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

When IV access is unavailable in an unconscious hypoglycemic patient, IM glucagon mobilizes hepatic glucose stores.

Question 2

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

Accepted Answer

0.9% normal saline

Answer

Isotonic normal saline is started first to restore intravascular volume before transitioning to hypotonic fluids and adding dextrose.

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

Corticosteroids are given in myxedema coma because coexisting adrenal insufficiency can be unmasked when thyroid hormone is replaced.

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

Adrenergic and neuroglycopenic symptoms such as sweating, tremor, and confusion that reverse with glucose are hallmark hypoglycemia findings.

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

As insulin drives glucose into cells, phosphate and magnesium shift intracellularly and can become depleted, requiring monitoring and replacement.

CCRN Review Practice Test