Endocrine NCLEX PN Practice Questions II Ana Corona, MSN, FNP-C Nursing Instructor July 2007
Question 1 • A thirty five year old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect? A: Atherosclerosis B: Diabetic nephropathy C: Autonomic neuropathy D: Somatic neuropathy
1 • Answer C is correct. Autonomic neuropathy can cause inability to urinate.
Question 2 • A patient’s chart indicates a history of hyperkalemia. Which of the following would you not expect to see with this patient if this condition were acute? A: Decreased HR B: Paresthesias C: Muscle weakness of the extremities D: Migraines
2 • Answer D is correct. Answer choices A-C were symptoms of acute hyperkalemia
Question 3 • A patient’s chart indicates a history of ketoacidosis. Which of the following would you not expect to see with this patient if this condition were acute? A: Vomiting B: Extreme Thirst C: Weight gain D: Acetone breath smell
3 • Answer C is correct. Weight loss would be expected
Question 4 • A 84 year-old male has been loosing mobility and gaining weight over the last 2 months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed? A: CBC (complete blood count) B: ECG (electrocardiogram) C: Thyroid function tests D: CT scan
4 • Answer C is correct. Weight gain and poor temperature tolerance indicate something may be wrong with the thyroid function.
Question 5 • A 28 year old male has been found wandering around in a confused pattern. The male is sweaty and pale. Which of the following tests is most likely to be performed first? A: Blood sugar check B: CT scan C: Blood cultures D: Arterial blood gases
5 • Answer A is correct. With a history of diabetes, the first response should be to check blood sugar levels.
Question 6 • The client with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is: • Measure the urinary output • Check the vital signs • Encourage increased fluid intake • Weigh the client
6 • Answer B is correct. The large amount of fluid loss can cause fluid and electrolyte imbalance that should be corrected. The loss of electrolytes would be reflected in the vital signs. Measuring the urinary output is important, but the stem already says that the client has polyuria, so answer A is incorrect. Encouraging fluid intake will not correct the problem, making answer C incorrect. Answer D is incorrect because weighing the client is not necessary at this time.
Question 7 • A client has had a unilateral adrenalectomy to remove a tumor. To prevent complications, the most important measurement in the immediate post-operative period for the nurse to take is: • Blood pressure • Temperature • Output • Specific gravity
7 • Answer A is correct. Blood pressure is the best indicator of cardiovascular collapse in the client who has had an adrenal gland removed. The remaining gland might have been suppressed due to the tumor activity. Temperature would be an indicator of infection, decreased output would be a clinical manifestation but would take longer to occur than blood pressure changes, and specific gravity changes occur with other disorders; therefore, answers B, C, and D are incorrect.
Question 8 • A client with Addison's disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids (Solu-Medrol). Which of the following interventions would the nurse implement? • Glucometer readings as ordered • Intake/output measurements • Sodium and potassium levels monitored • Daily weights
8 • Answer A is correct. IV glucocorticoids raise the glucose levels and often require coverage with insulin. Answer B is not necessary at this time, sodium and potassium levels would be monitored when the client is receiving mineral corticoids, and daily weights is unnecessary; therefore, answers B, C, and D are incorrect.
Question 9 • A client had a total thyroidectomy yesterday. The client is complaining of tingling around the mouth and in the fingers and toes. What would the nurses' next action be? • Obtain a crash cart • Check the calcium level • Assess the dressing for drainage • Assess the blood pressure for hypertension
9 • Answer B is correct. The parathyroid glands are responsible for calcium production and can be damaged during a thyroidectomy. The tingling is due to low calcium levels. The crash cart would be needed in respiratory distress but would not be the next action to take; thus, answer A is incorrect. Hypertension occurs in thyroid storm and the drainage would occur in hemorrhage, so answers C and D are incorrect.
Question 10 • A 32-year-old mother of three is brought to the clinic. Her pulse is 52, there is a weight gain of 30 pounds in 4 months, and the client is wearing two sweaters. The client is diagnosed with hypothyroidism. Which of the following nursing diagnoses is of highest priority? • Impaired physical mobility related to decreased endurance • Hypothermia r/t decreased metabolic rate • Disturbed thought processes r/t interstitial edema • Decreased cardiac output r/t bradycardia
10 • Answer D is correct. The decrease in pulse can affect the cardiac output and lead to shock, which would take precedence over the other choices; therefore, answers A, B, and C are incorrect.
Question 11 • The physician has prescribed Novalog insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs? • "I will make sure I eat breakfast within 10 minutes of taking my insulin." • "I will need to carry candy or some form of sugar with me all the time." • "I will eat a snack around three o'clock each afternoon." • "I can save my dessert from supper for a bedtime snack."
