Metabolic and Endocrine Disorders Practice questions.
Endocrine disorders alter a patient’s health and self-image. These disorders may affect the patient’s growth and development, reproductive system, energy level, metabolic rate, or ability to adapt to stress. Some disorders, such as Cushing’s syndrome and goiter, profoundly alter the body. Others, such as diabetes mellitus, require the patient to follow a stringent drug regimen and meal plan.
Following 10 Practice Questions are based on Metabolic and Endocrine Disorders.
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Question 1 of 7
1. Question
1 points
A health care provider prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription?
Correct
Answer: Option 4 is the correct answer.
Rationale: In hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment before administering potassium chloride intravenouslywould be to assess the status of the urine output. Potassium chloride should never be administered in the presence of oliguria or anuria. If the urine output is less than 1 to 2 mL/kg/hour, potassium chloride should not be administered. Although options 1, 2, and 3 are appropriate assessments for a child with dehydration, these assessments are not related specifically to the IV administration of potassium chloride. Test-Taking Strategy: Note the strategic word, priority. Focus on the IVprescription. Recalling that the kidneys play a key role in the excretion and reabsorption of potassium will direct you to the correct option. Review: Nursing considerations for the administration of potassium chloride • Level of Cognitive Ability: Analyzing • Client Needs: Physiological Integrity • Integrated Process: Nursing Process—Assessment • Content Area: Pediatrics—Metabolic/Endocrine • Priority Concepts: Clinical Judgment; Fluid and Electrolytes • Reference: Hockenberry, Wilson (2015), pp. 952-953.
Incorrect
Answer: Option 4 is the correct answer.
Rationale: In hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment before administering potassium chloride intravenouslywould be to assess the status of the urine output. Potassium chloride should never be administered in the presence of oliguria or anuria. If the urine output is less than 1 to 2 mL/kg/hour, potassium chloride should not be administered. Although options 1, 2, and 3 are appropriate assessments for a child with dehydration, these assessments are not related specifically to the IV administration of potassium chloride. Test-Taking Strategy: Note the strategic word, priority. Focus on the IVprescription. Recalling that the kidneys play a key role in the excretion and reabsorption of potassium will direct you to the correct option. Review: Nursing considerations for the administration of potassium chloride • Level of Cognitive Ability: Analyzing • Client Needs: Physiological Integrity • Integrated Process: Nursing Process—Assessment • Content Area: Pediatrics—Metabolic/Endocrine • Priority Concepts: Clinical Judgment; Fluid and Electrolytes • Reference: Hockenberry, Wilson (2015), pp. 952-953.
Question 2 of 7
2. Question
1 points
An adolescent client with type 1 diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note?
Correct
Answer: Option D is the correct answer.
Rationale: Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Signs of hyperglycemia include fruity breath odor and a decreasing level of consciousness. Hunger can be a sign of hypoglycemia or hyperglycemia, but hypertension is not a sign of diabetic ketoacidosis. Hypotension occurs because of a decrease in blood volume related to the dehydrated state that occurs during diabetic ketoacidosis. Cold clammy skin, irritability, sweating, and tremors all are signs of hypoglycemia.
Test-Taking Strategy: Focus on the subject, the signs of diabetic ketoacidosis, and recall that in this condition the blood glucose level is elevated. Eliminate options 1, 2, and 3 because these signs do not occur with hyperglycemia. Recall that fruity breath odor and a change in the level of consciousness can occur during diabetic ketoacidosis.
Review: Signs and symptoms of hyperglycemia, hypoglycemia, and diabetic ketoacidosis
Rationale: Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Signs of hyperglycemia include fruity breath odor and a decreasing level of consciousness. Hunger can be a sign of hypoglycemia or hyperglycemia, but hypertension is not a sign of diabetic ketoacidosis. Hypotension occurs because of a decrease in blood volume related to the dehydrated state that occurs during diabetic ketoacidosis. Cold clammy skin, irritability, sweating, and tremors all are signs of hypoglycemia.
Test-Taking Strategy: Focus on the subject, the signs of diabetic ketoacidosis, and recall that in this condition the blood glucose level is elevated. Eliminate options 1, 2, and 3 because these signs do not occur with hyperglycemia. Recall that fruity breath odor and a change in the level of consciousness can occur during diabetic ketoacidosis.
Review: Signs and symptoms of hyperglycemia, hypoglycemia, and diabetic ketoacidosis
A mother brings her 3-week-old infant to a clinic for a phenylketonuria rescreening blood test. The test indicates a serum phenylalanine level of 1 mg/dL (60.5 mcmol/L). The nurse reviews this result and makes which interpretation?
