NCLEX-PN endocrine practice questions

Question 1

A client who is legally blind from diabetic retinopathy is admitted to a medical unit with cellulitis of the foot. Which of the following interventions should the nurse contribute to the client's plan of care?

Accepted Answer

A: Describe where the foods are on the meal tray using the positions of a clock; B: Identify self by name and role on entering the room; D: Explain each procedure aloud before beginning any physical care; E: Keep the furniture and the client's belongings in the same places each day. A client who cannot see depends on sound, touch, and a predictable room to stay safe and independent. Announcing the nurse's name and role on entering tells the client who is there and avoids startling the client. Describing the meal tray as a clock, for example "the chicken is at 6 o'clock and the coffee is at 2 o'clock," lets the client eat without help. Keeping furniture and belongings in the same places lets the client learn the room and move around it safely. Telling the client before touching, and saying what the nurse is about to do, prevents startling a client who cannot see the nurse's hands approach.

Question 2

A client with a body mass index of 41 and type 2 diabetes is on postoperative day 1 after an open bowel resection. The client has a productive cough. Which instruction should the nurse reinforce to prevent wound dehiscence?

Accepted Answer

B: "Hold a pillow firmly against your incision each time you need to cough.". Obesity and diabetes slow healing and increase tension on the incision, and coughing sharply raises the pressure inside the abdomen. Splinting the incision with a pillow supports the wound edges during coughing and lowers the risk of dehiscence and evisceration. Coughing and deep breathing should still be done every 2 hours to clear the lungs, ideally sitting upright with the incision splinted.

Question 3

A 67-year-old female client with type 2 diabetes had a coronary angiogram with iodinated contrast through the right radial artery 2 days ago for a non-ST elevation myocardial infarction. The client has no new symptoms, the radial site is soft without bleeding, and discharge is planned for today. The nurse reviews the laboratory results before reinforcing the discharge instructions. Which finding should the nurse report to the registered nurse (RN)?

Accepted Answer

B: Creatinine 1.7 mg/dL. Contrast-associated acute kidney injury is a decline in kidney function within a few days of receiving iodinated contrast. The contrast constricts the small vessels inside the kidney and is directly toxic to the tubular cells. Older age, diabetes, existing kidney disease, dehydration, and large contrast volumes raise the risk.

The creatinine usually starts to rise within 24 to 48 hours and peaks at 3 to 5 days, often with no symptoms, so a client who feels well can still have it. A rise of 0.3 mg/dL or more within 48 hours, or to 1.5 times baseline, defines acute kidney injury. This client's creatinine has risen 0.8 mg/dL in 48 hours, from 0.9 to 1.7 mg/dL. The nurse reports it before the discharge goes ahead, checks the medication record to confirm that metformin is still on hold, and keeps an accurate record of the urine output.

Question 4

During a home health visit to a 70-year-old client who has type 2 diabetes and takes insulin glargine and insulin lispro, the nurse asks the spouse what to do if the client becomes shaky and diaphoretic but is still able to swallow. Which of the following statements by the spouse would require follow-up?

Accepted Answer

B: "I would give him crackers with peanut butter first and check again in an hour."; D: "I would give him a bowl of ice cream, since it is sweet and easy to eat.". Type 2 diabetes is a chronic disease in which the body does not use insulin well and may not make enough of it, so blood glucose stays too high.

Hypoglycemia, a glucose under 70 mg/dL, is treated with 15 g of fast-acting carbohydrate, a recheck in 15 minutes, and a repeat of the 15 g if the glucose is still under 70 mg/dL. Fast-acting means simple sugar with little fat or protein, such as 4 oz of juice or regular soda, 3 to 4 glucose tablets, or 1 tablespoon of sugar or honey. Once the glucose is back above 70 mg/dL, the client eats a snack with carbohydrate and protein if the next meal is more than an hour away, so the glucose does not drop again.

Two statements need follow-up. Ice cream is sweet, but its fat slows the emptying of the stomach and the absorption of the sugar, so the glucose rises too slowly to treat a low. Crackers with peanut butter are a good snack once the low is corrected, but as the first treatment they act slowly, and waiting an hour to recheck leaves the client at risk of losing consciousness. A caregiver who treats the lows at home needs the same rule the client uses, so the nurse reinforces it with the spouse.

Question 5

At a clinic visit, a 50-year-old client with type 2 diabetes who takes metformin 1,000 mg twice daily and glipizide 10 mg every morning says, "I plan to fast from dawn to sunset during Ramadan, which starts in 3 weeks." Which of the following information should the nurse reinforce?

Accepted Answer

A: Check the capillary glucose during the fasting hours as well as after the evening meal; B: End the fast and treat the glucose if it falls below 70 mg/dL during the day; D: Meet with the provider before the fast to review the timing and doses of the diabetes medications; E: Drink extra water and sugar-free fluids between the sunset meal and dawn. Many Muslim clients with diabetes choose to fast during Ramadan, and the nurse's role is to help make the fast as safe as possible rather than to argue against it. Long hours without food raise the risk of hypoglycemia during the day and of hyperglycemia and dehydration after large evening meals.

