ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER
CERTIFICATION ENDOCRINE EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS GRADED A+
1. A 25-year-old male patient is admitted to the intensive care unit after a motor vehicle collision
resulting in an isolated severe traumatic brain injury causing elevated intracranial pressure. He is
on a ventilator and minimally responsive. On the second day of hospitalization, he has increasing
vasopressor requirements and hourly urine output of 400 mL. To address this problem, the nurse
practitioner would:
1. Order a fluid restriction.
2. Order serum sodium, urine-specific gravity.
3. Order 24-hour urine protein and creatinine.
4. Order a stat noncontrast computed tomography of the head.
Answer>>2. Order serum sodium, urine-specific gravity.
Rationale: This scenario suggests a diagnosis of diabetes insipidus, for which serum sodium and
urine specific gravity will aid in the diagnosis.
2. A 25-year-old male patient is admitted to the intensive care unit after a motor vehicle collision
resulting in an isolated severe traumatic brain injury causing elevated intracranial pressure. He is
on a ventilator and minimally responsive. On the second day of hospitalization, he has increasing
vasopressor requirements and hourly urine output of 400 mL. His serum sodium increased from
146 to 155 in the last 6 hours and urine specific gravity (SG) is 1.001. To address this problem,
the nurse practitioner would:
1. Order 2 mcg desmopressin (DDAVP) intravenously (IV) and 1 L 0.9% saline.
2. Increase maintenance fluids from 75 to 150 mL/hr and repeat sodium and SG in 6 hours.
3. Order 2 mcg DDAVP IV and fluid restriction.
4. Calculate the free water deficit and order free water via nasogastric tube.
Answer>>1. Order 2 mcg desmopressin (DDAVP) intravenously (IV) and 1 L 0.9% saline.
Rationale: This patient has central diabetes insipidus from pituitary compression. Treatment
involves urgent administration of desmopressin and fluids to attenuate the hypernatremia.
,3. A 68-year-old 70-kg male patient with a history of tobacco abuse was admitted with dyspnea.
A chest x-ray revealed a pulmonary mass, flattened bilateral diaphragm, and no pulmonary
edema. He is alert and breathing comfortably after being started on 4 L of oxygen via nasal
cannula. His initial sodium is 128 mEq/L. Based on the nurse practitioner's knowledge of the
probable diagnosis, how would the nurse practitioner correct his sodium?
1. Start 3% saline at 75 mL/hr.
2. Start 0.9% saline at 1000 mL/hr.
3. Institute a fluid restriction.
4. Order 40 mg furosemide and repeat sodium in 8 hours.
Answer>>3. Institute a fluid restriction.
Rationale: The syndrome of inappropriate antidiuretic hormone is commonly caused by
pulmonary disease and malignancy. First-line treatment is a fluid restriction in the absence of
symptoms such as seizure, mental status change, and falls.
4. A 55-year-old female patient with a history of type 2 diabetes and diverticulitis is admitted to
the intensive care unit following laparotomy for colectomy. She remains intubated and requires
norepinephrine at 0.06 mcg/kg/min to maintain a mean arterial pressure greater than 65 mmHg
despite adequate intraoperative fluid resuscitation. Her blood glucose is 220 mg/dL. The nurse
practitioner's initial glucose management strategy will entail starting:
1. Insulin(R) infusion with target glucose less than 120 mg/dL.
2. Insulin(R) subcutaneous (SQ) sliding scale with target glucose 140 to 180 mg/dL.
3. Insulin(R) SQ sliding scale with target glucose less than 120 mg/dL.
4. Insulin(R) infusion with target glucose 140 to 180 mg/dL.
Answer>>4. Insulin(R) infusion with target glucose 140 to 180 mg/dL.
Rationale: Preferred insulin route in the intensive care unit setting is intravenous infusion with a
target of 140 to 180 mg/dL to avoid hypoglycemic complications. Vasoconstriction and edema of
subcutaneous tissue can alter absorption.
, 5. A 55-year-old female patient with a history of type 2 diabetes and diverticulitis was admitted
to the intensive care unit after laparotomy for colectomy. She was briefly intubated and on
vasopressors. She is now weaned off norepinephrine and transferred to a med/surg floor. She is
tolerating oral nutrition with a carbohydrate-controlled diet and is still on insulin infusion at 0.5
units/hr with a 24-hour glucose range of 150 to 180 mg/dL. Her home regimen involves
metformin 1000 mg twice a day (BID) by mouth and a carbohydrate-controlled diet. Hemoglobin
A1c is 7.8%. The most appropriate next step in the management of this patient's diabetes is:
1. Restart home metformin and monitor blood glucose Q achs.
2. Continue the insulin infusion for 24 more hours.
3. Restart and increase metformin to 2000 mg BID.
4. Start insulin glargine 12 units daily and a subcutaneous sliding scale.
Answer>>1. Restart home metformin and monitor blood glucose Q achs.
Rationale: This patient had adequate glucose control and can be safely transitioned back to her
home regimen in the absence of other contraindications.
6. An 85-year-old female patient is admitted to a med/surg floor with a urinary tract infection
and confusion. She is tolerating a regular diet and has no history of diabetes. The glucose on her
initial chemistry panel is 230 mg/dL and hemoglobin A1c is 10%. The most appropriate
management of this patient's glucose is:
1. Start insulin infusion and follow glucose once every hour.
2. Initiate a subcutaneous basal, prandial, correction regimen.
3. Start metformin 1500 mg twice a day.
4. Instruct patient to follow up with her primary care provider 2 weeks after discharge.
Answer>>2. Initiate a subcutaneous basal, prandial, correction regimen.
Rationale: Hospitalized patients with new hyperglycemia should be managed with basal,
prandial, correction.
