Endocrine NCLEX PN Practice Questions IIAna Corona, MSN, FNP-CNursing InstructorJuly 2!Question "A t#irty $i%e year old &ale #as 'een an insulin-de(endent dia'etic $or $i%e years and no) is una'le to urinate*+#ic# o$ t#e $ollo)ing )ould you &ost li,ely sus(ect- A.At#erosclerosis /.0ia'etic ne(#ro(at#y C.Autono&ic neuro(at#y 0.So&atic neuro(at#y "Answer C is correct*Autono&ic neuro(at#y can cause ina'ility to urinate*Question 2A (atient1s c#art indicates a #istory o$ #y(er,ale&ia*+#ic# o$ t#e $ollo)ing )ould you not e2(ect to see )it# t#is (atient i$ t#is condition )ere acute- A.0ecreased 34/.Parest#esiasC.Muscle )ea,ness o$ t#e e2tre&ities0.Migraines 2Answer D is correct* Ans)er c#oices A-C )ere sy&(to&s o$ acute #y(er,ale&ia Question 5A (atient1s c#art indicates a #istory o$ ,etoacidosis*+#ic# o$ t#e $ollo)ing )ould you not e2(ect to see )it# t#is (atient i$ t#is condition )ere acute- A.6o&iting/.E2tre&e 7#irstC.+eig#t gain0.Acetone 'reat# s&ell 5Answer C is correct* +eig#t loss )ould 'e e2(ected Question 8A 98 year-old &ale #as 'een loosing &o'ility and gaining )eig#t o%er t#e last 2 &ont#s*7#e (atient also #as t#e #eater running in #is #ouse 28 #ours a day, e%en on )ar& days* +#ic# o$ t#e $ollo)ing tests is &ost li,ely to 'e (er$or&ed- A.C/C :co&(lete 'lood count;/.EC< :electrocardiogra&;C.7#yroid $unction tests0.C7 scan 8Answer C is correct* +eig#t gain and (oor te&(erature tolerance indicate so&et#ing &ay 'e )rong )it# t#e t#yroid $unction*Question =A 29 year old &ale #as 'een $ound )andering around in a con$used (attern*7#e &ale is s)eaty and (ale*+#ic# o$ t#e $ollo)ing tests is &ost li,ely to 'e (er$or&ed $irst- A./lood sugar c#ec,/.C7 scanC./lood cultures0.Arterial 'lood gases =Answer A is correct*+it# a #istory o$ dia'etes, t#e $irst res(onse s#ould 'e to c#ec, 'lood sugar le%els*Question >7#e client )it# a #istory o$ dia'etes insi(idus is ad&itted )it# (olyuria, (olydi(sia, and &ental con$usion* 7#e (riority inter%ention $or t#is client is. A* Measure t#e urinary out(ut/* C#ec, t#e %ital signs C* Encourage increased $luid inta,e0* +eig# t#e client>Answer B is correct. 7#e large a&ount o$ $luid loss can cause $luid and electrolyte i&'alance t#at s#ould 'e corrected* 7#e loss o$ electrolytes )ould 'e re$lected in t#e %ital signs* Measuring t#e urinary out(ut is i&(ortant, 'ut t#e ste& already says t#at t#e client #as (olyuria, so ans)er A is incorrect* Encouraging $luid inta,e )ill not correct t#e (ro'le&, &a,ing ans)er C incorrect* Ans)er 0 is incorrect 'ecause )eig#ing t#e client is not necessary at t#is ti&e* Question !A client #as #ad a unilateral adrenalecto&y to re&o%e a tu&or* 7o (re%ent co&(lications, t#e &ost i&(ortant &easure&ent in t#e i&&ediate (ost-o(erati%e (eriod $or t#e nurse to ta,e is.A* /lood (ressure/* 7e&(eratureC* ?ut(ut0* S(eci$ic gra%ity!Answer A is correct. /lood (ressure is t#e 'est indicator o$ cardio%ascular colla(se in t#e client )#o #as #ad an adrenal gland re&o%ed* 7#e re&aining gland &ig#t #a%e 'een su((ressed due to t#e tu&or acti%ity* 7e&(erature )ould 'e an indicator o$ in$ection, decreased out(ut )ould 'e a