NCLEX Medical-Surgical: Endocrine Disorders 2 — Questions and Answers
Question 1: A client with type 1 diabetes is found unresponsive with cool, clammy skin and shallow respirations. What should the nurse do first?
- Administer subcutaneous insulin
- Give 15 g of oral glucose
- Administer IV dextrose 50% per protocol (Correct answer)
- Check the client's temperature
Correct answer: Administer IV dextrose 50% per protocol
An unresponsive hypoglycemic client cannot swallow safely, so IV dextrose (or IM glucagon) is the priority intervention.
Question 2: Which laboratory result best confirms long-term glycemic control over the previous 2 to 3 months?
- Fasting blood glucose
- Hemoglobin A1c (Correct answer)
- Random blood glucose
- Oral glucose tolerance test
Correct answer: Hemoglobin A1c
Hemoglobin A1c reflects average blood glucose over the lifespan of red blood cells, approximately 2 to 3 months.
Question 3: A nurse is teaching a client about Somogyi effect. Which statement indicates correct understanding?
- "I should increase my evening insulin to lower my morning sugars."
- "My morning high sugar may be a rebound from nighttime low blood sugar." (Correct answer)
- "I need to skip my bedtime snack to avoid this."
- "This happens only during the daytime."
Correct answer: "My morning high sugar may be a rebound from nighttime low blood sugar."
The Somogyi effect is morning hyperglycemia caused by a rebound from nocturnal hypoglycemia, often improved by reducing evening insulin or adding a snack.
Question 4: Which symptom is classically associated with diabetic ketoacidosis (DKA)?
- Moist skin and bradycardia
- Fruity (acetone) breath odor and Kussmaul respirations (Correct answer)
- Hypertension and bradypnea
- Decreased urine output and weight gain
Correct answer: Fruity (acetone) breath odor and Kussmaul respirations
DKA produces ketones causing a fruity breath odor and deep, rapid Kussmaul respirations as the body tries to blow off acid.
Question 5: A client newly diagnosed with type 2 diabetes asks about metformin. Which point should the nurse emphasize?
- It commonly causes hypoglycemia when taken alone
- It must be held before contrast dye imaging procedures (Correct answer)
- It should be taken on an empty stomach for best effect
- It is given by subcutaneous injection
Correct answer: It must be held before contrast dye imaging procedures
Metformin is held before and after iodinated contrast studies because of the risk of contrast-induced renal impairment and lactic acidosis.
Question 6: Which finding indicates that a client's hyperosmolar hyperglycemic state (HHS) is improving?
- Serum osmolality rising toward 350 mOsm/kg
- Improving level of consciousness and normalizing serum glucose (Correct answer)
- Increasing blood glucose to 800 mg/dL
- Worsening skin turgor
Correct answer: Improving level of consciousness and normalizing serum glucose
Improved mental status and a falling glucose level reflect successful fluid resuscitation and insulin therapy in HHS.
Question 7: A client with diabetes is sick with the flu and cannot eat. What instruction is most important?
- Stop all insulin until eating resumes
- Continue insulin, monitor glucose frequently, and stay hydrated (Correct answer)
- Double the insulin dose to prevent ketoacidosis
- Avoid checking blood glucose to reduce stress
Correct answer: Continue insulin, monitor glucose frequently, and stay hydrated
Sick-day rules direct clients to keep taking insulin, check glucose and ketones often, and maintain fluid intake to prevent DKA.
NCLEX Medical-Surgical: Endocrine Disorders 2
A client with type 1 diabetes is found unresponsive with cool, clammy skin and shallow respirations.
What should the nurse do first?