NCLEX-PN Test #10 2

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?

Accepted Answer

Diabetic ketoacidosis (DKA)

Answer

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?

Accepted Answer

Decrease the insulin infusion rate and add dextrose 5% to IV fluids

Answer

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?

Accepted Answer

Take on an empty stomach 30–60 minutes before breakfast for optimal absorption

Answer

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?

Accepted Answer

Blood pressure of 80/50 mmHg with tachycardia

Answer

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?

Accepted Answer

Propylthiouracil (PTU) and propranolol

Answer

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.

NCLEX Practice Test

NCLEX Practice Test

NCLEX-PN Test #10 2