ATI COMPLEX ENDOCRINE QUESTIONS & ANSWERS
2026/2027 | Detailed Answer Key | Latest Complete
Solutions | Pass Guaranteed - A+ Graded
Section 1: Diabetes Mellitus Complex Management (Q1-22)
Q1: A 24-year-old patient with Type 1 diabetes presents to the ED with Kussmaul
respirations, fruity breath, and confusion. Lab results: pH 7.25, HCO3 12 mEq/L,
glucose 485 mg/dL, ketones positive. The nurse recognizes this as:
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA) [CORRECT]
C. Hypoglycemic crisis
D. Thyroid storm
Correct Answer: B
Rationale: DKA is characterized by metabolic acidosis (pH <7.3, HCO3 <18),
hyperglycemia, and ketosis. Kussmaul respirations (compensatory hyperventilation)
and fruity breath (acetone) are classic. HHS (option A) lacks significant ketosis and
acidosis. Option C presents with low glucose. Option D has different metabolic and
clinical features.
Q2: The priority intervention for the patient in DKA is:
A. Immediate insulin bolus of 20 units IV push
B. Aggressive fluid resuscitation with 0.9% NS followed by insulin infusion [CORRECT]
,C. Sodium bicarbonate administration to correct acidosis
D. Oral glucose administration
Correct Answer: B
Rationale: Fluid resuscitation is the first priority in DKA to restore intravascular
volume, improve perfusion, and begin lowering glucose through dilution and renal
excretion. Insulin (option A) follows fluid resuscitation. Bicarbonate (option C) is
reserved for severe acidosis (pH <6.9). Option D is contraindicated in hyperglycemia.
Q3: A patient on an insulin drip has a glucose of 180 mg/dL after 4 hours of
treatment. The protocol calls for reducing the insulin infusion. The nurse should:
A. Discontinue the insulin drip immediately
B. Reduce the insulin rate per protocol and continue monitoring glucose hourly
[CORRECT]
C. Increase the insulin rate to achieve faster correction
D. Switch to subcutaneous insulin immediately
Correct Answer: B
Rationale: Gradual glucose reduction (50-70 mg/dL/hour) prevents cerebral edema.
The insulin rate is titrated down as glucose falls, but insulin is continued until anion
gap closes and ketosis resolves. Option A risks rebound hyperglycemia. Option C
risks cerebral edema. Option D is premature during active DKA.
Q4: A patient with Type 2 diabetes has glucose 920 mg/dL, pH 7.38, HCO3 24 mEq/L,
negative ketones, and altered mental status. This presentation is most consistent
with:
A. DKA
B. Hyperosmolar hyperglycemic state (HHS) [CORRECT]
,C. Hypoglycemia
D. Lactic acidosis
Correct Answer: B
Rationale: HHS features extreme hyperglycemia (>600 mg/dL), hyperosmolarity
(>320 mOsm/kg), minimal ketosis, and altered mental status without significant
acidosis. Option A requires acidosis and ketosis. Option C presents with low glucose.
Option D requires elevated lactate.
Q5: The primary difference in fluid resuscitation between DKA and HHS is:
A. HHS requires more aggressive fluid replacement due to greater total body water
deficit [CORRECT]
B. DKA requires dextrose-containing fluids immediately
C. HHS requires bicarbonate administration first
D. Both conditions use identical fluid protocols
Correct Answer: A
Rationale: HHS patients typically have greater free water deficits (8-12 L vs 3-6 L in
DKA) due to prolonged osmotic diuresis. Fluid resuscitation is more aggressive in
HHS. Option B applies to DKA when glucose falls to 200-250 mg/dL. Option C is not
standard for HHS. Option D is incorrect—protocols differ.
Q6: A patient on basal-bolus insulin therapy is NPO for surgery. The nurse should:
A. Hold all insulin to prevent hypoglycemia
B. Continue basal insulin (glargine/detemir) and hold bolus insulin [CORRECT]
C. Give regular insulin IV push every 4 hours
D. Switch to oral hypoglycemics
, Correct Answer: B
Rationale: Basal insulin prevents ketosis and maintains metabolic stability during
NPO status; bolus insulin is held because no carbohydrates are consumed. Option A
risks DKA. Option C is not standard basal-bolus management. Option D is
inappropriate for Type 1 and perioperative Type 2.
Q7: A patient using an insulin pump presents with glucose 340 mg/dL and moderate
ketones. The first action is to:
A. Change the infusion set and site, check for kinks/occlusions, and administer
correction bolus via injection [CORRECT]
B. Increase the basal rate by 50%
C. Disconnect the pump and wait for provider orders
D. Drink large amounts of water and recheck in 2 hours
Correct Answer: A
Rationale: Pump failure (occlusion, kinked tubing, dislodged cannula) is a common
cause of hyperglycemia/ketosis in pump users. Changing the set and giving injection
ensures insulin delivery. Option B doesn't address delivery failure. Option C delays
necessary intervention. Option D is insufficient.
Q8: A patient with Type 1 diabetes using a CGM (continuous glucose monitor) alarms
for glucose 55 mg/dL with downward trend arrow. The patient is awake and alert.
