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NCLEX Endocrine Questions (1-7)

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

NCLEX Endocrine Questions:


ANSWERS AND RATIONALE:
1) D
- The nurse must tell the patient to follow doctor's prescription. Type 1 or insulin dependent DM (IDDM), is
characterized by lack of insulin production so that the patient would require insulin injection throughout
life. At present, this is the only available treatment of IDDM.
2) D
3) D
- the most common problem of diabetics is related to their sugar control which could be hypoglycemia or
hyperglycemia. The initial response of the nurse to complaint of not feeling well by the patient would be to
check the patient's blood sugar level.
4) C
- the most important management for hyperglycemia is to take insulin. Hyperglycemia occurs when insulin
is not enough to transport glucose from the blood to the cells causing blood glucose to rise to abnormal
levels. Common causes of hyperglycemia are:

inadequate insulin injection

skipping insulin injection

increased insulin need: pregnancy, trauma, surgery, infection, stress, puberty

insulin resistance due to the presence of insulin antibodies

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.

Insulin Storage Instructions:

unopened vials should be refrigerated

opened vials can be stored at room temperature

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:

do not mix human and animal insulin

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:

rotate site of injection

inject insulin at room temperature

if it develops, do not use the site o at least 6 months to allow it to heal

To minimize discomfort:

avoid injecting air bubbles

do not change direction of the needle once it is inside the skin

do not inject insulin straight out of the refrigerator

don't use dull needle

wait until alcohol has dried completely before injecting

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:

avoid fasting as it causes hypoglycemia

avoid feasting as it causes hyperglycemia

eat before exercising to prevent hypoglycemia

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

alcohol affects 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.

Protein should provide 12% to 20% of calories

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

b) draws insulin from the bottle of delayed acting insulin first


c) fills both syringes with the prescribed insulin dosage then shake the bottle vigorously
d) withdraws the delayed action insulin before withdrawing the short acting insulin
11. Irish complains of nausea, vomiting, diaphoresis and headache. Which of the following nursing
interventions should the nurse carry out first?
a) withhold the client's next insulin injection
b) test the client's blood glucose level
c) administer tylenol (acetaminophen) as ordered
d) offer fruit juice, gelatin and chicken bouillon
12. The nurse should not instruct Irish mother that after injection of fast acting insulin at 7 in the morning,
Irish should avoid exercising and any strenuous activity.
a) around 9 to 11am
b) after 4 hours
c) between 8am and 9am
d) in the afternoon after taking lunch
13. The nurse also teaches Irish regarding the relationship of her diet, exercise and insulin requirements.
Which of the following statements below is wrong information that the nurse should not give Irish?
a) Irish should eat a snack before playing volleyball during P.E
b) Irish should always wear her medic-alert band or ID
c) Irish should go to school clinic to let the nurse give her insulin shots when its time for her medication
d) Irish should always carry a prefilled insulin syringe in her bag with instructions
14. After four months, Irish was brought to the emergency room because she fainted in school during her
P.E. class. The nurse should monitor which of the following tests to evaluate the over-all therapeutic
compliance of diabetic patient with normal serum hemoglobin?
a) glycosylated hemoglobin
b) fasting blood glucose
c) ketone levels
d) routine serum chemistry profile

ANSWERS AND RATIONALE


8) A
- the most appropriate diagnosis at this point would be knowledge deficit. The parents must be made
aware of the nature of their child's illness and the principles of care in order to ensure treatment
compliance. Letter B and C is inappropriate as the child's condition is already stable. There is no evidence
that family coping is compromised and it is too early to tell if the family is not coping well to the newly
diagnosed illness of Irish.
9) C
10) A
- the clear or regular insulin should be withdrawn first before the cloudy insulin or the intermediate insulin
11) B

- 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:

short acting/regular (clear) - 2-4 hours

intermediate/lente/NPH (cloudy) - 8-12 hours

long-acting/ultralente (cloudy) - 18-24 hours

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.

