Some Endocrine Med NCLEX Saunders Questions

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse would provide which instructions to the client? Select all that apply. 1Hypoglycemia may be experienced before dinnertime. 2The insulin dose needs to be decreased if illness occurs. 3The insulin needs to be administered at room temperature. 4The insulin vial needs to be shaken vigorously to break up the precipitates. 5The NPH insulin needs to be drawn into the syringe first, then the regular insulin.

1Hypoglycemia may be experienced before dinnertime. 3The insulin needs to be administered at room temperature. Rationale:Humulin NPH is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Regular insulin is a short-acting insulin. Depending on the type, the onset of action is 30 to 60 minutes, it peaks in 1 to 5 hours, and its duration is 6 to 10 hours. Hypoglycemic reactions most likely occur during peak time. Insulin would be at room temperature when administered. Clients may need their insulin dosages increased during times of illness. Insulin vials would never be shaken vigorously. Regular insulin is always drawn up before NPH.

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? 1Withdraws the NPH insulin first 2Withdraws the regular insulin first 3Injects air into NPH insulin vial first 4Injects an amount of air equal to the desired dose of insulin into each vial

1Withdraws the NPH insulin first Rationale:When preparing a mixture of short-acting insulin, such as regular insulin, with another insulin preparation, the short-acting insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of short-acting insulin with insulin of another type. Options 2, 3, and 4 identify correct actions for preparing NPH and short-acting insulin.

The nurse teaches the client, who is newly diagnosed with diabetes insipidus, about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? Select all that apply. 1"This medication will turn my urine orange." 2"I need to decrease my oral fluids when I start this medication." 3"The amount of urine I make would increase if this medicine is working." 4"I need to follow a low-fat diet to avoid pancreatitis when taking this medicine." 5"I need to report headache and drowsiness to my primary health care provider since these symptoms could be related to my desmopressin."

2"I need to decrease my oral fluids when I start this medication." 5"I need to report headache and drowsiness to my primary health care provider since these symptoms could be related to my desmopressin." Rationale:In diabetes insipidus, there is a deficiency in antidiuretic hormone (ADH), resulting in large urinary losses. Desmopressin is an analog of ADH. Clients with diabetes insipidus drink high volumes of fluid (polydipsia) as a compensatory mechanism to counteract urinary losses and maintain fluid balance. Once desmopressin is started, oral fluids would be decreased to prevent water intoxication. Therefore, clients with diabetes insipidus would decrease their oral fluid intake when they start desmopressin. Headache and drowsiness are signs of water intoxication in the client taking desmopressin and need to be reported to the primary health care provider. Desmopressin does not turn urine orange. The amount of urine would decrease, not increase, when desmopressin is started. Desmopressin does not cause pancreatitis.

A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. After diagnostic studies, diabetes insipidus is diagnosed. Desmopressin is prescribed. The client asks why this medication was prescribed. Which is a correct statement by the nurse? 1"It relieves the headaches." 2"It increases water reabsorption." 3"It stimulates the production of aldosterone." 4"It decreases the production of the antidiuretic hormone."

2"It increases water reabsorption." Rationale:Desmopressin is an antidiuretic hormone (ADH) used in the treatment of diabetes insipidus. It promotes renal conservation of water by acting on the collecting ducts of the kidney to increase the permeability to water, which results in increased water reabsorption. Desmopressin does not relieve headaches, stimulate aldosterone, or decrease production of ADH.

A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL (10.2 to 11.4 mmol/L). Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1Atenolol 2Prednisone 3Phenelzine 4Allopurinol

2Prednisone Rationale:Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 1, a beta blocker, and option 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

The emergency department nurse is caring for a client admitted with diabetic ketoacidosis. The physician prescribes intravenous (IV) insulin. The nurse plans to prepare which type of insulin for the client? 1Insulin glargine 2Regular insulin 3Insulin isophane 450% human insulin isophane/50% human insulin

2Regular insulin Rationale:Regular insulin can be administered by the IV route. Insulin glargine is a long-acting insulin. Insulin isophane and 50% human insulin isophane/50% human insulin are intermediate-acting insulins.

The nurse would tell the client, who is taking levothyroxine, to notify the primary health care provider (PHCP) if which problem occurs? 1Fatigue 2Tremors 3Cold intolerance 4Excessively dry skin

2Tremors Rationale:Levothyroxine is prescribed to treat hypothyroidism. Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating. The client needs to be instructed to notify the PHCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

The client with hyperparathyroidism is taking alendronate. Which statements by the client indicate understanding of the proper way to take this medication? Select all that apply. 1"I need to take this medication with food." 2"I need to take this medication at bedtime." 3"I would sit up for at least 30 minutes after taking this medication." 4"I need to take this medication first thing in the morning on an empty stomach." 5"I can pick a time to take this medication that best fits my lifestyle as long as I take it at the same time each day."

