Endocrine System Disorders NCLEX Quiz

1. When a client is first admitted with the hyperglycemic hyperosmolar nonketotic syndrome (HHNS). The nurse's priority is to provide:

Oxygen

Carbohydrates

Fluid replacement

Dietary instruction

When a client is first admitted with the hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse's priority is to provide fluid replacement. This is because HHNS is characterized by severe dehydration due to excessive urination and high blood glucose levels. Fluid replacement is crucial to correct the dehydration and restore normal fluid balance in the body. Oxygen may be necessary in some cases, but it is not the priority in this situation. Carbohydrates and dietary instruction may be important in managing the client's condition, but fluid replacement takes precedence in the immediate care of HHNS.

Explanation

When a client is first admitted with the hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse's priority is to provide fluid replacement. This is because HHNS is characterized by severe dehydration due to excessive urination and high blood glucose levels. Fluid replacement is crucial to correct the dehydration and restore normal fluid balance in the body. Oxygen may be necessary in some cases, but it is not the priority in this situation. Carbohydrates and dietary instruction may be important in managing the client's condition, but fluid replacement takes precedence in the immediate care of HHNS.

2. When a client is in diabetic ketoacidosis. The insulin that would be administered is:

Human NPH insulin

Human regular insulin

Insulin lispro injection

Insulin glargine injection

When a client is in diabetic ketoacidosis, the insulin that would be administered is human regular insulin. This is because human regular insulin has a slower onset and longer duration of action compared to other types of insulin. It helps to lower blood sugar levels and prevent the production of ketones, which are responsible for the acidosis in diabetic ketoacidosis. Human regular insulin is typically administered through injections and is a commonly used treatment for managing high blood sugar levels in diabetic patients.

Explanation

When a client is in diabetic ketoacidosis, the insulin that would be administered is human regular insulin. This is because human regular insulin has a slower onset and longer duration of action compared to other types of insulin. It helps to lower blood sugar levels and prevent the production of ketones, which are responsible for the acidosis in diabetic ketoacidosis. Human regular insulin is typically administered through injections and is a commonly used treatment for managing high blood sugar levels in diabetic patients.

3. The nurse knows that glucagon may be given in the treatment of hypoglycemia because it:

Inhibits gluconeogenesis

Stimulates the release of insulin

Increases blood glucose levels

Provides more storage of glucose.

Glucagon may be given in the treatment of hypoglycemia because it increases blood glucose levels. Glucagon is a hormone that is released by the pancreas and it works by stimulating the liver to break down glycogen into glucose, which is then released into the bloodstream. This helps to raise blood sugar levels and counteract the effects of low blood sugar. By increasing blood glucose levels, glucagon helps to restore normal blood sugar levels and prevent further hypoglycemia.

Explanation

Glucagon may be given in the treatment of hypoglycemia because it increases blood glucose levels. Glucagon is a hormone that is released by the pancreas and it works by stimulating the liver to break down glycogen into glucose, which is then released into the bloodstream. This helps to raise blood sugar levels and counteract the effects of low blood sugar. By increasing blood glucose levels, glucagon helps to restore normal blood sugar levels and prevent further hypoglycemia.

4. The insulin that has the most rapid onset of action would be:

Lente

Lispro

Ultralente

Humulin N

Lispro is a rapid-acting insulin analog that has a quick onset of action. It is designed to mimic the natural insulin response in the body, allowing for faster absorption and utilization of glucose by the cells. This rapid onset of action makes Lispro an ideal choice for controlling postprandial blood sugar levels, as it can be injected immediately before or after meals to effectively manage blood sugar spikes. Unlike other insulins mentioned, such as Lente, Ultralente, and Humulin N, Lispro acts more quickly, making it a preferred option for individuals who require fast-acting insulin therapy.

Explanation

Lispro is a rapid-acting insulin analog that has a quick onset of action. It is designed to mimic the natural insulin response in the body, allowing for faster absorption and utilization of glucose by the cells. This rapid onset of action makes Lispro an ideal choice for controlling postprandial blood sugar levels, as it can be injected immediately before or after meals to effectively manage blood sugar spikes. Unlike other insulins mentioned, such as Lente, Ultralente, and Humulin N, Lispro acts more quickly, making it a preferred option for individuals who require fast-acting insulin therapy.

5. A client's blood gases reflect diabetic acidosis. The nurse should expect:

Increased pH

Decreased PO2

Increased PCO2

Decreased HCO3

In diabetic acidosis, there is an excess of acid in the blood due to uncontrolled diabetes. This leads to a decrease in bicarbonate (HCO3-) levels, as the body tries to compensate for the excess acid. Therefore, it is expected that the client's HCO3- levels will be decreased.

Explanation

In diabetic acidosis, there is an excess of acid in the blood due to uncontrolled diabetes. This leads to a decrease in bicarbonate (HCO3-) levels, as the body tries to compensate for the excess acid. Therefore, it is expected that the client's HCO3- levels will be decreased.

6. The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer these drugs in 1 syringe. Identify the steps in this procedure by listing them in priority order.

