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Endocrine NCLEX practice questions
Endocrine emergencies are classic NCLEX material: DKA versus HHS, hypoglycemia, thyroid storm, adrenal crisis, SIADH and diabetes insipidus. Practice the presentation and the first action for each.
Question 1 · Physiological Adaptation
A nurse is assessing a client suspected of having an Addisonian crisis. Which findings should the nurse expect? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, C, D, E. Addisonian crisis, caused by acute adrenal insufficiency, results in severe hypotension, hypoglycemia (due to loss of cortisol's gluconeogenic effect), hyperkalemia (due to loss of aldosterone), and profound weakness. Hyperglycemia is not expected; cortisol deficiency leads to low, not high, blood glucose.
Checked against: OpenStax Medical-Surgical Nursing, 21.5
Question 2 · Physiological Adaptation
The nurse is caring for a client with suspected diabetic ketoacidosis (DKA). Which findings should the nurse expect? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, C, D, E. DKA is characterized by fruity (acetone) breath odor, Kussmaul respirations (deep, rapid breathing to blow off CO2), blood glucose typically greater than 250 mg/dL, and an onset over hours to days, most commonly in type 1 diabetes. A blood glucose of 220 mg/dL is below the threshold typically associated with DKA. Profound dehydration without ketones describes hyperosmolar hyperglycemic state (HHS), which occurs in type 2 diabetes without significant ketosis.
Checked against: OpenStax Medical-Surgical Nursing, 21.2; OpenStax Clinical Nursing Skills, 10.1
Question 3 · Reduction of Risk Potential
The nurse is planning care for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which findings and treatments does the nurse anticipate? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, B, D, F. SIADH causes water retention, leading to dilutional hyponatremia, scant dark concentrated urine, and seizure risk from severe low sodium; treatment includes fluid restriction. Polyuria with dilute urine is characteristic of diabetes insipidus (DI), where water is lost rather than retained, so it does not fit SIADH. Desmopressin is used to treat DI by replacing ADH, not SIADH, where the problem is already too much ADH.
Checked against: OpenStax Medical-Surgical Nursing, 21.4; OpenStax Pharmacology for Nurses, 26.3
Question 4 · Physiological Adaptation
A nurse finds an unresponsive client with a fingerstick glucose of 32 mg/dL. Which action should the nurse take?
Show answer and rationale
Answer: B. An unconscious client cannot safely swallow, so oral treatments (including glucose gel or juice) risk aspiration and are contraindicated. The nurse should administer IV D50 or IM glucagon, then recheck glucose after treatment. Delaying treatment in an unconscious, severely hypoglycemic client is unsafe.
Checked against: OpenStax Pharmacology for Nurses, 28.3; OpenStax Nutrition for Nurses, 7.2
Question 5 · Physiological Adaptation
A client with diabetes insipidus is being treated with IV fluid replacement. Which laboratory finding would the nurse expect before treatment begins?
Show answer and rationale
Answer: B. DI causes excretion of large volumes of dilute urine, leading to water loss and hypernatremia (elevated serum sodium), along with elevated serum osmolality and low urine specific gravity. A serum sodium of 130 mEq/L reflects hyponatremia, which is seen in SIADH, not DI. Urine specific gravity would be low (dilute), not 1.030 (concentrated), in DI.
Checked against: OpenStax Pharmacology for Nurses, 33.2
Question 6 · Pharmacological and Parenteral Therapies
The nurse teaches a client on long-term corticosteroid therapy. Which statements by the client indicate correct understanding of the teaching? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, B, C, D. Correct understanding includes never stopping steroids abruptly and always tapering, expecting elevated blood glucose, knowing infection signs can be masked, and recognizing possible mood changes — all expected effects of corticosteroid therapy. The statement about taking less steroid during illness or surgery is incorrect and shows a need for further teaching, because the body actually needs MORE steroid coverage during physiologic stress, and reducing the dose risks adrenal crisis.
Checked against: OpenStax Fundamentals of Nursing, 30.5; OpenStax Clinical Nursing Skills, 16.5
Question 7 · Physiological Adaptation
A client presents with bronze-colored skin, hypotension, and unintentional weight loss. The nurse suspects which condition?
