CCRN Endocrine and Metabolic Crises 2

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?

Accepted Answer

Total body potassium is depleted despite the elevated serum level

Answer

Potassium should be aggressively bound with kayexalate immediately

Answer

The elevated level reflects true potassium overload

Answer

Insulin should be withheld until potassium normalizes on its own

Question 2

Which laboratory finding best distinguishes hyperosmolar hyperglycemic state (HHS) from DKA?

Accepted Answer

Profound hyperglycemia with minimal ketosis and near-normal pH

Answer

Severe metabolic acidosis with large ketones

Answer

Low serum osmolality

Answer

Markedly elevated anion gap with normal glucose

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?

Accepted Answer

Add dextrose to the IV fluids while continuing the insulin infusion

Answer

Stop the insulin infusion immediately

Answer

Give a bolus of regular insulin

Answer

Switch to oral hypoglycemic agents

Question 4

Which assessment finding is most consistent with myxedema coma?

Accepted Answer

Hypothermia, bradycardia, and altered mental status

Answer

Hyperthermia, tachycardia, and agitation

Answer

Hypertension and exophthalmos

Answer

Diaphoresis and heat intolerance

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?

Accepted Answer

Propylthiouracil (PTU)

Answer

Levothyroxine

Answer

Aspirin

Answer

Furosemide

Question 6

Why is aspirin contraindicated for fever control in thyroid storm?

Accepted Answer

It displaces thyroid hormone from binding proteins, raising free hormone levels

Answer

It causes severe bradycardia

Answer

It blocks beta receptors excessively

Answer

It suppresses TSH dangerously

Question 7

A patient with adrenal (Addisonian) crisis presents with hypotension unresponsive to fluids. What is the priority pharmacologic treatment?

Accepted Answer

IV hydrocortisone

Answer

IV insulin

Answer

Beta-blockers

Answer

Diuretics