NCLEX Passpoint: Endocrine and Metabolic Disorders

The nurse is assessing a client with hepatitis A and notices that the aspartate transaminase (AST) and alanine transaminase (ALT) lab values have increased. Which statement by the client indicates the need for further instruction by the nurse

"I take acetaminophen for arthritis pain."

When educating the client with type 1 diabetes, the nurse knows that more education is needed when the client says:

"I will be able to switch to insulin pills when my sugar is under control."

A client has been diagnosed with hypothyroidism. Which statement by the client would demonstrate appropriate teaching by the nurse?

"I will increase fiber and fluids in my diet."

A nurse is teaching a client about how to recognize when treatment for hypothyroidism is effective. Which statement from the client would indicate that the nurse's teaching has been effective?

"I will start feeling more energetic."

A client is diagnosed with Addison's disease. Which statement by the client to the nurse would require further instruction?

"I will use salt substitute to flavor my foods."

The nurse reviews insulin administration with a client. Which statement best indicates that the client will continue to perform the procedure correctly?

"I wrote down the steps in case I forget what to do."

A client with hypothyroidism is afraid of needles and doesn't want to have their blood drawn. What should the nurse say to help alleviate the client's concerns?

"I'll stay here with you while the technician draws your blood."

A client with diabetes is doing a "teach-back" by explaining to the nurse how to care for the feet at home. Which statement indicates that the client understands proper foot care?

"It's important to dry my feet carefully after my bath."

A 24-year-old client with diabetes mellitus sustains a large laceration that requires suturing. Which statement indicates that the client understands wound healing?

"It's so hard to predict when this scar will disappear."

A client newly diagnosed with diabetes mellitus asks why they need ketone testing when the disease affects their blood glucose levels. How should the nurse respond?

"Ketones will tell us if your body is using other tissues for energy."

The nurse is teaching a client about levothyroxine. Which instruction should a nurse offer the client?

"Take the drug on an empty stomach."

A client with type 1 diabetes mellitus asks the nurse about taking ginseng at home. What should the nurse tell the client?

"Taking ginseng will increase the risk of hypoglycemia."

The nurse teaches a client with type 2 diabetes mellitus about diabetic retinopathy. Which statement if made by the client would indicate to the nurse that teaching was effective?

"Tight control of blood sugar and blood pressure can prevent damage to my eye."

A nurse is caring for a client with poorly managed diabetes mellitus who has a serious foot ulcer. When the nurse informs the client that the physician has ordered a wound care nurse to examine the wound, the client asks why should anyone other than the staff nurse care for the wound. The client states, "It's no big deal. I'll keep it covered and put antibiotic ointment on it." Which responses made by the nurse would be appropriate? Select all that apply.

"We're very concerned about your foot and we want to provide the best possible care for you." "You could possibly lose your foot without proper care." "The wound nurse is specially trained to care for diabetic wounds."

A client diagnosed with thyroid cancer signed a living will that states the client doesn't want ventilatory support if the condition deteriorates. As the client's condition worsens, the client states, "I changed my mind. I want everything done for me." Which response by the nurse is best?

"What exactly do you mean by wanting 'everything' done for you?"

A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents?

"Your child will need less blood work as their glucose levels stabilize."

A client with type 2 diabetes, admitted to a medical unit for a small bowel obstruction, reports feeling shaky and sweaty to the nurse. Because the client is to have nothing by mouth (NPO), blood glucose levels are being controlled with subcutaneous insulin. Complete the following sentence by choosing from the lists of options. The priority action for the nurse is to perform __________ followed by administration of __________ if the __________

- point-of-care testing to determine the capillary blood glucose level venipuncture to obtain blood for a hemoglobin A1C level - 15 g of glucose gel in the buccal cavity regular insulin 5 units subcutaneously - blood glucose level is less than 70 mg/dL (3.9 mmol/L) Normal range: less than or equal to 110 mg/dL (5.6 mmol/L)]

The nurse is teaching a client with type I diabetes self-administration of insulin. Which statement by the client would be an expected outcome of the teaching session? Select all that apply.

