CCRN - Review Endocrine and Metabolic Crises Questions and Answers

Question 1

A 78-year-old male with a history of type 2 diabetes is brought to the ICU with altered mental status.
His vital signs are: BP 90/60 mmHg, HR 125 bpm, RR 24, Temp 38.5°C.
Laboratory results show: Glucose 1,150 mg/dL, Serum Osmolality 345 mOsm/kg, Arterial pH 7.36, Serum Bicarbonate 25 mEq/L, and small ketones in the urine.
Which condition do these findings most strongly indicate?

Accepted Answer

Hyperosmolar Hyperglycemic State (HHS)

Answer

Diabetic Ketoacidosis (DKA)

Answer

Myxedema Coma

Answer

Thyroid Storm

Question 2

A patient with a history of Graves' disease is admitted to the ICU post-operatively and develops a fever of 40.5°C (105°F), heart rate of 165 bpm, agitation, and delirium. Which of the following medications is a priority to block the synthesis of new thyroid hormone?

Accepted Answer

Oral Propylthiouracil (PTU)

Answer

IV Levothyroxine

Answer

IV Amiodarone

Answer

Esmolol infusion

Question 3

A critical care nurse is managing a patient with central Diabetes Insipidus (DI) following neurosurgery. Which set of laboratory and clinical findings is most characteristic of this condition?

Accepted Answer

High serum sodium, low urine specific gravity, polyuria

Answer

Low serum sodium, high urine specific gravity, oliguria

Answer

High serum potassium, low serum osmolality, hypertension

Answer

Low serum sodium, low urine osmolality, fluid volume overload

Question 4

A patient with a known history of Addison's disease is admitted with profound hypotension that is refractory to fluid resuscitation and norepinephrine infusion. Labs reveal hyponatremia and hyperkalemia. Which medication is the priority to administer to treat the underlying cause of this patient's shock?

Accepted Answer

Hydrocortisone

Answer

Insulin and D50W

Answer

Desmopressin (DDAVP)

Answer

Fludrocortisone

Question 5

Which of the following findings is most consistent with a diagnosis of Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

Accepted Answer

Serum sodium 122 mEq/L, serum osmolality 260 mOsm/kg, urine specific gravity 1.030

Answer

Serum sodium 150 mEq/L, serum osmolality 315 mOsm/kg, polyuria

Answer

Serum sodium 138 mEq/L, urine specific gravity 1.002, intense thirst

Answer

Serum sodium 125 mEq/L, decreased urine osmolality, signs of dehydration

Question 6

A 76-year-old female is found unresponsive. In the ICU, she has a temperature of 34.4°C (94°F), heart rate of 45 bpm, blood pressure of 82/50 mmHg, periorbital edema, and a Glasgow Coma Scale score of 7. These clinical findings are most suggestive of which endocrine emergency?

Accepted Answer

Myxedema Coma

Answer

Adrenal Crisis

Answer

Thyroid Storm

Answer

Hyperosmolar Hyperglycemic State (HHS)