Correct
Answer: Option B is the correct answer.
Rationa le: Phenylketonuria is a genetic (autosomal recessive) disorder that results in central nervous system damage from toxic levels of phenylalanine (an essential amino acid) in the blood. It is characterized by blood phenylalanine levels greater than 20 mg/dL (12.1 mcmol/L); normal level is 0 to 2 mg/dL (0 to 121 mcmol/L). A result of 1 mg/dL is a negative test result. Test-Taking Strategy: Eliminate options 3 and 4 first because they are comparable or alike, indicating no definitive finding. Note that the level identified in the question is a low level; this should assist in directing you to the correct option.
Review: Phenylketonuria Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Pediatrics—Metabolic/Endocrine
Priority Concepts: Clinical Judgment; Health Promotion
Reference: Hockenberry, Wilson (2015), p. 71.
Incorrect
Answer: Option B is the correct answer.
Rationa le: Phenylketonuria is a genetic (autosomal recessive) disorder that results in central nervous system damage from toxic levels of phenylalanine (an essential amino acid) in the blood. It is characterized by blood phenylalanine levels greater than 20 mg/dL (12.1 mcmol/L); normal level is 0 to 2 mg/dL (0 to 121 mcmol/L). A result of 1 mg/dL is a negative test result. Test-Taking Strategy: Eliminate options 3 and 4 first because they are comparable or alike, indicating no definitive finding. Note that the level identified in the question is a low level; this should assist in directing you to the correct option.
Review: Phenylketonuria Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Pediatrics—Metabolic/Endocrine
Priority Concepts: Clinical Judgment; Health Promotion
Reference: Hockenberry, Wilson (2015), p. 71.
Question 4 of 7
4. Question
1 points
A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion?
Correct
Answer: Option 4 is the correct answer.
Rationale: Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level decreases to an acceptable level. Intravenously administered potassium may be required, depending on the potassium level, but would not be part of the initial treatment.
Test-Taking Strategy: Focus on the subject, treatment for diabetic ketoacidosis. Eliminate option 3, knowing that dextrose would not be administered in a hyperglycemic state. Eliminate option 2 next, knowing that NPH insulin is not administered by the IV route. Recalling that hydration is the initial treatment in diabetic ketoacidosis will direct you to the correct option.
Rationale: Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level decreases to an acceptable level. Intravenously administered potassium may be required, depending on the potassium level, but would not be part of the initial treatment.
Test-Taking Strategy: Focus on the subject, treatment for diabetic ketoacidosis. Eliminate option 3, knowing that dextrose would not be administered in a hyperglycemic state. Eliminate option 2 next, knowing that NPH insulin is not administered by the IV route. Recalling that hydration is the initial treatment in diabetic ketoacidosis will direct you to the correct option.
The nurse has just administered ibuprofen to a child with a temperature of 102 °F (38.8 °C). The nurse should also take which action?
Correct
Answer: Option D is the correct answer.
Rationale: After administering ibuprofen, excess clothing and blankets should be removed. The child can be sponged with tepid water but not cold water, because the cold water can cause shivering, which increasesmetabolic requirements above those already caused by the fever. Aspirin is not administered to a child with fever because of the risk of Reye’s syndrome Fluids should be encouraged to prevent dehydration, so oral fluids should not be withheld.
Test-Taking Strategy: Focus on the subject, interventions for an elevated temperature. Remember that cooling measures such as removing excess clothing and blankets should be done when a child has a fever. Options 1, 2, and 3 are not interventions for a child with a fever.
Rationale: After administering ibuprofen, excess clothing and blankets should be removed. The child can be sponged with tepid water but not cold water, because the cold water can cause shivering, which increasesmetabolic requirements above those already caused by the fever. Aspirin is not administered to a child with fever because of the risk of Reye’s syndrome Fluids should be encouraged to prevent dehydration, so oral fluids should not be withheld.
Test-Taking Strategy: Focus on the subject, interventions for an elevated temperature. Remember that cooling measures such as removing excess clothing and blankets should be done when a child has a fever. Options 1, 2, and 3 are not interventions for a child with a fever.
A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted?
Correct
Answer: Option C is the correct answer.