The most appropriate response to the client is which of the following?


a) two weeks
b) one month
c) two months
d) six months
17. Which of the following is the appropriate initial action by the nurse when preparing insulin
administration?
a) injecting air into the regular insulin
b) withdrawing the cloudy insulin first before the clear insulin
c) injecting air into the cloudy insulin but withdrawing the clear insulin first
d) withdrawing the clear insulin and cloudy insulin in separate syringes
18. The client with insulin-dependent diabetes mellitus (IDDM) has been brought to the emergency room.
What should the nurse watch for if blood pH is 7.28
a) lactic acidosis
b) ketoacidosis
c) metabolic alkalosis
d) respiratory acidosis
19. A client has been diagnosed to have Type II diabetes mellitus. She experiences hypoglycemia. After
receiving a glass of orange juice, what should the nurse give next?
a) peanut butter sandwich
b) 1 tablespoon sugar
c) 1 cup skim milk
d) a cup chocolate drink
20. Which of the following laboratory test best indicate compliance of the diabetic client and insulin
therapy?
a) 2-hour postprandial blood glucose
b) fasting blood glucose
c) glycosylated hemoglobin
d) oral glucose tolerance test

NCLEX Endocrine Questions:


ANSWERS AND RATIONALE
15) B
- insulin lowers blood sugar levels. Insulin pump gives small doses of insulin continuously and the patient
can bolus himself before each meal.

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?

a) start an intravenous glucose


b) administer insulin per IV
c) give a glass of orange juice
d) give a cup of skim milk
25. The client has been diagnosed to have NIDDM (non-insulin dependent diabetes mellitus). Which of
the following signs and symptoms characterize the disease? Select all that apply.
a) occurs after 30 years of age
b) obesity
c) requires lifetime insulin injection
d) can be controlled by diet, exercise, and drug
e) prone to diabetic ketoacidosis
f) experience weight loss
g) may require insulin in case of stress, surgery, pregnancy

NCLEX Endocrine Questions:


ANSWERS AND RATIONALE
21) C - bacon is fat and may be exchanged with fat component in the diet, e.g. butter. Exchange food
within the same food group.
22) C
- inderal is a beta adrenergic blocker. It may cause hypoglycemia and is contraindicated in a client with
DM.
23) A, C, D
- these are characteristics of type II DM. The other choices describe type I DM.
24) B
- ketoacidosis is characterized by severe hyperglycemia. The emergency management of ketoacidosis is
regular insulin/IV.
25) A, B, D, and G
- all of these describes NIDDM.o 4 months.

NCLEX Endocrine Questions (26-30)


26. The following are characteristics of type I DM. Select all that apply
a) the client is thin
b) it requires lifelong insulin
c) the client may take sulfonylureas
d) the client is at risk to develop diabetic ketoacidosis
e) onset of the disease is after 30 years of age
f) there is insulin secretion, but the body's demands are increased

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

NCLEX Endocrine Questions:


ANSWERS AND RATIONALE
26) A, B, D
- these are the characteristic of type I DM.
27) A, C, E, F, G
- these are signs and symptoms of hyperglycemia.
28) A
- propranolol, a beta-adrenergic blocker causes hypoglycemia. It is contraindicated among diabetic
clients.
29) A
- insulin needs decrease in the first trimester because of increase insulin production by the pancreas and
increased peripheral sensitivity to insulin. The statements in option B, C, and D are accurate and signify
that the client understands control of her diabetes during pregnancy.

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.

Online Nursing Practice Test/Exam about Endocrine (31-35)


Situation: Miss Eleanor is a 25 year old woman who is being treated in the endocrine clinic for adultonset Myxedema.
31. While taking a nursing history, the nurse should expect Miss Eleanor to assess:
a) facial puffiness
b) intolerance to heat
c) exopthalmus
d) heart palpitations
32. The physician has ordered serum thyroxine (T4) concentration and serum cholesterol test. Which
finding should the nurse expect?
a) decreased serum T4 and decreased serum cholesterol
b) decreased serum T4 and increased serum cholesterol
c) increased serum T4 and increased serum cholesterol
d) increased serum T4 and increased serum cholesterol
33. Which of the following manifestations does the nurse expect in a client with myxedema?
a) increased heart rate
b) edema
c) weight loss
d) intolerance to heat
34. Which of the following are most important to monitor in a client who had undergone total
thyroidectomy?
a) pulse and temperature
b) serum electrolyte levels
c) weight and food intake
d) hoarseness of the voice and ability to swallow
35. Which of the following should be included when giving health teachings to a client with
hyperthyroidism.
a) wear long-sleeved clothing
b) use artificial tears to the eyes as necessary
c) increase fibers in the diet
d) take medications with milk

ANSWERS AND RATIONALE


31) A
- Hypothyroidism is due to absence or deficiency in thyroid hormone that causes a decline in the
metabolic rate. It is classified according to the time or life in which it occurs:

Cretinism - hypothyroidism in infants and young children

Hypothyroidism without myxedema - mild degree of thyroid failure in older children and adult

Hypothyroidism with myxedema - severe degree of thyroid failure or hypothyroidism in adults

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.