11 • Answer A is correct. Novalog insulin onsets very quickly, so food should be available within 10–15 minutes of taking the insulin. Answer B does not address a particular type of insulin, so it is incorrect. NPH insulin peaks in 8–12 hours, so a snack should be eaten at the expected peak time. It may not be 3 p.m. as stated in answer C. Answer D is incorrect because there is no need to save the dessert until bedtime.
Question 12 • A 25-year-old client with Grave's disease is admitted to the unit. What would the nurse expect the admitting assessment to reveal? • Bradycardia • Decreased appetite • Exophthalmos • Weight gain
12 • Answer C is correct. Exophthalmos (protrusion of eyeballs) often occurs with hyperthyroidism. The client with hyperthyroidism will often exhibit tachycardia, increased appetite, and weight loss; therefore, answers A, B, and D are incorrect.
Question 13 • A client with hypothyroidism asks the nurse if she will still need to take thyroid medication during the pregnancy. The nurse's response is based on the knowledge that: • There is no need to take thyroid medication because the fetus's thyroid produces a thyroid-stimulating hormone. • Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy. • It is more difficult to maintain thyroid regulation during pregnancy due to a slowing of metabolism. • Fetal growth is arrested if thyroid medication is continued during pregnancy.
13 • Answer B is correct. During pregnancy, the thyroid gland triples in size. This makes it more difficult to regulate thyroid medication. Answer A is incorrect because there could be a need for thyroid medication during pregnancy. Answer C is incorrect because the thyroid function does not slow. Fetal growth is not arrested if thyroid medication is continued, so answer D is incorrect.
Question 14 • A client with diabetes has an order for ultrasonography. Preparation for an ultrasound includes: • Increasing fluid intake • Limiting ambulation • Administering an enema • Withholding food for 8 hours
14 • Answer A is correct. Before ultrasonography, the client should be taught to drink plenty of fluids and not void. The client may ambulate, an enema is not needed, and there is no need to withhold food for 8 hours. Therefore, answers B, C, and D are incorrect.
Question 15 • The nurse should visit which of the following clients first? • The client with diabetes with a blood glucose of 95mg/dL • The client with hypertension being maintained on Lisinopril • The client with chest pain and a history of angina • The client with Raynaud's disease
15 • Answer C is correct. The client with chest pain should be seen first because this could indicate a myocardial infarction. The client in answer A has a blood glucose within normal limits. The client in answer B is maintained on blood pressure medication. The client in answer D is in no distress.
Question 16 • The physician has prescribed NPH insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs? • "I will make sure I eat breakfast within 2 hours of taking my insulin." • "I will need to carry candy or some form of sugar with me all the time." • "I will eat a snack around three o'clock each afternoon." • "I can save my dessert from supper for a bedtime snack."
16 • Answer C is correct. NPH insulin peaks in 8–12 hours, so a snack should be offered at that time. NPH insulin onsets in 90–120 minutes, so answer A is incorrect. Answer B is untrue because NPH insulin is time released and does not usually cause sudden hypoglycemia. Answer D is incorrect, but the client should eat a bedtime snack.
Question 17 • The physician has ordered a thyroid scan to confirm the diagnosis. Before the procedure, the nurse should: • Assess the client for allergies • Bolus the client with IV fluid • Tell the client he will be asleep • Insert a urinary catheter
17 • Answer A is correct. A thyroid scan uses a dye, so the client should be assessed for allergies to iodine. The client will not have a bolus of fluid, will not be asleep, and will not have a urinary catheter inserted, so answers B, C, and D are incorrect.
Question 18 • A client hospitalized with MRSA (methicillin-resistant staph aureus) is placed on contact precautions. Which statement is true regarding precautions for infections spread by contact? • The client should be placed in a room with negative pressure. • Infection requires close contact; therefore, the door may remain open. • Transmission is highly likely, so the client should wear a mask at all times. • Infection requires skin-to-skin contact and is prevented by hand washing, gloves, and a gown.
18 • Answer D is correct. The client with MRSA should be placed in isolation. Gloves, a gown, and a mask should be used when caring for the client and hand washing is very important. The door should remain closed, but a negative-pressure room is not necessary, so answers A and B are incorrect. MRSA is spread by contact with blood or body fluid or by touching the skin of the client. It is cultured from the nasal passages of the client, so the client should be instructed to cover his nose and mouth when he sneezes or coughs. It is not necessary for the client to wear the mask at all times; the nurse should wear the mask, so answer C is incorrect.