-"I need to make sure that I eat my meals and snacks on time after I take my insulin." -"If I monitor and control my blood glucose levels carefully, there is less likelihood of suffering long-term complications." -"If I exercise more than is normal, there is a risk that I might become hypoglycemic."

A client with diabetes and peripheral neuropathy is being discharged from the hospital. What instruction should the nurse provide to decrease the risk for skin breakdown? Select all that apply.

-Always wear socks and, preferably, shoes to protect the feet. -Check the feet daily to look for any injuries. -Use lotion on feet to keep skin from becoming dry and cracked.

A client with type 2 diabetes has just started to take dulaglutide. The client reports having severe nausea. What should the nurse instruct the client to do to manage the nausea? Select all that apply.

-Eat small meals more frequently. -Drink ginger tea. -Avoid fried foods.

A client receives 12 units of intermediate- or long-acting insulin and 6 units of fast-acting insulin each morning. Place the following actions in chronological order of how the nurse would demonstrate how to mix insulins. Use all options.

-Wipe off the vials with an alcohol swab. -Inject 12 units of air into the intermediate- or long-acting insulin vial. -Inject 6 units of air into the fast-acting insulin vial. -Withdraw 6 units of fast-acting insulin. -Withdraw 12 units of intermediate- or long-acting insulin .

The client with type 1 diabetes mellitus is taught to take isophane insulin suspension NPH at 1700 each day. The client should be instructed that the greatest risk for hypoglycemia will occur at about what time?

0100, while sleeping

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, (2.3 mmol/L) and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting

15 g of a simple carbohydrate.

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What should the nurse anticipate in this client's plan of care?

An increased need for insulin and blood glucose monitoring

A nurse is caring for a client with type 1 diabetes who is light headed, begins sweating profusely, and loses consciousness. Which action should the nurse take?

Administer an IV bolus of 50% dextrose.

When preparing to draw up 8 units of a short-acting insulin and 20 units of a long-acting insulin in the same syringe, the nurse should use which technique?

Inject air in the vial with the long-acting insulin first.

A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do?

Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.

A client presents to the clinic for a follow-up visit for hospitalization due to uncontrolled diabetes. Which of the following assessment findings indicates a complication of diabetes mellitus?

Blood pressure of 160/100 mm Hg

During an emergency, a physician has asked for I.V. calcium to treat a client with hypocalcemia. The nurse should:

Check with the physician for his complete order.

The physician has prescribed sodium chloride for a hospitalized 51-year-old client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply.

Compare ABG findings with previous results. Maintain intake and output records. Document presenting signs and symptoms.

A client is informed by his healthcare provider that a tumor has been found. When the nurse sees the client later, the client states that no one knows what is wrong with him. The nurse determines that the client is experiencing which of the following?

Could be in denial

The nurse is developing a teaching plan with a client who had a bilateral adrenalectomy. What information should the nurse include in the plan?

The client will need steroid replacement for the rest of their life.

The nurse is teaching a client who is taking dexamethasone for cerebral edema about early symptoms of Cushing's disease. The nurse should advise the client to report which of the following is a symptom of hyperadrenocorticism?

Easy bruising.

A client's fasting blood sugar (FBS) is 63 mg/dL (3.5 mmol/L) at 0700. The client is alert and oriented. What should the nurse do first?

Give 15 g of carbohydrate and recheck the blood glucose in 15 minutes.

The nurse is preparing a client for paracentesis. What should the nurse do?

Have the client void before the procedure.

A nurse hears a staff member giving incorrect information to the family of a client newly diagnosed with diabetes mellitus who is being discharged to home. The nurse wants to make sure the family has the proper information before the client is discharged. What should the nurse do?

Have the nurse step outside of the room, discuss the situation, and use it as a learning opportunity.

