Endocrine NCLEX PN Practice Questions II

Ana Corona, MSN, FNP-C

Nursing Instructor
July 2007
Question 1
A thirty five year old male has been an insulin-
dependent diabetic for five years and now is unable to
urinate. Which of the following would you most likely
suspect?
A: Atherosclerosis
B: Diabetic nephropathy
C: Autonomic neuropathy
D: Somatic neuropathy
1
Answer C is correct. Autonomic neuropathy can cause
inability to urinate.
Question 2
A patient’s chart indicates a history of hyperkalemia.
Which of the following would you not expect to see with
this patient if this condition were acute?
A: Decreased HR
B: Paresthesias
C: Muscle weakness of the extremities
D: Migraines
2
Answer D is correct. Answer choices A-C were
symptoms of acute hyperkalemia
Question 3
A patient’s chart indicates a history of ketoacidosis.
Which of the following would you not expect to see with
this patient if this condition were acute?
A: Vomiting
B: Extreme Thirst
C: Weight gain
D: Acetone breath smell
3
Answer C is correct. Weight loss would be expected
Question 4
A 84 year-old male has been loosing mobility and gaining weight
over the last 2 months. The patient also has the heater running
in his house 24 hours a day, even on warm days. Which of the
following tests is most likely to be performed?
A: CBC (complete blood count)
B: ECG (electrocardiogram)
C: Thyroid function tests
D: CT scan
4
Answer C is correct. Weight gain and poor
temperature tolerance indicate something may be
wrong with the thyroid function.
Question 5
A 28 year old male has been found wandering around in
a confused pattern. The male is sweaty and pale.
Which of the following tests is most likely to be
performed first?
A: Blood sugar check
B: CT scan
C: Blood cultures
D: Arterial blood gases
5
Answer A is correct. With a history of diabetes, the
first response should be to check blood sugar levels.
Question 6
The client with a history of diabetes insipidus is admitted
with polyuria, polydipsia, and mental confusion. The
priority intervention for this client is:
Measure the urinary output
Check the vital signs
Encourage increased fluid intake
Weigh the client
6
Answer B is correct. The large amount of fluid loss can cause
fluid and electrolyte imbalance that should be corrected. The
loss of electrolytes would be reflected in the vital signs.
Measuring the urinary output is important, but the stem
already says that the client has polyuria, so answer A is
incorrect. Encouraging fluid intake will not correct the
problem, making answer C incorrect. Answer D is incorrect
because weighing the client is not necessary at this time.
Question 7
A client has had a unilateral adrenalectomy to remove a tumor.
To prevent complications, the most important measurement in
the immediate post-operative period for the nurse to take is:
Blood pressure
Temperature
Output
Specific gravity
7
Answer A is correct. Blood pressure is the best indicator of
cardiovascular collapse in the client who has had an adrenal
gland removed. The remaining gland might have been
suppressed due to the tumor activity. Temperature would be
an indicator of infection, decreased output would be a clinical
manifestation but would take longer to occur than blood
pressure changes, and specific gravity changes occur with
other disorders; therefore, answers B, C, and D are incorrect.
Question 8
A client with Addison's disease has been admitted with a history
of nausea and vomiting for the past 3 days. The client is
receiving IV glucocorticoids (Solu-Medrol). Which of the
following interventions would the nurse implement?
Glucometer readings as ordered
Intake/output measurements
Sodium and potassium levels monitored
Daily weights
8
Answer A is correct. IV glucocorticoids raise the
glucose levels and often require coverage with
insulin. Answer B is not necessary at this time,
sodium and potassium levels would be monitored
when the client is receiving mineral corticoids, and
daily weights is unnecessary; therefore, answers B,
C, and D are incorrect.
Question 9
A client had a total thyroidectomy yesterday. The client is
complaining of tingling around the mouth and in the fingers
and toes. What would the nurses' next action be?
Obtain a crash cart
Check the calcium level
Assess the dressing for drainage
Assess the blood pressure for hypertension