clinical &ani$estation 'ut )ould ta,e longer to occur t#an 'lood (ressure c#anges, and s(eci$ic gra%ity c#anges occur )it# ot#er disorders@ t#ere$ore, ans)ers /, C, and 0 are incorrect*Question 9A client )it# AddisonAs disease #as 'een ad&itted )it# a #istory o$ nausea and %o&iting $or t#e (ast 5 days* 7#e client is recei%ing I6 glucocorticoids :Solu-Medrol;* +#ic# o$ t#e $ollo)ing inter%entions )ould t#e nurse i&(le&ent-A* Answer C is correct. NP3 insulin (ea,s in 9F"2 #ours, so a snac, s#ould 'e o$$ered at t#at ti&e* NP3 insulin onsets in DF"2 &inutes, so ans)er A is incorrect* Ans)er / is untrue 'ecause NP3 insulin is ti&e released and does not usually cause sudden #y(oglyce&ia* Ans)er 0 is incorrect, 'ut t#e client s#ould eat a 'edti&e snac,*Question "!7#e (#ysician #as ordered a t#yroid scan to con$ir& t#e diagnosis* /e$ore t#e (rocedure, t#e nurse s#ould.A* Assess t#e client $or allergies/* /olus t#e client )it# I6 $luidC* 7ell t#e client #e )ill 'e aslee(0* Insert a urinary cat#eter"!Answer A is correct. A t#yroid scan uses a dye, so t#e client s#ould 'e assessed $or allergies to iodine* 7#e client )ill not #a%e a 'olus o$ $luid, )ill not 'e aslee(, and )ill not #a%e a urinary cat#eter inserted, so ans)ers /, C, and 0 are incorrect*Question "9A client #os(italiGed )it# M4SA :&et#icillin-resistant sta(# aureus; is (laced on contact (recautions* +#ic# state&ent is true regarding (recautions $or in$ections s(read 'y contact-A* 7#e client s#ould 'e (laced in a roo& )it# negati%e (ressure*/* In$ection reCuires close contact@ t#ere$ore, t#e door &ay re&ain o(en*C* 7rans&ission is #ig#ly li,ely, so t#e client s#ould )ear a &as, at all ti&es*0* In$ection reCuires s,in-to-s,in contact and is (re%ented 'y #and )as#ing, glo%es, and a go)n*"9Answer D is correct. 7#e client )it# M4SA s#ould 'e (laced in isolation* )ee,s*E An I*6* line is started and 'lood is dra)n $or la'oratory studies* 3er seru& calciu& le%el is =*= &gBdl*Question 2In assessing t#is (atient $or #y(ocalce&ia, C#%oste,As sign is elicited 'y.A*A((lying a :/P; cu$$ to t#e u((er ar&, in$lating it, and o'ser%ing $or car(o(edal s(as&* /*7a((ing a $inger on t#e s,in a'o%e t#e su(ra&andi'ular (ortion o$ t#e (arotid gland and o'ser%ing $or t)itc#ing o$ t#e u((er li( on side o((osite sti&ulation* C*7a((ing a $inger on t#e s,in a'o%e t#e su(ra&andi'ular (ortion o$ t#e (arotid gland and o'ser%ing $or t)itc#ing o$ t#e u((er li( on sa&e side as sti&ulation* 0*3a%ing t#e (atient #y(er%entilate :&ore t#an 5 'reat#sB&inute; to (roduce car(o(edal s(as& resulting $ro& res(iratory al,alosis* 2Answer C is correct* A decrease in ioniGed calciu& causes an increase in neuro&uscular e2cita'ility* 7a((ing o%er a 'ranc# o$ t#e $acial ner%e and o'ser%ing $or t)itc#ing o$ t#e u((er li( on t#e i(silateral :sa&e; side as sti&ulation is considered a (ositi%e C#%oste,As sign* In$lating a /P cu$$ on t#e u((er ar& or #a%ing t#e (atient #y(er%entilate )ill 'ot# (roduce car(o(edal s(as& and are (art o$ t#e diagnostic tests used to elicit 7rousseauAs sign*Question 2"Trousseau's sign can be elicited in the hypocalcemic patient