Rationale: Indicators that fluid volume deficit is resolving would be capillary refill less than 2 seconds, specific gravity of 1.003 to 1.030, urine output of at least 1 mL/kg/hour, and adequate tear production. A capillary refill time less than 2 seconds is the only indicator that the child is improving. Urine output of less than 1 mL/kg/hour, a specific gravity of 1.035, and no tears would indicate that the deficit is not resolving.
Test-Taking Strategy: Focus on the subject, assessment findings indicating that fluid volume deficit is resolving. Recall the parameters that indicate adequate hydration status. The only option that indicates an improving fluid balance is option
The other options indicate fluid imbalance.
Review: Fluid volume deficit and fluid volume excess
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Evaluation
Content Area: Pediatrics—Metabolic/Endocrine
Priority Concepts: Evidence; Fluid and Electrolyte Balance
Reference: Hockenberry, Wilson (2015), p. 958.
Incorrect
Answer: Option C is the correct answer.
Rationale: Indicators that fluid volume deficit is resolving would be capillary refill less than 2 seconds, specific gravity of 1.003 to 1.030, urine output of at least 1 mL/kg/hour, and adequate tear production. A capillary refill time less than 2 seconds is the only indicator that the child is improving. Urine output of less than 1 mL/kg/hour, a specific gravity of 1.035, and no tears would indicate that the deficit is not resolving.
Test-Taking Strategy: Focus on the subject, assessment findings indicating that fluid volume deficit is resolving. Recall the parameters that indicate adequate hydration status. The only option that indicates an improving fluid balance is option
The other options indicate fluid imbalance.
Review: Fluid volume deficit and fluid volume excess
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Evaluation
Content Area: Pediatrics—Metabolic/Endocrine
Priority Concepts: Evidence; Fluid and Electrolyte Balance
Reference: Hockenberry, Wilson (2015), p. 958.
Question 7 of 7
7. Question
1 points
The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellituswho has a blood glucose level of 60 mg/dL (3.4 mmol/L)? Select all that apply.
Correct
Answer: Option 3,6 are correct answer.
Rationale: Hypoglycemia is defined as a blood glucose level less than 70 mg/dL (4 mmol/L). Hypoglycemia occurs as a result of too much insulin, not enough food, or excessive activity. If possible, the nurse should confirm hypoglycemia with a blood glucose reading. Glucose is administered orally immediately; rapid-releasing glucose is followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker. An extra snack is given if the next meal is not planned for more than 30 minutes or if activity is planned. If the child becomes unconscious, cake frosting or glucose paste is squeezed onto the gums, and the blood glucose level is retested in 15 minutes; if the reading remains low, additional glucose is administered. If the child remains unconscious, administration of glucagon may be necessary, and the nurse should be prepared for this intervention.
Encouraging the child to ambulate and administering regular insulin would result in a lowered blood glucose level. Providing electrolyte replacement therapy intravenously is an intervention to treat diabetic ketoacidosis.Waiting 30 minutes to confirm the blood glucose level delays necessary intervention.
Incorrect
Answer: Option 3,6 are correct answer.
Rationale: Hypoglycemia is defined as a blood glucose level less than 70 mg/dL (4 mmol/L). Hypoglycemia occurs as a result of too much insulin, not enough food, or excessive activity. If possible, the nurse should confirm hypoglycemia with a blood glucose reading. Glucose is administered orally immediately; rapid-releasing glucose is followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker. An extra snack is given if the next meal is not planned for more than 30 minutes or if activity is planned. If the child becomes unconscious, cake frosting or glucose paste is squeezed onto the gums, and the blood glucose level is retested in 15 minutes; if the reading remains low, additional glucose is administered. If the child remains unconscious, administration of glucagon may be necessary, and the nurse should be prepared for this intervention.
Encouraging the child to ambulate and administering regular insulin would result in a lowered blood glucose level. Providing electrolyte replacement therapy intravenously is an intervention to treat diabetic ketoacidosis.Waiting 30 minutes to confirm the blood glucose level delays necessary intervention.
The endocrine system consists of three major components:
glands, which are specialized cell clusters or organs
hormones, which are chemical substances secreted by glands in response to stimulation
receptors, which are protein molecules that trigger specific physiologic changes in a target cell in response to hormonalstimulation.
Metabolic Disorder:
A metabolic disorder occurs when abnormal chemical reactions in your body disrupt this process. When this happens, you might have too much of some substances or too little of other ones that you need to stay healthy. There are different groups of disorders. Some affect the breakdown of amino acids, carbohydrates, or lipids. Another group, mitochondrial diseases, affects the parts of the cells that produce the energy.
