Endocrine NCLEX

An indication of Chvostek' sign is: Answers: A. Twitching of the lips after tapping the face B. Elevated blood sugar after glucose infusion C. Inability to hold one's arms straight D. Spasms of the hand after blood circulation is cut off

. A Twitching of the lips after tapping the face in the right place is an indication of Chvostek's sign and a sign of hypocalcaemia. Spasms of the hand are associated with Trousseau's sign.

Acromegaly is most frequently diagnosed in: a. Middle-aged adults b. Newborns c. Children ages 2 to 5 d. Adults age 65 and older

. A: Acromegaly results from benign tumors on the pituitary gland that produce excessive amounts of growth hormone. Although symptoms may present at any age, the diagnosis generally occurs in middle-aged persons. Untreated, the consequences of acromegaly include

What is a hormone secreted from the posterior lobe of the pituitary gland? Answers: A. LH B. MSH C. ADH D. GnRH

. C ADH is secreted from the posterior pituitary. LH comes from the anterior pituitary, MSH from the intermediate. GnRH is released from the hypothalamus.

18. A client with type 1 diabetes mellitus tells the nurse, "I usually begin to feel sick late in the afternoon; is there something wrong with me?" The appropriate response by the nurse is which of the following? a) don't worry about that. Most diabetics feel that way b) can you describe what you mean by feeling sick? c) let me know if that happens today d) most people feel tired late in the afternoon

18) B - An excess of insulin relative to the amount of blood glucose induces hypoglycemia. Depending on the length of action of the insulin administered, the risk of hypoglycemia may be greatest in the late afternoon. The nurse needs to collect more data to determine if the client is actually experiencing hypoglycemia. Asking the client to describe the sick feeling provides the nurse with more data. Options A, C, and D are nontherapeutic communication statements.

19. A nurse is gathering data from a client newly diagnosed with diabetes mellitus concerning events leading to the client's seeking medical attention. The nurse identifies which of the following as the major symptoms of diabetes mellitus? a) polydipsia, polyuria, and polyphagia b) dyspepsia, polyuria, and polyphagia c) hypoglycemia, polyuria, and dysphagia d) hypoglycemia, polyuria, and dysphasia

19) A - Polydipsia, polyuria, and polyphagia are the classic signs and symptoms of diabetes mellitus. Dyspepsia, dysphagia, and dysphasia are associated with other body systems (gastric and neurological). Hyperglycemia also occurs.

28. A nurse receives a report that an adult client with delirium has a blood glucose level of 33 mg/dL. The nurse analyzes this report as: a) higher than normal, indicating a cause of the delirium b) a normal reading for this client c) a lower than normal reading, indicating a cause for the delirium d) insignificant and unrelated to the delirium

28) C - Blood glucose levels for an adult normally range between 60 and 120 mg/dL. A level of 33 mg/dL indicates hypoglycemia. Metabolic disorders can be an etiological factor of delirium.

7. A nurse is assessing a lethargic client who was brought to the emergency department by emergency medical services and notes a fruity odor to the client's breath. The nurse immediately suspects that the client has: a) hyperglycemic hyperosmolar nonketotic syndrome (HHNS) b) diabetic ketoacidosis (DKA) c) ethanol oxide intoxication d) hypoglycemia

7) B - Clients with DKA accumulate large amounts of ketone bodies in extracellular fluids. A fruity odor to the breath develops due to the volatile nature of acetone. A fruity odor is not a manifestation associated with the conditions noted in options A, C, and D.

