Endocrine NCLEX

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1. An agitated, confused female client arrives in the emergency
department. Her history includes type 1 diabetes mellitus, hy- B.
pertension, and angina pectoris. Assessment reveals pallor, di- To reverse hypoglycemia, the American Diabetes Association rec-
aphoresis, headache, and intense hunger. A stat blood glucose ommends ingesting 10 to 15 g of a simple carbohydrate, such as
sample measures 42 mg/dl, and the client is treated for an acute three to five pieces of hard candy, two to three packets of sugar
hypoglycemic reaction. After recovery, nurse Lily teaches the (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can
client to treat hypoglycemia by ingesting: be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple
a. 2 to 5 g of a simple carbohydrate. carbohydrate may not raise the blood glucose level sufficiently.
b. 10 to 15 g of a simple carbohydrate. Ingesting more than 15 g may raise it above normal, causing
c. 18 to 20 g of a simple carbohydrate. hyperglycemia.
d. 25 to 30 g of a simple carbohydrate.
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
D.
its effect on his marriage. In planning this client's care, the most
The nurse should refer this client to a sex counselor or other
appropriate intervention would be to:
professional. Making appropriate referrals is a valid part of plan-
a. Encourage the client to ask questions about personal sexuality.
ning the client's care. The nurse doesn't normally provide sex
b. Provide time for privacy.
counseling.
c. Provide support for the spouse or significant other.
d. Suggest referral to a sex counselor or other appropriate profes-
sional.
B.
4. During a class on exercise for diabetic clients, a female client
Diabetic clients must exercise at least three times a week to meet
asks the nurse educator how often to exercise. The nurse educator
the goals of planned exercise — lowering the blood glucose level,
advises the clients to exercise how often to meet the goals of
reducing or maintaining the proper weight, increasing the serum
planned exercise?
high-density lipoprotein level, decreasing serum triglyceride lev-
a. At least once a week
els, reducing blood pressure, and minimizing stress. Exercising
b. At least three times a week
once a week wouldn't achieve these goals. Exercising more than
c. At least five times a week
three times a week, although beneficial, would exceed the mini-
d. Every day
mum requirement.
A.
8. When caring for a male client with diabetes insipidus, nurse Because diabetes insipidus results from decreased antidiuretic
Juliet expects to administer: hormone (vasopressin) production, the nurse should expect to ad-
a. vasopressin (Pitressin Synthetic). minister synthetic vasopressin for hormone replacement therapy.
b. furosemide (Lasix). Furosemide, a diuretic, is contraindicated because a client with
c. regular insulin. diabetes insipidus experiences polyuria. Insulin and dextrose are
d. 10% dextrose. used to treat diabetes mellitus and its complications, not diabetes
insipidus.
10. A male client with type 1 diabetes mellitus has a highly ele-
C.
vated glycosylated hemoglobin (Hb) test result. In discussing the
The glycosylated Hb test provides an objective measure of
result with the client, nurse Sharmaine would be most accurate in
glycemic control over a 3-month period. The test helps identify
stating:
trends or practices that impair glycemic control, and it doesn't
a. "The test needs to be repeated following a 12-hour fast."
require a fasting period before blood is drawn. The nurse can't
b. "It looks like you aren't following the prescribed diabetic diet."
conclude that the result occurs from poor dietary management or
c. "It tells us about your sugar control for the last 3 months."
inadequate insulin coverage.
d. "Your insulin regimen needs to be altered significantly."
11. Following a unilateral adrenalectomy, nurse Betty would as- A.
sess for hyperkalemia shown by which of the following? Muscle weakness, bradycardia, nausea, diarrhea, and paresthe-
a. Muscle weakness sia of the hands, feet, tongue, and face are findings associated
b. Tremors with hyperkalemia, which is transient and occurs from transient
c. Diaphoresis hypoaldosteronism when the adenoma is removed. Tremors, di-
d. Constipation aphoresis, and constipation aren't seen in hyperkalemia.
12. Nurse Louie is developing a teaching plan for a male client
diagnosed with diabetes insipidus. The nurse should include in-
formation about which hormone lacking in clients with diabetes
A.
insipidus?
