CCRN Practice Questions – Endocrine
2025 with Answers
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 - ANSWER-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.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
,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 - ANSWER-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
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
,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 - ANSWER-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 oz of apple juice.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 3
, d. 100 mL of 5% dextrose in water (D5W). - ANSWER-Correct answer: a
Rationale: The treatment for mild hypoglycemia is 10 to 15 g of carbohydrates.
This normally is administered as 4 oz of orange juice if the patient can drink
(unless the patient has renal failure when lower potassium, lower water options are
better). This patient has not been able to take anything by mouth all day. Glucagon
is a hormone that mobilizes glucose from glucose stores but takes longer than
directly giving glucose. D5W has 5 g of dextrose per 100 mL, which would provide
only 20 calories. D50W has 50 g of dextrose per 100 mL. A volume of 25 mL of
D50W would provide 12.5 g of carbohydrate and 50 calories.
Test-Taking Strategy: The case presentation is a hypoglycemic patient who is
unable to take food by mouth, so eliminate option c. Glucagon should be used
only if intravenous administration of glucose is not possible, so eliminate option b.
Administration of 100 mL of D5W would provide less than the recommended
carbohydrate dosage for mild hypoglycemia. Choose option a.
A 25-year-old woman is admitted with diabetic ketoacidosis (DKA). The following
laboratory values were reported from blood taken at admission: Serum glucose 450
mg/dL Potassium 4.5 mEq/L pH 7.15 She has received regular insulin bolus, and
an infusion has been initiated. Two liters of normal saline has been administered.
The last serum glucose is 215 mg/dL, and the pH is 7.32. Which therapy would be
inappropriate?
a. Changing the intravenous solution to include dextrose
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 4
2025 with Answers
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 - ANSWER-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.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
,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 - ANSWER-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
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
,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 - ANSWER-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 oz of apple juice.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 3
, d. 100 mL of 5% dextrose in water (D5W). - ANSWER-Correct answer: a
Rationale: The treatment for mild hypoglycemia is 10 to 15 g of carbohydrates.
This normally is administered as 4 oz of orange juice if the patient can drink
(unless the patient has renal failure when lower potassium, lower water options are
better). This patient has not been able to take anything by mouth all day. Glucagon
is a hormone that mobilizes glucose from glucose stores but takes longer than
directly giving glucose. D5W has 5 g of dextrose per 100 mL, which would provide
only 20 calories. D50W has 50 g of dextrose per 100 mL. A volume of 25 mL of
D50W would provide 12.5 g of carbohydrate and 50 calories.
Test-Taking Strategy: The case presentation is a hypoglycemic patient who is
unable to take food by mouth, so eliminate option c. Glucagon should be used
only if intravenous administration of glucose is not possible, so eliminate option b.
Administration of 100 mL of D5W would provide less than the recommended
carbohydrate dosage for mild hypoglycemia. Choose option a.
A 25-year-old woman is admitted with diabetic ketoacidosis (DKA). The following
laboratory values were reported from blood taken at admission: Serum glucose 450
mg/dL Potassium 4.5 mEq/L pH 7.15 She has received regular insulin bolus, and
an infusion has been initiated. Two liters of normal saline has been administered.
The last serum glucose is 215 mg/dL, and the pH is 7.32. Which therapy would be
inappropriate?
a. Changing the intravenous solution to include dextrose
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 4