Question 19 • The client has recently returned from having a thyroidectomy. The nurse should keep which of the following at the bedside? • A tracheotomy set • A padded tongue blade • An endotracheal tube • An airway
19 • Answer A is correct. The client who has recently had a thyroidectomy is at risk for tracheal edema. A padded tongue blade is used for seizures and not for the client with tracheal edema, so answer B is incorrect. If the client experiences tracheal edema, the endotracheal tube or airway will not correct the problem, so answers C and D are incorrect.
Situation: A 17-year-old female model comes to your ER complaining of generalized cramps and numbness in her fingers. Medical history is noncontributory. When questioned, she tells you that She has been on a high-protein diet for "about 6 weeks." An I.V. line is started and blood is drawn for laboratory studies. Her serum calcium level is 5.5 mg/dl.
Question 20 In assessing this patient for hypocalcemia, Chvostek's sign is elicited by: A. Applying a (BP) cuff to the upper arm, inflating it, and observing for carpopedal spasm. B. Tapping a finger on the skin above the supramandibular portion of the parotid gland and observing for twitching of the upper lip on side opposite stimulation. C. Tapping a finger on the skin above the supramandibular portion of the parotid gland and observing for twitching of the upper lip on same side as stimulation. D. Having the patient hyperventilate (more than 30 breaths/minute) to produce carpopedal spasm resulting from respiratory alkalosis.
20 • Answer C is correct. A decrease in ionized calcium causes an increase in neuromuscular excitability. Tapping over a branch of the facial nerve and observing for twitching of the upper lip on the ipsilateral (same) side as stimulation is considered a positive Chvostek's sign. Inflating a BP cuff on the upper arm or having the patient hyperventilate will both produce carpopedal spasm and are part of the diagnostic tests used to elicit Trousseau's sign.
Question 21 • Trousseau's sign can be elicited in the hypocalcemic patient by: A. Applying a BP cuff to upper arm, inflating it, and observing for carpopedal spasm. B. Tapping a finger on the supramandibular portion of the parotid cland and observing for twitching of the upper lip on the side opposite to the stimulation. C. Tapping a finger on the supramandibular portion of the parotid gland and observing for twitching of the upper lip on the same side as stimulation. D. Having the patient hyperventilate (more than 30 breaths/minute) to produce carpopedal spasm resulting from respiratory acidosis.
21 • Answer A is correct. Trousseau's sign is elicited by applying a BP cuff to the patient's arm, inflating to the patient's systolic pressure, and observing for carpopedal spasm. Another method for producing this phenomenon is hyperventilation, in which the alkalotic state decreases serum calcium levels.
Situation: • A 71-year-old woman is transported to the ED because of fatigue and a change in mental status. On physical examination, her temperature is 96.8 degrees F. (36 degrees C.) rectally. Her BP is 110/74 mm Hg; pulse, 48 beats/minute; respirations, 12 breaths/minute; periorbital edema is present, and a yellowish skin pigmentation is noted. Her daughter relates a history of "thyroid problem" and noncompliance with medical therapy. The diagnosis of myxedema is made. • Question next slide
Question 22 • The patient admitted with hypothyroid crisis (myxedema coma) would most likely have which of the following electrolyte abnormalities? A. Hyponatremia B. Hypernatremia C. Hyperglycemia D. Hypocalcemia
22 • Answer A is correct. Patients with myxedema coma suffer from hyponatremia. This usually is a result of inappropriate secretion of antidiuretic hormone (ADH). Also, the myxedematous state results from the interstitial accumulation of a mucopolysaccharide substance that attracts water and produces water retention. Therefore, the hyponatremia is caused by dilution. Hypoglycemia is also seen in myxedema coma, owing to the hypometabolic state.
Question 23 • Which of the following acid-base imbalances is most likely to occur in this patient? A. Respiratory acidosis B. Respiratory alkalosis without compensation C. Metabolic alkalosis D. Respiratory alkalosis with compensation
23 • Answer A is correct. Respiratory acidosis and CO2 narcosis are a result of lowered thyroxine (T4) and Tri-iodothyronine (T3) levels. These hormones increase metabolic functions, such as respiration. Thus, a decrease in T3 and T4 levels depresses respiratory function, thereby causing hypoventilation. In addition, metabolic acidosis may develop as hypoxia increases serum lactate levels.
Question 24 • Parental injections of cortisol for patients with addison’s disease should be injected: • After the patient eats • Deep into the deltoid • Deep into the gluteal muscle • Into the subcutaneous tissue