CCRN Endocrine and Metabolic Crises 2 — Questions and Answers
Question 1: A patient in diabetic ketoacidosis (DKA) has a serum potassium of 5.8 mEq/L on admission. What is the priority nursing consideration regarding potassium?
- Total body potassium is depleted despite the elevated serum level (Correct answer)
- Potassium should be aggressively bound with kayexalate immediately
- The elevated level reflects true potassium overload
- Insulin should be withheld until potassium normalizes on its own
Correct answer: Total body potassium is depleted despite the elevated serum level
In DKA, acidosis shifts potassium extracellularly, so a normal or high serum level masks a significant total-body deficit that worsens once insulin drives potassium back into cells.
Question 2: Which laboratory finding best distinguishes hyperosmolar hyperglycemic state (HHS) from DKA?
- Profound hyperglycemia with minimal ketosis and near-normal pH (Correct answer)
- Severe metabolic acidosis with large ketones
- Low serum osmolality
- Markedly elevated anion gap with normal glucose
Correct answer: Profound hyperglycemia with minimal ketosis and near-normal pH
HHS is characterized by extreme hyperglycemia and high osmolality but little or no ketosis because residual insulin prevents lipolysis.
Question 3: A patient with DKA is started on an insulin infusion. The glucose drops from 600 to 250 mg/dL. What is the appropriate next step?
- Add dextrose to the IV fluids while continuing the insulin infusion (Correct answer)
- Stop the insulin infusion immediately
- Give a bolus of regular insulin
- Switch to oral hypoglycemic agents
Correct answer: Add dextrose to the IV fluids while continuing the insulin infusion
Once glucose reaches about 200-250 mg/dL, dextrose is added so insulin can continue clearing ketones without causing hypoglycemia.
Question 4: Which assessment finding is most consistent with myxedema coma?
- Hypothermia, bradycardia, and altered mental status (Correct answer)
- Hyperthermia, tachycardia, and agitation
- Hypertension and exophthalmos
- Diaphoresis and heat intolerance
Correct answer: Hypothermia, bradycardia, and altered mental status
Myxedema coma is severe hypothyroidism presenting with hypothermia, bradycardia, hypoventilation, and decreased consciousness.
Question 5: A patient in thyroid storm has a temperature of 105.8°F and heart rate of 160. Which medication is given to block peripheral conversion of T4 to T3 and reduce thyroid output?
- Propylthiouracil (PTU) (Correct answer)
- Levothyroxine
- Aspirin
- Furosemide
Correct answer: Propylthiouracil (PTU)
PTU both inhibits thyroid hormone synthesis and blocks peripheral conversion of T4 to the more active T3.
Question 6: Why is aspirin contraindicated for fever control in thyroid storm?
- It displaces thyroid hormone from binding proteins, raising free hormone levels (Correct answer)
- It causes severe bradycardia
- It blocks beta receptors excessively
- It suppresses TSH dangerously
Correct answer: It displaces thyroid hormone from binding proteins, raising free hormone levels
Salicylates displace thyroid hormone from thyroid-binding globulin, increasing free hormone and worsening the storm.
Question 7: A patient with adrenal (Addisonian) crisis presents with hypotension unresponsive to fluids. What is the priority pharmacologic treatment?
- IV hydrocortisone (Correct answer)
- IV insulin
- Beta-blockers
- Diuretics
Correct answer: IV hydrocortisone
Addisonian crisis is acute cortisol deficiency, so IV hydrocortisone is the lifesaving treatment along with fluids and glucose.
CCRN Endocrine and Metabolic Crises 2
A patient in diabetic ketoacidosis (DKA) has a serum potassium of 5.8 mEq/L on admission.
What is the priority nursing consideration regarding potassium?