The nurse has been assigned to a client who has had diabetes for 10 years. The nurse gives the client's usual dose of regular insulin at 7 a.m. At 10:30 a.m., the client has light-headedness and sweating. The nurse should contact the physician, report the situation, background, and assessment, and recommend intervention for:

Hypoglycemia.

A client with a history of Addison's disease is experiencing weakness and headache. The vital signs are blood pressure of 100/60 and heart rate of 80. Laboratory values are Na 130, potassium 4.8, and blood glucose 70. Which solution would the nurse expect to administer?

I.V. normal saline and glucocorticoids

A nurse explains to a client that the nurse will administer the client's first insulin dose in the client's abdomen. How does absorption at the abdominal site compare with absorption at other sites?

Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

A client with diabetes is being tested for glycosylated hemoglobin. How would the nurse explain the reason for this diagnostic test?

It determines the average blood glucose level in the previous 2-3 months.

Immediately following a thyroidectomy, the nurse asks the client to say "hello." The client moves their lips but is not able to speak the word. What should the nurse do next?

Notify the surgeon.

The unlicensed assistive personnel (UAP) records a capillary blood glucose of 253 mg/dL (14.04 mmol/L) and the nurse administered insulin for coverage to the client. The UAP reports to the nurse that the blood glucose was incorrect. What actions should the nurse take? Select all that apply.

Obtain a current blood glucose level. Observe the client for hypoglycemia. Report the incident to the healthcare provider. Complete an incident report.

The nurse is caring for a client with type 1 diabetes. The nurse finds the client unconscious and administers glucagon, 1 mg intramuscularly. What is the next action by the nurse when the client regains consciousness?

Offer orange juice and crackers.

The nurse administers lactulose to a client with cirrhosis. What is the expected outcome from the administration of the lactulose?

Reduced serum ammonia levels.

The nurse is assigned to a client with pheochromocytoma. In providing nursing care for the client, which action should the nurse delegate to the unlicensed assistive personnel (UAP)?

Remind the client not to smoke, drink caffeinated beverages, or change positions suddenly.

A nurse is assigned to a client who is using an insulin pump. The nurse has never cared for a client with an insulin pump and isn't sure what to do. What should the nurse do first?

Request information about nursing responsibilities in caring for a client with a pump.

A client is recovering from transsphenoidal hypophysectomy. What should the nurse instruct the client to do to ensure oral hygiene?

Rinse the mouth with saline.

A nurse is teaching a client with diabetes mellitus about self-management. Which statement would be correct about the administration of lispro insulin?

Take the insulin at around the same time each day at a meal.

A nurse is caring for a client with hypothyroidism. The client is extremely upset about altered physical appearance. The client doesn't want to take the medication because "it isn't doing any good." What should the nurse do?

Tell the client that as the medication corrects the hormone deficiency, improvement in appearance can be expected soon.

The client who has undergone a bilateral adrenalectomy is concerned about persistent body changes and unpredictable moods. What should the nurse teach the client about these changes?

The body and mood will gradually return to normal.

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane (NPH) insulin to be taken before breakfast. At about 4:30 p.m. (1630), the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?

The isophane (NPH) insulin is peaking.

A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland?

adrenal cortex

After surgery for bilateral adrenalectomy, the client is kept on bed rest for several days. Which exercise will be most effective for preparing a client for ambulation after a period of bed rest?

alternately flexing and relaxing the quadriceps femoris muscles

What is the most common cause of hyperaldosteronism?

an adrenal adenoma

A client with diabetic ketoacidosis (DKA) has asked the unlicensed nursing assistant for another pitcher of water. It is the third such request over the past 4 hours. The nurse would recognize this request as which manifestation?

an occurrence of the excess loss of fluid associated with osmotic diuresis

The nurse is caring for a client with a metabolic acidosis (pH 7.25). Which value is most useful to the nurse in determining whether the cause of the acidosis is due to acid gain or to bicarbonate loss?

anion gap

A client is diagnosed with diabetic ketoacidosis. Which finding would the nurse anticipate?

arterial pH 7.33

During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently?

assess vital signs.

