1
HESI Endocrine Exam Bank: Diabetes,
Thyroid Disorders & Critical Care
Q&A
Table of Contents
Subtopic 1: Type 1 Diabetes Mellitus, Pathophysiology, Diagnosis, and Initial
Management....................................................................................................2
Subtopic 2: Type 2 Diabetes Mellitus—Screening, Progression, and
Pharmacologic Management..........................................................................10
Subtopic 3: Diabetes Complications Microvascular, Macrovascular, and Acute
Crises.............................................................................................................19
Subtopic 4: Thyroid Disorders, Hypothyroidism, Hyperthyroidism, and
Autoimmune Thyroiditis.................................................................................27
Subtopic 5: Diabetes in Special Populations, Geriatric, Pediatric, and
Pregnancy......................................................................................................36
Subtopic 6: Pharmacologic Interactions and Endocrine Emergencies in
Diabetes and Thyroid Disorders.....................................................................44
Subtopic 7: Monitoring and Managing Endocrine Disorders in Critical Care
Settings..........................................................................................................53
Subtopic 8: Endocrine Pathophysiology and Lab Interpretation in Acute and
Chronic Illness................................................................................................62
Subtopic 9: Pharmacologic Interventions and Hormonal Replacement in
Endocrine Disorders.......................................................................................70
Subtopic 10: Patient Education, Health Promotion, and Long-Term Endocrine
Management..................................................................................................78
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Subtopic 1: Type 1 Diabetes Mellitus,
Pathophysiology, Diagnosis, and Initial
Management
Question 1:
A 14-year-old patient presents to the ED with fruity breath, rapid breathing,
and altered mental status. Which lab value most strongly supports the
diagnosis of diabetic ketoacidosis (DKA)?
A. Serum sodium of 140 mEq/L
B. Blood glucose of 180 mg/dL
C. Arterial pH of 7.10
D. Hemoglobin A1c of 6.5%
Correct Answer: C. Arterial pH of 7.10
Rationale: A low arterial pH confirms metabolic acidosis, a hallmark of DKA.
Hyperglycemia, ketonemia, and acidosis must all be present for diagnosis.
Question 2:
In newly diagnosed Type 1 diabetes, what is the first-line method for insulin
administration in pediatric patients?
A. Oral insulin tablets
B. Multiple daily subcutaneous injections
C. Intravenous insulin at home
D. Transdermal insulin patches
Correct Answer: B. Multiple daily subcutaneous injections
Rationale: Subcutaneous insulin via multiple daily injections or insulin pump
is standard for managing T1DM. Oral or transdermal insulin is not effective.
, 3
Question 3:
Which symptom is most characteristic of new-onset Type 1 Diabetes in
children?
A. Bradycardia
B. Edema
C. Polyuria
D. Weight gain
Correct Answer: C. Polyuria
Rationale: Polyuria occurs due to osmotic diuresis from hyperglycemia. This
is a key symptom of diabetes onset, particularly in children.
Question 4:
A 10-year-old with Type 1 Diabetes is being educated about "sick day"
management. What should the nurse emphasize?
A. Discontinue insulin if not eating
B. Avoid checking ketones during illness
C. Continue insulin and check blood glucose every 3–4 hours
D. Take extra insulin even with low blood sugar
Correct Answer: C. Continue insulin and check blood glucose every 3–4 hours
Rationale: Insulin should never be stopped during illness, as stress hormones
raise glucose. Monitoring glucose and ketones frequently is vital.
Question 5:
What autoimmune marker is commonly tested to confirm Type 1 Diabetes
diagnosis?
, 4
A. Glutamic acid decarboxylase (GAD) antibodies
B. C-peptide
C. Thyroid-stimulating hormone
D. Cortisol level
Correct Answer: A. Glutamic acid decarboxylase (GAD) antibodies
Rationale: GAD antibodies are found in the majority of T1DM patients and
confirm autoimmune beta-cell destruction.
Question 6:
What is the most appropriate initial insulin regimen for a newly diagnosed
adult with Type 1 Diabetes?
A. Sliding scale insulin only
B. NPH once daily
C. Basal-bolus regimen with rapid and long-acting insulin
D. Oral hypoglycemics with low-dose insulin
Correct Answer: C. Basal-bolus regimen with rapid and long-acting insulin
Rationale: Basal-bolus therapy closely mimics physiologic insulin secretion
and is the standard for T1DM management.
Question 7:
Which condition most commonly coexists with Type 1 Diabetes due to shared
autoimmune etiology?
