NCLEX-PN Test #10 2 — Questions and Answers
Question 1: A client with type 1 diabetes is brought to the ED with confusion, Kussmaul respirations, fruity breath odor, and blood glucose of 520 mg/dL. Which condition does the nurse recognize?
- Hyperosmolar hyperglycemic state (HHS)
- Diabetic ketoacidosis (DKA) (Correct answer)
- Hypoglycemic unawareness
- Somogyi effect
Correct answer: Diabetic ketoacidosis (DKA)
DKA is characterized by hyperglycemia, ketonemia, and metabolic acidosis. Classic signs include Kussmaul respirations (deep, rapid breathing to blow off CO₂), fruity breath (acetone), nausea, vomiting, and altered mental status. It occurs predominantly in type 1 diabetes due to absolute insulin deficiency leading to fat breakdown and ketone production.
Question 2: A client in DKA is receiving an insulin infusion. The blood glucose drops to 250 mg/dL. What is the expected next nursing action?
- Discontinue the insulin infusion
- Decrease the insulin infusion rate and add dextrose 5% to IV fluids (Correct answer)
- Switch to subcutaneous insulin only
- Administer IV glucagon
Correct answer: Decrease the insulin infusion rate and add dextrose 5% to IV fluids
When blood glucose reaches 200–250 mg/dL in DKA, the IV fluid is changed to D5 0.45% NaCl to prevent hypoglycemia, while the insulin infusion continues at a reduced rate to continue resolving the acidosis and ketosis. Stopping the insulin prematurely will allow ketoacidosis to recur. DKA is resolved by ketone clearance, not just glucose normalization.
Question 3: A client with hypothyroidism is prescribed levothyroxine (Synthroid). Which instruction is most important?
- Take the medication with a calcium supplement for better absorption
- Take on an empty stomach 30–60 minutes before breakfast for optimal absorption (Correct answer)
- Take with food to prevent GI upset
- Take at bedtime to minimize side effects
Correct answer: Take on an empty stomach 30–60 minutes before breakfast for optimal absorption
Levothyroxine is best absorbed when taken on an empty stomach, 30–60 minutes before the first meal. Many foods, supplements (calcium, iron, antacids), and medications reduce absorption. Consistent dosing time is important for maintaining stable thyroid hormone levels.
Question 4: A client with Addison's disease is admitted with acute adrenal crisis (Addisonian crisis). Which clinical finding is most concerning?
- Serum sodium of 132 mEq/L
- Serum potassium of 6.2 mEq/L
- Blood pressure of 80/50 mmHg with tachycardia (Correct answer)
- Mild hyperpigmentation of the skin
Correct answer: Blood pressure of 80/50 mmHg with tachycardia
Addisonian crisis (acute adrenal insufficiency) presents with severe hypotension, tachycardia, and hypovolemic shock due to cortisol and aldosterone deficiency. This is life-threatening and requires immediate IV hydrocortisone and fluid resuscitation. Hypotension/shock is the most immediately threatening finding requiring emergency intervention.
Question 5: A client has a thyroid storm. Which medication should the nurse anticipate administering?
- Levothyroxine (Synthroid)
- Propylthiouracil (PTU) and propranolol (Correct answer)
- Methimazole and radioactive iodine
- Dexamethasone alone
Correct answer: Propylthiouracil (PTU) and propranolol
Thyroid storm is treated by blocking thyroid hormone synthesis (PTU), blocking peripheral conversion of T4 to T3 (PTU, glucocorticoids), blocking the cardiovascular effects of excess thyroid hormone (propranolol), and iodine therapy (Lugol's solution — given after PTU). Levothyroxine would worsen the condition.
Question 6: A client with diabetes insipidus has urine output of 8 liters in 24 hours. The priority nursing assessment is:
- Daily weight and serum glucose
- Signs of dehydration: dry mucous membranes, skin turgor, blood pressure, and serum sodium (Correct answer)
- Urine culture and sensitivity
- 24-hour urine protein
Correct answer: Signs of dehydration: dry mucous membranes, skin turgor, blood pressure, and serum sodium
DI causes massive water loss from inadequate ADH (central) or renal ADH insensitivity (nephrogenic). With 8 L/day output, the client is at extreme risk for dehydration and hypernatremia (serum Na+ can exceed 160 mEq/L). Monitoring for dehydration signs and serum sodium is the priority assessment to guide fluid replacement and desmopressin therapy.
NCLEX-PN Test #10 2
A client with type 1 diabetes is brought to the ED with confusion, Kussmaul respirations, fruity breath odor, and blood glucose of 520 mg/dL.
Which condition does the nurse recognize?