Show answer and rationale
Answer: B. Bronze skin, hypotension, and weight loss are classic signs of Addison's disease (low cortisol) — remember "ADDison's = ADD steroids" for treatment. Cushing's disease features the opposite: moon face, buffalo hump, thin skin, and high glucose from excess cortisol, not bronzing or weight loss. SIADH and diabetes insipidus are disorders of ADH and fluid balance, not cortisol, and do not cause skin bronzing or this weight pattern.
Checked against: openstax.org; pubmed.ncbi.nlm.nih.gov
Question 8 · Reduction of Risk Potential
A client with type 1 diabetes receives regular insulin at 0730 before breakfast. Based on the peak action of regular insulin, at what time should the nurse anticipate the greatest risk for hypoglycemia?
Show answer and rationale
Answer: D. Regular insulin peaks 2 to 4 hours after administration, so the highest risk for hypoglycemia after a 0730 dose falls between 0930 and 1130; the nurse should schedule glucose checks and ensure food intake during this window. 0745 to 0800 is too soon after injection, occurring near onset rather than peak. 0830 is still before the peak window begins. 1930 is many hours later and does not correspond to this dose's peak action.
Checked against: OpenStax Pharmacology for Nurses, 28.2
Question 9 · Management of Care
A client is admitted with a temperature of 105°F (40.6°C), heart rate of 168 beats/min, and severe agitation. The client has a history of Graves' disease and recently stopped taking antithyroid medication. The nurse should prioritize which action?
Show answer and rationale
Answer: A. These findings indicate thyroid storm, a life-threatening emergency requiring immediate provider notification and rapid treatment with antithyroid medications, beta-blockers, and cooling measures. A warming blanket would worsen hyperthermia. Waiting 4 hours delays urgently needed treatment. Beta-blockers should be given promptly, not delayed until the temperature normalizes, as they help control the dangerous tachycardia.
Checked against: openstax.org
Question 10 · Pharmacological and Parenteral Therapies
A client has been taking oral corticosteroids for 3 months for a chronic inflammatory condition. The nurse teaches the client that the medication must never be stopped abruptly because doing so can cause which complication?
Show answer and rationale
Answer: A. Long-term corticosteroid use suppresses the adrenal glands' own cortisol production; abrupt discontinuation does not allow the adrenal glands time to resume function, risking a life-threatening adrenal (Addisonian) crisis. The dose must always be tapered gradually. Thyroid storm, DKA, and SIADH are unrelated to corticosteroid withdrawal.
Checked against: OpenStax Medical-Surgical Nursing, 21.5
Question 11 · Pharmacological and Parenteral Therapies
A client receives NPH insulin at 0700. The nurse should assess most closely for signs of hypoglycemia during which time frame?
Show answer and rationale
Answer: A. NPH insulin peaks between 4 and 12 hours after administration, so the window of highest hypoglycemia risk after a 0700 dose is roughly 1100 to 1900. The 0715-0800 window reflects the peak time of rapid-acting insulin, not NPH. The 0900-1100 window matches the peak of regular insulin, which peaks at 2-4 hours. The 2100-2300 window is beyond NPH's peak action, so hypoglycemia risk is lower by then even though some insulin activity may remain.
Checked against: openstax.org
Question 12 · Physiological Adaptation
A client is admitted with thyroid storm. Which nursing intervention is priority?
Show answer and rationale
Answer: D. Thyroid storm causes a hypermetabolic state with fever, tachycardia, and agitation, so the priority is cooling the client and giving antithyroid medication such as methimazole or propylthiouracil to stop further thyroid hormone production. Warming blankets and levothyroxine treat myxedema coma, the opposite picture, and would worsen thyroid storm. Restricting fluids is a treatment for SIADH and would worsen the fluid loss from fever and a high metabolic rate, and desmopressin replaces ADH in diabetes insipidus, which is treated with adequate fluids and desmopressin; neither belongs in thyroid storm care. Hydrocortisone and fluids given for adrenal crisis address Addisonian crisis, a different endocrine emergency.
Checked against: OpenStax Pharmacology for Nurses, 27.2
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Frequently asked questions
What is the difference between DKA and HHS?
Both involve high blood glucose, but DKA (usually type 1) produces ketones and metabolic acidosis with Kussmaul respirations, while HHS (usually type 2) has extreme glucose and dehydration with little or no ketosis.
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About these questions
Every question on this page was approved by a licensed RN, and its answer was checked against open nursing references (mostly OpenStax nursing textbooks) before publishing. They are NCLEX-style practice, not real NCLEX items. NurseLingo is not affiliated with NCSBN. Spot a problem? Tell us.