CCRN Practice Questions – Endocrine Questions and Answers 100% Solved

CCRN Practice Questions – Endocrine Questions and Answers 100% Solved Which laboratory values would differentiate diabetic ketoacidosis (DKA) from a hyperosmolar hyperglycemic state (HHS)? a. Serum glucose of 600 mg/dL b. Serum potassium of 4 mEq/L c. Positive serum ketones d. Serum osmolality of 320 mOsm/L Correct answer: c Rationale: In DKA there is an absolute insulin deficiency that causes glycogenolysis and gluconeogenesis. The gluconeogenesis causes the incomplete breakdown of free fatty acids, which results in ketones in the blood and urine. In HHS, there is a relative insulin deficiency that causes glycogenolysis but does not cause gluconeogenesis. Therefore tests for ketones are positive in DKA but typically negative in HHS. Test-Taking Strategy: A serum glucose of 600 mg/dL is abnormal but could be due to DKA or HHS. A serum potassium of 4 mEq/L could be seen in DKA or HHS. Elevated serum osmolality of 320 mOsm/L could be seen in DKA or HHS and is due to dehydration. Only the serum ketones distinguish between the two hyperglycemic crises. A patient with type 1 diabetes mellitus is discharged after myocardial infarction. When teaching the patient about his medications, it is important to inform him that which of the following medications would prevent the early symptoms of hypoglycemia? a. Verapamil (Calan) b. Diazepam (Valium) c. Metoprolol (Lopressor) d. Humulin insulin Correct answer: c Rationale: The early symptoms of hypoglycemia are mediated by the sympathetic nervous system. Sympathetic blocking agents would block these symptoms. Metoprolol (Lopressor) is a beta-blocker, which would block the tachycardia, nervousness, and diaphoresis indicative of early hypoglycemia. Test-Taking Strategy: Think "prevent equals block." Option a is a calcium channel blocker, and option c is a beta-blocker. Remember that beta in beta-blocker refers to the receptors of the sympathetic nervous system and that the early indications of hypoglycemia are sympathetic nervous system symptoms. Choose option c A patient received Humulin NPH insulin at 7 AM. He was nauseated and vomiting at lunchtime and did not eat. It is now 3 PM. What are the early signs of hypoglycemia for which the nurse should monitor? a. Decreased skin turgor; abdominal pain; fever b. Tachycardia; tachypnea; diaphoresis c. Thirst; hypotension; fruity odor to breath d. Flushed skin; confusion; rapid, deep breathing Correct answer: b Rationale: The early signs of hypoglycemia are mediated by the sympathetic nervous system, which acts to mobilize glucose stores. Later signs of hypoglycemia are related to low glucose levels in the brain (neuroglycopenia). Test-Taking Strategy: Remember that sympathetic nervous system innervation occurs in any physiologic stressor. Because the question says "early," choose the option that identifies sympathetic nervous system signs. Choose option b. A patient received Humulin NPH insulin at 7 AM. He was nauseated and vomiting at lunchtime and did not eat. If this patient develops manifestations of hypoglycemia, treatment would include: a. 25 mL of 50% dextrose in water (D50W). b. glucagon intramuscularly. c. 4