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NCLEX Endocrine Questions
NCLEX Endocrine Questions
NCLEX Endocrine Questions
Situation: Maria, 48 years old, is a known diabetic type 1. She has often consulted her internist for
medication. She asks you if she can get well.
1. If Maria asks you what to take for medication, you would answer that she;
a) must try other alternative
b) could consult other doctors
c) can't take a herbal medicine
d) has to follow doctor's prescription
2. One party time, you saw Maria eating a big piece of cake. As a concerned nurse you would tell her
a) it's okay Maria, it's party time anyway
b) why are you hard-headed Maria
c) Maria stop eating the cake
d) Maria, remember that you are taking medicine for diabetes
3. The next morning Maria said she did not feel well, you would say
a) see your doctor once
b) come let me assess your health status
c) I told you so
d) have your blood sugar checked
4. Upon checking, Maria was having hyperglycemia, you tell Maria to;
a) drink plenty of water
b) have a good rest
c) take her prescribed insulin
d) see her doctor right away
5. The following are nursing interventions when administering insulin except:
a) administer insulin at room temperature
b) rotate site of injection
c) aspirate cloudy insulin before clear insulin to combine in one syringe
d) shake insulin vial gently to redistribute insulin particles
6. To prevent lipodystrophy due to insulin injection, the nurse should do the following except:
a) inject insulin at room temperature
b) rotate the site of injection
c) inject insulin between layer of fats and muscles
d) introduce insulin rapidly
7. Among the topics you will include as priority in health teaching to Mario is:
a) nutrition and diet therapy
b) daily foot care
c) good exercise daily
d) prevention of complication
In the absence of glucose, fat stores are mobilized as an alternate source of energy. The end product fats
metabolism, however, are ketone bodies. As more and more fats are burned, more ketone bodies are
produced. Ketones, then, accumulate because the body cannot excrete them in the same speed as they
are being produced resulting to ketoacidosis. Ketoacidosis is the most common complication of
hyperglycemia.
5) C
- insulin is administered at room temperature to prevent lipodystrophy and minimize discomfort.
It is important to rotate sites of insulin injection in order to avoid tissue damage. The instructions to the
patient regarding site for insulin injection are:
do not use the same site more than once in one month
avoid areas above muscles that will be used for exercise during the day or where heat will be
applied as it will cause more rapid absorption
the abdomen is the site because of it's more rapid and even rate of absorption
change injection area until the whole site has been used. Sites for injection should be spaced
about one inch apart. This is in order to avoid sudden changes in absorption rate
the areas of absorption are the abdomen (fastest absorption), deltoid, upper thigh and the hip
pressure may be applied over the site but do not massage after injection as this will alter
absorption rate.
prefilled syringes can be stored for up to 3 weeks in the refrigerator with the needles pointing
upward to prevent suspended particles from clogging the needle
insulin should not be left in the car or checked in airline baggage because of potential changes in
temperature
Mixing Insulin:
two types of insulin is usually recommended to diabetic patient's in order to achieve a more
effective diabetic control. Insulin may be mixed so that the patient will only one have injection.
Patient instructions regarding insulin mixing are:
NPH and PZI insulin can be mixed only with regular insulin
Lente insulin may be mixed with each other but it is not recommended to mix it with regular, NPH
or PZI insulin.
withdraw clear or regular insulin first before cloudy insulin to prevent contaminating the clear
insulin with the cloudy insulin
gently rotate cloudy insulin before withdrawing the drug from the vial. Experts now believe that it
is alright to shake insulin vials in order to mix insulin thoroughly.
6) C
- lipodystrophy occurs when tissue changes occur due to repeated insulin injection. It can be in form of
hypertrophy or atrophy. The tissue affected feels hard under the skin and it is often caused by using the
same site for injection repeatedly and with porcine and beef insulin.
