Answer& Rational Diabetes Mellitus and Endocrine Disorder Nclex RN

 Diabetes Mellitus and Endocrine Disorder Nclex RN Answer & Rational
01. Answer: C
Rational: A post-operative diabetic patient who is unable to eat is likely to be suffering from hypoglycemia. Confusion and shakiness are common symptoms. An anesthesia reaction would not occur on the second post-operative day. Hyperglycemia and ketoacidosis do not cause confusion and shakiness.

02. Answer: B
Rational: Glucagon is given to treat insulin overdose in an unresponsive patient. Following Glucagon administration, the patient should respond within 15-20 minutes at which time oral carbohydrates should be given. Glucagon reverses rather than enhances or prolongs the effects of insulin. Lipoatrophy refers to the effect of repeated insulin injections on subcutaneous fat.

03. Answer: b
Rational: Hypoglycemia in diabetes mellitus causes confusion, indicating the need for carbohydrates. Polydipsia, blurred vision, and polyphagia are symptoms of hyperglycemia.

04.Answer a
Rational: If the nurse administers the client's normal daily dose of insulin while he's on nothing-by-mouth status before surgery, he'll experience hypoglycemia. Therefore, the nurse should administer half the daily insulin dose as ordered. Oral antidiabetic agents aren't effective for type 1 diabetes. I.V. insulin infusions aren't necessary to manage blood glucose levels in clients undergoing routine surgery.

05.Answer a
Rational: The client's response indicates that he's in denial and needs further insight and education about his condition. Letting the client know that the nurse has his best interests in mind helps him accept the wound-care nurse. Although telling the client that his condition is serious and that the wound care nurse will see him that day are true statements, they're much too direct and may increase client resistance. Telling the client he could lose his foot is inappropriate and isn't therapeutic communication.

06.Answer d
Rational: The best way to validate blood glucose meter use is to allow the nursing assistant to demonstrate correct technique. Verbalizing understanding doesn't demonstrate that the nursing assistant knows proper technique. Documenting a normal blood glucose level and having previous certification don't demonstrate blood glucose meter use.

07.Answer: a
Rational: The patient who is having Kussmaul respirations would have abnormally deep, regular and increased respirations. Bradypnea would produce regular, slow respirations. Hyperpnea is labored, increased respirations, and apnea is when a patient stops breathing for short periods of time.

08.Answer a
Rationale: Pheochromocytomas are tumors of chromaffin tissues in the adrenal medulla. These tumors which are usually benign produce catecholamines (epinephrine or norepinephrine) that stimulate the sympathetic nervous system. Although many organs are affected, the most dangerous effects are peripheral vasoconstriction and increased cardiac rate and contractility with resultant paroxysmal hypertension. Systolic blood pressure may rise to 200 to 300 mmHg, the diastolic to 150 to 175 mmHg. # 1 is correct because the careful monitoring of blood pressure is essential. Attacks are often precipitated by physical, emotional, or environmental stimuli, so # 2 is incorrect because more than physical stressors are considered. This condition is life threatening and is usually treated with surgery as the preferred treatment. # 3 is incorrect because it is a random sample and not a 24 hour urine collection. Because catecholamine secretion is episodic, a 24-hour urine is a better surveillance method than serum catecholamines. (Pagana & Pagana, 2002). Surgical removal of the tumor(s) by adrenalectomy is the treatment of choice. # 4 is incorrect because surgery would be the treatment usually completed.

09.Answer d
Rationale: All of the above assessments have importance, but airway and breathing in a client should always be addressed first when prioritizing care. Assess for signs of latent tetany due to calcium deficiency, including tingling of toes, fingers, and lips; muscular twitches; positive Chvostek’s and Trousseau’s signs; and decreased serum calcium levels. However, tetany may occur in 1 to 7 days after thyroidectomy so # 1 is not the highest priority. Assessing for hemorrhage is always important, but the danger of hemorrhage is greatest in the first 12 to 24 hours after surgery, and as this client is immediately post operative it is not the main concern at this time. Pain medication is important but according to Maslow, pain is a psychosocial need to be addressed after a physiologic need.

10.Answer d
Rationale: The client with hyperthyroidism typically has an increased appetite, yet loses weight and may have hypermotile bowels and diarrhea. Additional manifestations related to hypermetabolism include heat intolerance, insomnia, palpitations, and increased sweating. # 1 is incorrect because pretibial myxedema is a rare characteristic of Graves’ disease. It is manifested by plaques and nodule development bilaterally over the shins and dorsal surface of the feet. # 3 is incorrect because proptosis is the forward displacement of the eye. # 4 is incorrect because the symptoms in the stem describe symptoms of hyperthyroidism, and not hypothyroidism. In hypothyroidism, clients characteristically have the manifestations of goiter, fluid retention and edema, decreased appetite, weight gain, constipation, dry skin, dyspnea, pallor, hoarseness, and muscle stiffness.