Inject air equal to the NPH dose into the NPH vial

Invert regular insulin bottle and withdraw regular insulin dose

Inject air equal to regular dose into regular dose

Invert the NPH vial and withdraw the NPH dose.

The correct order of steps in this procedure is as follows: Inject air equal to the NPH dose into the NPH vial, invert the regular insulin bottle and withdraw the regular insulin dose, inject air equal to the regular dose into the regular dose, and finally invert the NPH vial and withdraw the NPH dose. This sequence ensures that the correct amount of air is injected into each vial before withdrawing the respective doses, preventing any contamination or inaccurate dosing.

Explanation

The correct order of steps in this procedure is as follows: Inject air equal to the NPH dose into the NPH vial, invert the regular insulin bottle and withdraw the regular insulin dose, inject air equal to the regular dose into the regular dose, and finally invert the NPH vial and withdraw the NPH dose. This sequence ensures that the correct amount of air is injected into each vial before withdrawing the respective doses, preventing any contamination or inaccurate dosing.

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7. The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says:

“I need to rub my forearm vigorously until warm before testing at this site.”

“The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.”

“I have to make sure that my current glucose monitor can be used at an alternate site.”

“Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels.”

The nurse recognizes that additional teaching is necessary when the client says, "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected." This statement is incorrect because the fingertip is not preferred for glucose monitoring if hyperglycemia is suspected. Hyperglycemia is characterized by high blood sugar levels, and in this case, alternative site testing (AST) would be more appropriate as it can provide more accurate results. Therefore, the client needs to be corrected and educated about the correct use of AST for glucose monitoring.

Explanation

The nurse recognizes that additional teaching is necessary when the client says, "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected." This statement is incorrect because the fingertip is not preferred for glucose monitoring if hyperglycemia is suspected. Hyperglycemia is characterized by high blood sugar levels, and in this case, alternative site testing (AST) would be more appropriate as it can provide more accurate results. Therefore, the client needs to be corrected and educated about the correct use of AST for glucose monitoring.

8. Albert, a 35-year-old insulin-dependent diabetic, Is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830. 1230. and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of:

1130 and 1330

1330 and 1930

1530 and 2130

1730 and 2330

NPH insulin is an intermediate-acting insulin that typically reaches its peak effect around 6-8 hours after administration. In this case, Albert is given NPH insulin at 0730, so it is expected to reach its peak effect between 1530 and 2130. This timing allows for the insulin to be most effective during meal times at 1230 and 1830, helping to control Albert's blood sugar levels.

Explanation

NPH insulin is an intermediate-acting insulin that typically reaches its peak effect around 6-8 hours after administration. In this case, Albert is given NPH insulin at 0730, so it is expected to reach its peak effect between 1530 and 2130. This timing allows for the insulin to be most effective during meal times at 1230 and 1830, helping to control Albert's blood sugar levels.

9. The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply.

Thirst

Palpitations

Diaphoresis

Slurred speech

Hyperventilation

The nurse should expect the client with hypoglycemia to exhibit palpitations, diaphoresis, and slurred speech. Palpitations refer to a rapid or irregular heartbeat, which can be a symptom of low blood sugar. Diaphoresis, or excessive sweating, is another common sign of hypoglycemia. Slurred speech can occur due to the brain's reduced ability to function properly when blood sugar levels are low. Thirst, hyperventilation, and the repeated mention of hyperventilation in the options are not typically associated with hypoglycemia.

Explanation

The nurse should expect the client with hypoglycemia to exhibit palpitations, diaphoresis, and slurred speech. Palpitations refer to a rapid or irregular heartbeat, which can be a symptom of low blood sugar. Diaphoresis, or excessive sweating, is another common sign of hypoglycemia. Slurred speech can occur due to the brain's reduced ability to function properly when blood sugar levels are low. Thirst, hyperventilation, and the repeated mention of hyperventilation in the options are not typically associated with hypoglycemia.

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10. Which adaptations should the nurse caring for a client with diabetic ketoacidosis expect the client to exhibit? Select all that apply:

Sweating

Low PCO2

Retinopathy

Acetone breath

Elevated serum bicarbonate

The nurse caring for a client with diabetic ketoacidosis should expect the client to exhibit low PCO2 and retinopathy. Low PCO2 is expected because diabetic ketoacidosis is characterized by an acid-base imbalance, resulting in decreased levels of carbon dioxide in the blood. Retinopathy, which is damage to the blood vessels in the retina, is a common complication of diabetes and can be seen in clients with diabetic ketoacidosis. Sweating, acetone breath, and elevated serum bicarbonate are not specific adaptations associated with diabetic ketoacidosis.

Explanation

The nurse caring for a client with diabetic ketoacidosis should expect the client to exhibit low PCO2 and retinopathy. Low PCO2 is expected because diabetic ketoacidosis is characterized by an acid-base imbalance, resulting in decreased levels of carbon dioxide in the blood. Retinopathy, which is damage to the blood vessels in the retina, is a common complication of diabetes and can be seen in clients with diabetic ketoacidosis. Sweating, acetone breath, and elevated serum bicarbonate are not specific adaptations associated with diabetic ketoacidosis.

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