Fatima College of Health Sciences

NURSING PROGRAM

BSN 430 Consolidated Clinical Practice

Endocrine System

1. A client is brought to the emergency department in an unresponsive state, and a diagnosis of the
hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate
which anticipated health care provider’s prescription?
1. Endotracheal intubation
2. 100 units of NPH insulin
3. Intravenous infusion of normal saline ✔
4. Intravenous infusion of sodium bicarbonate

2. An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the
nurse about the functioning of the pump, the nurse bases the response on which information about
the pump?

1. It is timed to release programmed doses of either short-duration or NPH insulin into the
bloodstream at specific intervals.
2. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly
monitoring blood glucose levels.
3. It is surgically attached to the pancreas and infuses regular insulin into the pancreas. This
releases insulin into the bloodstream.
4. It administers a small continuous dose of short duration insulin subcutaneously. The client can
self-administer an additional bolus dose from the pump before each meal. ✔

3. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency
department. Which findings support this diagnosis? Select all that apply.
1. Increase in pH
2. Comatose state✔
3. Deep, rapid breathing✔
4. Decreased urine output
5. Elevated blood glucose level✔

4. The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and
ketoacidosis. Does the client demonstrate an understanding of the teaching by stating that a form of
glucose should be taken if which symptom or symptoms develop? Select all that apply.
1. Polyuria
2. Shakiness✔
3. Palpitations✔
4. Blurred vision
5. Lightheadedness✔
6. Fruity breath odour

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5. A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the
treatment of hyperglycemia. What is the appropriate intervention to decrease the client’s anxiety?
1. Administer a sedative.
2. Convey empathy, trust, and respect toward the client. ✔
3. Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear.
4. Make sure that the client is familiar with the correct medical terms to promote understanding
of what is happening.

6. The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse
recognizes an accurate understanding of measures to prevent diabetic ketoacidosis when the client
makes which statement?

1. “I will stop taking my insulin if I’m too sick to eat.”

2. “I will decrease my insulin dose during times of illness.”
3. “I will adjust my insulin dose according to the level of glucose in my urine.”
4. “I will notify my health care provider (HCP) if my blood glucose level is higher than /dL (14.2
mmol/L).” ✔

7. A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood
glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of short-acting
insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now
decreased to 240 mg/dL (13.7 mmol/L). The nurse would next prepare to administer which
medication?

1. An ampule of 50% dextrose

2. NPH insulin subcutaneously
3. IV fluids containing dextrose✔
4. Phenytoin for the prevention of seizures

8. The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications.
Which sign or symptom, if exhibited in the client, indicates that the client is at risk for chronic
complications of diabetes if the blood glucose is not adequately managed?
1. Polyuria✔
2. Diaphoresis
3. Pedal oedema
4. Decreased respiratory rate

9. The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The
nurse places priority on which client problem?

1. Lack of knowledge
2. Inadequate fluid volume✔
3. Compromised family coping
4. Inadequate consumption of nutrients

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10. The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a
history of vomiting and diarrhoea and tells the nurse that no food has been consumed for the last 24
hours. Which additional statement by the client indicates a need for further teaching?

1. “I need to stop my insulin.” ✔

2. “I need to increase my fluid intake.”
3. “I need to monitor my blood glucose every 3 to 4 hours.”
4. “I need to call the health care provider (HCP) because of these symptoms.”

11. The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the
client’s nostril. The nurse should take which initial action ? A hypophysectomy is a surgery done
to remove the pituitary gland.
1. Lower the head of the bed.
2. Test the drainage for glucose. ✔
3. Obtain a culture of drainage.
4. Continue to observe the drainage.

12. The nurse is admitting a client who is diagnosed with the syndrome of inappropriate antidiuretic
hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which health care
provider prescriptions should the nurse anticipate receiving? Select all that apply.

1. Initiate an infusion of 3% NaCl. ✔

2. Administer intravenous furosemide.
3. Restrict fluids to 800 mL over 24 hours. ✔
4. Elevate the head of the bed to high Fowler’s.
5. Administer a vasopressin antagonist as prescribed. ✔

13. A client is admitted to an emergency department, and a diagnosis of myxedema coma is made.
Which action should the nurse prepare to carry out initially?