Measures to prevent lipodystrophy include:
To minimize discomfort:
penetrate the skin quickly with the needle. Aspiration is not a routine
Insulin should be injected at the subcutaneous tissue. Injecting it in the muscle will increase
absorption rate and can lead to fluctuations in the blood glucose level. It is injected at 90 degree angle. If
the patient is very thin. It is injected at 45 degree angle to avoid the needle reaching the muscle layer.
7) A
- the most important aspect of health teaching to diabetics is regarding their nutrition and diet therapy.
Nutrition and Diet Therapy for Diabetics:
have a bedtime snack especially if taking insulin snacks to prevent hypoglycemia while asleep
distribute food intake to 6 small meals a day to maintain blood sugar level and prevent sudden
surges in blood sugar
stress, anxiety and illness affect blood sugar level and insulin requirements may need to be
adjusted
Teach patient that compared to fats and protein, carbohydrates have the greatest impact on blood
sugar.
carbohydrates should provide between 50% and 60% of the daily caloric intake
complex carbohydrates found in whole grains and vegetables are preferred over those found in
starch-heavy foods, such as pastas because they are longer to digest causing glucose from these
type of carbs to be released slowly in the blood preventing a sudden rise in serum glucose level.
simple sugars, either as sucrose or fructose, increases blood glucose levels quickly, and provides
no other nutrients
avoid food with high glycemic index. Glycemic index refers to how quickly a food can raise blood
glucose. Foods that raise blood glucose quickly have high glycemic index such as simple sugars
and starches. Foods with low glycemic index include high fiber foods such as insoluble fiber
found in wheat bran, whole grains, seeds, nuts, legumes, and fruit and vegetable peels and
soluble fiber found in dried beans, oat bran, barley, apples, citrus fruits, and potatoes.
fish is probably the best source of protein for heart protection as it can help lower blood pressure,
triglyceride levels, and tendency for blood clots, and the risk for stroke
soy is rich in both soluble and insoluble fiber, omega-3 fatty acids, and provides all essential
proteins. Soybeans also contain natural compounds that may reduce LDL (harmful cholesterol)
and triglycerides and increase HDL (beneficial cholesterol). The best sources are soy products
(tofu, soymilk) or whole soy protein
Avoid harmful fats such as saturated fats and trans fatty acids to maintain normal cholesterol levels.
Saturated fats are mostly found on animal products, including meat and dairy products.
Trans fatty acids are manufactured fats which are used at stabilizing polyunsaturated oils to prevent them
from becoming rancid and to keep them solid at room temperature.
Good fats include polyunsaturated fats that are found in safflower, sunflower, corn, and cottonseed oils
and fish; and monosaturated fats found in olive, canola, and peanut oils and in most nuts. Some studies
have reported that replacing carbohydrates with monosaturated fats improves glucose control after meals
and reduces triglycerides in people with type 2 diabetes.
Situation: The nurse is meeting with the parents of 11 year old Irish, who has recently been diagnosed
with insulin dependent mellitus (IDDM).
8. Irish has been hospitalized for the past 3 days. His physiologic condition has been stabilized and he is
now on subcutaneous injections of insulin. In developing a plan of care for Irish and his family, which of
the following would be the most appropriate nursing diagnosis?
a) parent knowledge deficit related to newly diagnosed illness
b) fluid volume deficit related to hypoglycemia
c) altered nutrition less than body requirements, related to insulin deficiency
d) compromised family coping related to newly diagnosed illness
9. Irish's parents stated that they really do not understands exactly what this disease is. Which of the
following is the best way to explain IDDM to them?
a) IDDM is an inborn error in metabolism that makes the child unable to burn, fatty acids without insulin
supplement
b) IDDM is a genetic disorder that makes the child unable to metabolize protein without insulin
supplements.
c) IDDM is a deficiency in the secretions of insulin by the pancreas, which makes the child unable to
metabolize carbohydrates without insulin supplements
d) IDDM is a deficiency in the secretions of the insulin by the gallbladder, which makes the child unable to
metabolize carbohydrates without insulin
10. The mother of Irish is preparing a mixed dose of insulin. The nurse is satisfied with the mother's
performance when she:
a) draws insulin from bottle of clear insulin first
- the first action to take would be to assess the blood glucose level of the patient to find out if the
symptoms are due to abnormal glucose level or other causes.
