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Endocrine NCLEX practice questions

Five NCLEX-style questions on diabetes and insulin, DKA, thyroid disorders, Addison’s and Cushing’s disease and SIADH. Pick your answer, then open it to see the right choice and why. New questions every week.

1. Question 1

   A nurse is caring for a patient who has syndrome of inappropriate antidiuretic hormone (SIADH) and a sodium level of 123 mEq/L. What prescription should the nurse anticipate?

   • A.Provide a diet containing 2 g of sodium per day.
   • B.Administer desmopressin acetate 0.2 mg orally.
   • C.Restrict fluid intake to 1,000 mL per day.
   • D.Maintain an IV of 0.45% sodium chloride.
   Show answer and rationale ▾Answer and rationale ▴

   Answer: C. Restrict fluid intake to 1,000 mL per day.

   Providing a diet containing 2 g of sodium per day is not typically part of the treatment for SIADH. In fact, increasing sodium intake could potentially worsen hyponatremia, a common condition in SIADH7. Administering desmopressin acetate 0.2 mg orally is not typically part of the treatment for SIADH. Desmopressin is a synthetic form of ADH, and administering this medication could potentially worsen the symptoms of SIADH, which is characterized by an overproduction of ADH7. Restricting fluid intake to 1,000 mL per day is often part of the treatment for SIADH. This helps to correct the imbalance of water in the body, which is a common issue in SIADH8. Maintaining an IV of 0.45% sodium chloride is not typically part of the treatment for SIADH. This type of IV fluid is hypotonic, meaning it has a lower concentration of solutes (like sodium) than the blood. This could potentially worsen the hyponatremia seen in SIADH7.

2. Question 2

   Lena Mason, who has diabetes, is admitted in a stuporous condition. Her blood gases show a pH of 7.33, PaCO2 of 40 mm Hg, and HCO3- of 20 mEq/L. What type of acid-base imbalance does this patient have?

   • A.Metabolic alkalosis, uncompensated
   • B.Respiratory alkalosis, uncompensated
   • C.Respiratory acidosis, uncompensated
   • D.Metabolic acidosis, uncompensated
   Show answer and rationale ▾Answer and rationale ▴

   Answer: D. Metabolic acidosis, uncompensated

   This is incorrect because metabolic alkalosis is characterized by a high pH and a high HCO3-. The patient's pH and HCO3- are both low, indicating acidosis, not alkalosis. This is incorrect because respiratory alkalosis is characterized by a high pH and a low PaCO2. The patient's pH is low and PaCO2 is normal, indicating a metabolic problem, not a respiratory one. This is incorrect because respiratory acidosis is characterized by a low pH and a high PaCO2. The patient's pH is low, but PaCO2 is normal, indicating a metabolic problem, not a respiratory one. This is correct because metabolic acidosis is characterized by a low pH and a low HCO3-. The patient's pH and HCO3- are both low, indicating a metabolic disorder. The condition is uncompensated because the PaCO2 is normal, meaning the respiratory system is not compensating for the metabolic acidosis.

3. Question 3

   The nurse observed that a client with diabetic ketoacidosis is experiencing abnormally deep, regular, and rapid respirations. How would the nurse document this observation in the medical record?

   • A.Bradypnea
   • B.Kussmaul's respirations
   • C.Cheyne-Stokes respirations
   • D.Biot's respirations
   Show answer and rationale ▾Answer and rationale ▴

   Answer: B. Kussmaul's respirations

   This is incorrect because bradypnea is a term for slow breathing, usually less than 12 breaths per minute. The client is breathing rapidly, not slowly. This is correct because Kussmaul's respirations are a type of breathing pattern that is deep, regular, and rapid, usually more than 20 breaths per minute. Kussmaul's respirations are a sign of metabolic acidosis, which occurs in diabetic ketoacidosis due to the accumulation of ketones in the blood. The client is trying to exhale the excess carbon dioxide and lower the acidity of the blood. This is incorrect because Cheyne-Stokes respirations are a type of breathing pattern that is irregular, with periods of apnea (no breathing) alternating with periods of rapid breathing. Cheyne-Stokes respirations are a sign of cerebral dysfunction, such as stroke, brain injury, or coma. This is incorrect because Biot's respirations are a type of breathing pattern that is irregular, with periods of apnea (no breathing) interspersed with periods of normal breathing. Biot's respirations are a sign of brainstem damage, such as meningitis, encephalitis, or head trauma.

4. Question 4

   A client has been diagnosed with diabetes mellitus and must learn how to do his own finger stick blood sugar analysis as part of his treatment. The client has been sullen and uncommunicative since receiving the diagnosis. How can the nurse best increase the client's motivation to learn?

   • A.Encouraging the client's participation each time the procedure is performed
   • B.Offering to do the procedure for the client each time it is scheduled
   • C.Teaching the client's support system how to perform the procedure
   • D.Demonstrating the finger stick procedure on the nurse
   Show answer and rationale ▾Answer and rationale ▴

   Answer: A. Encouraging the client's participation each time the procedure is performed

   The best way to increase the client's motivation to learn is by encouraging their participation each time the procedure is performed. This can help the client feel more involved in their own care and increase their confidence in performing the procedure. The other options (Offering to do the procedure for the client each time it is scheduled, Teaching the client's support system how to perform the procedure, and Demonstrating the finger stick procedure to the nurse) may not be as effective in increasing the client's motivation to learn.

5. Question 5

   A nurse is providing care for a client who has recently been diagnosed with type 1 diabetes mellitus. To focus on affective learning with this client, the nurse should use which of the following interventions?

   • A.Review the action of insulin therapy.
   • B.Ask the client to perform a return demonstration of insulin injection.
   • C.Explore the client's feelings about dietary modifications.
   • D.Have the client practice blood-glucose monitoring using a glucometer.
   Show answer and rationale ▾Answer and rationale ▴

   Answer: C. Explore the client's feelings about dietary modifications.

   To focus on affective learning with this client, the nurse should explore the client's feelings about dietary modifications. Affective learning involves the development of values, attitudes, and emotions. By exploring the client's feelings about dietary modifications, the nurse can help the client understand and accept the changes that are necessary for managing their condition.