9
Answer B is correct. The parathyroid glands are responsible for
calcium production and can be damaged during a
thyroidectomy. The tingling is due to low calcium levels. The
crash cart would be needed in respiratory distress but would
not be the next action to take; thus, answer A is incorrect.
Hypertension occurs in thyroid storm and the drainage would
occur in hemorrhage, so answers C and D are incorrect.
Question 10
A 32-year-old mother of three is brought to the clinic. Her pulse is 52, there is a
weight gain of 30 pounds in 4 months, and the client is wearing two sweaters.
The client is diagnosed with hypothyroidism. Which of the following nursing
diagnoses is of highest priority?
Impaired physical mobility related to decreased endurance
Hypothermia r/t decreased metabolic rate
Disturbed thought processes r/t interstitial edema
Decreased cardiac output r/t bradycardia

10
Answer D is correct. The decrease in pulse can affect
the cardiac output and lead to shock, which would
 take precedence over the other choices; therefore,
answers A, B, and C are incorrect.
Question 11
The physician has prescribed Novalog insulin for a client with diabetes mellitus.
Which statement indicates that the client knows when the peak action of the
insulin occurs?
"I will make sure I eat breakfast within 10 minutes of taking my insulin."
"I will need to carry candy or some form of sugar with me all the time."
"I will eat a snack around three o'clock each afternoon."
"I can save my dessert from supper for a bedtime snack."

11
Answer A is correct. Novalog insulin onsets very quickly, so
food should be available within 10–15 minutes of taking the
insulin. Answer B does not address a particular type of
insulin, so it is incorrect. NPH insulin peaks in 8–12 hours, so
a snack should be eaten at the expected peak time. It may
not be 3 p.m. as stated in answer C. Answer D is incorrect
because there is no need to save the dessert until bedtime.
Question 12
A 25-year-old client with Grave's disease is admitted to
the unit. What would the nurse expect the admitting
assessment to reveal?
Bradycardia
Decreased appetite
Exophthalmos
Weight gain

12
Answer C is correct. Exophthalmos (protrusion of
eyeballs) often occurs with hyperthyroidism. The
client with hyperthyroidism will often exhibit
tachycardia, increased appetite, and weight loss;
therefore, answers A, B, and D are incorrect.
Question 13
A client with hypothyroidism asks the nurse if she will still need to take thyroid
medication during the pregnancy. The nurse's response is based on the
knowledge that:
There is no need to take thyroid medication because the fetus's thyroid produces
a thyroid-stimulating hormone.
Regulation of thyroid medication is more difficult because the thyroid gland
increases in size during pregnancy.
It is more difficult to maintain thyroid regulation during pregnancy due to a
slowing of metabolism.
Fetal growth is arrested if thyroid medication is continued during pregnancy.

13
Answer B is correct. During pregnancy, the thyroid gland
triples in size. This makes it more difficult to regulate thyroid
medication. Answer A is incorrect because there could be a
need for thyroid medication during pregnancy. Answer C is
incorrect because the thyroid function does not slow. Fetal
growth is not arrested if thyroid medication is continued, so
answer D is incorrect.
Question 14
A client with diabetes has an order for ultrasonography.
Preparation for an ultrasound includes:
Increasing fluid intake
Limiting ambulation
Administering an enema
Withholding food for 8 hours

14
Answer A is correct. Before ultrasonography, the
client should be taught to drink plenty of fluids and
not void. The client may ambulate, an enema is not
needed, and there is no need to withhold food for 8
hours. Therefore, answers B, C, and D are incorrect.
Question 15
The nurse should visit which of the following clients
first?
The client with diabetes with a blood glucose of 95mg/dL
The client with hypertension being maintained on
Lisinopril
The client with chest pain and a history of angina
The client with Raynaud's disease

15
Answer C is correct. The client with chest pain should
be seen first because this could indicate a myocardial
infarction. The client in answer A has a blood glucose
within normal limits. The client in answer B is
maintained on blood pressure medication. The client
in answer D is in no distress.
Question 16
The physician has prescribed NPH insulin for a client with
diabetes mellitus. Which statement indicates that the client
knows when the peak action of the insulin occurs?
"I will make sure I eat breakfast within 2 hours of taking my
insulin."
"I will need to carry candy or some form of sugar with me all the
time."
"I will eat a snack around three o'clock each afternoon."
"I can save my dessert from supper for a bedtime snack."