A client asks what the purpose of the Hb A1c test is. The nurses best explanation would be that the test measures the average: a. blood sugar lvl's over a 6-10 week period b. hemoglobin lvl's over a 6 - 10 week period c. protien lvl over a 3 month period d. vanillylmandelic acid lvl's

a

The primary function of insuln is to: A. Lower blood glucose levels B. Produce melanin C. regulate the bodys metabolic rate D. stimulate release of digestive enzymes

a

A nurse is caring for a client in the late stage of Ketoacidosis. The nurse notices that the clients breath has a characteristic fruity odor. Which of the following substances is responsible for the fruity smell in the breath? a. iodine b. acetone c.alcohol d. glucose

b

Which nursing action is most appropriate for a client in ketoacidosis? a. admin of carbs b. admin of IV fluids c. applying cold compress d. giving glucagon IV

b

25. A client newly diagnosed with diabetes mellitus is admitted to the hospital for evaluation and control of the disease. When analyzing the assessment data, which of the following would the nurse likely expect to find? a) hyperglycemia b) hypoglycemia c) weight gain d) hematuria

25) A - Hyperglycemia is characteristic of newly diagnosed diabetes mellitus. Newly diagnosed diabetic clients present a variety of symptoms, which may include polydipsia, polyuria, polyphagia, weakness, weight loss, and dehydration.

Which of the following statements by a client with Type II Diabetes indicates the need for further education? Answers: A. I should avoid hot tubs B. I should aim for an HbA1C level of 5.5% C. I may need insulin at times D. My life expectancy is likely reduced by 10 years

. B While an HbA1C level of 5.5% would be below the threshold for diabetes, it is an unrealistic target. Data has shown that trying to lower the HbA1C level too much can lead to an increase in complications.

17. A client with type 1 diabetes mellitus tells the nurse that mealtimes are not important and that she eats whenever it is convenient. It is important for the nurse to explain that mealtimes: a) must be approximately the same time each day to maintain a stable blood glucose b) can be varied as long as the time of insulin administration is also varied c) are not important as long as the client monitors the blood glucose regularly d) are not important as long as snack foods are readily available

17) A - It is important for clients with type 1 diabetes mellitus to correlate eating with insulin administration to prevent hypoglycemia. Insulin should be given at approximately the same time each day, and meals should be eaten at approximately the same time each day. This will establish regular patterns of glucose availability that approximate glucose availability in a nondiabetic body. Options B, C, and D are incorrect because they infer that mealtimes are not important.

22. A nurse is caring for a hospitalized older client with a diagnosis of dehydration who also has diabetes mellitus. The client is alert but disoriented, pale, and slightly diaphoretic, and the nurse suspects that the client is hypoglycemic. The initial nursing intervention would be to: a) administer oral glucose b) assist the client to bed, put the side rails up, and call the physician c) seat the client at the nurse's desk while checking the physician's order d) obtain a fingerstick blood specimen and test the glucose level

22) D - The nurse should confirm that the client is hypoglycemic by checking the blood glucose. Option A is incorrect because hypoglycemia has not been determined. More information should be gathered before calling the physician, so option B is incorrect. Option C does not meet the client's immediate needs.

23. An adult client with diabetes mellitus reports to the health care clinic for a glycosylated hemoglobin A (HgbA1c) level. Which laboratory result indicates client compliance with the prescribed diabetic regimen? a) 5% b) 8% c) 10% d) 15%

23) A - The normal level for HgbA1C is 4.5% to 7.5%. This test measures the amount of glucose that has become permanently bound to the red blood cells from circulating glucose. Elevations in blood glucose will cause elevations in the amount of glycosylation. Elevations indicate continued need for teaching related to prevention of hyperglycemic episodes.

24. A client is diagnosed with type 2 diabetes mellitus and is started on glyburide (Micronase) 2.5 mg orally. The client smiles and says, "Oh, good, as long as I take this pill I can eat whatever I want." In this situation, the nurse's intervention is focused on addressing which coping mechanism? a) denial b) anger c) depression d) acceptance

24) A - The client is denying the experience of a chronic illness that will require her to make lifestyle changes. There is no evidence of anger or depression in the statement made by the client. The client has not accepted the disease if expectations are unrealistic.