3"I would sit up for at least 30 minutes after taking this medication." 4"I need to take this medication first thing in the morning on an empty stomach." Rationale:Alendronate is a bisphosphonate used in hyperparathyroidism to inhibit bone loss and normalize serum calcium levels. Esophagitis is an adverse effect of primary concern in clients taking alendronate. For this reason, the client is instructed to take alendronate first thing in the morning with a full glass of water on an empty stomach, not to eat or drink anything else for at least 30 minutes after taking the medication, and to remain sitting upright for at least 30 minutes after taking it. A daily dosing schedule and a once-weekly dosing schedule are available for clients taking alendronate.

The nurse provides family teaching to the parent of a 13-year-old client with pituitary dwarfism who is on growth hormone therapy. Which statement by the parent indicates that teaching has been successful? 1"My child's growth will be slow and steady." 2"My child will have growth spurts every 2 years." 3"My child will have an immediate increase in growth." 4"My child will have an increase in height in young adulthood."

3"My child will have an immediate increase in growth." Rationale:Growth hormone may be used in the treatment of dwarfism. When treatment is started, height may be increased by as much as 6 inches. The increase is immediate and continual. To monitor treatment, height and weight would be measured monthly. All other options indicate delayed or sporadic increases in growth, which are incorrect.

The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching? 1. "I would keep the insulin in the cabinet during the day only." 2. "I know I have to keep my insulin in the refrigerator at all times." 3. "I can store the open insulin bottle in the kitchen cabinet for 1 month." 4. "The best place for my insulin is on the windowsill, but in the cupboard is just as good."

3. "I can store the open insulin bottle in the kitchen cabinet for 1 month." Rationale:An insulin vial in current use can be kept at room temperature for 1 month without significant loss of activity. Direct sunlight and heat must be avoided. Therefore, options 1, 2, and 4 are incorrect.

A client with diabetes mellitus received 20 units of Humulin N insulin subcutaneously at 0800. At what time would the nurse plan to assess the client for a hypoglycemic reaction? 1. 1000 2. 1100 3. 1700 4. 2400

3. 1700 Rationale:Humulin N is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and the duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.

A client received 20 units of Humulin N insulin subcutaneously at 08:00. At what time would the nurse plan to assess the client for a hypoglycemic reaction? 1. 10:00 2. 11:00. 3. 17:00 4. 24:00

3. 17:00 Rationale:Humulin N is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and the duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care would the nurse review with the client's primary health care provider? 1A decreased dosage of levothyroxine 2An increased dosage of levothyroxine 3A decreased dosage of warfarin sodium 4An increased dosage of warfarin sodium

3A decreased dosage of warfarin sodium Rationale:Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin would be reduced.

Insulin lispro is prescribed for the client with diabetes mellitus, and the client is instructed to administer the insulin before meals. When would the nurse instruct the client to administer the insulin? 1. 45 minutes before eating 2. 60 minutes before eating 3. 90 minutes before eating 4. Immediately before eating

4. Immediately before eating Rationale:Insulin lispro acts more rapidly than regular insulin and has a shorter duration of action. The effect of insulin lispro begins within 25 minutes after subcutaneous injection, peaks in 0.5 to 1.5 hours, and has a duration of action of approximately 5 hours. Because of its rapid onset, it can be administered from 15 minutes to immediately before eating. In contrast, regular insulin is generally administered 30 minutes before meals.

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Hypothyroidism is diagnosed, and levothyroxine is prescribed. What is an expected outcome of the medication? 1Alleviates depression 2Increases energy levels 3Increases blood glucose levels 4Achieves normal thyroid hormone levels

4Achieves normal thyroid hormone levels Rationale:Laboratory determinations of the serum thyroid-stimulating hormone (TSH) level are an important means of evaluation. Successful therapy causes elevated TSH levels to decline. These levels begin their decline within hours of the onset of therapy and continue to decrease as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels remain suppressed for the duration of therapy. Although energy levels may increase and the client's mood may improve following effective treatment, these are not noted until normal thyroid hormone levels are achieved with medication therapy. An increase in the blood glucose level is not associated with this condition.

Metformin is prescribed for a client with type 2 diabetes mellitus. The nurse would tell the client that which is the most common side or adverse effect of the medication? 1Weight gain 2Hypoglycemia 3Flushing and palpitations 4Gastrointestinal (GI) disturbances

4Gastrointestinal (GI) disturbances

Metformin is prescribed for a client with type 2 diabetes mellitus. What is the most common side effect that the nurse would include in the client's teaching plan? 1Weight gain 2Hypoglycemia 3Flushing and palpitations 4Gastrointestinal disturbances

4Gastrointestinal disturbances Rationale:The most common side effect of metformin is gastrointestinal disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; clients lose an average of 7 to 8 lb (3.2 to 3.6 kg) because the medication causes nausea and decreased appetite. Although hypoglycemia can occur, it is not the most common side effect. Flushing and palpitations are not specifically associated with this medication.