ADH is the hormone clients with diabetes insipidus lack. The
a. antidiuretic hormone (ADH).
client's TSH, FSH, and LH levels won't be affected.
b. thyroid-stimulating hormone (TSH).
c. follicle-stimulating hormone (FSH).
d. luteinizing hormone (LH).

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C.
14. For a male client with hyperglycemia, which assessment find-
In hyperglycemia, urine osmolarity (the measurement of dissolved
ing best supports a nursing diagnosis of Deficient fluid volume?
particles in the urine) increases as glucose particles move into
a. Cool, clammy skin
the urine. The client experiences glucosuria and polyuria, losing
b. Distended neck veins
body fluids and experiencing fluid volume deficit. Cool, clammy
c. Increased urine osmolarity
skin; distended neck veins; and a decreased serum sodium level
d. Decreased serum sodium level
are signs of fluid volume excess, the opposite imbalance.
16. A male client is admitted for treatment of the syndrome of
inappropriate antidiuretic hormone (SIADH). Which nursing inter-
C.
vention is appropriate?
To reduce water retention in a client with the SIADH, the nurse
a. Infusing I.V. fluids rapidly as ordered
should restrict fluids. Administering fluids by any route would fur-
b. Encouraging increased oral intake
ther increase the client's already heightened fluid load.
c. Restricting fluids
d. Administering glucose-containing I.V. fluids as ordered
A.
17. A female client has a serum calcium level of 7.2 mg/dl. During This client's serum calcium level indicates hypocalcemia, an
the physical examination, nurse Noah expects to assess: electrolyte imbalance that causes Trousseau's sign (carpopedal
a. Trousseau's sign. spasm induced by inflating the blood pressure cuff above systolic
b. Homans' sign. pressure). Homans' sign (pain on dorsiflexion of the foot) indicates
c. Hegar's sign. deep vein thrombosis. Hegar's sign (softening of the uterine isth-
d. Goodell's sign. mus) and Goodell's sign (cervical softening) are probable signs of
pregnancy.
A.
18. Which outcome indicates that treatment of a male client with Diabetes insipidus is characterized by polyuria (up to 8 L/day),
diabetes insipidus has been effective? constant thirst, and an unusually high oral intake of fluids. Treat-
a. Fluid intake is less than 2,500 ml/day. ment with the appropriate drug should decrease both oral fluid
b. Urine output measures more than 200 ml/hour. intake and urine output. A urine output of 200 ml/hour indicates
c. Blood pressure is 90/50 mm Hg. continuing polyuria. A blood pressure of 90/50 mm Hg and a heart
d. The heart rate is 126 beats/minute. rate of 126 beats/minute indicate compensation for the continued
fluid deficit, suggesting that treatment hasn't been effective.
19. Jemma, who weighs 210 lb (95 kg) and has been diagnosed A.
with hyperglycemia tells the nurse that her husband sleeps in Acromegaly, which is caused by a pituitary tumor that releases
another room because her snoring keeps him awake. The nurse excessive growth hormone, is associated with hyperglycemia,
notices that she has large hands and a hoarse voice. Which of hypertension, diaphoresis, peripheral neuropathy, and joint pain.
the following would the nurse suspect as a possible cause of the Enlarged hands and feet are related to lateral bone growth, which
client's hyperglycemia? is seen in adults with this disorder. The accompanying soft tissue
a. Acromegaly swelling causes hoarseness and often sleep apnea. Type 1 dia-
b. Type 1 diabetes mellitus betes is usually seen in children, and newly diagnosed persons
c. Hypothyroidism are usually very ill and thin. Hypothyroidism isn't associated with
d. Deficient growth hormone hyperglycemia, nor is growth hormone deficiency.
20. Nurse Kate is providing dietary instructions to a male client
with hypoglycemia. To control hypoglycemic episodes, the nurse
D.
should recommend:
To control hypoglycemic episodes, the nurse should instruct the
a. Increasing saturated fat intake and fasting in the afternoon.
client to consume a low-carbohydrate, high-protein diet, avoid
b. Increasing intake of vitamins B and D and taking iron supple-
fasting, and avoid simple sugars. Increasing saturated fat intake
ments.
and increasing vitamin supplementation wouldn't help control hy-
c. Eating a candy bar if light-headedness occurs.
poglycemia.
d. Consuming a low-carbohydrate, high-protein diet and avoiding
fasting.
