NP Endocrine & Diabetes Test Bank: 150
Questions with Rationales
2025/2026
1. A 45-year-old patient presents with polyuria, polydipsia, and
unexplained weight loss. Fasting plasma glucose is 145 mg/dL.
What is the most likely diagnosis?
A. Type 1 diabetes
B. Type 2 diabetes
C. Diabetes insipidus
D. Metabolic syndrome
Rationale:
Type 2 diabetes is commonly diagnosed in adults with fasting plasma
glucose ≥126 mg/dL and symptoms of hyperglycemia. Type 1 diabetes
is less common in adults and often presents more acutely.
2. The first-line pharmacologic treatment for type 2 diabetes is:
A. Sulfonylureas
B. Insulin
C. Thiazolidinediones
D. Metformin
Rationale:
Metformin is first-line due to its efficacy, safety profile, weight
neutrality, and cardiovascular benefit.
3. A patient with type 1 diabetes is experiencing recurrent
hypoglycemia. Which adjustment is most appropriate?
A. Increase basal insulin dose
B. Reduce insulin dose or adjust timing
, C. Add sulfonylurea
D. Stop monitoring blood glucose
Rationale:
Hypoglycemia in type 1 diabetes usually requires insulin dose
adjustment or meal planning changes rather than adding other
medications.
4. Which hemoglobin A1c level confirms a diagnosis of diabetes?
A. 5.6%
B. 6.0%
C. 6.5% or higher
D. 7.0%
Rationale:
The ADA defines diabetes as A1c ≥6.5%, fasting glucose ≥126 mg/dL,
or 2-hour OGTT ≥200 mg/dL.
5. A 60-year-old patient with type 2 diabetes has an eGFR of 25
mL/min/1.73 m². Which glucose-lowering medication is
contraindicated?
A. Insulin
B. Glipizide
C. Metformin
D. DPP-4 inhibitors
Rationale:
Metformin is contraindicated in patients with eGFR <30 mL/min due
to risk of lactic acidosis.
6. Which of the following is a classic symptom of hyperthyroidism?
A. Weight gain
B. Bradycardia
, C. Heat intolerance
D. Constipation
Rationale:
Hyperthyroidism increases metabolism, leading to heat intolerance,
weight loss, tachycardia, and hyperreflexia.
7. A 55-year-old patient presents with fatigue, cold intolerance, and
constipation. TSH is elevated. The most likely diagnosis is:
A. Hyperthyroidism
B. Subclinical hyperthyroidism
C. Hypothyroidism
D. Thyroid storm
Rationale:
Elevated TSH with symptoms of low metabolism indicates primary
hypothyroidism.
8. Preferred initial therapy for hypothyroidism is:
A. Methimazole
B. Levothyroxine
C. Propylthiouracil
D. Radioactive iodine
Rationale:
Levothyroxine is synthetic T4, standard therapy for hypothyroidism,
titrated based on TSH levels.
9. A patient presents with a thyroid nodule. Which feature is most
concerning for malignancy?
A. Cystic consistency
B. Mobile nodule
C. Rapid growth with hoarseness
D. Painful nodule
, Rationale:
Rapid growth, vocal cord changes, and fixation suggest malignancy;
most thyroid nodules are benign.
10. Which lab finding is consistent with primary
hyperparathyroidism?
A. Low calcium, high phosphate
B. High calcium, low phosphate
C. Low calcium, low phosphate
D. High phosphate, low calcium
Rationale:
Primary hyperparathyroidism causes hypercalcemia and
hypophosphatemia due to excess PTH.
11. A 32-year-old patient presents with symptoms of
hypoglycemia. Blood glucose is 45 mg/dL. Which is the first step?
A. Administer insulin
B. Give oral glucose if patient is conscious
C. Give sulfonylurea
D. Observe without treatment
Rationale:
Immediate correction of hypoglycemia with oral glucose (if conscious)
or IV dextrose (if unconscious) is required to prevent neurologic
damage.