Glipizide stimulates insulin release whether or not the client eats, so taking the usual morning dose and then fasting can cause a dangerous low in the afternoon. The provider usually moves the sulfonylurea to the sunset meal and may reduce the dose. Checking the glucose with a finger stick does not break the fast, and it is the only way to catch a low or a high during the day. Religious guidance allows a person to end the fast when health is at risk, so a glucose under 70 mg/dL means the client breaks the fast and treats the low. No fluid is taken during daylight, and high glucose levels pull water out through the urine, so the client drinks extra water and sugar-free fluids during the nonfasting hours to prevent dehydration.

Question 6

The nurse is preparing a single syringe containing regular insulin 8 units and NPH insulin 22 units. Place the steps in the order the nurse should perform them.

Accepted Answer

1: Inject 22 units of air into the NPH vial without touching the liquid; 2: Inject 8 units of air into the regular insulin vial; 3: Withdraw 8 units of regular insulin; 4: Withdraw 22 units of NPH insulin to the 30 unit mark. Air first, into the cloudy vial, and the needle does not go into the liquid while doing it. That puts pressure in the NPH vial so the insulin will come out easily later, and keeping the needle above the surface means nothing is drawn up yet.

Then air into the clear vial, and the clear insulin is drawn straight away while the needle is already there. Then back to the cloudy vial for the NPH. Clear before cloudy is the order, and the reason is contamination: a trace of clear regular insulin carried into the NPH vial matters far less than a trace of NPH carried into the regular vial, because that would turn a fast insulin into a slower one without anyone knowing.

Mixing insulin from two vials is a nursing action the practical nurse performs. The total on the barrel, 30 units, is what is checked before the injection, because once both are in the syringe neither can be identified again.

Question 7

The nurse is reinforcing home care with a client who has Cushing syndrome. Which of the following statements by the client requires further teaching?

Accepted Answer

B: "I will take a hot bath every night to help with the aching in my back.". Cushing syndrome is a condition caused by too much cortisol in the body, either from the adrenal glands or from long-term steroid medicine.

The bath is the statement to correct, and the aching back is the reason. Back pain in a client with too much steroid is a possible fracture in the spine, because steroid pulls calcium out of bone, and it is reported rather than soaked.

The other three are the client getting it right. A soft toothbrush and an electric razor protect skin and gums that bruise and bleed easily. Keeping away from infection matters because the immune response is blunted. And reporting sudden back pain is exactly the finding the client in Option B is proposing to treat at home.

Hot water has a second problem in these clients that is worth knowing. Thin, fragile skin burns and breaks down more easily, so very hot baths are discouraged anyway.

Question 8

At a clinic visit, the nurse is reinforcing the dietitian's meal plan with a 63-year-old client with newly diagnosed type 2 diabetes and the client's spouse. The spouse says, "I've thrown out every sweet in the house, and from now on I'm going to check everything he eats." The client looks down and says nothing. Which of the following responses by the nurse is most appropriate?

Accepted Answer

D: "Your support will help. Let's hear from both of you about how to plan meals together.". A new diagnosis of diabetes changes the whole household, and a worried family member may try to take control of the client's eating. Policing meals tends to cause conflict, secret eating, and a client who never learns to make choices independently. The client's silence and downcast look suggest the plan is not shared.

The nurse acknowledges that the spouse wants to help, then brings the client into the conversation as the person who manages the diabetes. Planning meals together turns the spouse's energy into support, such as cooking meals that fit the plan and keeping healthy foods in the house, while the client keeps control of food choices.

Question 9

On a rehabilitation unit, the nurse prepares to give insulin aspart 4 units with dinner to a 58-year-old client with type 2 diabetes. The client's own insulin pen cannot be found, and the dinner tray has arrived. Which of the following actions should the nurse take?

Accepted Answer

A: Obtain a new insulin aspart pen from the pharmacy and label it with this client's name. An insulin pen is for one client only, even when the needle is changed. After an injection, tiny amounts of blood and tissue can flow back from the needle into the insulin cartridge. The next client's dose then comes out of a cartridge that may hold another person's blood, and shared pens have exposed clients to hepatitis B, hepatitis C, and HIV.

The nurse obtains a new pen for this client from the pharmacy and labels it with the client's name. Insulin aspart is rapid-acting and is timed with the meal, so the nurse asks for the pen promptly and tells the client the insulin will come with dinner. The pen is primed with 2 units before every injection, needle pointing up, until a drop appears, and it is kept for this client only.

Question 10

At a primary care clinic, a 52-year-old client with hypothyroidism who started levothyroxine 50 mcg daily 2 weeks ago reports constipation and a 4-kg (9-lb) weight gain over the past 3 months. The nurse is reinforcing the dietary teaching. Which of the following statements by the client would require follow-up?

Accepted Answer

B: "I will cut back to about 800 calories a day until the extra weight comes off."; C: "I will take my fiber supplement together with my thyroid pill each morning.". Hypothyroidism slows metabolism and slows the bowel. Clients gain weight, partly from a lower calorie need and partly from fluid held in the tissues, and constipation is common. The diet is moderately lower in calories, high in fiber, and generous in fluids, with regular activity.

Two statements need follow-up. Fiber supplements, calcium, iron, and antacids bind levothyroxine in the gut and lower the amount absorbed. Levothyroxine is taken alone with water on an empty stomach, 30 to 60 minutes before breakfast, and fiber supplements are taken several hours apart. A diet of 800 calories a day is a very-low-calorie diet that needs medical supervision. It causes muscle loss and fatigue in a client who is already tired, and it does not fix the cause of the weight gain, which is the low hormone level.

NCLEX-PN endocrine practice questions.