by:A.A((lying a /P cu$$ to u((er ar&, in$lating it, and o'ser%ing $or car(o(edal s(as&*B.7a((ing a $inger on t#e su(ra&andi'ular (ortion o$ t#e (arotid cland and o'ser%ing $or t)itc#ing o$ t#e u((er li( on t#e side o((osite to t#e sti&ulation*C.7a((ing a $inger on t#e su(ra&andi'ular (ortion o$ t#e (arotid gland and o'ser%ing $or t)itc#ing o$ t#e u((er li( on t#e sa&e side as sti&ulation*D.3a%ing t#e (atient #y(er%entilate :&ore t#an 5 'reat#sB&inute; to (roduce car(o(edal s(as& resulting $ro& res(iratory acidosis*2"Answer A is correct. 7rousseauAs sign is elicited 'y a((lying a /P cu$$ to t#e (atientAs ar&, in$lating to t#e (atientAs systolic (ressure, and o'ser%ing $or car(o(edal s(as&* Anot#er &et#od $or (roducing t#is (#eno&enon is #y(er%entilation, in )#ic# t#e al,alotic state decreases seru& calciu& le%els*Situation. A 71-year-old woman is transported to the D because o! !atigue and a change in mental status. "n physical e#amination$ her temperature is %&.' degrees (. )*& degrees C.+ rectally. ,er B- is 11./70 mm ,g1 pulse$ 0' beats/minute1 respirations$ 12 breaths/minute1 periorbital edema is present$ and a yellowish s3in pigmentation is noted. ,er daughter relates a history o! 4thyroid problem4 and noncompliance with medical therapy. The diagnosis o! my#edema is made.Question ne2t slideQuestion 22The patient admitted with hypothyroid crisis )my#edema coma+ would most li3ely ha5e which o! the !ollowing electrolyte abnormalities6A.3y(onatre&iaB.3y(ernatre&iaC.3y(erglyce&iaD.3y(ocalce&ia 22Answer A is correct*Patients )it# &y2ede&a co&a su$$er $ro& #y(onatre&ia* 7#is usually is a result o$ ina((ro(riate secretion o$ antidiuretic #or&one :A03;* Also, t#e &y2ede&atous state results $ro& t#e interstitial accu&ulation o$ a &uco(olysacc#aride su'stance t#at attracts )ater and (roduces )ater retention* 7#ere$ore, t#e #y(onatre&ia is caused 'y dilution* 3y(oglyce&ia is also seen in &y2ede&a co&a, o)ing to t#e #y(o&eta'olic state*Question 257hich o! the !ollowing acid-base imbalances is most li3ely to occur in this patient6A.4es(iratory acidosisB.4es(iratory al,alosis )it#out co&(ensationC.Meta'olic al,alosisD.4es(iratory al,alosis )it# co&(ensation25Answer A is correct. 4es(iratory acidosis and C?2 narcosis are a result o$ lo)ered t#yro2ine :78; and 7ri-iodot#yronine :75; le%els* 7#ese #or&ones increase &eta'olic $unctions, suc# as res(iration* 7#us, a decrease in 75 and 78 le%els de(resses res(iratory $unction, t#ere'y causing #y(o%entilation* In addition, &eta'olic acidosis &ay de%elo( as #y(o2ia increases seru& lactate le%els*Question 28Parental inHections o$ cortisol $or (atients )it# addison1s disease s#ould 'e inHected.A* A$ter t#e (atient eats/* 0ee( into t#e deltoidC* 0ee( into t#e gluteal &uscle0* Into t#e su'cutaneous tissue 28Answer C is correct. /ecause su$$icient &uscle &ass is necessary or acute inHection o$ (arental cortisol (re(arations, t#e nurse s#ould inHect t#e& dee( into t#e gluteal &uscle*Cortisol s#ould not 'e inHected su'C 'ecause it &ay cause sterile a'scess, tissue atro(#y and (ig&entation a'nor&alities*Steroid t#era(y causes