22. A male client with type 1 diabetes mellitus asks the nurse
about taking an oral antidiabetic agent. Nurse Jack explains that B.
these medications are only effective if the client: Oral antidiabetic agents are only effective in adult clients with
a. prefers to take insulin orally. type 2 diabetes. Oral antidiabetic agents aren't effective in type
b. has type 2 diabetes. 1 diabetes. Pregnant and lactating women aren't prescribed oral
c. has type 1 diabetes. antidiabetic agents because the effect on the fetus is uncertain.
d. is pregnant and has type 2 diabetes.
23. When caring for a female client with a history of hypoglycemia, A.
nurse Ruby should avoid administering a drug that may potentiate Sulfisoxazole and other sulfonamides are chemically related to
hypoglycemia. Which drug fits this description? oral antidiabetic agents and may precipitate hypoglycemia. Mex-
a. sulfisoxazole (Gantrisin) iletine, an antiarrhythmic, is used to treat refractory ventricular
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b. mexiletine (Mexitil) arrhythmias; it doesn't cause hypoglycemia. Prednisone, a cor-
c. prednisone (Orasone) ticosteroid, is associated with hyperglycemia. Lithium may cause
d. lithium carbonate (Lithobid) transient hyperglycemia, not hypoglycemia.
24. After taking glipizide (Glucotrol) for 9 months, a male client
B.
experiences secondary failure. Which of the following would the
Many clients (25% to 60%) with secondary failure respond to a
nurse expect the physician to do?
different oral antidiabetic agent. Therefore, it wouldn't be appro-
a. Initiate insulin therapy.
priate to initiate insulin therapy at this time. However, if a new oral
b. Switch the client to a different oral antidiabetic agent.
antidiabetic agent is unsuccessful in keeping glucose levels at an
c. Prescribe an additional oral antidiabetic agent.
acceptable level, insulin may be used in addition to the antidiabetic
d. Restrict carbohydrate intake to less than 30% of the total caloric
agent.
intake.
What is a hormone secreted from the posterior lobe of the pituitary
gland?
.C
Answers:
ADH is secreted from the posterior pituitary. LH comes from the
A. LH
anterior pituitary, MSH from the intermediate. GnRH is released
B. MSH
from the hypothalamus.
C. ADH
D. GnRH
An indication of Chvostek' sign is:
Answers: .A
A. Twitching of the lips after tapping the face Twitching of the lips after tapping the face in the right place is
B. Elevated blood sugar after glucose infusion an indication of Chvostek's sign and a sign of hypocalcaemia.
C. Inability to hold one's arms straight Spasms of the hand are associated with Trousseau's sign.
D. Spasms of the hand after blood circulation is cut off
Which of the following statements by a client with Type II Diabetes
indicates the need for further education? .B
Answers: While an HbA1C level of 5.5% would be below the threshold for
A. I should avoid hot tubs diabetes, it is an unrealistic target. Data has shown that trying
B. I should aim for an HbA1C level of 5.5% to lower the HbA1C level too much can lead to an increase in
C. I may need insulin at times complications.
D. My life expectancy is likely reduced by 10 years
Acromegaly is most frequently diagnosed in: . A: Acromegaly results from benign tumors on the pituitary gland
a. Middle-aged adults that produce excessive amounts of growth hormone. Although
b. Newborns symptoms may present at any age, the diagnosis generally oc-
c. Children ages 2 to 5 curs in middle-aged persons. Untreated, the consequences of
d. Adults age 65 and older acromegaly include
The primary function of insuln is to:
A. Lower blood glucose levels
B. Produce melanin a
C. regulate the bodys metabolic rate
D. stimulate release of digestive enzymes
Which nursing action is most appropriate for a client in ketoaci-
dosis?
a. admin of carbs
b
b. admin of IV fluids
c. applying cold compress
d. giving glucagon IV
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
c
b. insulin shock
c. ketoacidosis
d. weight loss
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
a
b. hemoglobin lvl's over a 6 - 10 week period
c. protien lvl over a 3 month period
d. vanillylmandelic acid lvl's

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 Endocrine NCLEX
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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?
b
a. iodine
b. acetone
c.alcohol
d. glucose
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 d
b. retinopathy
c. nephropathy
d. Arteriosclerosis
A nurse is instructing a 50yr diabetic client about the steps to be
followed for self admin of insulin. Which of the following instruc-
tions should be included in te client teaching?
