Endocrine and Diabetes
A patient presents with confusion, sweating, and tremors. Blood glucose is 50 mg/dL. What is the priority action?
A) Administer 15-20 g of glucose orally
B) Administer IV insulin
C) Administer IV dextrose
D) Give 100 mL of water
A) Administer 15-20 g of glucose orally
A patient with chronic GERD complains of new-onset chest pain after meals. What is the most appropriate action?
A) Assess for signs of cardiac involvement (ECG), then manage GERD symptoms
B) Administer antacids and observe for relief
C) Schedule an upper GI endoscopy
D) Administer a proton pump inhibitor (PPI) immediately
A) Assess for signs of cardiac involvement (ECG), then manage GERD symptoms
A patient with cirrhosis develops jaundice, confusion, and asterixis. What lab value is most likely elevated?
A) Ammonia
B) Potassium
C) Sodium
D) Hemoglobin
A) Ammonia
A patient with burns covering 30% TBSA develops difficulty breathing and stridor. What is the most appropriate intervention?
A) Secure airway and prepare for intubation
B) Apply humidified oxygen and monitor
C) Begin fluid resuscitation
D) Prepare for surgical debridement
A) Secure airway and prepare for intubation
A patient with acute kidney injury develops ECG changes (peaked T waves). What is the priority intervention?
A) Administer IV calcium gluconate and insulin with dextrose
B) Administer sodium bicarbonate
C) Start dialysis immediately
D) Monitor potassium levels without intervention
A) Administer IV calcium gluconate and insulin with dextrose
A 28-year-old female with type 1 diabetes is admitted for DKA. What lab finding is expected?
A) Elevated blood glucose and ketones in urine
B) Elevated BUN and creatinine
C) Decreased potassium levels
D) Increased hemoglobin levels
A) Elevated blood glucose (>250 mg/dL) and ketones in urine
A patient with cirrhosis develops ascites and a low albumin level. What is the next intervention?
A) Administer albumin and diuretics
B) Administer vasopressin
C) Perform a liver biopsy
D) Increase sodium intake
A) Administer albumin and diuretics
A patient with acute pancreatitis develops hypotension and tachycardia. What complication is suspected?
A) Hypovolemic shock from third-spacing
B) Peritonitis
C) Severe GI bleeding
D) Acute kidney injury
A) Hypovolemic shock from third-spacing
A burn patient is receiving fluid resuscitation. Which sign is the most reliable indicator of adequate fluid replacement?
A) Urine output of at least 30 mL/hr
B) Blood pressure of 130/80 mmHg
C) Heart rate of 90 bpm
D) Respiratory rate of 18 breaths per minute
A) Urine output of at least 30 mL/hr
A patient on hemodialysis develops sudden shortness of breath and hypotension. What complication is most likely?
A) Dialysis-related hypotension
B) Air embolism
C) Peritoneal dialysis catheter malfunction
D) Hyperkalemia
A) Dialysis-related hypotension
A patient with hyperthyroidism develops a fever of 102°F, tachycardia (HR 140), and confusion. What condition is suspected?
A) Thyroid storm
B) Diabetic ketoacidosis
C) Acute adrenal crisis
D) Myxedema coma
A) Thyroid storm
A patient with acute pancreatitis reports severe epigastric pain radiating to the back. What position is most comfortable for the patient?
A) Fetal position or sitting upright
B) Supine position with legs extended
C) Lying flat with arms over the head
D) Trendelenburg position
A) Fetal position or sitting upright
A patient with gallstones complains of upper right quadrant pain, nausea, and vomiting. What is the most appropriate diagnostic test?
A) Abdominal ultrasound
B) Abdominal CT scan
C) Endoscopic retrograde cholangiopancreatography (ERCP)
D) MRI of the abdomen
A) Abdominal ultrasound
A patient with partial-thickness burns (second-degree) has severe pain. What is the priority intervention?
A) Administer IV opioids for pain control
B) Apply cold compresses to the burn site
C) Administer NSAIDs for pain relief
D) Elevate the burned area and apply a dry dressing
A) Administer IV opioids for pain control
A patient with end-stage renal disease on dialysis develops peritonitis. What is the priority intervention?
A) Start antibiotics immediately and assess catheter site
B) Increase dialysis flow rate
C) Administer analgesics and monitor symptoms
D) Perform a dialysis exchange
A) Start antibiotics immediately and assess catheter site
A patient with Addison’s disease develops confusion and hypotension. What is the first step in management?
A) Administer IV fluids (NS) and hydrocortisone
B) Administer beta-blockers
C) Increase oral sodium intake
D) Perform a CT scan of the abdomen
A) Administer IV fluids (NS) and hydrocortisone
A patient with Crohn's disease has a serum vitamin B12 level of 120 pg/mL. What is the next step?
A) Initiate B12 supplementation
B) Begin iron supplementation
C) Increase folate intake
D) Start corticosteroid therapy
A) Initiate B12 supplementation
A patient with severe liver disease presents with bleeding gums and bruising. What is the most likely cause?
A) Low platelet count
B) High fibrinogen levels
C) Elevated prothrombin time
D) Hyperbilirubinemia
A) Low platelet count (thrombocytopenia)
A patient with full-thickness burns is scheduled for an escharotomy. Which finding supports the need for this procedure?
A) Absent pulses in the affected extremity
B) Severe itching at the burn site
C) Mild redness surrounding the burn
D) Increased urine output
A) Absent pulses in the affected extremity
A patient with hypovolemia and a peripheral IV in the forearm has slow flow. What is the best intervention?
A) Assess the catheter for occlusion or kink, and adjust the position
B) Increase the infusion rate to push through the occlusion
C) Replace the IV site immediately
D) Administer a vasopressor to improve flow
A) Assess the catheter for occlusion or kink, and adjust the position
A diabetic patient is NPO for surgery but has been on long-acting insulin at night. What is the nurse’s next step?
A) Contact the provider for potential insulin dose adjustment or omission
B) Administer the normal dose of insulin before surgery
C) Withhold insulin and monitor glucose
D) Administer half of the long-acting insulin dose
A) Contact the provider for potential insulin dose adjustment or omission
A patient has sudden severe abdominal pain, fever, and rebound tenderness. What is the most likely diagnosis?
A) Acute appendicitis
B) Acute pancreatitis
C) Gastroenteritis
D) Peptic ulcer disease
A) Acute appendicitis
A patient is receiving IV fluids after a pancreatitis diagnosis. What is the goal fluid rate for the first 24 hours?
A) 4-5 liters of fluid replacement in the first 24 hours
B) 1-2 liters for the first 12 hours
C) Restrict fluids and monitor urine output
D) 10 liters of fluids within 24 hours
A) 4-5 liters of fluid replacement in the first 24 hours
A patient with a major burn injury has a potassium level of 6.0 mEq/L. What is the priority intervention?
A) Administer calcium gluconate
B) Administer potassium-sparing diuretics
C) Decrease fluid resuscitation rate
D) Administer sodium bicarbonate
A) Administer calcium gluconate
A patient receiving NG tube feeding develops diarrhea. What is the most appropriate next step?
A) Slow the feeding rate and assess for feeding intolerance
B) Increase the feeding rate to promote tolerance
C) Switch to a different type of enteral formula
D) Initiate TPN instead of tube feeding
A) Slow the feeding rate and assess for feeding intolerance