NCLEX-PN : Conditions and Treatments

Study concepts, example questions & explanations for NCLEX-PN

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Example Questions

Example Question #23 : Endocrine Conditions

A 45-year-old female client with Addison's disease has presented to the client for instruction on her medication regiment The nurse understands that the patient may require lifelong corticosteroid replacement. It will be necessary to educate the client about possible side effects of this type of therapy. 

Which of the following should a nurse include in his/her teaching plan about corticosteroid therapy?

Possible Answers:

Monitor glucose with finger sticks to check for hypoglycemia.

The medications should be taken on a empty stomach in the morning to avoid nausea if taken with food. 

Increase calcium intake to at least  with vitamin D, to help to prevent steroid induced osteoporosis. 

Incease intake of folic acid and B12 to prevent neurological side effects such as paresthesias of the hands and feet.

Increase sodium intake to prevent hypotension due to edema. 

Correct answer:

Increase calcium intake to at least  with vitamin D, to help to prevent steroid induced osteoporosis. 

Explanation:

Corticosteroids may lead to bone loss, especially after long term treatment (over 3 months). Calcium and vitamin D supplementation can help prevent these side effects. The client should also be advised to start a low impact exercise regimine if possible, and if necessary take a bisphosphonate drug. 

Example Question #432 : Conditions And Treatments

You are caring for a patient who is started on clindamycin, ketorolac, prednisone, lisinopril, and simvastatin. After receiving multiple doses of each of these medications, you notice that the patient's blood glucose is . Which of these medications is known to cause hyperglycemia?

Possible Answers:

Ketorolac

Simvastatin

Prednisone

Lisinopril

Clindamycin

Correct answer:

Prednisone

Explanation:

The correct answer is prednisone. Of all the medications listed, prednisone is the only medication that is known to cause hyperglycemia. 

Prednisone has a number of side effects including hyperglycemia, acne, headache, restlessness, insomnia, nausea, vomiting, and weight gain, among others. 

Clindamycin's side effects include diarrhea (including Clostridium difficile), and less commonly nausea, vomiting, and abdominal pain, among others, but not hyperglycemia.

Ketorolac's side effects include renal toxicity, tinnitus, heartburn, diarrhea, and abdominal pain, among others, but not hyperglycemia.

Lisinopril's side effects include hypotension, lightheadedness, angioedema, and barky cough, among others, but not hyperglycemia.

Simvastatin's side effects include muscle pains/aches, muscle weakness, and less frequently confusion, and electrolyte disturbances, but not hyperglycemia.

Example Question #432 : Conditions And Treatments

You are the nurse taking care of a patient with type two diabetes mellitus. The patient is hospitalized for pneumonia and switched from his home medication, metformin, to sliding-scale insulin, while inpatient. You explain to the patient that the specific reason is which of the following? 

Possible Answers:

To prevent depression while hospitalized 

To prevent stroke while hospitalized

To prevent lactic acidosis while hospitalized

To prevent headache while hospitalized

To prevent myocardial infarction while hospitalized

Correct answer:

To prevent lactic acidosis while hospitalized

Explanation:

The correct answer is "to prevent lactic acidosis while hospitalized." This is the correct answer because a known side effect of metformin use is development of lactic acidosis (a form of metabolic acidosis). Patients who are hospitalized, especially if hospitalized for infections, like pneumonia, are independently at an elevated risk of developing a lactic acidosis. As such, to minimize the risk of lactic acidosis, a modifiable risk factor, metformin use, is frequently temporarily discontinued while inpatient. Patients on metformin are frequently switched to sliding-scale insulin as inpatients, as this allows for adequate glycemic monitoring, titration, and control. Once they are stable for discharge and the cause of their hospitalization is addressed and treated, most can be safely discharged home on metformin without issue.

While numerous measures are carried out while patients are hospitalized to prevent myocardial infarction, stroke, headache, and depression, the switching of metformin to sliding-scale insulin is not performed specifically for any of those reasons.

Example Question #24 : Endocrine Conditions

Which of the following is true of type I diabetes?

Possible Answers:

Patients typically present in diabetic ketoacidosis

Patients are typically overweight adults

Patients develop insulin resistance

Patients do not require treatment with insulin

Correct answer:

Patients typically present in diabetic ketoacidosis

Explanation:

Type I diabetes is an autoimmune process that typically presents in young children in the form of DKA (diabetic ketoacidosis). This potentially life threatening condition is treated with IV insulin. Type II diabetes is insulin resistance, and is found in older adults (typically those who are overweight).

Example Question #1 : Symptoms And Tests For Endocrine Conditions

The nurse is caring for a patient who is to receive a fasting blood glucose test. The nurse does all of the following to prepare the patient except __________.