a. instruct client to aviod injections to the abdomen c
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
5. A clinic nurse is performing an assessment on a client recently
diagnosed with diabetes mellitus. Which assessment question is 5) C
appropriate when assessing the client's degree of adaptation to Open-ended questions allow the client to take the lead in the
this disorder? conversation. Options A and B denote judgment and may block
communication. Option D allows the client to answer with a yes
a) you really don't think you caused your disorder, do you? or no response and does not provide the client an opportunity to
b) your family is helping you stick to your diet, aren't they? share feelings. Option C is open-ended and focuses on the subject
c) how do you feel about your progress? of the question, the client's degree of adaptation to the disorder.
d) are you feeling anxious?
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 7) B
suspects that the client has: - Clients with DKA accumulate large amounts of ketone bodies
in extracellular fluids. A fruity odor to the breath develops due to
a) hyperglycemic hyperosmolar nonketotic syndrome (HHNS) the volatile nature of acetone. A fruity odor is not a manifestation
b) diabetic ketoacidosis (DKA) associated with the conditions noted in options A, C, and D.
c) ethanol oxide intoxication
d) hypoglycemia
17. A client with type 1 diabetes mellitus tells the nurse that
mealtimes are not important and that she eats whenever it is 17) A
convenient. It is important for the nurse to explain that mealtimes: - It is important for clients with type 1 diabetes mellitus to correlate
eating with insulin administration to prevent hypoglycemia. Insulin
a) must be approximately the same time each day to maintain a should be given at approximately the same time each day, and
stable blood glucose meals should be eaten at approximately the same time each
b) can be varied as long as the time of insulin administration is day. This will establish regular patterns of glucose availability that
also varied approximate glucose availability in a nondiabetic body. Options B,
c) are not important as long as the client monitors the blood C, and D are incorrect because they infer that mealtimes are not
glucose regularly important.
d) are not important as long as snack foods are readily available
18. A client with type 1 diabetes mellitus tells the nurse, "I usually 18) B
begin to feel sick late in the afternoon; is there something wrong - An excess of insulin relative to the amount of blood glucose
with me?" The appropriate response by the nurse is which of the induces hypoglycemia. Depending on the length of action of the
following? insulin administered, the risk of hypoglycemia may be greatest
in the late afternoon. The nurse needs to collect more data to
a) don't worry about that. Most diabetics feel that way determine if the client is actually experiencing hypoglycemia. Ask-
b) can you describe what you mean by feeling sick? ing the client to describe the sick feeling provides the nurse with
c) let me know if that happens today more data. Options A, C, and D are nontherapeutic communication
d) most people feel tired late in the afternoon statements.

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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 19) A
the major symptoms of diabetes mellitus? - Polydipsia, polyuria, and polyphagia are the classic signs and
symptoms of diabetes mellitus. Dyspepsia, dysphagia, and dys-
a) polydipsia, polyuria, and polyphagia phasia are associated with other body systems (gastric and neu-
b) dyspepsia, polyuria, and polyphagia rological). Hyperglycemia also occurs.
c) hypoglycemia, polyuria, and dysphagia
d) hypoglycemia, polyuria, and dysphasia
22. A nurse is caring for a hospitalized older client with a diag-
nosis 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 22) D
intervention would be to: - The nurse should confirm that the client is hypoglycemic by
checking the blood glucose. Option A is incorrect because hy-
a) administer oral glucose poglycemia has not been determined. More information should
b) assist the client to bed, put the side rails up, and call the be gathered before calling the physician, so option B is incorrect.
physician Option C does not meet the client's immediate needs.