12. Which is a common side effect of GLP-1 receptor agonists?
A. Hypoglycemia
B. Weight gain
C. Nausea
D. Hypertension
Questions with Rationales
2025/2026
1. A 45-year-old patient presents with polyuria, polydipsia, and
unexplained weight loss. Fasting plasma glucose is 145 mg/dL.
What is the most likely diagnosis?
A. Type 1 diabetes
B. Type 2 diabetes
C. Diabetes insipidus
D. Metabolic syndrome
Rationale:
Type 2 diabetes is commonly diagnosed in adults with fasting plasma
glucose ≥126 mg/dL and symptoms of hyperglycemia. Type 1 diabetes
is less common in adults and often presents more acutely.
2. The first-line pharmacologic treatment for type 2 diabetes is:
A. Sulfonylureas
B. Insulin
C. Thiazolidinediones
D. Metformin
Rationale:
Metformin is first-line due to its efficacy, safety profile, weight
neutrality, and cardiovascular benefit.
3. A patient with type 1 diabetes is experiencing recurrent
hypoglycemia. Which adjustment is most appropriate?
A. Increase basal insulin dose
B. Reduce insulin dose or adjust timing
, C. Add sulfonylurea
D. Stop monitoring blood glucose
Rationale:
Hypoglycemia in type 1 diabetes usually requires insulin dose
adjustment or meal planning changes rather than adding other
medications.
4. Which hemoglobin A1c level confirms a diagnosis of diabetes?
A. 5.6%
B. 6.0%
C. 6.5% or higher
D. 7.0%
Rationale:
The ADA defines diabetes as A1c ≥6.5%, fasting glucose ≥126 mg/dL,
or 2-hour OGTT ≥200 mg/dL.
5. A 60-year-old patient with type 2 diabetes has an eGFR of 25
mL/min/1.73 m². Which glucose-lowering medication is
contraindicated?
A. Insulin
B. Glipizide
C. Metformin
D. DPP-4 inhibitors
Rationale:
Metformin is contraindicated in patients with eGFR <30 mL/min due
to risk of lactic acidosis.
6. Which of the following is a classic symptom of hyperthyroidism?
A. Weight gain
B. Bradycardia
, C. Heat intolerance
D. Constipation
Rationale:
Hyperthyroidism increases metabolism, leading to heat intolerance,
weight loss, tachycardia, and hyperreflexia.
7. A 55-year-old patient presents with fatigue, cold intolerance, and
constipation. TSH is elevated. The most likely diagnosis is:
A. Hyperthyroidism
B. Subclinical hyperthyroidism
C. Hypothyroidism
D. Thyroid storm
Rationale:
Elevated TSH with symptoms of low metabolism indicates primary
hypothyroidism.
8. Preferred initial therapy for hypothyroidism is:
A. Methimazole
B. Levothyroxine
C. Propylthiouracil
D. Radioactive iodine
Rationale:
Levothyroxine is synthetic T4, standard therapy for hypothyroidism,
titrated based on TSH levels.
9. A patient presents with a thyroid nodule. Which feature is most
concerning for malignancy?
A. Cystic consistency
B. Mobile nodule
C. Rapid growth with hoarseness
D. Painful nodule
, Rationale:
Rapid growth, vocal cord changes, and fixation suggest malignancy;
most thyroid nodules are benign.
10. Which lab finding is consistent with primary
hyperparathyroidism?
A. Low calcium, high phosphate
B. High calcium, low phosphate
C. Low calcium, low phosphate
D. High phosphate, low calcium
Rationale:
Primary hyperparathyroidism causes hypercalcemia and
hypophosphatemia due to excess PTH.
11. A 32-year-old patient presents with symptoms of
hypoglycemia. Blood glucose is 45 mg/dL. Which is the first step?
A. Administer insulin
B. Give oral glucose if patient is conscious
C. Give sulfonylurea
D. Observe without treatment
Rationale:
Immediate correction of hypoglycemia with oral glucose (if conscious)
or IV dextrose (if unconscious) is required to prevent neurologic
damage.
12. Which is a common side effect of GLP-1 receptor agonists?
A. Hypoglycemia
B. Weight gain
C. Nausea
D. Hypertension
