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NCLEX ENDOCRINE LATEST TESTBANK QUESTIONS & DEEPLY ELABORATED ANSWERS-A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated health care provider's pr...

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  • 4 juni 2021
  • 21 januari 2025
  • 49
  • 2024/2025
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  • nclex endocrine
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NCLEX ENDOCRINE QUESTIONS & ANSWERS
A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar
hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated health
care provider's prescription?

1.Endotracheal intubation
2.100 units of NPH insulin
3.Intravenous infusion of normal saline
4.Intravenous infusion of sodium bicarbonate

Intravenous infusion of normal saline

The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to
restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) 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 HHS.

An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the nurse about
the functioning of the pump, the nurse bases the response on which information about the pump?

1. It is timed to release programmed doses of either short-duration or NPH insulin into the bloodstream at
specific intervals.
2. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood
glucose levels.
3. It is surgically attached to the pancreas and infuses regular insulin into the pancreas. This releases insulin into
the bloodstream.
4. It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-
administer an additional bolus dose from the pump before each meal.

It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer
an additional bolus dose from the pump before each meal.

An insulin pump provides a small continuous dose of short-duration (rapid- or short-acting) insulin
subcutaneously throughout the day and night. The client can self-administer an additional bolus dose from the
pump before each meal as needed. Short-duration insulin is used in an insulin pump. An external pump is not
attached surgically to the pancreas.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which
findings support this diagnosis? Select all that apply.

1.Increase in pH
2.Comatose state
3.Deep, rapid breathing
4.Decreased urine output
5.Elevated blood glucose level

2.Comatose state
3.Deep, rapid breathing
5.Elevated blood glucose level

,Because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy and the

,body breaks down fat as a secondary source of energy. Ketones, which are acid byproducts of fat metabolism,
build up and the client experiences a metabolic ketoacidosis. High serum glucose contributes to an osmotic
diuresis and the client becomes severely dehydrated. If untreated, the client will become comatose due to severe
dehydration, acidosis, and electrolyte imbalance. Kussmaul's respirations, the deep rapid breathing associated
with DKA, is a compensatory mechanism by the body. The body attempts to correct the acidotic state by
blowing off carbon dioxide (CO2), which is an acid. In the absence of insulin, the client will experience severe
hyperglycemia. Option 1 is incorrect because in acidosis the pH would be low. Option 4 is incorrect because a
high serum glucose will result in an osmotic diuresis and the client will experience polyuria.

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis.
The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if
which symptom or symptoms develop? Select all that apply.

1. Polyuria
2.Shakiness
3.Palpitations
4.Blurred vision
5.Lightheadedness
6.Fruity breath odor

2. Shakiness
3.Palpitations
5.Lightheadedness

Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and would indicate the need
for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.

A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of
hyperglycemia. What is the appropriate intervention to decrease the client's anxiety?


1. Administer a sedative.
2. Convey empathy, trust, and respect toward the client.
3. Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear.
4. Make sure that the client is familiar with the correct medical terms to promote understanding of what is
happening.

Convey empathy, trust, and respect toward the client.

Anxiety is a subjective feeling of apprehension, uneasiness, or dread. The appropriate intervention is to address
the client's feelings related to the anxiety. Administering a sedative is not the most appropriate intervention and
does not address the source of the client's anxiety. The nurse should not ignore the client's anxious feelings.
Anxiety needs to be managed before meaningful client education can occur.

The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes
accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement?

1. "I will stop taking my insulin if I'm too sick to eat."
2. "I will decrease my insulin dose during times of illness."
3. "I will adjust my insulin dose according to the level of glucose in my urine."
4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2
mmol/L)."

, "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2
mmol/L)."

During illness, the client with type 1 diabetes mellitus is at increased risk of diabetic ketoacidosis, due to
hyperglycemia associated with the stress response and due to a typically decreased caloric intake. As part of
sick day management, the client with diabetes should monitor blood glucose levels and should notify the HCP if
the level is higher than 250 mg/dL (14.2 mmol/L). Insulin should never be stopped. In fact, insulin may need to
be increased during times of illness. Doses should not be adjusted without the HCP's advice and are usually
adjusted on the basis of blood glucose levels, not urinary glucose readings.

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose
level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated,
along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.7
mmol/L). The nurse would next prepare to administer which medication?

1.An ampule of 50% dextrose
2.NPH insulin subcutaneously
3.IV fluids containing dextrose
4.Phenytoin for the prevention of seizures

IV fluids containing dextrose

Emergency management of DKA focuses on correcting fluid and electrolyte imbalances and normalizing the
serum glucose level. If the corrections occur too quickly, serious consequences, including hypoglycemia and
cerebral edema, can occur. During management of DKA, when the blood glucose level falls to 250 to 300
mg/dL (14.2 to 17.1 mmol/L), the IV infusion rate is reduced and a dextrose solution is added to maintain a
blood glucose level of about 250 mg/dL (14.2 mmol/L), or until the client recovers from ketosis. Fifty percent
dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin is not a usual treatment
measure for DKA.

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign
or symptom, if exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if
the blood glucose is not adequately managed?

1.Polyuria
2.Diaphoresis
3.Pedal edema
4.Decreased respiratory rate

Polyuria

Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular and
macrovascular complications of diabetes mellitus. Classic symptoms of hyperglycemia include polydipsia,
polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia. Hypoglycemia is an acute complication of
diabetes mellitus; however, it does not predispose a client to the chronic complications of diabetes mellitus.
Therefore, option 2 can be eliminated because this finding is characteristic of hypoglycemia. Options 3 and 4
are not associated with diabetes mellitus.

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse
places priority on which client problem?

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