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Endocrine CCRN Practice Questions

10 free CCRN-style endocrine practice questions with full rationales. Perfect for last-minute review or rapid drilling on high-yield concepts.

Question Index

  1. Q1: A Type 1 diabetic presents with glucose 450 mg/dL, pH 7.18, HCO3 10, positive ke…
  2. Q2: Which finding differentiates DKA from HHS?
  3. Q3: A patient in thyroid storm would present with all of the following EXCEPT:
  4. Q4: A patient with hyponatremia (Na 118), low serum osmolality (100 most likely has:…
  5. Q5: A patient with adrenal insufficiency requires surgery. The appropriate stress-do…
  6. Q6: Diabetes Insipidus is characterized by all EXCEPT:
  7. Q7: The target blood glucose range for critically ill patients in the ICU is:
  8. Q8: Myxedema coma is treated with IV thyroid hormone PLUS:
  9. Q9: A patient with known Type 2 diabetes presents with glucose 1100 mg/dL, serum osm…
  10. Q10: What should be given BEFORE feeding a severely malnourished patient to prevent W…
Question 1

A Type 1 diabetic presents with glucose 450 mg/dL, pH 7.18, HCO3 10, positive ketones. After IV fluids are started, the NEXT priority is:

  1. Check potassium level before insulin
  2. Give sodium bicarbonate
  3. Start IV regular insulin immediately
  4. Give oral glucose

Correct Answer: A. Check potassium level before insulin

Rationale: Check potassium BEFORE starting insulin in DKA. Although total body potassium is depleted, serum K may be normal or high due to acidosis shifting K out of cells. Insulin drives K back into cells, potentially causing fatal hypokalemia. Hold insulin if K <3.3 until K is replaced. Replace K when <5.3 and patient is voiding.
Question 2

Which finding differentiates DKA from HHS?

  1. Hyperglycemia
  2. Dehydration
  3. Presence of ketones
  4. Altered mental status

Correct Answer: C. Presence of ketones

Rationale: Ketones differentiate DKA from HHS. DKA has ketoacidosis (ketones present, pH <7.3, anion gap acidosis). HHS has minimal or no ketones and pH usually >7.3. Both have hyperglycemia (though HHS typically higher >600), dehydration, and can have altered mental status (more common in HHS due to hyperosmolarity).
Question 3

A patient in thyroid storm would present with all of the following EXCEPT:

  1. Fever >104°F
  2. Tachycardia >140 bpm
  3. Bradycardia
  4. Altered mental status

Correct Answer: C. Bradycardia

Rationale: Thyroid storm is a hypermetabolic state with tachycardia (often >140), hyperpyrexia (>104°F), hypertension progressing to hypotension, and altered mental status. Bradycardia is NOT seen in thyroid storm but is characteristic of hypothyroidism/myxedema coma. Treatment includes beta blockers, PTU, iodine (after PTU), and glucocorticoids.
Question 4

A patient with hyponatremia (Na 118), low serum osmolality (<275), and urine osmolality >100 most likely has:

  1. Diabetes insipidus
  2. SIADH
  3. Psychogenic polydipsia
  4. Addison's disease

Correct Answer: B. SIADH

Rationale: SIADH presents with: Hyponatremia, low serum osmolality (<275), inappropriately concentrated urine (osmolality >100), high urine sodium (>40). Excess ADH causes water retention and dilutional hyponatremia. DI would show hypernatremia with dilute urine. Treat with fluid restriction, and hypertonic saline if severe.
Question 5

A patient with adrenal insufficiency requires surgery. The appropriate stress-dose steroid is:

  1. Dexamethasone 4 mg
  2. Hydrocortisone 100 mg IV
  3. Prednisone 20 mg PO
  4. Methylprednisolone 40 mg IV

Correct Answer: B. Hydrocortisone 100 mg IV

Rationale: Hydrocortisone 100 mg IV bolus is the standard stress-dose steroid for adrenal crisis or surgical stress in patients with adrenal insufficiency. Continue with 50-100 mg every 6-8 hours during the acute stress period. Hydrocortisone has both glucocorticoid and mineralocorticoid activity, which is important in adrenal insufficiency.
Question 6

Diabetes Insipidus is characterized by all EXCEPT:

  1. Polyuria
  2. Hypernatremia
  3. Concentrated urine
  4. Low urine specific gravity

Correct Answer: C. Concentrated urine

Rationale: DI presents with DILUTE urine (low specific gravity <1.005, low urine osmolality <200), NOT concentrated urine. The patient produces large volumes (5-15 L/day) of dilute urine due to lack of ADH effect, leading to hypernatremia and elevated serum osmolality. Concentrated urine with low output suggests SIADH.
Question 7