60-90mg/100ml fasting blood sugar
60-105mg/100ml before meals
140-or less mg/100ml one hour after meals
if hyperglycemic - give insulin
if hypoglycemic - orange juice, sugar, candy
12) A
- the child should avoid exercising during peak hours of insulin action in order to prevent hypoglycemia.
Peak action regular insulin occurs after 2-4 hours after administration. For the other types of insulin:
13) C
- starting 9 years old, a child has already developed enough finger dexterity to handle a syringe and thus
can be taught how to administer her own insulin. If the nurse will see that Irish can and is willing to inject
her own insulin, the child need not go to the school clinic. Another important instruction to Irish is to avoid
injecting insulin in her arm during P.E. days when she plays volleyball. Exercise increases absorption of
insulin. She should, then inject it in her abdomen. If Irene is runner, it would not be advisable to inject it
her thigh.
It is important for the child to eat a carbohydrate snack before engaging in sports as exercise increases
glucose utilization and make her hypoglycemic
Carrying a medic alert band or ID and prefilled syringe with instructions are important in cases of
emergency.
14) A
- the glycosylated hemoglobin shows the patients blood glucose level during the last three months so iti s
the best test that would reflect the patient's compliance to therapy and her glucose control.
Fasting blood glucose reflects only the current glucose control
Ketone appears in the urine when blood glucose levels exceed 200 mg'dl
Routine serum chemistry is not necessary in assessing the therapeutic compliance of a diabetic patient.
NCLEX Endocrine Questions
15. Which of the following should the nurse include in the discharge instructions to be given to a client on
continuous insulin infusion through insulin pump?
a) change needle site every 2 to 3 days
b) check blood sugar level daily
c) push button on the device to self-administer insulin after each meal
d) the machine gives continuous small doses of insulin, so there is no need to check blood sugar levels
16. A client with diabetes mellitus is self-administering NPH insulin from a vial kept at room temperature.
The client asks a nurse about the length of time an unrefrigerated vial of insulin will remain its potency.
16) B
- insulin, when stored at room temperature is potent for 30 days (1 month).
17) C
- this action ensures prevention of contamination of the rapid-acting insulin. In case of emergency (DKA),
rapid effect of the clear insulin is maintained. Injecting air into the cloudy insulin will promote easy
aspiration of the medication, once the syringe already contains the clear insulin.
18) B
- ketoacidosis is characterized by low blood pH. Type I diabetic clients are prone to ketoacidosis.
19) A
- orange juice provides quick source of glucose; slices of bread provide sustained supply of glucose. This
will be followed with skim milk as source of protein, to inhibit breakdown of fats. This in turn, prevents
ketoacidosis.
20) C
- glycosylated hemoglobin (HbA1c) is the best indicator of diabetic control. It reflects blood glucose level
for the past 3 t0 4 mthNCLEX Endocrine Questions
21. A diabetic client asks a nurse if bacon is allowed in the diet. Which nursing response is most
appropriate?
a) bacon is much too high in fats
b) bacon is not allowed
c) one strip of bacon may be eaten if you eliminate 1 teaspoon of butter
d) bacon may be eaten if you eliminate one meat from the diet
22. The client with congestive heart disease is diagnosed to have diabetes mellitus (DM). Which of the
following medications should not be administered by the nurse to this client?
a) capoten (captopril)
b) lanoxin (digoxin)
c) inderal (propranolol)
d) calan (verapamil)
23. The client has been diagnosed to have type 2 diabetes mellitus. Which of the following are correct
statements about type 2 DM. Select all that apply
a) managed by diet and exercise
b) prone ot diabetic ketoacidosis
c) prone to HHNC (hyperglycemic hyperosmolar - nonketotic coma)
d) managed by OHA (oral hypoglycemic agents)
e) requires lifelong insulin therapy
f) onset is before age 30 years
g) with absolute deficiency of insulin
24. The diabetic client is having ketoacidosis. Which of the following is the appropriate initial nursing
action?
