Free NCLEX endocrine questions with full rationales
Four free NCLEX-RN endocrine emergency questions covering DKA fluid resuscitation priorities, post-thyroidectomy airway compromise, Addisonian crisis, and insulin management during hypokalemia.
Top endocrine NCLEX topics
- DKA vs HHS. DKA: type 1, glucose 250–600, pH < 7.3, ketones. HHS: type 2, glucose > 600, pH normal, no ketones. Both need fluids first, then insulin, then K+ replacement.
- Hypoglycemia. Glucose < 70 with symptoms. Conscious + can swallow → 15 g fast carbs. Unconscious → IM glucagon or IV dextrose.
- Thyroid storm. Hyperthermia, tachyarrhythmia, agitation. Beta-blockers, PTU/methimazole, cooling, IV fluids.
- Myxedema coma. Hypothermia, bradycardia, hypotension, altered mental status. IV levothyroxine, gentle rewarming.
- SIADH vs DI. SIADH: too much ADH, dilutional hyponatremia, fluid restriction. DI: too little ADH, polyuria of dilute urine, desmopressin.
- Addisonian crisis. Cortisol deficiency: hypotension, hyperkalemia, hyponatremia, hypoglycemia. Immediate IV hydrocortisone + fluids.
- Cushing's syndrome. Cortisol excess: moon face, buffalo hump, striae, hyperglycemia. Surgical or medical management.
The 4 endocrine emergencies that absolutely appear on NCLEX
- DKA. Fluids → insulin → K+ replacement. Watch for cerebral edema in pediatrics (do not drop glucose faster than 50–75 mg/dL/hr).
- Hypoglycemia. Treat immediately. Don't delay for repeat glucose check.
- Post-thyroidectomy. Stridor = airway emergency. Watch for hypocalcemia (parathyroid injury).
- Addisonian crisis. IV hydrocortisone first, fluids next. Don't fluid-restrict.
Try these 4 questions now
No signup required. Tap an answer to reveal the rationale.
- Question 1 · Endocrine · MCQ
A client with type 1 diabetes is admitted with DKA. Initial labs: glucose 580, K+ 5.2, pH 7.20. Which order should the nurse implement first?
- a.Start regular insulin IV drip at 0.1 units/kg/hr
- b.Bolus 1 L normal saline IV
- c.Administer sodium bicarbonate IV
- d.Give 40 mEq KCl PO
Show answer + rationale
Correct: B. DKA treatment priority: fluids first (1 L NS bolus), then insulin, then potassium replacement as it drops. Insulin without volume resuscitation can drop blood pressure dangerously and worsen perfusion. Sodium bicarbonate is reserved for pH below 6.9 in most protocols. K+ 5.2 doesn't need replacement yet (but will drop with insulin).
- Question 2 · Endocrine · MCQ
A client returns from a thyroidectomy. Which finding is the MOST concerning?
- a.Hoarse voice
- b.Sore throat
- c.Stridor and difficulty swallowing
- d.Numbness around the mouth
Show answer + rationale
Correct: C. Stridor post-thyroidectomy signals airway compromise from hematoma or laryngeal edema — surgical emergency requiring immediate provider notification and bedside opening of the incision if compression is severe. Hoarse voice may indicate recurrent laryngeal nerve irritation (usually transient). Sore throat is expected. Perioral numbness signals hypocalcemia from inadvertent parathyroid removal — also serious but secondary to airway.
- Question 3 · Endocrine · MCQ
A client with Addison's disease is admitted in adrenal crisis. Which intervention is the priority?
- a.Administer IV hydrocortisone immediately
- b.Restrict fluids to prevent overload
- c.Begin slow IV insulin drip
- d.Encourage oral salt intake
Show answer + rationale
Correct: A. Adrenal crisis is a life-threatening cortisol deficiency. Immediate IV hydrocortisone (100 mg) is the priority. The client typically needs aggressive volume resuscitation (NOT fluid restriction) for hypotension and hyponatremia. Insulin worsens hypoglycemia common in this state. Oral salt is far too slow for crisis.
- Question 4 · Endocrine · NGN case study
A client with type 1 diabetes is admitted with blood glucose 612 mg/dL, pH 7.18, HCO3 12 mEq/L, K+ 5.4 mEq/L, and ketones in the urine. The provider orders an IV insulin infusion. After 2 hours of treatment, the K+ is 3.3 mEq/L. What is the nurse's priority action?
- a.Continue insulin and notify the provider for potassium replacement
- b.Hold insulin until potassium is rechecked in 4 hours
- c.Administer 10 units of regular insulin IV push
- d.Encourage the client to drink orange juice with a banana
Show answer + rationale
Correct: A. Insulin drives potassium intracellularly. In DKA, hypokalemia is expected once treatment begins and is life-threatening (dysrhythmia risk) below 3.3 mEq/L. The protocol is to continue insulin while replacing potassium IV — not to hold insulin, which would cause rebound ketosis. Holding insulin without addressing potassium also delays correction of acidosis. Oral intake in DKA is unsafe.
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What's the priority in DKA treatment?
Fluids first. IV NS 1 L bolus before starting insulin. Insulin without volume resuscitation can drop perfusion and worsen acidosis. Then continuous IV insulin at 0.1 units/kg/hr. Then potassium replacement as it drops with insulin.
When do I worry about a thyroidectomy patient?
Stridor or difficulty swallowing post-thyroidectomy is an airway emergency from hematoma or laryngeal edema. Perioral numbness or Chvostek sign suggests hypocalcemia from parathyroid injury. Both need immediate intervention.
What's the difference between SIADH and DI?
SIADH = too much ADH, retains water, dilutional hyponatremia, concentrated urine. Treat with fluid restriction. DI = too little ADH, dumps water, hypernatremia, dilute urine. Treat with desmopressin and free water.
How do I treat hypoglycemia in an unconscious patient?
IM glucagon 1 mg if no IV access, IV dextrose D50 (25 g) if IV access. Recheck glucose in 15 min. Once awake, give complex carb + protein to prevent rebound.