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
23. An adult client with diabetes mellitus reports to the health
care clinic for a glycosylated hemoglobin A (HgbA1c) level. Which 23) A
laboratory result indicates client compliance with the prescribed - The normal level for HgbA1C is 4.5% to 7.5%. This test measures
diabetic regimen? the amount of glucose that has become permanently bound to
the red blood cells from circulating glucose. Elevations in blood
a) 5% glucose will cause elevations in the amount of glycosylation. Ele-
b) 8% vations indicate continued need for teaching related to prevention
c) 10% of hyperglycemic episodes.
d) 15%
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
24) A
I want." In this situation, the nurse's intervention is focused on
- The client is denying the experience of a chronic illness that
addressing which coping mechanism?
will require her to make lifestyle changes. There is no evidence
of anger or depression in the statement made by the client. The
a) denial
client has not accepted the disease if expectations are unrealistic.
b) anger
c) depression
d) acceptance
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 25) A
nurse likely expect to find? - Hyperglycemia is characteristic of newly diagnosed diabetes
mellitus. Newly diagnosed diabetic clients present a variety of
a) hyperglycemia symptoms, which may include polydipsia, polyuria, polyphagia,
b) hypoglycemia weakness, weight loss, and dehydration.
c) weight gain
d) hematuria
26. A client with diabetes mellitus says that it is very difficult to
26) B
adhere to the diabetic treatment plan. The nurse interprets the
- It is important to determine and deal with a client's concerns
client's concern and determines that the appropriate response is:
and to identify measures that will assist the client to comply with
the diabetic regimen. The nurse should determine if a knowledge
a) if you don't take your insulin you will develop diabetic ketoaci-
deficit exists and if the client's treatment plan maintains normalcy
dosis (DKA)
as much as is possible with the lifestyle. Scare tactics as described
b) let's go over your diet again to be sure it contains foods you like
in options A and C should not be used. Positive reinforcement is
c) do you understand what noncompliance can mean to your
necessary instead of focusing on negative behaviors. Option D
future health?
does not address the subject of the question.
d) let's check your blood glucose now

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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: 28) C
- Blood glucose levels for an adult normally range between 60 and
a) higher than normal, indicating a cause of the delirium 120 mg/dL. A level of 33 mg/dL indicates hypoglycemia. Metabolic
b) a normal reading for this client disorders can be an etiological factor of delirium.
c) a lower than normal reading, indicating a cause for the delirium
d) insignificant and unrelated to the delirium
A diabetic client has been maintained on Glucophage (metformin)
Answer A is correct. Glucophage (metformin) can cause renal
for regulation of his blood glucose levels. Which teaching should
complications. The client should be monitored for changes in renal
be included in the plan of care?
function. In answer B, the medication begins working immediately,
A. Report changes in urinary pattern.
so it is incorrect. In answer C, the amount of carbohydrates should
B. Allow six weeks for optimal effects.
be regulated with a diabetic diet, so it is incorrect. The use of
C. Increase the amount of carbohydrates in your diet.
lotions in answer D is unnecessary, so it is incorrect.
D. Use lotions to treat itching.
A client with diabetes experiences Somogyi's effect. To prevent
Answer D is correct. Somogyi's is characterized by a drop in
this complication, the nurse should instruct the client to:
glucose levels at approximately 2 a.m. or 3 a.m. followed by a false
A. Take his insulin each day at 1400 hours
elevation. Eating a protein and carbohydrate snack before retiring
B. Engage in physical activity daily
prevents the hypoglycemia and rebound elevation. Answers A, B,
C. Increase the amount of regular insulin
and C are incorrect because they do not prevent Somogyi's effect.
D. Eat a protein and carbohydrate snack at bedtime
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: Answer B is correct. This insulin, unlike others, is most frequently
A. Prior to each meal administered at night. Its duration is 24-36 hours. A, C, and D are
B. At night incorrect they are incorrect times to administer Lantus insulin.
C. Midday
D. Prior to the evening meal
A client with polyuria, polydipsia, and polyphagia is diagnosed
with diabetes mellitus. The nurse would expect that these symp-
Answer B is correct. The client with hyperglycemia will exhibit
toms are related to
polyuria, polydipsia, or increased thirst, and polyphagia, or in-
A. Hypoglycemia
creased hunger. A, C, and D are incorrect because they are not
B. Hyperglycemia
signs of hypoglycemia.
C. Hyperparathyroidism
D. Hyperthyroidism
Which laboratory test conducted on the client with diabetes mel-
litus indicates compliance? Answer C is correct. The Hgb A-1C indicates that the client has
A. Fasting blood glucose been compliant for approximately three months. Answers A, B, and
B. Two-hour post-prandial D tell the nurse the client's blood glucose at the time of the test,
C. Hgb A-1C so they are incorrect.
D. Dextrostix

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