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NCLEX RN Exam Bank: Endocrine Emergencies, DKA,
Thyroid Storm & Addison’s Crisis
Table of Contents
Subtopic 1: Diabetic Ketoacidosis (DKA): Recognition, Labs & Acute Management ............ 2
Subtopic 2: Thyroid Storm—Etiology, Crisis Recognition & Emergency Interventions ........ 11
Subtopic 3: Addisonian Crisis—Pathophysiology, Recognition & Emergency Response .... 20
Subtopic 4: Combined Endocrine Emergency Scenarios—Differential Diagnosis & Nursing
Prioritization ............................................................................................................... 29
Subtopic 5: Thyroid Storm—Electrolyte Imbalance, Cardiovascular Effects, and ICU
Interventions (Questions 81–100) ................................................................................. 39
Subtopic 6: Fluid and Electrolyte Shifts in Endocrine Emergencies ................................. 48
Subtopic 7: Thyroid Storm—Pharmacologic Management, Beta Blockers & Antithyroid
Agents (Q121–Q140) ................................................................................................... 55
Subtopic 8: Fluid and Electrolyte Imbalances in Endocrine Crises (DKA, HHS, Addisonian
Crisis) ........................................................................................................................ 63
Subtopic 9: Pediatric Endocrine Emergencies—Recognition & Age-Specific Interventions 70
Subtopic 10: Post-Emergency Recovery, Monitoring & Patient Education ......................... 78
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Subtopic 1: Diabetic Ketoacidosis (DKA): Recognition,
Labs & Acute Management
Question 1
A nurse assesses a newly admitted patient with suspected DKA. Which of the following
findings would the nurse most likely expect?
A. Bradycardia and cold, clammy skin
B. Fruity breath odor and Kussmaul respirations
C. Hyperactive bowel sounds and hypertension
D. Metabolic alkalosis and decreased serum glucose
Correct Answer: B
Rationale: DKA presents with hyperglycemia, metabolic acidosis, and ketone buildup.
Fruity breath odor is due to acetone, and Kussmaul respirations are deep, rapid breathing
to compensate for acidosis.
Question 2
Which lab value is most critical to monitor during the initial treatment phase of DKA?
A. Hemoglobin A1c
B. Serum calcium
C. Serum potassium
D. White blood cell count
Correct Answer: C
Rationale: Potassium can shift dangerously during DKA correction. Insulin pushes
potassium into cells, risking hypokalemia during treatment.
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Question 3
The priority nursing intervention when starting IV insulin therapy for a patient with DKA is:
A. Administer IV potassium chloride immediately
B. Discontinue all oral antidiabetic medications
C. Initiate continuous cardiac monitoring
D. Restrict oral fluid intake
Correct Answer: C
Rationale: Cardiac monitoring is essential due to the risk of arrhythmias from insulin-
induced potassium shifts.
Question 4
Which fluid should the nurse anticipate administering first to a patient with DKA?
A. 0.9% Normal Saline
B. D5W
C. 0.45% Normal Saline
D. Lactated Ringer’s with insulin
Correct Answer: A
Rationale: Initial fluid resuscitation uses isotonic saline (0.9% NS) to restore perfusion and
volume.
Question 5
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Which of the following findings differentiates DKA from hyperosmolar hyperglycemic state
(HHS)?
A. Elevated blood glucose
B. Dehydration
C. Presence of ketones
D. Mental status changes
Correct Answer: C
Rationale: Ketones are present in DKA due to fat metabolism; HHS lacks significant
ketosis.
Question 6
A patient in DKA begins to have a declining level of consciousness. What is the nurse’s
priority action?
A. Administer naloxone
B. Decrease insulin rate
C. Check blood glucose
D. Increase fluid rate
Correct Answer: C
Rationale: Hypoglycemia from insulin therapy can cause decreased consciousness;
glucose should be checked immediately.
Question 7
What is the expected arterial blood gas (ABG) result in a patient with DKA?