After a 3-month trial of dietary therapy, a client with type 2 diabetes still has blood glucose levels above 180 mg/dl (9.99mmol/L). The physician adds glyburide, 2.5 mg P.O. daily, to the treatment regimen. The nurse should instruct the client to take the glyburide:

at breakfast.

A nurse has just been trained in how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor?

calibrating the machine after installing a new battery

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will order diuretic therapy, restrict fluid intake, and provide sodium replacement to treat the disorder. If the client does not comply with the recommended treatment, which complication may arise?

cerebral edema

A nurse should expect to administer which medication to a client with gout?

colchicine

A client's blood glucose level is 45 mg/dl (2.5 mmol/L). The nurse should be alert for which signs and symptoms?

coma, anxiety, confusion, headache, and cool, moist skin

The nurse is assessing a client with Addison disease about taking a glucocorticoid replacement. Which is the best indicator that the medication is having the intended effect?

daily weight

After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. The nurse knows that this may be the result of what complication of the surgery?

damage to the parathyroid glands

A client with hepatitis C has been admitted to the hospital. The nurse should institute which measure to prevent transmission of the hepatitis C virus to health care personnel?

decreasing contact with blood and blood-contaminated fluids

client with hepatitis C has been admitted to the hospital. The nurse should institute which measure to prevent transmission of the hepatitis C virus to health care personnel?

decreasing contact with blood and blood-contaminated fluids

A client with type 1 diabetes mellitus is admitted to the emergency department. Which respiratory pattern in a client with diabetes mellitus requires immediate action?

deep, rapid respirations with long expirations

A client has had a bilateral adrenalectomy. For which potential complication should the nurse assess the client?

delayed wound healing

The nurse teaches the client with type 1 diabetes mellitus about the importance of maintaining stable blood glucose levels. To minimize the rise in blood glucose level after meals, the nurse should suggest that the client include which type of food?

dietary fiber

A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which of the following findings is the nurse most likely to observe in this client? Select all that apply.

excessive thirst excessive hunger frequent, high-volume urination

The nurse is caring for a client who has returned from having a subtotal thyroidectomy. What finding would require a nurse to take immediate action?

facial muscle twitching

A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis?

fluid deprivation test

A client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan? Select all that apply.

high-fiber, low-calorie diet use of stool softeners thyroid hormone replacements

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?

hypercalcemia

The nurse is caring for a client on the urinary unit. When providing report to the next shift, it is noted that the client has osteopenia and history of renal calculi. Which disorder would the nurse suspect?

hyperparathyroidism

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?

hypocalcemia

Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis?

hypokalemia and hypoglycemia

A client has had a hypophysectomy. What sign of a potential complication should the nurse teach the client to report?

hypopituitarism

Which results would indicate that levothyroxine sodium is effectively resolving the symptoms of a client with hypothyroidism?

increased energy, weight loss, and a higher temperature and pulse rate

A nurse is teaching a school-age child with diabetes and their parents about managing diabetes during illness. The nurse determines that the parents understand the instruction when they indicate that they will make which treatment plan modification on days when the child is ill?

increasing the frequency of blood glucose monitoring

The nurse is caring for a client in a diabetic coma. The nurse is aware that this is caused by an excess of which substance in the blood?

ketones from rapid fat breakdown, causing acidosis

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer?

lactated Ringer's solution

Following a subtotal thyroidectomy, the nurse asks the client to speak immediately upon regaining consciousness. The client is not able to make a sound. The nurse determines that the client is experiencing which complication of the surgery?

laryngeal nerve damage

Which statement indicates that the client with diabetes insipidus understands how to manage care? The client will:

maintain normal fluid and electrolyte balance.