26. A client with diabetes mellitus says that it is very difficult to adhere to the diabetic treatment plan. The nurse interprets the client's concern and determines that the appropriate response is: a) if you don't take your insulin you will develop diabetic ketoacidosis (DKA) b) let's go over your diet again to be sure it contains foods you like c) do you understand what noncompliance can mean to your future health? d) let's check your blood glucose now

26) B - It is important to determine and deal with a client's concerns and to identify measures that will assist the client to comply with the diabetic regimen. The nurse should determine if a knowledge deficit exists and if the client's treatment plan maintains normalcy as much as is possible with the lifestyle. Scare tactics as described in options A and C should not be used. Positive reinforcement is necessary instead of focusing on negative behaviors. Option D does not address the subject of the question.

5. A clinic nurse is performing an assessment on a client recently diagnosed with diabetes mellitus. Which assessment question is appropriate when assessing the client's degree of adaptation to this disorder? a) you really don't think you caused your disorder, do you? b) your family is helping you stick to your diet, aren't they? c) how do you feel about your progress? d) are you feeling anxious?

5) C Open-ended questions allow the client to take the lead in the conversation. Options A and B denote judgment and may block communication. Option D allows the client to answer with a yes or no response and does not provide the client an opportunity to share feelings. Option C is open-ended and focuses on the subject of the question, the client's degree of adaptation to the disorder.

12. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? a. antidiuretic hormone (ADH). b. thyroid-stimulating hormone (TSH). c. follicle-stimulating hormone (FSH). d. luteinizing hormone (LH).

A. ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.

19. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia? a. Acromegaly b. Type 1 diabetes mellitus c. Hypothyroidism d. Deficient growth hormone

A. Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn't associated with hyperglycemia, nor is growth hormone deficiency.

8. When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: a. vasopressin (Pitressin Synthetic). b. furosemide (Lasix). c. regular insulin. d. 10% dextrose.

A. Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

18. Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? a. Fluid intake is less than 2,500 ml/day. b. Urine output measures more than 200 ml/hour. c. Blood pressure is 90/50 mm Hg. d. The heart rate is 126 beats/minute.

A. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.

11. Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following? a. Muscle weakness b. Tremors c. Diaphoresis d. Constipation

A. Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

23. When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description? a. sulfisoxazole (Gantrisin) b. mexiletine (Mexitil) c. prednisone (Orasone) d. lithium carbonate (Lithobid)

A. Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn't cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.

17. A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess: a. Trousseau's sign. b. Homans' sign. c. Hegar's sign. d. Goodell's sign.

A. This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

A diabetic client has been maintained on Glucophage (metformin) for regulation of his blood glucose levels. Which teaching should be included in the plan of care? A. Report changes in urinary pattern. B. Allow six weeks for optimal effects. C. Increase the amount of carbohydrates in your diet. D. Use lotions to treat itching.

Answer A is correct. Glucophage (metformin) can cause renal complications. The client should be monitored for changes in renal function. In answer B, the medication begins working immediately, so it is incorrect. In answer C, the amount of carbohydrates should be regulated with a diabetic diet, so it is incorrect. The use of lotions in answer D is unnecessary, so it is incorrect.

A client with polyuria, polydipsia, and polyphagia is diagnosed with diabetes mellitus. The nurse would expect that these symptoms are related to A. Hypoglycemia B. Hyperglycemia C. Hyperparathyroidism D. Hyperthyroidism

Answer B is correct. The client with hyperglycemia will exhibit polyuria, polydipsia, or increased thirst, and polyphagia, or increased hunger. A, C, and D are incorrect because they are not signs of hypoglycemia.

A diabetic client is taking Lantus insulin for regulation of his blood glucose levels. The nurse should know that this insulin will most likely be administered: A. Prior to each meal B. At night C. Midday D. Prior to the evening meal

Answer B is correct. This insulin, unlike others, is most frequently administered at night. Its duration is 24-36 hours. A, C, and D are incorrect they are incorrect times to administer Lantus insulin.