16
Answer C is correct. NPH insulin peaks in 8–12 hours,
so a snack should be offered at that time. NPH insulin
onsets in 90–120 minutes, so answer A is incorrect.
Answer B is untrue because NPH insulin is time
released and does not usually cause sudden
hypoglycemia. Answer D is incorrect, but the client
should eat a bedtime snack.
Question 17
The physician has ordered a thyroid scan to confirm the
diagnosis. Before the procedure, the nurse should:
Assess the client for allergies
Bolus the client with IV fluid
Tell the client he will be asleep
Insert a urinary catheter
17
Answer A is correct. A thyroid scan uses a dye, so the
client should be assessed for allergies to iodine. The
client will not have a bolus of fluid, will not be asleep,
and will not have a urinary catheter inserted, so
answers B, C, and D are incorrect.
Question 18
A client hospitalized with MRSA (methicillin-resistant staph aureus) is placed on
contact precautions. Which statement is true regarding precautions for infections
spread by contact?
The client should be placed in a room with negative pressure.
Infection requires close contact; therefore, the door may remain open.
Transmission is highly likely, so the client should wear a mask at all times.
Infection requires skin-to-skin contact and is prevented by hand washing, gloves,
and a gown.

18
Answer D is correct. The client with MRSA should be placed in isolation.
Gloves, a gown, and a mask should be used when caring for the client and
hand washing is very important. The door should remain closed, but a
negative-pressure room is not necessary, so answers A and B are incorrect.
MRSA is spread by contact with blood or body fluid or by touching the skin of
the client. It is cultured from the nasal passages of the client, so the client
should be instructed to cover his nose and mouth when he sneezes or
coughs. It is not necessary for the client to wear the mask at all times; the
nurse should wear the mask, so answer C is incorrect.

Question 19
The client has recently returned from having a
thyroidectomy. The nurse should keep which of the
following at the bedside?
A tracheotomy set
A padded tongue blade
An endotracheal tube
An airway

19
Answer A is correct. The client who has recently had a
thyroidectomy is at risk for tracheal edema. A padded
 tongue blade is used for seizures and not for the
client with tracheal edema, so answer B is incorrect.
If the client experiences tracheal edema, the
endotracheal tube or airway will not correct the
problem, so answers C and D are incorrect.
Situation:
A 17-year-old female model comes to your ER complaining of
generalized cramps and numbness in her fingers. Medical history is
noncontributory. When questioned, she tells you that She has been
on a high-protein diet for "about 6 weeks." An I.V. line is started
and blood is drawn for laboratory studies.
Her serum calcium level is 5.5 mg/dl.
Question 20
In assessing this patient for hypocalcemia, Chvostek's sign is elicited
by:
A. Applying a (BP) cuff to the upper arm, inflating it, and observing
for carpopedal spasm.
B. Tapping a finger on the skin above the supramandibular portion of
the parotid gland and observing for twitching of the upper lip on
side opposite stimulation.
C. Tapping a finger on the skin above the supramandibular portion of
the parotid gland and observing for twitching of the upper lip on
same side as stimulation.
D. Having the patient hyperventilate (more than 30 breaths/minute)
to produce carpopedal spasm resulting from respiratory alkalosis.
20
Answer C is correct. A decrease in ionized calcium causes an
increase in neuromuscular excitability. Tapping over a branch
of the facial nerve and observing for twitching of the upper lip
on the ipsilateral (same) side as stimulation is considered a
positive Chvostek's sign. Inflating a BP cuff on the upper arm
or having the patient hyperventilate will both produce
carpopedal spasm and are part of the diagnostic tests used to
elicit Trousseau's sign.
Question 21
Trousseau's sign can be elicited in the hypocalcemic patient by:
A. Applying a BP cuff to upper arm, inflating it, and observing for carpopedal
spasm.
B. Tapping a finger on the supramandibular portion of the parotid cland and
observing for twitching of the upper lip on the side opposite to the
stimulation.
C. Tapping a finger on the supramandibular portion of the parotid gland and
observing for twitching of the upper lip on the same side as stimulation.
D. Having the patient hyperventilate (more than 30 breaths/minute) to produce
carpopedal spasm resulting from respiratory acidosis.