27. The following are signs and symptoms that indicate hyperglycemia in a client with diabetes mellitus.
Select all that apply
a) elevated blood sugar level
b) cold, clammy skin
c) increased urination
d) tremors
e) deep, rapid respiration
f) excessive thirst
g) metabolic acidosis
28. The client has been diagnosed to have IDDM. Which order should you question?
a) propranolol
b) insulin injection
c) acetaminophen
d) diltiazem
29. The nurse is assessing a pregnant client with type I diabetes mellitus about her understanding
regarding changing insulin needs during pregnancy. The nurse determines that teaching is needed if the
client makes which statement?
a) I will need to increase my insulin dosage during the first 3 months of pregnancy
b) my insulin dose will likely need to be increased during the second and third trimester
c) episodes of hypoglycemia are more likely to occur during the first 3 months of pregnancy
d) my insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding
30. An adolescent client with type I diabetes mellitus is admitted to the emergency department for
treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note?
a) sweating and tremors
b) hunger and hypertension
c) cold, clammy skin and irritability
d) fruity breath and decreasing level of consciousness
30) D
Hyperglycemia occurs with diabetic ketoacidosis. Signs of hyperglycemia include fruity breath and a
decreasing level of consciousness. Hunger can be a sign of hypoglycemia or hyperglycemia, but
hypertension is not a sign of diabetic ketoacidosis. Instead, hypotension occurs because of a decrease in
blood volume related to the dehydrated state that occurs during diabetic ketoacidosis. Cold, clammy skin,
irritability, sweating, and tremors are all signs of hypoglycemia.
Hypothyroidism without myxedema - mild degree of thyroid failure in older children and adult
Manifestations of hypothyroidism are associated with the slowing of the metabolic rate and include:
Patient's with myxedema exhibits nonpitting edema in connective tissues all over the body,
including the face which appears puffy and the tongue which is enlarged. The edema is due to
accumulation of mucoprotein and water retention.
Goiter - enlargement of the thyroid gland may or may not be present. Goiter occurs from
excessive stimulation of TSH from the pituitary because of continuous deficient or lack thyroxine.
Hypothyroidism caused by lack of TSH does not cause goiter.
Altered protein, fat and carbohydrate metabolism: weight gain (edema) slow wound healing,
decreased blood glucose, hypoalbuminemia
32) B
- Hypothyroidism is due to deficient thyroxine hormone so naturally serum T4 will be below normal.
Thyroxine regulates fat or lipid metabolism. Deficiency in thyroxine will result in slow metabolic activity
resulting in slowing of lipid metabolism which increases serum cholesterol and triglyceride levels making
the patient at risk for atherosclerosis and cardiac disorders.
Management:
1. Prevention - prevention of iodine deficiency
2. Replacement therapy throughout life
a. Drugs used:
c. During initiation of therapy - patient is seen by physician every 2-4 weeks until condition is stable and
then thyroid therapy is monitored annually.
3. Nursing Care:
Activity Intolerance - limit activity to patient's tolerance. If patient develops tachycardia or chest
pain, stop activity
Use frequent stimulation at dusk and nightfall - use nightlights to prevent confusion
4. Surgery - may be performed for large goiters especially if it causes dysphagia, chocking sensation,
inspiratory stridor, hoarseness and positive Pemberton's sign (elevation of arms results in dizziness and
syncope) caused by pressure on veins that venous return from the head.
33) B
- myxedema is manifested by hypothyroidism. (A, C, and D are manifestations of hyperthyroidism)
34) A
- thyroid crisis /storm/thyroidtoxicosis is the most life-threatening postop complication of thyroid surgery. It
is characterized by hyperthermia and tachycardia. Therefore it is necessary to monitor the client's pulse
and temperature.
35) B
- hyperthyroidism may cause exopthalmos. To prevent corneal ulceration, artificial tears will be instilled
into the eyes as necessary. The client usually develops diarrhea so, high fiber diet is not indicated. The
medication should not be taken with antacid. Antacid inhibits absorption of anti thyroid drugs.