Which laboratory test conducted on the client with diabetes mellitus indicates compliance? A. Fasting blood glucose B. Two-hour post-prandial C. Hgb A-1C D. Dextrostix

Answer C is correct. The Hgb A-1C indicates that the client has been compliant for approximately three months. Answers A, B, and D tell the nurse the client's blood glucose at the time of the test, so they are incorrect.

A client with diabetes experiences Somogyi's effect. To prevent this complication, the nurse should instruct the client to: A. Take his insulin each day at 1400 hours B. Engage in physical activity daily C. Increase the amount of regular insulin D. Eat a protein and carbohydrate snack at bedtime

Answer D is correct. Somogyi's is characterized by a drop in glucose levels at approximately 2 a.m. or 3 a.m. followed by a false elevation. Eating a protein and carbohydrate snack before retiring prevents the hypoglycemia and rebound elevation. Answers A, B, and C are incorrect because they do not prevent Somogyi's effect.

24. After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the following would the nurse expect the physician to do? a. Initiate insulin therapy. b. Switch the client to a different oral antidiabetic agent. c. Prescribe an additional oral antidiabetic agent. d. Restrict carbohydrate intake to less than 30% of the total caloric intake.

B. Many clients (25% to 60%) with secondary failure respond to a different oral antidiabetic agent. Therefore, it wouldn't be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent.

4. During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise? a. At least once a week b. At least three times a week c. At least five times a week d. Every day

B. Diabetic clients must exercise at least three times a week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once a week wouldn't achieve these goals. Exercising more than three times a week, although beneficial, would exceed the minimum requirement.

22. A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client: a. prefers to take insulin orally. b. has type 2 diabetes. c. has type 1 diabetes. d. is pregnant and has type 2 diabetes.

B. Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't prescribed oral antidiabetic agents because the effect on the fetus is uncertain.

1. An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, nurse Lily teaches the client to treat hypoglycemia by ingesting: a. 2 to 5 g of a simple carbohydrate. b. 10 to 15 g of a simple carbohydrate. c. 18 to 20 g of a simple carbohydrate. d. 25 to 30 g of a simple carbohydrate.

B. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

14. For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? a. Cool, clammy skin b. Distended neck veins c. Increased urine osmolarity d. Decreased serum sodium level

C. In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing fluid volume deficit. Cool, clammy skin; distended neck veins; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.

10. A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating: a. "The test needs to be repeated following a 12-hour fast." b. "It looks like you aren't following the prescribed diabetic diet." c. "It tells us about your sugar control for the last 3 months." d. "Your insulin regimen needs to be altered significantly."

C. The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.

16. A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? a. Infusing I.V. fluids rapidly as ordered b. Encouraging increased oral intake c. Restricting fluids d. Administering glucose-containing I.V. fluids as ordered

C. To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

3. Nurse John is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to: a. Encourage the client to ask questions about personal sexuality. b. Provide time for privacy. c. Provide support for the spouse or significant other. d. Suggest referral to a sex counselor or other appropriate professional.

D. The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.

20. Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: a. Increasing saturated fat intake and fasting in the afternoon. b. Increasing intake of vitamins B and D and taking iron supplements. c. Eating a candy bar if light-headedness occurs. d. Consuming a low-carbohydrate, high-protein diet and avoiding fasting.

D. To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn't help control hypoglycemia.

A nurse is instructing a 50yr diabetic client about the steps to be followed for self admin of insulin. Which of the following instructions should be included in te client teaching? a. instruct client to aviod injections to the abdomen b. encourage client to always inject insulin in the same site c. inform client about the type of syringe to use d. encourage client to do active exercise after injection

c

The nurse smells a sweet fruity odor on the breath of a client admitted with T1DM. This odor may be associated with? a. alcohol intoxication b. insulin shock c. ketoacidosis d. weight loss

c

A nurse is assigned to care for and monitor any complications in a 40 yr client with chronic diabetes. Which of the following is a macrovascular complication of diabetes. a. neuropathy b. retinopathy c. nephropathy d. Arteriosclerosis

d