1. Warm the client.

2. Maintain a patent airway. ✔
3. Administer thyroid hormone.
4. Administer fluid replacement.

14. The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis
(DKA). In the acute phase, the nurse plans for which priority intervention?

1. Correct the acidosis.

2. Administer 5% dextrose intravenously.
3. Apply a monitor for an electrocardiogram.
4. Administer short-duration insulin intravenously. ✔

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15. A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia
with exercising. Which statement by the client indicates an adequate understanding of the peak
action of NPH insulin and exercise?

1. “I should not exercise since I am taking insulin.”

2. “The best time for me to exercise is after breakfast.” ✔
3. “The best time for me to exercise is mid-to-late afternoon.”
4. “NPH is a basal insulin, so I should exercise in the evening.”

16. The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for
primary hyperparathyroidism. Which client complaint would be characteristic of this disorder?
Select all that apply.

1. Polyuria✔
2. Headache
3. Bone pain✔
4. Nervousness
5. Weight gain

17. The nurse is teaching a client with hyperparathyroidism how to manage the condition at home.
Which response by the client indicates the need for additional teaching?

1. “I should limit my fluids to 1 litre per day.” ✔

2. “I should use my treadmill or go for walks daily.”
3. “I should follow a moderate-calcium, high fibre diet.”
4. “My alendronate helps to keep calcium from coming out of my bones.”

18. A client with a diagnosis of Addisonian crisis is being admitted to the intensive care unit. Which
findings will the interprofessional health care team focus on? Select all that apply . An addisonian
crisis is a life-threatening situation that results in low blood pressure, low blood levels of
sugar and high blood levels of potassium.

1. Hypotension✔
2. Leukocytosis
3. Hyperkalemia✔
4. Hypercalcemia
5. Hypernatremia

19. The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being
treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of
a possible hypoglycemic reaction? Select all that apply.

1. Tremors✔
2. Anorexia
3. Irritability✔

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 4. Nervousness✔
5. Hot, dry skin
6. Muscle cramps

20. The nurse is assessing a client with pheochromocytoma. Which assessment data would indicate a
potential complication associated with this disorder?
Pheochromocytoma is a type of neuroendocrine tumor that grows from cells called
chromaffin cells
1. A urinary output of 50 mL/hour
2. A coagulation time of 5 minutes
3. A heart rate that is 90 beats/minute and irregular ✔
4. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L)

21. The nurse is monitoring a client diagnosed with acromegaly who was treated with transsphenoidal
hypophysectomy and is recovering in the intensive care unit. Which findings should alert the nurse
to the presence of a possible postoperative complication? Select all that apply.

1. Anxiety
2. Leukocytosis✔
3. Chvostek’s sign
4. Urinary output of 800 mL/hour✔
5. Clear drainage on nasal dripper pad ✔

22. The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include
a fasting blood glucose level of 120 mg/dL (6.8 mmol/L), a temperature of 101 °F (38.3 °C), a pulse of
102 beats/minute, respirations of 22 breaths/minute, and blood pressure of 142/72 mm Hg. Which
finding would be the priority concern to the nurse?

1. Pulse
2. Respiration
3. Temperature✔
4. Blood pressure

23. What should be included in the nursing care plan for a client with diabetes insipidus?

1. Blood pressure every hour

2. Strict intake and output✔
3. Urine for ketone bodies
4. Glucose monitoring four times a day

24 The client is ready for discharge following adrenalectomy. Which statement that the client makes
indicates the best understanding of the client’s condition?

1. “I will continue on a low-sodium, low potassium diet.”

2. “My husband has arranged for a marriage counsellor because of our fights.”
3. “I will stay out of the sun so I will not turn splotchy brown.”
4. “I will take all of those pills every day.” ✔

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25. Antibiotics are ordered for a client who has had transsphenoidal hypophysectomy. He asks why he is
receiving an antibiotic when he does not have an infection. The primary reason for administering
antibiotics to this client is based on which information? hypophysectomy is an effective surgical
technique for removing pituitary and other intrasellar tumors 

1. Antibiotics will help to prevent respiratory complications following surgery.

2. Meningitis is a complication following transsphenoidal hypophysectomy. ✔

3. Fluid retention can cause dangerously high cerebrospinal fluid pressure.

4. Hormone replacement is essential after hypophysectomy.