11. Answer d
Rational: An insufficient level of thyroid hormone causes a decrease in metabolic rate and heat production. Intolerance to cold would be noted. Options A, B and C are clinical manifestations of hyperthyroidism.

12.Answer c.
Rational: Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or traumatized during surgery. If the client develops numbness and tingling around the mouth or in the fingertips or toes, muscle spasms, or twitching, the physician should be called immediately. A hoarse or weak voice may occur temporarily if there has been unilateral injury to the laryngeal nerve during surgery. Pain is expected in the postoperative period. Calcium gluconate ampules should be available at the bedside, and the client should have a patent intravenous (IV) line in the event that hypocalcemic tetany occurs.

13. Answer a
Rational: Thyroid storm is a potentially fatal acute episode of thyroid overactivity characterized by high fever, severe tachycardia, delirium, dehydration, and extreme irritability. Because it is an emergency, thyroid storm requires heroic interventions for control. The high fever is treated with hypothermic blankets, and dehydration is reversed with intravenous fluids. Options C and D are treatment measures for hypothyroidism.

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Nclex RN Diabetes Mellitus and Endocrine Disorder Practice Questions

 Nclex RN Diabetes Mellitus and Endocrine Disorder Practice Questions
01. A patient with a history of diabetes mellitus is in the second post-operative day following cholecystectomy. She has complained of nausea and isn't able to eat solid foods. The nurse enters
the room to find the patient confused and shaky. Which of the following is the most likely explanation
for the patient's symptoms?
A. Anesthesia reaction.
B. Hyperglycemia.
C. Hypoglycemia.
D. Diabetic ketoacidosis.

02.A newly diagnosed 8-year-old child with type I diabetes mellitus and his mother are receiving diabetes education prior to discharge. The physician has prescribed Glucagon for emergency use. The mother
asks the purpose of this medication. Which of the following statements by the nurse is correct?
A. Glucagon enhances the effect of insulin in case the blood sugar remains high one hour after injection.
B. Glucagon treats hypoglycemia resulting from insulin overdose.
C. Glucagon treats lipoatrophy from insulin injections.
D. Glucagon prolongs the effect of insulin, allowing fewer injections.

03. A patient with newly diagnosed diabetes mellitus is learning to recognize the symptoms of hypoglycemia. Which of the following symptoms is indicative of hypoglycemia?
A. Polydipsia.
B. Confusion.
C. Blurred vision.
D. Polyphagia.

04.A client with type 1 diabetes must undergo bowel resection in the morning. How should the nurse proceed while caring for him on the morning of surgery?
a)Administer half of the client's typical morning insulin dose as ordered.
b)Administer an oral antidiabetic agent as ordered.
c)Administer an I.V. insulin infusion as ordered.
d)Administer the client's normal daily dose of insulin as ordered.

05.A nurse is caring for a client with poorly managed diabetes mellitus who has a serious foot ulcer. When she informs him that the physician has ordered a wound care nurse to examine his foot,
the client asks why he should see anyone other than this nurse. He states, "It's no big deal. I'll keep it covered and put antibiotic ointment on it." What is the nurse's best response?
a)"We're very concerned about your foot and we want to provide the best possible care for you."
b)"This is a big deal and you need to recognize how serious it is."
c)"This is the physician's recommendation. The wound care nurse will see you today."
d)"You could lose your foot if you don't see the wound care nurse."

06.Which finding best indicates that a nursing assistant has an understanding of blood glucose meter use?
a)Verbalizing an understanding of blood glucose meter use
b)Documenting a normal blood glucose level
c)Providing documentation of previous certification
d)Demonstrating correct technique

07.A Nurse caring for a patient who is in diabetic ketoacidosis. Nurse observe the patient in Kussmaul respiration. What are Kussmaul respirations?
a.Abnormally deep, regular and increased respirations
b.Regular, slow respirations
c.Labored, increased respirations
d.Short periods of apnea

08.The nurse is caring for a client with pheochromocytoma. Which of the following must be included in planning the nursing care for this client ?
a.Monitor blood pressure frequently, assessing for hypertension.
b.Assess only for physical stressors present.
c.Collect a random urine sample.
d.Prepare the client for chemotherapy to shrink the tumor.

09.A nurse on a surgical floor is caring for a post-operative client who has just had a subtotal thyroidectomy. Which of the following assessments should be completed first on the client?
a.Assess for signs of tetany by checking for Chvostek’s and Trousseau’s signs
b.Assess dressing (if present) and the area under the client’s neck and shoulders for drainage.
c.Administer analgesic pain medications as ordered, and monitor their effectiveness.
d.Assess respiratory rate, rhythm, depth, and effort.