The nurse instructs the patient to:
A. Administer glucagon 1 mg IM immediately
B. Follow the 15-15 rule: consume 15g fast-acting carbohydrate, recheck in 15
minutes [CORRECT]
C. Take 5 units of rapid-acting insulin to prevent rebound hyperglycemia
2026/2027 | Detailed Answer Key | Latest Complete
Solutions | Pass Guaranteed - A+ Graded
Section 1: Diabetes Mellitus Complex Management (Q1-22)
Q1: A 24-year-old patient with Type 1 diabetes presents to the ED with Kussmaul
respirations, fruity breath, and confusion. Lab results: pH 7.25, HCO3 12 mEq/L,
glucose 485 mg/dL, ketones positive. The nurse recognizes this as:
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA) [CORRECT]
C. Hypoglycemic crisis
D. Thyroid storm
Correct Answer: B
Rationale: DKA is characterized by metabolic acidosis (pH <7.3, HCO3 <18),
hyperglycemia, and ketosis. Kussmaul respirations (compensatory hyperventilation)
and fruity breath (acetone) are classic. HHS (option A) lacks significant ketosis and
acidosis. Option C presents with low glucose. Option D has different metabolic and
clinical features.
Q2: The priority intervention for the patient in DKA is:
A. Immediate insulin bolus of 20 units IV push
B. Aggressive fluid resuscitation with 0.9% NS followed by insulin infusion [CORRECT]
,C. Sodium bicarbonate administration to correct acidosis
D. Oral glucose administration
Correct Answer: B
Rationale: Fluid resuscitation is the first priority in DKA to restore intravascular
volume, improve perfusion, and begin lowering glucose through dilution and renal
excretion. Insulin (option A) follows fluid resuscitation. Bicarbonate (option C) is
reserved for severe acidosis (pH <6.9). Option D is contraindicated in hyperglycemia.
Q3: A patient on an insulin drip has a glucose of 180 mg/dL after 4 hours of
treatment. The protocol calls for reducing the insulin infusion. The nurse should:
A. Discontinue the insulin drip immediately
B. Reduce the insulin rate per protocol and continue monitoring glucose hourly
[CORRECT]
C. Increase the insulin rate to achieve faster correction
D. Switch to subcutaneous insulin immediately
Correct Answer: B
Rationale: Gradual glucose reduction (50-70 mg/dL/hour) prevents cerebral edema.
The insulin rate is titrated down as glucose falls, but insulin is continued until anion
gap closes and ketosis resolves. Option A risks rebound hyperglycemia. Option C
risks cerebral edema. Option D is premature during active DKA.
Q4: A patient with Type 2 diabetes has glucose 920 mg/dL, pH 7.38, HCO3 24 mEq/L,
negative ketones, and altered mental status. This presentation is most consistent
with:
A. DKA
B. Hyperosmolar hyperglycemic state (HHS) [CORRECT]
,C. Hypoglycemia
D. Lactic acidosis
Correct Answer: B
Rationale: HHS features extreme hyperglycemia (>600 mg/dL), hyperosmolarity
(>320 mOsm/kg), minimal ketosis, and altered mental status without significant
acidosis. Option A requires acidosis and ketosis. Option C presents with low glucose.
Option D requires elevated lactate.
Q5: The primary difference in fluid resuscitation between DKA and HHS is:
A. HHS requires more aggressive fluid replacement due to greater total body water
deficit [CORRECT]
B. DKA requires dextrose-containing fluids immediately
C. HHS requires bicarbonate administration first
D. Both conditions use identical fluid protocols
Correct Answer: A
Rationale: HHS patients typically have greater free water deficits (8-12 L vs 3-6 L in
DKA) due to prolonged osmotic diuresis. Fluid resuscitation is more aggressive in
HHS. Option B applies to DKA when glucose falls to 200-250 mg/dL. Option C is not
standard for HHS. Option D is incorrect—protocols differ.
Q6: A patient on basal-bolus insulin therapy is NPO for surgery. The nurse should:
A. Hold all insulin to prevent hypoglycemia
B. Continue basal insulin (glargine/detemir) and hold bolus insulin [CORRECT]
C. Give regular insulin IV push every 4 hours
D. Switch to oral hypoglycemics
, Correct Answer: B
Rationale: Basal insulin prevents ketosis and maintains metabolic stability during
NPO status; bolus insulin is held because no carbohydrates are consumed. Option A
risks DKA. Option C is not standard basal-bolus management. Option D is
inappropriate for Type 1 and perioperative Type 2.
Q7: A patient using an insulin pump presents with glucose 340 mg/dL and moderate
ketones. The first action is to:
A. Change the infusion set and site, check for kinks/occlusions, and administer
correction bolus via injection [CORRECT]
B. Increase the basal rate by 50%
C. Disconnect the pump and wait for provider orders
D. Drink large amounts of water and recheck in 2 hours
Correct Answer: A
Rationale: Pump failure (occlusion, kinked tubing, dislodged cannula) is a common
cause of hyperglycemia/ketosis in pump users. Changing the set and giving injection
ensures insulin delivery. Option B doesn't address delivery failure. Option C delays
necessary intervention. Option D is insufficient.
Q8: A patient with Type 1 diabetes using a CGM (continuous glucose monitor) alarms
for glucose 55 mg/dL with downward trend arrow. The patient is awake and alert.
The nurse instructs the patient to:
A. Administer glucagon 1 mg IM immediately
B. Follow the 15-15 rule: consume 15g fast-acting carbohydrate, recheck in 15
minutes [CORRECT]
C. Take 5 units of rapid-acting insulin to prevent rebound hyperglycemia
