find out if the symptoms are due to abnormal glucose level or other causes.

60-90mg/100ml fasting blood sugar
60-105mg/100ml before meals
140-or less mg/100ml one hour after meals
if hyperglycemic - give insulin
if hypoglycemic - orange juice, sugar, candy

12) A
- the child should avoid exercising during peak hours of insulin action in order to prevent hypoglycemia. Peak action regular insulin occurs after 2-4 hours after administration. For the other types of insulin:

• short acting/regular (clear) - 2-4 hours

• intermediate/lente/NPH (cloudy) - 8-12 hours

• long-acting/ultralente (cloudy) - 18-24 hours

13) C
- starting 9 years old, a child has already developed enough finger dexterity 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 inject her own insulin, the child need not go to the school clinic. Another important instruction to Irish is to avoid injecting insulin in her arm during P.E. days when she plays volleyball. Exercise increases absorption of insulin. She should, then inject it in her abdomen. If Irene is runner, it would not be advisable to inject it her thigh.
It is important for the child to eat a carbohydrate snack before engaging in sports as exercise increases glucose utilization and make her hypoglycemic
Carrying a medic alert band or ID and prefilled syringe with instructions are important in cases of emergency.

14) A
- the glycosylated hemoglobin shows the patients blood glucose level during the last three months so iti s the best test that would reflect the patient's compliance to therapy and her glucose control.
Fasting blood glucose reflects only the current glucose control
Ketone appears in the urine when blood glucose levels exceed 200 mg'dl
Routine serum chemistry is not necessary in assessing the therapeutic compliance of a diabetic patient.


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Online Nursing Practice Test/Exam about Endocrine (31-35)

Situation: Miss Eleanor is a 25 year old woman who is being treated in the endocrine clinic for adult-onset Myxedema.

31. While taking a nursing history, the nurse should expect Miss Eleanor to assess:

a) facial puffiness
b) intolerance to heat
c) exopthalmus
d) heart palpitations

32. The physician has ordered serum thyroxine (T4) concentration and serum cholesterol test. Which finding should the nurse expect?

a) decreased serum T4 and decreased serum cholesterol
b) decreased serum T4 and increased serum cholesterol
c) increased serum T4 and increased serum cholesterol
d) increased serum T4 and increased serum cholesterol

33. Which of the following manifestations does the nurse expect in a client with myxedema?
a) increased heart rate
b) edema
c) weight loss
d) intolerance to heat

34. Which of the following are most important to monitor in a client who had undergone total thyroidectomy?

a) pulse and temperature
b) serum electrolyte levels
c) weight and food intake
d) hoarseness of the voice and ability to swallow

35. Which of the following should be included when giving health teachings to a client with hyperthyroidism.

a) wear long-sleeved clothing
b) use artificial tears to the eyes as necessary
c) increase fibers in the diet
d) take medications with milk



ANSWERS AND RATIONALE

31) A
- Hypothyroidism 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:

• Cretinism - hypothyroidism in infants and young children
• Hypothyroidism without myxedema - mild degree of thyroid failure in older children and adult
• Hypothyroidism with myxedema - severe degree of thyroid failure or hypothyroidism in adults

Manifestations of hypothyroidism are associated with the slowing of the metabolic rate and include:

• Patient's with myxedema exhibits nonpitting edema in connective tissues all over the body, including the face which appears puffy and the tongue which is enlarged. The edema is due to accumulation of mucoprotein and water retention.
• Goiter - enlargement of the thyroid gland may or may not be present. Goiter occurs from excessive stimulation of TSH from the pituitary because of continuous deficient or lack thyroxine. Hypothyroidism caused by lack of TSH does not cause goiter.
• Bradycardia, hypotension, dysrrhythmias, enlarged heart
• Apathy, slow and slurred speech, lethargy
• Decreased heat production-sensitivity to cold
• Decreased nutrient requirements: poor appetite
• Decreased sweat and sebaceous gland function: dry scaly skin
• Altered protein, fat and carbohydrate metabolism: weight gain (edema) slow wound healing, decreased blood glucose, hypoalbuminemia
• Decreased erythropoietin production: anemia

32) B
- Hypothyroidism is due to deficient thyroxine hormone so naturally serum T4 will be below normal.

Thyroxine regulates fat or lipid metabolism. Deficiency in thyroxine will result in slow metabolic activity resulting in slowing of lipid metabolism which increases serum cholesterol and triglyceride levels making the patient at risk for atherosclerosis and cardiac disorders.

Management:

1. Prevention - prevention of iodine deficiency

2. Replacement therapy throughout life
a. Drugs used:

• Sodium L-thyroxine/levothyroxine (Synthroid, Levoid)
• Sodium L-triidothyroxine (Cytomel, Trionine)
• Synthetic combination of T3 and T4 (Euthroid, thyrolar)
• Natural combination of T3 and T4 extract

b. Major Side Effects:

• Inadequate treatment - show recurrence/persistence of signs of hypothyroidism
• Excessive treatment - show signs of hyperthyroidism
• Too fast increase in drug dose - angina, palpitations, tachycardia
• Bone loss and decreased bone density

c. During initiation of therapy - patient is seen by physician every 2-4 weeks until condition is stable and then thyroid therapy is monitored annually.

3. Nursing Care:

• Activity Intolerance - limit activity to patient's tolerance. If patient develops tachycardia or chest pain, stop activity
• Constipation - increase fiber and fluids
• Hypothermia - maintain comfortable environmental temperature, use blankets as necessary
• Use frequent stimulation at dusk and nightfall - use nightlights to prevent confusion
• maintain safe environment
• promote positive body image - educate about reversible body changes

4. Surgery - may be performed for large goiters especially if it causes dysphagia, chocking sensation, inspiratory stridor, hoarseness and positive Pemberton's sign (elevation of arms results in dizziness and syncope) caused by pressure on veins that venous return from the head.


33) B
- myxedema is manifested by hypothyroidism. (A, C, and D are manifestations of hyperthyroidism)

34) A
- thyroid crisis /storm/thyroidtoxicosis is the most life-threatening postop complication of thyroid surgery. It is characterized by hyperthermia and tachycardia. Therefore it is necessary to monitor the client's pulse and temperature.

35) B
- hyperthyroidism may cause exopthalmos. To prevent corneal ulceration, artificial tears will be instilled into the eyes as necessary. The client usually develops diarrhea so, high fiber diet is not indicated. The medication should not be taken with antacid. Antacid inhibits absorption of anti thyroid drugs.


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• Online Nursing Practice Test/Exam about Endocrine (36-40)
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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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