Medical-Surgical Nursing: Endocrine Disorders (Med-Surg) Practice Questions
Test yourself on Endocrine Disorders (Med-Surg) with 13 original NCLEX-RN practice questions. Pick an answer to see instant feedback and a full explanation.
Free original practice questions for study purposes. Open Exam Prep is an independent study resource and is not affiliated with, endorsed by, or sponsored by the makers of NCLEX-RN.
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1. A nurse is caring for a client with type 1 diabetes who has a blood glucose of 48 mg/dL and is awake, alert, and able to swallow. Which action should the nurse take first?
Explanation. For a conscious client able to swallow, the rule of 15 applies: give 15 g of fast-acting carbohydrate, recheck in 15 minutes, and repeat if still low. Glucagon and IV dextrose are reserved for unconscious clients or those unable to swallow. Waiting an hour is unsafe.
2. A client with Cushing's syndrome is admitted to the unit. Which assessment finding does the nurse expect?
Explanation. Cushing's reflects excess cortisol, producing truncal obesity, moon face, buffalo hump, thin extremities, hyperglycemia, hypertension, and easy bruising. Hypotension, weight loss, hyperpigmentation, hypoglycemia, and salt craving are features of adrenal insufficiency (Addison's), not Cushing's.
3. A nurse reviews labs for a client suspected of having hypothyroidism. Which combination of results best supports primary hypothyroidism?
Explanation. In primary hypothyroidism the thyroid gland fails, so free T4 falls and the pituitary compensates by raising TSH. Thus high TSH with low free T4 is classic. High TSH with high T4 or low TSH with high T4 indicate hyperthyroid states or pituitary causes.
4. A client with diabetes insipidus is most likely to exhibit which findings?
Explanation. Diabetes insipidus results from ADH deficiency or resistance, causing excretion of large volumes of dilute urine (low specific gravity), polydipsia, and risk of hypernatremia and dehydration. Fluid retention, hyponatremia, and decreased output describe SIADH, the opposite disorder.
5. A client with SIADH is admitted with a serum sodium of 118 mEq/L. Which intervention does the nurse anticipate?
Explanation. SIADH causes water retention and dilutional hyponatremia. The primary treatment is fluid restriction to correct the dilution. Increasing free water or giving hypotonic D5W would worsen hyponatremia and increase cerebral edema risk.
6. A nurse is teaching a client newly prescribed levothyroxine. Which statement indicates correct understanding?
Explanation. Levothyroxine absorption is reduced by food, calcium, and iron, so it should be taken on an empty stomach 30-60 minutes before breakfast and is a lifelong therapy. Taking it with food or calcium impairs absorption, and stopping it leads to recurrent hypothyroidism.
7. A client is in thyroid storm following a thyroidectomy. Which finding requires immediate intervention?
Explanation. Thyroid storm is a life-threatening emergency marked by severe tachycardia, high fever, hypertension, agitation, and possible cardiac decompensation. A heart rate of 150 with a temperature of 104°F demands immediate cooling, beta-blockers, and antithyroid measures. The other vitals are stable.
8. A client with Addison's disease is at risk for an addisonian crisis. Which finding is the priority concern?
Explanation. Addisonian crisis is caused by acute cortisol and aldosterone deficiency, leading to profound hypotension, hyponatremia, hyperkalemia, hypoglycemia, and vascular collapse (shock). Treatment includes IV hydrocortisone and fluids. Hypertension, hyperglycemia, and weight gain are not features of crisis.
9. A nurse evaluates a client with diabetic ketoacidosis (DKA). Which lab finding is most characteristic?
Explanation. DKA features hyperglycemia (usually >250 mg/dL), metabolic acidosis (pH <7.3), and ketosis. A glucose of 450 with pH 7.20 and ketones fits. Very high glucose without ketones and high osmolality describes HHS, not DKA.
10. When administering regular and NPH insulin together in one syringe, the nurse should:
Explanation. To prevent contaminating the short-acting regular insulin with intermediate NPH, draw the clear (regular) insulin first, then the cloudy (NPH): "clear before cloudy." Air is injected into both vials before withdrawing. Mixing in one syringe is appropriate for these two insulins.
11. A nurse cares for a client after a parathyroidectomy. Which assessment is the priority during recovery?
Explanation. Removal of parathyroid tissue can cause acute hypocalcemia. The nurse monitors for tetany signs—positive Chvostek's and Trousseau's signs, tingling, and laryngospasm—and keeps IV calcium gluconate available. Hyperglycemia and polyuria are not the primary concerns after this procedure.
12. A client with hyperthyroidism (Graves' disease) is prescribed propranolol in addition to methimazole. The nurse explains that propranolol is used primarily to:
Explanation. Propranolol is a beta-blocker used to relieve adrenergic symptoms of hyperthyroidism—tachycardia, palpitations, and tremor—while methimazole reduces actual hormone synthesis. Propranolol does not block hormone production or replace hormone.
13. A client with type 2 diabetes is started on metformin. Which teaching point is most important to prevent a serious complication?
Explanation. Metformin should be held before and after iodinated IV contrast procedures because of the risk of lactic acidosis and contrast-induced nephropathy. Metformin alone rarely causes hypoglycemia, and grapefruit interaction/headache are not key safety issues here.
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FAQ
How can I keep SIADH and diabetes insipidus straight on the NCLEX?
Think opposites. SIADH = too much ADH = water retention, dilute blood, low sodium, concentrated urine; treat with fluid restriction. Diabetes insipidus = too little ADH = lots of dilute urine, dehydration, high sodium; treat with desmopressin and fluids.
What endocrine emergencies should I prioritize for the exam?
Know thyroid storm (severe tachycardia and fever), myxedema coma (hypothermia, decreased LOC), addisonian crisis (hypotension/shock, hyperkalemia), DKA and HHS (hyperglycemic crises), and severe hypoglycemia. These are high-yield because they require rapid recognition and intervention.
How do I remember which insulin to draw first when mixing?
Remember "clear before cloudy"—draw the clear regular insulin into the syringe first, then the cloudy NPH. This prevents contaminating the fast-acting regular insulin with the longer-acting NPH.