21
Answer A is correct. Trousseau's sign is elicited by
applying a BP cuff to the patient's arm, inflating to
the patient's systolic pressure, and observing for
carpopedal spasm. Another method for producing this
phenomenon is hyperventilation, in which the
alkalotic state decreases serum calcium levels.
Situation:
A 71-year-old woman is transported to the ED because of fatigue and a
change in mental status. On physical examination, her temperature is
96.8 degrees F. (36 degrees C.) rectally. Her BP is 110/74 mm Hg;
pulse, 48 beats/minute; respirations, 12 breaths/minute; periorbital
edema is present, and a yellowish skin pigmentation is noted. Her
daughter relates a history of "thyroid problem" and noncompliance with
medical therapy. The diagnosis of myxedema is made.
Question next slide

Question 22
The patient admitted with hypothyroid crisis
(myxedema coma) would most likely have which
of the following electrolyte abnormalities?
A. Hyponatremia
B. Hypernatremia
C. Hyperglycemia
D. Hypocalcemia

22
Answer A is correct. Patients with myxedema coma suffer
from hyponatremia. This usually is a result of inappropriate
secretion of antidiuretic hormone (ADH). Also, the
myxedematous state results from the interstitial accumulation
of a mucopolysaccharide substance that attracts water and
produces water retention. Therefore, the hyponatremia is
caused by dilution. Hypoglycemia is also seen in myxedema
coma, owing to the hypometabolic state.
Question 23
Which of the following acid-base imbalances is
most likely to occur in this patient?
A. Respiratory acidosis
B. Respiratory alkalosis without compensation
C. Metabolic alkalosis
D. Respiratory alkalosis with compensation

23
Answer A is correct. Respiratory acidosis and CO2 narcosis
are a result of lowered thyroxine (T4) and Tri-iodothyronine
(T3) levels. These hormones increase metabolic functions,
such as respiration. Thus, a decrease in T3 and T4 levels
depresses respiratory function, thereby causing
hypoventilation. In addition, metabolic acidosis may develop
as hypoxia increases serum lactate levels.
Question 24
Parental injections of cortisol for patients with addison’s
disease should be injected:
After the patient eats
Deep into the deltoid
Deep into the gluteal muscle
Into the subcutaneous tissue
24
Answer C is correct. Because sufficient muscle mass is
necessary or acute injection of parental cortisol preparations,
the nurse should inject them deep into the gluteal muscle.
Cortisol should not be injected subC because it may cause
sterile abscess, tissue atrophy and pigmentation
abnormalities. Steroid therapy causes GI disturbances with
oral administration, not IM injections. The patient does not
have to have food in the stomach before administration.
Question 25
Which medication is not an oral hypoglycemic agent?
Glypizide (Glucotrol)
Tolbutamide (Orinase)
Chlorpropamide (diabinese)
Diazoxide (Hyperstat)
25
Answer D is correct. Hyperstat is a benzothiadiazide
that causes hyperglycemia by inhibiting insulin
secretions. It is used to treat hypoglycemia by
excessive insulin productions. Glypizide
(Glucotrol),Tolbutamide (Orinase), Chlorpropamide
(diabinese), Diazoxide (Hystat) are hypoglycemia
agents. (sulfonyrlueas)
Question 26
While reviewing a clients lab results, the nurse
recognizes that a fasting glucose value of
________________ is within normal limits.
80
120
160
200
26
Answer A is correct. Normal fasting blood sugar is
70-99
Question 27
A diabetic client is admitted to the ER by a coworker, who found him
unconscious on the floor. A nurse would first:

A. Check the client's blood sugar level and

start an IV infusion.
B. Contact the client's family and tell them to come to
the hospital immediately.
C. Assess the client for head trauma.
D. Ask the coworker how long the client was
unconscious.

27
Answer A is correct. It is priority to assess the
client's blood sugar level. A low blood sugar level is
life threatening & must be corrected immediately.