Endocrine System Disorders | NCLEX Quiz 95

1.

Dr. Kennedy prescribes glipizide (Glucotrol). an oral antidiabetic agent. for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide?

A.

“Be sure to take glipizide 30 minutes before meals.”
B.

“Glipizide may cause a low serum sodium level. so make sure you have your sodium level checked monthly.”
C.

“You won’t need to check your blood glucose level after you start taking glipizide.”
D.

“Take glipizide after a meal to prevent heartburn.”

Correct Answer
A. “Be sure to take glipizide 30 minutes before meals.”

Explanation
The client should take glipizide twice a day. 30 minutes before a meal. because food decreases its absorption. The drug doesn’t cause hyponatremia and therefore doesn’t necessitate monthly serum sodium measurement. The client must continue to monitor the blood glucose level during glipizide therapy.

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2.

For a diabetic male client with a foot ulcer. the physician orders bed rest. a wet-to-dry dressing change every shift. and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client?

A.

They contain exudate and provide a moist wound environment.
B.

They protect the wound from mechanical trauma and promote healing.
C.

They debride the wound and promote healing by secondary intention.
D.

They prevent the entrance of microorganisms and minimize wound discomfort.

Correct Answer
C. They debride the wound and promote healing by secondary intention.

Explanation
For this client. wet-to-dry dressings are most appropriate because they clean the foot ulcer by debriding exudate and necrotic tissue. thus promoting healing by secondary intention. Moist. transparent dressings contain exudate and provide a moist wound environment. Hydrocolloid dressings prevent the entrance of microorganisms and minimize wound discomfort. Dry sterile dressings protect the wound from mechanical trauma and promote healing.

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3.

When instructing the female client diagnosed with hyperparathyroidism about diet. nurse Gina should stress the importance of which of the following?

A.

Restricting fluids
B.

Restricting sodium
C.

Forcing fluids
D.

Restricting potassium

Correct Answer
C. Forcing fluids

Explanation
The client should be encouraged to force fluids to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn’t necessary in hyperparathyroidism.

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4.

Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?

A.

Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
B.

Risk for impaired skin integrity related to edema. skin fragility. and poor wound healing
C.

Body image disturbance related to weight gain and edema
D.

Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

Correct Answer
D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

Explanation
In the client with hyperthyroidism. excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance. increased protein synthesis and breakdown. decreased glucose tolerance. and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency. making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis. Options B and C may be appropriate for a client with hypothyroidism. which slows the metabolic rate.

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5.

A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent. tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder?

A.

Serum potassium level
B.

Serum sodium level
C.

Arterial blood gas (ABG) values
D.

Serum osmolarity

Correct Answer
D. Serum osmolarity

Explanation
Serum osmolarity is the most important test for confirming HHNS; it’s also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium. serum sodium. and ABG values are also measured. but they aren’t as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis. and the potassium level is variable.

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6.

A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements. Nurse Joy should include which guideline?

A.

“You’ll need more insulin when you exercise or increase your food intake.”
B.

“You’ll need less insulin when you exercise or reduce your food intake.”
C.

“You’ll need less insulin when you increase your food intake.”
D.

“You’ll need more insulin when you exercise or decrease your food intake.”

Correct Answer
B. “You’ll need less insulin when you exercise or reduce your food intake.”

Explanation
Exercise. reduced food intake. hypothyroidism. and certain medications decrease the insulin requirements. Growth. pregnancy. greater food intake. stress. surgery. infection. illness. increased insulin antibodies. and certain medications increase the insulin requirements.

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7.

Nurse Noemi administers glucagon to her diabetic client. then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon?

A.

Oral anticoagulants
B.

Anabolic steroids
C.

Beta-adrenergic blockers
D.

Thiazide diuretics

Correct Answer
A. Oral anticoagulants

Explanation
As a normal body protein. glucagon only interacts adversely with oral anticoagulants. increasing the anticoagulant effects. It doesn’t interact adversely with anabolic steroids. beta-adrenergic blockers. or thiazide diuretics.

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8.

Which instruction about insulin administration should nurse Kate give to a client?

A.

“Always follow the same order when drawing the different insulins into the syringe.”
B.

“Shake the vials before withdrawing the insulin.”
C.

“Store unopened vials of insulin in the freezer at temperatures well below freezing.”
D.

“Discard the intermediate-acting insulin if it appears cloudy.”

Correct Answer
A. “Always follow the same order when drawing the different insulins into the syringe.”

Explanation
The client should be instructed always to follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin also should never be frozen because the insulin protein molecules may be damaged. Intermediate-acting insulin is normally cloudy.

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9.

Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion. light-headedness. and aberrant behavior. The client is still conscious. The nurse should first administer:

A.

I.M. or subcutaneous glucagon.
B.

I.V. bolus of dextrose 50%.
C.

15 to 20 g of a fast-acting carbohydrate such as orange juice.
D.

10 U of fast-acting insulin.

Correct Answer
C. 15 to 20 g of a fast-acting carbohydrate such as orange juice.

Explanation
This client is having a hypoglycemic episode. Because the client is conscious. the nurse should first administer a fast-acting carbohydrate. such as orange juice. hard candy. or honey. If the client has lost consciousness. the nurse should administer either I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn’t administer insulin to a client who’s hypoglycemic; this action will further compromise the client’s condition.

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10.

For the first 72 hours after thyroidectomy surgery. nurse Jamie would assess the female client for Chvostek’s sign and Trousseau’s sign because they indicate which of the following?

A.

Hypocalcemia
B.

Hypercalcemia
C.

Hypokalemia
D.

Hyperkalemia

Correct Answer
A. Hypocalcemia

Explanation
The client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek’s sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau’s sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren’t present with hypercalcemia. hypokalemia. or hyperkalemia.

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