Possible Answers:

Stops the patient's D5 0.45 IV maintenance fluid

Instructs the patient to refrain from the use of hard candy

Instructs the patient not to use any gum or breath mints

Marks the patient NPO 2 hours before the test

Restricts meals 4-8 hours before the test

Correct answer:

Marks the patient NPO 2 hours before the test

Explanation:

The patient should refrain from ingesting any material that may contain sugar prior to a fasting blood glucose. However, is not necessary for a patient to be labeled NPO as they are still able to ingest water. All other preparations should be made.

Example Question #1241 : Nclex

The nurse cares for a patient newly diagnosed with systemic lupus erythematosus (SLE). Which of the following is a characteristic sign of SLE?

Possible Answers:

Lesions on extremities

Blood in urine

Arthritis and joint swelling

Butterfly rash across bridge of nose and cheeks

Pain during exposure to cold

Correct answer:

Butterfly rash across bridge of nose and cheeks

Explanation:

The most characteristic sign of SLE is a butterfly rash across the bridge of nose and cheeks. The others listed are also signs and symptoms of SLE, but the most well-known sign that is specific to SLE is the butterfly rash. Arthritis and joint swelling, hematuria, lesions on extremities, and pain during exposure to cold (Raynaud’s phenomenon) may be signs of other diseases 

Example Question #2 : Symptoms And Tests For Endocrine Conditions

The nurse reviews lab results for a patient with hyperparathyroidism. Which of the following changes in lab findings would the nurse expect?

Possible Answers:

Low vitamin D level

Low serum calcium level

High serum calcium level

Normal vitamin D level

Low parathyroid hormone level

Correct answer:

High serum calcium level

Explanation:

The nurse should know the parathyroid glands regulate serum calcium levels; in hyperparathyroidism, serum calcium levels are elevated. Parathyroid hormones are not low in hyperparathyroidism due to the overactivity of the parathyroid glands. Urine calcium may be elevated due to spilling of the high serum calcium level into the urine. Vitamin D levels should be low, as the body will increase vitamin D in the blood to lower the calcium level.

Example Question #1 : Endocrine Condition Follow Up

What type of thyroid cancer has the worst prognosis?

Possible Answers:

Medullary carcinoma

Anaplastic carcinoma

Follicular carcinoma

Papillary carcinoma

Correct answer:

Anaplastic carcinoma

Explanation:

The 5 year survival rate for aplastic carcinoma of the thyroid is 7-14%. The 5 year survival rates of papillary, medullary, and follicular thyroid carcinomas are close to 100% for stage I cancers. Survival rates decrease to approximately 50% for stage IV papillary and follicular carcinomas and 28% for stage IV medullary carcinoma. 

Example Question #2 : Endocrine Condition Follow Up

The home health nurse assesses the home of a elderly diabetic patient with peripheral neuropathy who lives alone. Which of the following observations most concerns the nurse?

Possible Answers:

The patient uses the bath without testing the temperature of the water.

The patient wears slippers when walking around the house.

The patient does not exercise when her blood sugar is high.

The patient has a full-length mirror to assess feet daily.

The patient cuts toenails straight across.

Correct answer:

The patient uses the bath without testing the temperature of the water.

Explanation:

Peripheral neuropathy is a common condition among elderly diabetic patients. Due to the loss of sensation in fingers, arms, legs, and toes, these patients must be aware of their surroundings, use proper foot care, inspect feet daily (with a mirror if the patient is elderly or has decreased joint mobility), wear well-fitting shoes, avoid heating pads on feet, avoid walking barefoot, and cut toenails straight across without rounding corners. It is also important for the patient to avoid exercise when their condition is poorly controlled due to the increased demand for glucose. This patient must be sure to check the temperature of baths before using them, as the potential for burns is high in those with decreased sensation and neuropathy.

Example Question #3 : Endocrine Condition Follow Up

The bedside nurse cares for a patient newly diagnosed with cystic fibrosis and educates the patient on new diet modifications. The nurse is concerned when the patient makes which of the following statements?

Possible Answers:

“A good meal for me to eat would have fruits, vegetables, and lean meats.”

“I will increase the amount of calories I consume when I am sick.”

“I will avoid soda, junk food, bacon, and butter.”

“I will cut all protein from my diet because I do not absorb proteins well.”

“I will make sure to take my medications for enzyme replacement before or with my meals.”

Correct answer:

“I will cut all protein from my diet because I do not absorb proteins well.”

Explanation:

Cystic fibrosis is a disorder that mainly affects the lungs, but also alters fat metabolism from a lack of pancreatic enzymes. The disorder is treated with pancreatic enzyme replacement, which is best absorbed when taken before meals or with food. The best diet for cystic fibrosis is low-fat and cholesterol-restricted with good sources of protein, such as fruit, vegetables, lean meats, and cereals. These patients must avoid fatty, marbled meats such as bacon, fatty foods such as avocado, egg yolks, and butter. During illness, patients with cystic fibrosis have higher calorie and protein demands.

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