10.A nurse is assessing a newly admitted client with symptoms of heat intolerance, insomnia, palpitations, and increased sweating. Which of the following diagnoses may be the reason for these symptoms?   
a.Pretibial myxedema
b.Hyperthroidism
c.Proptosis
d.Hypothroidism

11. A clinic nurse is performing an assessment on a client who has hypothyroidism. The nurse would expect to note which clinical manifestation?
a) complaints of difficulty sleeping
b) complaints of diarrhea
c) significant weight loss since the last clinic visit
d) complaints of intolerance to cold weather

12. A nurse is caring for a client following thyroidectomy and is monitoring for complications. Which of the following if noted in the client, would indicate a need for physician notification?
a)surgical pain in the neck area
b)voice hoarseness
c)numbness and tingling around the mouth
d)weakness of the voice

13. A nurse is planning care for a client with a diagnosis of thyrotoxicosis (thyroid storm). Which of the following would the nurse include in the plan of care for the client?
a)use of a hypothermic (cooling) blanket
b)restriction of fluid intake
c)administration of levothyroxine (synthroid)
d)administration of enemas and stool softeners as needed

Answers and Rationals

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Nclex RN Exams Practice Questions a Client With Endocrine Disorder

1. An adult client who has type 2 diabetes and requires insulin tells the nurse about feeling trembly, weak, and anxious before supper.The nurse should:
A. Tell the client to lie down for 30 min.
B. Have the client drink a glass of milk or orange juice.
C. Contact the client’s physician to decrease the insulin dose.
D. Administer the next dose of insulin.

2. The nurse is instructing a client with DM about a diet plan comprised of 45 g of carbohydrate
at each meal. Which selections does the nurse encourage?
A. 1 cup of skim milk, 1/2 cut unsweetened applesauce with cinnamon, 2 ounces of pork chop, 1/2 cup mashed potatoes, 1 cup coffee with cream.
B. 1 cup sugar-free hot chocolate, 3/4 cup unsweetened cold cereal, 1 slice bacon,1/2 cup scrambled egg, 1 cup skim milk, 1 slice whole wheat toast.
C. 1 cup yogurt (100 calorie, lite), 1/3 cup pasta, 1/2 cup peas, 1 cup canned pineapple in its own juice.
D. 2 ounces chicken breast, 1 cup cooked carrots,1 cup ice cream, 5 radishes, 1 can diet soda.

3. When evaluating teaching to a client on how to administer insulin, which of the following indicates that additional teaching is necessary?
A. Client draws up the regular insulin first and then the NPH.
B. Client rotates sites from legs to arms.
C. Client identifies that the syringe is U-100.
D. Client waits 30 min to eat breakfast after injecting rapid-acting insulin.

4. A client with newly diagnosed DM is scheduled to receive regular insulin 10 units and NPH insulin 20 units every morning. When should the nurse schedule the administration of these medications?
A. Regular insulin with breakfast; NPH after breakfast.
B. Both insulins 0.5 hr before breakfast.
C. In two separate syringes with breakfast.
D. NPH 1 hr before and regular 0.5 hr before breakfast.

5. The nurse is instructing a client with DM who takes insulin about the causes of hypoglycemia. The client understands the underlying cause of hypoglycemia when telling the nurse hypoglycemia is caused by:
A. Drinking too much water.
B. Getting too little exercise.
C. Eating too much food.
D. Taking too much insulin.

6. A client with hyperthyroidism is hospitalized to have a thyroidectomy. The physician has
prescribed propranolol (Inderal). In reviewing the client’s history, the nurse notes that
the client has asthma. The nurse should next:
A. Take the client’s pulse and hold the propranolol (Inderal) if the pulse is less than 100 beats per minute.
B. Count the client’s respirations and hold the propranolol (Inderal) if the respirations
are less than 20 breaths per minute.
C. Contact the physician; question the order for propranolol (Inderal) with the client’s asthma history.
D. Instruct the client to make position changes slowly.

7. A client with a pituitary tumor had a transsphenoidal hypophysectomy. Following surgery,
the nurse places the head of the bed in which of the following positions?
A. Flat.
B. Lowered 20 degrees.
C. Elevated 90 degrees.
D. Elevated 30 degrees.

8. A client with Addison disease is hospitalized for an acute crisis. During the crisis, which of
the following nursing diagnoses is a priority?
A. Deficit fluid volume.
B. Activity intolerance.
C. Anxiety.
D. Risk for injury.

9. A client with Cushing disease has an order to receive IV solution of 3% sodium chloride
(NaCl). The nurse contacts the physician to verify the order because:
A. 3% sodium chloride (NaCl) is a hypertonic solution that will increase the extracellular
fluid (ECF) volume.
B. 3% sodium chloride (NaCl) is a hypotonic solution that will cause extracellular fluid
(ECF) volume depletion.
C. 3% sodium chloride (NaCl) is like normal saline.
D. 3% sodium chloride (NaCl) is an isotonic solution with no net effect on cellular dynamics.

10. When sympathetic blocking agents are used to decrease the BP prior to removal of an adrenal
tumor, the nurse should instruct the client to:
A. Continue current prescriptions.
B. Change position cautiously.
C. Walk 30 min daily.
D. Place furniture for support.
Answer And Rational

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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.

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