Nclex RN Exams Answer and Rational a Client With Endocrine Disorder

01.Answer B
Rational: Hypoglycemia is a blood glucose level below 70 mg/dl. The signs and symptoms of hypoglycemia include confusion, irritability,diaphoresis, tremors, hunger, weakness, and visual disturbances. Untreated hypoglycemia can progress to loss of consciousness,seizures, coma, and death. With effective
treatment, hypoglycemia can usually be quickly reversed. If the client has manifestations of hypoglycemia and monitoring equipment is not available, hypoglycemia is assumed, and treatment is initiated. Hypoglycemia is treated by ingesting 10 to 15 g of simple (fast-acting) carbohydrate, such as 4 to 8 ounces of fruit juice or regular (nondiet) soft drink or 8 ounces of low-fat milk. The client is then advised to eat the regularly scheduled meal or a snack that has protein,such as cheese or peanut butter, to prevent hypoglycemia from recurring. Without treating the possible hypoglycemia, the blood glucose level will go down even lower and the client may lose consciousness, develop seizures, or go into a coma. Contacting the physician would delay treating the possible hypoglycemia. Decreasing the insulin dose or increasing the meal plan may prevent episodes of hypoglycemia in the future. Administering insulin would cause the blood sugar to go even lower.
2. Answer A.
Rational: Carbohydrate “carb” counting is a meal-planning method especially useful for those on rapid-acting insulin, such as lispro (Humalog),aspart (NovoLog), or on an insulin pump. Carbohydrate is the primary nutrient that affects the after-meal (postprandial)blood glucose level because carbohydrates
turn into glucose within the first 1 to 2 hr after being eaten. Counting carbs correctly helps in calculating a more accurate dose of rapid-acting insulin. Carbohydrate groups include fruit, starch, milk, and other carbohydrates.One serving 15 g 1 carbohydrate.
One cup skim milk 1 carbohydrate; 1/2 cup unsweetened applesauce 1 carbohydrate;cinnamon is free; 2 ounces pork chop 0 carbohydrate, it is protein; 1/2 cup mashed potatoes 1 carbohydrate; 1 cup coffee is
free; cream 0 carbohydrate, it is fat. Total 3 carbohydrates 45 g carbohydrate.Options 2 and 4 contain 4 carbohydrates 60 g carbohydrate. Option 3 contains 5 carbohydrates 75 g carbohydrate.
3. Answer D:
Rational: The nurse instructs the client to not wait any longer than 5 to 15 min to eat after injecting rapid-acting insulin, which has an onset action of 5 min and duration of 1 hr.
The client is using proper technique for mixing the insulins, rotating sites, and using the U-100 syringe.
4. Answer B:
 Rational: Regular and NPH insulins are scheduled together one-half hour before breakfast.
They do not need to be given separately or in different syringes.
5.Answer D:
Rational: Insulin assists glucose transport into the cells and causes the blood glucose levels to drop. Taking too much insulin could significantly drop blood levels and cause symptoms of hypoglycemia. Drinking excessive water does not directly drop blood glucose levels.Decreasing exercise or eating excessively causes elevations in blood glucose levels.
6.Answer C.
Rational: Propranolol hydrochloride (Inderal) is a nonselective beta blocker of both cardiac and bronchial adrenoreceptors, which competes with epinephrine and norepinephrine for available beta-receptor sites. Propranolol (Inderal) blocks cardiac effects of betaadrenergic stimulation; as a result, it reduces heart rate; a hypertensive effect is associated with decreased cardiac output. A contraindication of propranolol (Inderal) is bronchial asthma; propranolol (Inderal) can cause bronchiolar constriction even in normal
clients. The nurse takes the apical pulse and BP before administering propranolol (Inderal). The medication is held if the heart rate is less than 60 beats per minute or the systolic BP is less than 90 mmHg.
7. Answer D.
Rational: After surgery in which a transsphenoidal approach has been used, the head of the client’s bed is elevated at a 30-degree angle at all times. This elevation avoids pressure on the sella turcica and decreases headaches,a frequent postoperative problem. The nurse monitors neurologic status, including pupillary response, in order to detect neurologic complications. None of the other head-ofbed positions avoids pressure on the sella turcica or prevents increased intracranial pressure.
8.Answer A.
Rational: When the client with Addison disease is experiencing a crisis, restoration of fluid and electrolyte imbalance is the priority for care. The client may be at risk for injury from ineffective stress response, will likely have anxiety because of the crisis situation,and may have activity intolerance related to decreased cortisol production. However,these diagnoses have lower priority and can be addressed once the fluid and electrolyte levels are stabilized.
9.Answer A.
Rational: In Cushing disease, there is marked sodium and water retention and a tendency toward edema. There is also hypertension and hypervolemia. The nurse questions the physician’s order to give a 3% sodium chloride (NaCl) solution because it is hypertonic and would increase the extracellular fluid (ECF) volume even further. With sodium and water retention and hypertension and
hypervolemia already in Cushing disease,the additional extracellular fluid (ECF) volume would increase even further an elevated BP and contribute to ECF volume overload. Hypotonic solutions cause fluids
to shift out of blood vessels and into the intestinal space, causing ECF volume depletion.Normal saline is an isotonic solution that expands the ECF volume, but has no net effect on cellular dynamics
10.Answer A.
Rational: The primary treatment for pheochromocytoma is surgical removal of the tumor. Preoperatively, sympathetic blocking agents such as prazosin (Minipress), doxazosin (Cardura), or terazosin (Hytrin) are used to reduce the BP and alleviate other symptoms of catecholamine excess. The use of these drugs may result in orthostatic hypotension;the nurse instructs the client to make postural changes slowly and cautiously. The current prescriptions may not include the most therapeutic antihypertensive agents.
Walking daily promotes circulation, but it may also increase the BP. Placement of furniture for support may become obstacles for safe ambulation. When a client experiences orthostatic hypotension or an abnormally
low BP occurs when assuming a standing position, vertigo may be present also.