CCRN Endocrine and Metabolic Crises 5

Question 1

A patient with severe hypoglycemia (glucose 38 mg/dL) is unconscious without IV access. What is the appropriate intervention?

Accepted Answer

Administer intramuscular glucagon

Answer

Give oral juice

Answer

Wait and recheck glucose in 30 minutes

Answer

Administer IV insulin

Question 2

Which fluid is typically given first in the initial resuscitation of DKA?

Accepted Answer

0.9% normal saline

Answer

5% dextrose in water

Answer

0.45% half-normal saline as first bolus

Answer

Lactated Ringer's with potassium 40 mEq

Question 3

A patient with myxedema coma requires thyroid hormone replacement plus which additional therapy before or with levothyroxine?

Accepted Answer

IV corticosteroids to cover possible adrenal insufficiency

Answer

High-dose diuretics

Answer

Beta-blockers

Answer

Insulin infusion

Question 4

Which sign in a critically ill patient most strongly suggests hypoglycemia rather than another cause of altered mentation?

Accepted Answer

Diaphoresis, tremor, and confusion that resolves with glucose

Answer

Fever and rash

Answer

Bradycardia and hypothermia

Answer

Polyuria and dehydration

Question 5

When managing DKA, why must phosphate and magnesium be monitored?

Accepted Answer

Insulin therapy and acidosis correction can cause significant depletion of these electrolytes

Answer

They always rise dangerously high

Answer

They have no role in DKA management

Answer

They cause cerebral edema directly

Question 6

A patient with thyroid storm should be managed in which sequence of medications when iodine is needed?

Accepted Answer

Give an antithyroid drug (PTU) before iodine to prevent new hormone synthesis

Answer

Give iodine first, then PTU hours later

Answer

Give only iodine

Answer

Avoid antithyroid drugs entirely

Question 7

Which intervention is most important when caring for a comatose patient in myxedema coma with hypoventilation?

Accepted Answer

Provide ventilatory support and passive rewarming

Answer

Apply aggressive external rapid rewarming

Answer

Administer a beta-agonist

Answer

Restrict all fluids strictly