38. After thyroidectomy, which of the following is the priority assessment to observe laryngeal nerve
damage?
a) hoarseness of voice
b) difficulty in swallowing
c) tetany
d) fever
39. A home care nurse is teaching an adolescent with type I diabetes mellitus about insulin administration
and rotation sites. Which statement, if made by the adolescent, would indicate effective teaching?
a) I need to use a different site for each insulin injection
b) I should use only my stomach and my thighs for injections
c) I need to use the same site for 1 month before rotating to another
d) I need to use one major site for 2 to 3 weeks before changing major sites
40. A child with type I diabetes mellitus is brought to an emergency room by the mother, who states that
the child has been complaining of abdominal pain and has a fruity odor of the breath. Diabetic
ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which
intravenous infusion?
a) potassium
b) NPH insulin
c) 5% dextrose
d) normal saline
43. A client is brought to the emergency room in an unresponsive state, and a diagnosis of hyperglycemic
hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which of the
following anticipated physician's orders?
a) endotracheal intubation
b) 100 units of NPH insulin
c) intravenous infusion of normal saline
d) intravenous infusion of sodium bicarbonate
44. An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse
about the functioning of the pump. The nurse bases the response on the information that the pump:
a) is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific
intervals
b) continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring
blood glucose levels
c) is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn
releases the insulin into the bloodstream
d) gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a
bolus with an additional dose form the pump before each meal
45. A client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A
nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which of the
following concepts?
a) always keep insulin vials refrigerated
b) ketones in the urine signify a need for less insulin
c) increase the amount of insulin before unusual exercise
d) systematically rotate insulin injections within one anatomic site
44) D
- An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day
and night, and the client can self-administer a bolus with an additional dose from the pump before each
meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to
the pancreas.
45) D
- Insulin doses should not be adjusted nor increased before unusual exercise. If ketones are found in the
urine, it possibly may indicate the need for additional insulin. To minimize the discomfort associated with
insulin injections, insulin should be administered at room temperature. Injection sites should be rotated
systematically within one anatomic site
48. A client with diabetes mellitus demonstrates acute anxiety when first admitted for the treatment of
hyperglycemia. The appropriate intervention to decrease the client's anxiety is to:
a) administer a sedative
b) convey empathy, trust, and respect toward the client
c) ignore the signs and symptoms of anxiety so that they will soon disappear
d) make sure that the client knows all the correct medical terms to understand what is happening
49. A nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse
recognizes accurate understanding of measures to prevent diabetic ketoacidosis is when the client states:
a) I will stop taking my insulin if I'm too sick to eat
b) I will decrease my insulin dose during times of illness
c) I will adjust my insulin dose according to the level of glucose in my urine
d) I will notify my physician if my blood glucose level is higher than 250 mg/dL
50. A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood
glucose level was 950 mg/dL. A continuous intravenous infusion of regular insulin is intiated, along with
intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would
next prepare to administer which of the following?
53. A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with
hypothyroidism. The nurse will prepare to administer this medication:
a) in the morning to prevent insomnia
b) only when the client complains of fatigue and cold intolerance
c) at various times during the day to prevent tolerance from occurring
d) three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels
54. A nurse is monitoring a client with diabetes insipidus and desmopressin acetate (DDAVP) has been
prescribed for the client. Which of the following outcomes reflects a therapeutic effect of this medication?
a) decreased urine output
b) decreased blood pressure
c) urine osmolality lower than 100 mOsm/kg
d) serum osmolality higher than 320 mOsm/kg
55. A nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which
of the following, if exhibited in the client, would indicate hyperglycemia and warrant physician notification?
a) polyuria
b) diaphoresis
c) hypertension
d) increased pulse rate
osmolality, because less fluid is excreted. Hypotension may be apparent with diabetes insipidus and
blood pressure may increase as extracellular fluid volume is restored.
55) A
- Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Options B, C, and D
are not signs of hyperglycemia.