NCLEX RN Exam Bank: Endocrine Emergencies, DKA,
Thyroid Storm & Addison’s Crisis
Table of Contents
Subtopic 1: Diabetic Ketoacidosis (DKA): Recognition, Labs & Acute Management ............ 2
Subtopic 2: Thyroid Storm—Etiology, Crisis Recognition & Emergency Interventions ........ 11
Subtopic 3: Addisonian Crisis—Pathophysiology, Recognition & Emergency Response .... 20
Subtopic 4: Combined Endocrine Emergency Scenarios—Differential Diagnosis & Nursing
Prioritization ............................................................................................................... 29
Subtopic 5: Thyroid Storm—Electrolyte Imbalance, Cardiovascular Effects, and ICU
Interventions (Questions 81–100) ................................................................................. 39
Subtopic 6: Fluid and Electrolyte Shifts in Endocrine Emergencies ................................. 48
Subtopic 7: Thyroid Storm—Pharmacologic Management, Beta Blockers & Antithyroid
Agents (Q121–Q140) ................................................................................................... 55
Subtopic 8: Fluid and Electrolyte Imbalances in Endocrine Crises (DKA, HHS, Addisonian
Crisis) ........................................................................................................................ 63
Subtopic 9: Pediatric Endocrine Emergencies—Recognition & Age-Specific Interventions 70
Subtopic 10: Post-Emergency Recovery, Monitoring & Patient Education ......................... 78
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Subtopic 1: Diabetic Ketoacidosis (DKA): Recognition,
Labs & Acute Management
Question 1
A nurse assesses a newly admitted patient with suspected DKA. Which of the following
findings would the nurse most likely expect?
A. Bradycardia and cold, clammy skin
B. Fruity breath odor and Kussmaul respirations
C. Hyperactive bowel sounds and hypertension
D. Metabolic alkalosis and decreased serum glucose
Correct Answer: B
Rationale: DKA presents with hyperglycemia, metabolic acidosis, and ketone buildup.
Fruity breath odor is due to acetone, and Kussmaul respirations are deep, rapid breathing
to compensate for acidosis.
Question 2
Which lab value is most critical to monitor during the initial treatment phase of DKA?
A. Hemoglobin A1c
B. Serum calcium
C. Serum potassium
D. White blood cell count
Correct Answer: C
Rationale: Potassium can shift dangerously during DKA correction. Insulin pushes
potassium into cells, risking hypokalemia during treatment.
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Question 3
The priority nursing intervention when starting IV insulin therapy for a patient with DKA is:
A. Administer IV potassium chloride immediately
B. Discontinue all oral antidiabetic medications
C. Initiate continuous cardiac monitoring
D. Restrict oral fluid intake
Correct Answer: C
Rationale: Cardiac monitoring is essential due to the risk of arrhythmias from insulin-
induced potassium shifts.
Question 4
Which fluid should the nurse anticipate administering first to a patient with DKA?
A. 0.9% Normal Saline
B. D5W
C. 0.45% Normal Saline
D. Lactated Ringer’s with insulin
Correct Answer: A
Rationale: Initial fluid resuscitation uses isotonic saline (0.9% NS) to restore perfusion and
volume.
Question 5
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Which of the following findings differentiates DKA from hyperosmolar hyperglycemic state
(HHS)?
A. Elevated blood glucose
B. Dehydration
C. Presence of ketones
D. Mental status changes
Correct Answer: C
Rationale: Ketones are present in DKA due to fat metabolism; HHS lacks significant
ketosis.
Question 6
A patient in DKA begins to have a declining level of consciousness. What is the nurse’s
priority action?
A. Administer naloxone
B. Decrease insulin rate
C. Check blood glucose
D. Increase fluid rate
Correct Answer: C
Rationale: Hypoglycemia from insulin therapy can cause decreased consciousness;
glucose should be checked immediately.
Question 7
What is the expected arterial blood gas (ABG) result in a patient with DKA?