A. Rheumatoid arthritis
B. Hashimoto’s thyroiditis
C. Addison’s disease
D. Crohn’s disease
HESI Endocrine Exam Bank: Diabetes,
Thyroid Disorders & Critical Care
Q&A
Table of Contents
Subtopic 1: Type 1 Diabetes Mellitus, Pathophysiology, Diagnosis, and Initial
Management....................................................................................................2
Subtopic 2: Type 2 Diabetes Mellitus—Screening, Progression, and
Pharmacologic Management..........................................................................10
Subtopic 3: Diabetes Complications Microvascular, Macrovascular, and Acute
Crises.............................................................................................................19
Subtopic 4: Thyroid Disorders, Hypothyroidism, Hyperthyroidism, and
Autoimmune Thyroiditis.................................................................................27
Subtopic 5: Diabetes in Special Populations, Geriatric, Pediatric, and
Pregnancy......................................................................................................36
Subtopic 6: Pharmacologic Interactions and Endocrine Emergencies in
Diabetes and Thyroid Disorders.....................................................................44
Subtopic 7: Monitoring and Managing Endocrine Disorders in Critical Care
Settings..........................................................................................................53
Subtopic 8: Endocrine Pathophysiology and Lab Interpretation in Acute and
Chronic Illness................................................................................................62
Subtopic 9: Pharmacologic Interventions and Hormonal Replacement in
Endocrine Disorders.......................................................................................70
Subtopic 10: Patient Education, Health Promotion, and Long-Term Endocrine
Management..................................................................................................78
, 2
Subtopic 1: Type 1 Diabetes Mellitus,
Pathophysiology, Diagnosis, and Initial
Management
Question 1:
A 14-year-old patient presents to the ED with fruity breath, rapid breathing,
and altered mental status. Which lab value most strongly supports the
diagnosis of diabetic ketoacidosis (DKA)?
A. Serum sodium of 140 mEq/L
B. Blood glucose of 180 mg/dL
C. Arterial pH of 7.10
D. Hemoglobin A1c of 6.5%
Correct Answer: C. Arterial pH of 7.10
Rationale: A low arterial pH confirms metabolic acidosis, a hallmark of DKA.
Hyperglycemia, ketonemia, and acidosis must all be present for diagnosis.
Question 2:
In newly diagnosed Type 1 diabetes, what is the first-line method for insulin
administration in pediatric patients?
A. Oral insulin tablets
B. Multiple daily subcutaneous injections
C. Intravenous insulin at home
D. Transdermal insulin patches
Correct Answer: B. Multiple daily subcutaneous injections
Rationale: Subcutaneous insulin via multiple daily injections or insulin pump
is standard for managing T1DM. Oral or transdermal insulin is not effective.
, 3
Question 3:
Which symptom is most characteristic of new-onset Type 1 Diabetes in
children?
A. Bradycardia
B. Edema
C. Polyuria
D. Weight gain
Correct Answer: C. Polyuria
Rationale: Polyuria occurs due to osmotic diuresis from hyperglycemia. This
is a key symptom of diabetes onset, particularly in children.
Question 4:
A 10-year-old with Type 1 Diabetes is being educated about "sick day"
management. What should the nurse emphasize?
A. Discontinue insulin if not eating
B. Avoid checking ketones during illness
C. Continue insulin and check blood glucose every 3–4 hours
D. Take extra insulin even with low blood sugar
Correct Answer: C. Continue insulin and check blood glucose every 3–4 hours
Rationale: Insulin should never be stopped during illness, as stress hormones
raise glucose. Monitoring glucose and ketones frequently is vital.
Question 5:
What autoimmune marker is commonly tested to confirm Type 1 Diabetes
diagnosis?
, 4
A. Glutamic acid decarboxylase (GAD) antibodies
B. C-peptide
C. Thyroid-stimulating hormone
D. Cortisol level
Correct Answer: A. Glutamic acid decarboxylase (GAD) antibodies
Rationale: GAD antibodies are found in the majority of T1DM patients and
confirm autoimmune beta-cell destruction.
Question 6:
What is the most appropriate initial insulin regimen for a newly diagnosed
adult with Type 1 Diabetes?
A. Sliding scale insulin only
B. NPH once daily
C. Basal-bolus regimen with rapid and long-acting insulin
D. Oral hypoglycemics with low-dose insulin
Correct Answer: C. Basal-bolus regimen with rapid and long-acting insulin
Rationale: Basal-bolus therapy closely mimics physiologic insulin secretion
and is the standard for T1DM management.
Question 7:
Which condition most commonly coexists with Type 1 Diabetes due to shared
autoimmune etiology?
A. Rheumatoid arthritis
B. Hashimoto’s thyroiditis
C. Addison’s disease
D. Crohn’s disease