For a client with Graves' disease, which nursing intervention promotes comfort?

maintaining room temperature in the low-normal range

The nurse is admitting a client with newly diagnosed diabetes mellitus and left-sided heart failure. Assessment reveals low blood pressure, increased respiratory rate and depth, drowsiness, and confusion. The client reports headache and nausea. Based on the serum laboratory results, how would the nurse interpret the client's acid-base balance?

metabolic acidosis

A 75-year-old client who complains of a "sour stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for what acid-base imbalance?

metabolic alkalosis

A client in the emergency department reports that they have been vomiting excessively for the past 2 days. The client's arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?

metabolic alkalosis

A client receiving thyroid replacement therapy develops influenza and forgets to take the prescribed thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing what life-threatening complication?

myxedema coma

An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of

myxedema coma.

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply.

numbness tingling muscle twitching and spasms

A group of nursing assistants hired for the medical-surgical floors are attending hospital orientation. Which topic should the educator cover when teaching the group about caring for clients with diabetes mellitus?

obtaining, reporting, and documenting fingerstick glucose levels

When obtaining the nursing history of a client who has diabetes mellitus, the nurse should assess the client for which of the following early symptom of renal insufficiency?

polyuria

A client has been diagnosed with insulin-requiring diabetes. The nurse should instruct the client about which factor(s) that can contribute to the risk for diabetic retinopathy? Select all that apply.

poor control of blood sugar length of time of being diagnosed with diabetes hypertension elevated cholesterol

A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question?

potassium chloride

A child with type 1 diabetes is admitted to the emergency department with hot and dry skin, rapid and deep respirations, and a fruity odor to their breath. Which task, when performed by a new graduate registered nurse (RN), requires the RN preceptor to intervene?

providing encouragement to the child to drink some orange juice

A nurse should expect a client with hypothyroidism to report

puffiness of the face and hands.

A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add?

related to bone demineralization resulting in pathologic fractures

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH?

restricting fluids to 800 ml/day

A client with type 1 diabetes takes 15 units of insulin isophane before breakfast and 8 units before dinner. During a follow-up visit, the nurse reevaluates the client's knowledge about insulin therapy and self-administration skills. The nurse realizes the client requires additional teaching when the nurse discovers the client takes which over-the-counter preparations?

salicylate-containing preparations

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease?

serum potassium level of 5.8 mEq/L (5.8 mmol/L)

The nurse is caring for a client with Cushing's disease. During change of shift report, which assessment laboratory data would the nurse anticipate communicating? Select all that apply.

serum sodium level serum potassium level blood glucose level white blood cell count

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result?

serum sodium level of 124 mEq/L

Propylthiouracil (PTU) is prescribed for a client with Graves disease. Which symptom should the nurse teach the client to report?

sore throat

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to

suggest referral to a sex counselor or other appropriate professional.

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?

sweating, tremors, and tachycardia

A client with hypothyroidism (myxedema) is receiving levothyroxine, 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug?

tachycardia

Which client will the community health nurse visit first?

the client with type 1 diabetes mellitus with acute visual changes

The nurse is instructing the client with hypothyroidism who takes levothyroxine 100 mcg, digoxin, and simvastatin. The nurse judges that the teaching regarding the use of these medications is effective if the client will take:

the levothyroxine before breakfast and the other medications 4 hours later.

A client is to have a transsphenoidal hypophysectomy to remove a large, invasive pituitary tumor. Where should the nurse tell the client the surgical incision will be made?

upper gingival mucosa in the space between the upper gums and lip

When caring for a client with diabetes insipidus, the nurse expects to administer

vasopressin.

A nurse is evaluating the effectiveness of teaching a client about how to self-administer insulin. Which action indicates that additional teaching is necessary? The client:

waits 30 minutes to eat breakfast after injecting rapid-acting insulin

The health care provider has prescribed pancreatic enzyme replacements for a client with chronic pancreatitis. When should the nurse tell the client about how to take them to obtain the most therapeutic effect?

with each meal and snack