CERTIFICATION ENDOCRINE EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS GRADED A+
1. A 25-year-old male patient is admitted to the intensive care unit after a motor vehicle collision
resulting in an isolated severe traumatic brain injury causing elevated intracranial pressure. He is
on a ventilator and minimally responsive. On the second day of hospitalization, he has increasing
vasopressor requirements and hourly urine output of 400 mL. To address this problem, the nurse
practitioner would:
1. Order a fluid restriction.
2. Order serum sodium, urine-specific gravity.
3. Order 24-hour urine protein and creatinine.
4. Order a stat noncontrast computed tomography of the head.
Answer>>2. Order serum sodium, urine-specific gravity.
Rationale: This scenario suggests a diagnosis of diabetes insipidus, for which serum sodium and
urine specific gravity will aid in the diagnosis.
2. A 25-year-old male patient is admitted to the intensive care unit after a motor vehicle collision
resulting in an isolated severe traumatic brain injury causing elevated intracranial pressure. He is
on a ventilator and minimally responsive. On the second day of hospitalization, he has increasing
vasopressor requirements and hourly urine output of 400 mL. His serum sodium increased from
146 to 155 in the last 6 hours and urine specific gravity (SG) is 1.001. To address this problem,
the nurse practitioner would:
1. Order 2 mcg desmopressin (DDAVP) intravenously (IV) and 1 L 0.9% saline.
2. Increase maintenance fluids from 75 to 150 mL/hr and repeat sodium and SG in 6 hours.
3. Order 2 mcg DDAVP IV and fluid restriction.
4. Calculate the free water deficit and order free water via nasogastric tube.
Answer>>1. Order 2 mcg desmopressin (DDAVP) intravenously (IV) and 1 L 0.9% saline.
Rationale: This patient has central diabetes insipidus from pituitary compression. Treatment
involves urgent administration of desmopressin and fluids to attenuate the hypernatremia.
,3. A 68-year-old 70-kg male patient with a history of tobacco abuse was admitted with dyspnea.
A chest x-ray revealed a pulmonary mass, flattened bilateral diaphragm, and no pulmonary
edema. He is alert and breathing comfortably after being started on 4 L of oxygen via nasal
cannula. His initial sodium is 128 mEq/L. Based on the nurse practitioner's knowledge of the
probable diagnosis, how would the nurse practitioner correct his sodium?
1. Start 3% saline at 75 mL/hr.
2. Start 0.9% saline at 1000 mL/hr.
3. Institute a fluid restriction.
4. Order 40 mg furosemide and repeat sodium in 8 hours.
Answer>>3. Institute a fluid restriction.
Rationale: The syndrome of inappropriate antidiuretic hormone is commonly caused by
pulmonary disease and malignancy. First-line treatment is a fluid restriction in the absence of
symptoms such as seizure, mental status change, and falls.
4. A 55-year-old female patient with a history of type 2 diabetes and diverticulitis is admitted to
the intensive care unit following laparotomy for colectomy. She remains intubated and requires
norepinephrine at 0.06 mcg/kg/min to maintain a mean arterial pressure greater than 65 mmHg
despite adequate intraoperative fluid resuscitation. Her blood glucose is 220 mg/dL. The nurse
practitioner's initial glucose management strategy will entail starting:
1. Insulin(R) infusion with target glucose less than 120 mg/dL.
2. Insulin(R) subcutaneous (SQ) sliding scale with target glucose 140 to 180 mg/dL.
3. Insulin(R) SQ sliding scale with target glucose less than 120 mg/dL.
4. Insulin(R) infusion with target glucose 140 to 180 mg/dL.
Answer>>4. Insulin(R) infusion with target glucose 140 to 180 mg/dL.
Rationale: Preferred insulin route in the intensive care unit setting is intravenous infusion with a
target of 140 to 180 mg/dL to avoid hypoglycemic complications. Vasoconstriction and edema of
subcutaneous tissue can alter absorption.
, 5. A 55-year-old female patient with a history of type 2 diabetes and diverticulitis was admitted
to the intensive care unit after laparotomy for colectomy. She was briefly intubated and on
vasopressors. She is now weaned off norepinephrine and transferred to a med/surg floor. She is
tolerating oral nutrition with a carbohydrate-controlled diet and is still on insulin infusion at 0.5
units/hr with a 24-hour glucose range of 150 to 180 mg/dL. Her home regimen involves
metformin 1000 mg twice a day (BID) by mouth and a carbohydrate-controlled diet. Hemoglobin
A1c is 7.8%. The most appropriate next step in the management of this patient's diabetes is:
1. Restart home metformin and monitor blood glucose Q achs.
2. Continue the insulin infusion for 24 more hours.
3. Restart and increase metformin to 2000 mg BID.
4. Start insulin glargine 12 units daily and a subcutaneous sliding scale.
Answer>>1. Restart home metformin and monitor blood glucose Q achs.
Rationale: This patient had adequate glucose control and can be safely transitioned back to her
home regimen in the absence of other contraindications.
6. An 85-year-old female patient is admitted to a med/surg floor with a urinary tract infection
and confusion. She is tolerating a regular diet and has no history of diabetes. The glucose on her
initial chemistry panel is 230 mg/dL and hemoglobin A1c is 10%. The most appropriate
management of this patient's glucose is:
1. Start insulin infusion and follow glucose once every hour.
2. Initiate a subcutaneous basal, prandial, correction regimen.
3. Start metformin 1500 mg twice a day.
4. Instruct patient to follow up with her primary care provider 2 weeks after discharge.
Answer>>2. Initiate a subcutaneous basal, prandial, correction regimen.
Rationale: Hospitalized patients with new hyperglycemia should be managed with basal,
prandial, correction.