Bradycardia, hypotension, dysrrhythmias, enlarged heart

Apathy, slow and slurred speech, lethargy

Decreased heat production-sensitivity to cold

Decreased nutrient requirements: poor appetite

Decreased sweat and sebaceous gland function: dry scaly skin

Altered protein, fat and carbohydrate metabolism: weight gain (edema) slow wound healing,
decreased blood glucose, hypoalbuminemia

Decreased erythropoietin production: anemia

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:

Sodium L-thyroxine/levothyroxine (Synthroid, Levoid)

Sodium L-triidothyroxine (Cytomel, Trionine)

Synthetic combination of T3 and T4 (Euthroid, thyrolar)

Natural combination of T3 and T4 extract

b. Major Side Effects:

Inadequate treatment - show recurrence/persistence of signs of hypothyroidism

Excessive treatment - show signs of hyperthyroidism

Too fast increase in drug dose - angina, palpitations, tachycardia

Bone loss and decreased bone density

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

Constipation - increase fiber and fluids

Hypothermia - maintain comfortable environmental temperature, use blankets as necessary

Use frequent stimulation at dusk and nightfall - use nightlights to prevent confusion

maintain safe environment

promote positive body image - educate about reversible body changes

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.

NCLEX Endocrine Questions (36-40)


NCLEX Endocrine Questions
36. Which of the following assessment findings characterize thyroid storm?
a) increased body temperature, decreased pulse, and increased blood pressure
b) increased body temperature, increased pulse, and increased blood pressure
c) increased body temperature, decreased pulse, and decreased blood pressure
d) increased body temperature, increased pulse, and decreased blood pressure
37. The nurse is planning care for a client with hyperthyroidism. Which of the following nursing
interventions are appropriate? Select all that apply
a) instill isotonic eye drops as necessary
b) provide several, small, well-balanced meals
c) provide rest periods
d) keep environment warm
e) encourage frequent visitors and conversation
f) weigh the client daily

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

NCLEX Endocrine Questions:


ANSWERS AND RATIONALE
36) B
- thyroid storm is characterized by SNS activation. Thyroid hormones potentiate effects of cathecolamines
(epinephrine/norepinephrine). Therefore, all vital signs will be increased.
37) A, B, C, and F
- the client with hyperthyroidism may experience exopthalmos. This requires instillation of eye drops to
prevent dryness and ulceration of the cornea. The client experiences weight loss because of
hypermetabolism. Several, small, well-balanced meals are given to improve nutritional status of the client
and daily weights should be monitored. Weight is the most objective indicator of nutritional status. The
client is usually exhausted due to restlessness and agitation. Frequent rest periods help the client regain
energy.
38) A
- laryngeal nerve damage is manifested by severe hoarseness of voice or "whispery voice".
39) D
- To help decrease variations in absorption from day to day, the adolescent should use one major site for
injections for 2 to 3 weeks before changing major sites. The injections are rotated to different locations
within that major site. Options A, B, and C are incorrect.
40) D
- Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration
fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment
when the blood glucose level reaches an acceptable level. Intravenously administered potassium may be
required, depending on the potassium level, but would not be part of the initial treatment.

NCLEX Endocrine Questions (41-45)


NCLEX Endocrine Questions
41. A client with diabetes mellitus has a glycosylated hemoglobin level of 9%. Based on this result, the
nurse plans to teach the client about the need to:
a) avoid infection
b) take in adequate fluids
c) prevent and recognize hypoglycemia
d) prevent and recognize hyperglycemia
42. A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care.
Which instruction is included in the plan?
a) soak feet in hot water
b) avoid using a mild soap on the feet
c) apply a moisturizing lotion to dry feet but not between the toes
d) always have a podiatrist cut your toenails; never cut them yourself

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

NCLEX Endocrine Questions:


ANSWERS AND RATIONALE
41) D
- In the test result for glycosylated hemoglobin A1c, 7% or less indicates good control, 7% to 8% indicates
fair control, and 8% or higher indicates poor control. This test measures the amount of glucose that has
become permanently bound to the red blood cells from circulating glucose. Elevations in the blood
glucose level will cause elevations in the amount of glycosylation. Thus, the test is useful in identifying
clients who have periods of hyperglycemia that are undetected in other ways. Elevations indicate
continued need for teaching related to the prevention of hyperglycemic episodes.
42) C
- The client is instructed to use a moisturizing lotion on the feet and to avoid applying the lotion between
the toes. The client should be instructed not to soak the feet and should avoid hot water to prevent burns.
The client may cut the toenails straight across and even with the toe itself and would consult a podiatrist if
the toenails were thick or hard to cut or if vision were poor. The client should be instructed to wash the
feet daily with a mild soap.
43) C
- The primary goal of treatment in hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is to
rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous fluid
replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of
normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to
correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation
and mechanical ventilation are not required to treat HHNS.

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

NCLEX Endocrine Questions (46-50)


NCLEX Endocrine Questions
46. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in an emergency room. Which
finding would a nurse expect to note as confirming this diagnosis?
a) comatose state
b) decreased urine output
c) increased respiration and an increase in pH
d) elevated blood glucose level and low plasma bicarbonate level
47. A nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and
ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be
taken if which of the following symptoms develops?
a) polyuria
b) shakiness
c) blurred vision
d) fruity breath odor

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?

a) ampule of 50% dextrose


b) NPH insulin subcutaneously
c) intravenous fluids containing 5% dextrose
d) phenytoin (Dilantin) for the prevention of seizures

NCLEX Endocrine Questions:


ANSWERS AND RATIONALE
46) D
- In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood
glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would
be experiencing polyuria, and Kussmauls respirations would be present. A comatose state may occur if
DKA is not treated, but coma would not confirm the diagnosis.
47) B
- Shakiness is a sign of hypoglycemia and would indicate the need for food or glucose. A fruity breath
odor, blurred vision, and polyuria are signs of hyperglycemia.
48) B
- The appropriate intervention is to address the clients feelings related to the anxiety. Administering a
sedative is not the most appropriate intervention. The nurse should not ignore the clients anxious
feelings. A client will not relate to medical terms, particularly when anxiety exists.
49) D
- During illness, the client should monitor blood glucose levels and should notify the physician if the level
is higher than 250 mg/dL. Insulin should never be stopped. In fact, insulin may need to be increased
during times of illness. Doses should not be adjusted without the physicians advice and are usually
adjusted based on blood glucose levels, not urinary glucose readings.
50) C
- During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is
reduced and 5% dextrose is added to maintain a blood glucose level of about 250 mg/dL, or until the
client recovers from ketosis. NPH insulin is not used to treat DKA. Fifty percent dextrose is used to treat
hypoglycemia. Phenytoin (Dilantin) is not a usual treatment measure for DKA.

NCLEX Endocrine Questions 51-55


NCLEX Endocrine Questions
51. A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse
develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding
this medication is to assess for:
a) relief of pain
b) signs of renal toxicity
c) signs and symptoms of hyperglycemia
d) signs and symptoms of hypothyroidism
52. A nurse develops a plan of care for a client with hyperparathyroidism who is receiving calcitonin
salmon (Calcimar). Which of the following outcome criteria has the highest priority regarding this
medication?
a) relief of pain

b) absence of side effects


c) achievement of normal serum calcium levels
d) verbalization of appropriate medication knowledge

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

NCLEX ENDOCRINE QUESTIONS:


ANSWERS AND RATIONALE
51) D
- Excessive dosing with propylthiouracil (PTU) may convert the client from a hyperthyroid state to a
hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid
hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or
renal toxicity.
52) C
- Calcitonin can lower plasma calcium levels in clients with hypercalcemia caused by
hyperparathyroidism. The therapeutic effect in this client situation would be a reduction in serum calcium
levels. Options A, B, and D are incorrect outcome criteria.
53) A
- Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases cellular metabolism.
Levothyroxine should be given in the morning in a single dose to prevent insomnia and should be given at
the same time each day to maintain an adequate drug level. Therefore, options B, C, and D are incorrect.
54) A
- Desmopressin acetate (DDAVP) is a synthetic form of antidiuretic hormone that causes increased
reabsorption of water, with a resultant decrease in urine output. The therapeutic response to DDAVP
would be a decrease in serum osmolality, because more fluid is retained, and an increase in urine

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.