The target blood glucose range for critically ill patients in the ICU is:

  1. 80-110 mg/dL
  2. 110-140 mg/dL
  3. 140-180 mg/dL
  4. 180-220 mg/dL

Correct Answer: C. 140-180 mg/dL

Rationale: Current guidelines recommend a target glucose of 140-180 mg/dL for most critically ill patients. Tight glucose control (80-110) was shown to increase hypoglycemia and mortality (NICE-SUGAR trial). Very high glucose (>180) is associated with worse outcomes. Individualize based on patient factors.
Question 8

Myxedema coma is treated with IV thyroid hormone PLUS:

  1. Insulin
  2. Calcium gluconate
  3. Glucocorticoids
  4. Beta blockers

Correct Answer: C. Glucocorticoids

Rationale: Myxedema coma treatment includes IV T4 (and/or T3) PLUS glucocorticoids. Corticosteroids are given because thyroid hormone replacement increases metabolic rate and can precipitate adrenal crisis if underlying adrenal insufficiency exists. Also provide supportive care: passive warming, ventilatory support, and cautious fluid administration.
Question 9

A patient with known Type 2 diabetes presents with glucose 1100 mg/dL, serum osmolality 340, pH 7.38, and minimal ketones. This is most consistent with:

  1. Diabetic ketoacidosis
  2. Hyperosmolar hyperglycemic state
  3. Lactic acidosis
  4. Alcoholic ketoacidosis

Correct Answer: B. Hyperosmolar hyperglycemic state

Rationale: HHS is characterized by: Type 2 diabetes, severe hyperglycemia (often >600-1000), hyperosmolarity (>320), minimal/no ketones, and pH usually >7.3. The profound hyperglycemia and hyperosmolarity differentiate it from DKA. HHS has higher mortality and more neurological symptoms due to severe dehydration and hyperosmolarity.
Question 10

What should be given BEFORE feeding a severely malnourished patient to prevent Wernicke encephalopathy?

  1. Phosphorus
  2. Magnesium
  3. Thiamine
  4. Folate

Correct Answer: C. Thiamine

Rationale: Thiamine (Vitamin B1) should be given BEFORE feeding malnourished patients. Carbohydrate metabolism requires thiamine as a cofactor. Refeeding increases carbohydrate metabolism, depleting thiamine stores and potentially causing Wernicke encephalopathy (confusion, ataxia, ophthalmoplegia). Always give thiamine before glucose in at-risk patients.

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Premium Practice Question

A 19-year-old with type 1 DM arrives with abdominal pain and Kussmaul respirations. Labs: glucose 610 mg/dL, pH 7.08, HCO₃ 10, anion gap 28, serum K 3.0, lactate 2.2. BP 92/54, HR 128. Which provider order should the nurse prioritize first?

  1. Start insulin infusion now
  2. Give IV potassium replacement and begin isotonic fluids
  3. Give sodium bicarbonate bolus
  4. Start D5½NS immediately
Rationale: In DKA, insulin will shift K into cells—if K <3.3, you must replace K first (and start fluids) before insulin to prevent lethal arrhythmias. Bicarb is not first-line and D5 fluids are used later when ...
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Premium Practice Question

A 76-year-old with type 2 DM is brought in for progressive confusion and lethargy over 3 days. VS: HR 118, BP 86/48, dry mucous membranes. Labs: glucose 1180, pH 7.36, HCO₃ 24, anion gap 10, ketones negative, serum osmolality 338. Which diagnosis best fits?

  1. DKA
  2. HHS
  3. Mixed DKA-HHS
  4. SIADH
Rationale: HHS = very high glucose, hyperosmolarity (>320), minimal/absent ketones, and near-normal pH. Neuro symptoms are prominent due to hyperosmolar state....
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Premium Practice Question

A 58-year-old with type 2 DM presents with tachypnea and confusion. Labs: glucose 960, pH 7.22, HCO₃ 16, anion gap 22, ketones positive, serum osmolality 326, K 4.8. BP 90/50. What is the best initial management priority?

  1. Insulin bolus first, then fluids
  2. Aggressive isotonic fluid resuscitation, then insulin infusion
  3. Hypertonic saline for hyperosmolarity
  4. Fluid restriction due to dilutional hyponatremia
Rationale: This is mixed DKA-HHS (gap acidosis + hyperosmolarity). In both conditions, fluids are first priority to restore perfusion/volume; insulin follows after resuscitation is underway....
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