🎯 High-Yield Points
- Hypoglycaemia (<70 mg/dL): give 15g fast-acting carb; recheck in 15 min (15-15 rule)
- DKA: fruity breath, Kussmaul respirations, blood glucose >300 + ketones; treat with IV fluids + insulin
- Hypothyroidism: slow metabolism, weight gain, cold intolerance, myxoedema coma risk
- Hyperthyroidism: thyroid storm = fever + tachycardia + extreme anxiety after stress/surgery
- Addisonian crisis: life-threatening; give IV hydrocortisone immediately + fluids
[Concept Map: Endocrine NCLEX Questions — Clinical Manifestations, Nursing Interventions, Priority Actions]
Practice Questions
Question 1
A client with type 1 diabetes reports shakiness, diaphoresis, and confusion. Blood glucose is 52 mg/dL. Which action does the nurse take FIRST?
✓ Correct: Give 15g of fast-acting carbohydrate orally
A glucose of 52 mg/dL with symptoms confirms hypoglycaemia. For a conscious client who can swallow, the first action is to give 15g of fast-acting carbohydrate orally (4 oz juice, glucose tablets, or regular soda). Recheck glucose in 15 minutes (the 15-15 rule). IV dextrose is reserved for unconscious or NPO clients. Never give more insulin during hypoglycaemia.
A glucose of 52 mg/dL with symptoms confirms hypoglycaemia. For a conscious client who can swallow, the first action is to give 15g of fast-acting carbohydrate orally (4 oz juice, glucose tablets, or regular soda). Recheck glucose in 15 minutes (the 15-15 rule). IV dextrose is reserved for unconscious or NPO clients. Never give more insulin during hypoglycaemia.
Question 2
A client with type 1 diabetes presents with blood glucose of 485 mg/dL, fruity-smelling breath, and Kussmaul respirations. Which condition does the nurse suspect?
✓ Correct: Diabetic ketoacidosis (DKA)
DKA presents with hyperglycaemia (>300), ketoacidosis (fruity breath from acetone), Kussmaul respirations (deep, rapid breathing to compensate for metabolic acidosis), polyuria, and polydipsia. It occurs primarily in type 1 diabetes. HHS also has extreme hyperglycaemia but no ketosis. Treatment: IV fluid resuscitation, insulin infusion, electrolyte monitoring (especially potassium).
DKA presents with hyperglycaemia (>300), ketoacidosis (fruity breath from acetone), Kussmaul respirations (deep, rapid breathing to compensate for metabolic acidosis), polyuria, and polydipsia. It occurs primarily in type 1 diabetes. HHS also has extreme hyperglycaemia but no ketosis. Treatment: IV fluid resuscitation, insulin infusion, electrolyte monitoring (especially potassium).
Question 3
A client with hypothyroidism is prescribed levothyroxine. Which statement by the client indicates understanding of the medication?
✓ Correct: I will take it in the morning on an empty stomach, 30-60 minutes before eating
Levothyroxine must be taken on an empty stomach in the morning, 30-60 minutes before food or other medications, to maximise absorption. Many substances reduce absorption: calcium, iron supplements, antacids, and high-fibre foods. Missing a dose should not be doubled. This is a critical medication education point for hypothyroid clients.
Levothyroxine must be taken on an empty stomach in the morning, 30-60 minutes before food or other medications, to maximise absorption. Many substances reduce absorption: calcium, iron supplements, antacids, and high-fibre foods. Missing a dose should not be doubled. This is a critical medication education point for hypothyroid clients.
Question 4
A nurse is caring for a client post-thyroidectomy who develops sudden restlessness, extreme fever (40.5°C), and tachycardia of 148 bpm. Which complication does the nurse suspect?
✓ Correct: Thyroid storm (thyrotoxic crisis)
Thyroid storm is a life-threatening post-operative complication of thyroidectomy presenting with extreme fever, severe tachycardia, agitation, and extreme diaphoresis. It results from sudden massive release of thyroid hormones. Emergency treatment includes: propylthiouracil (PTU), beta blockers (to control HR), glucocorticoids, IV fluids, and cooling measures. This requires immediate ICU-level intervention.
Thyroid storm is a life-threatening post-operative complication of thyroidectomy presenting with extreme fever, severe tachycardia, agitation, and extreme diaphoresis. It results from sudden massive release of thyroid hormones. Emergency treatment includes: propylthiouracil (PTU), beta blockers (to control HR), glucocorticoids, IV fluids, and cooling measures. This requires immediate ICU-level intervention.
Question 5
A client with Addison disease presents to the emergency department with severe hypotension, confusion, and weakness after developing a viral infection. Which medication does the nurse anticipate administering?
✓ Correct: IV hydrocortisone (Solu-Cortef) immediately
Addisonian crisis (acute adrenal insufficiency) is triggered by physiological stress (illness, surgery, trauma) in a client with Addison disease. The adrenal glands cannot produce sufficient cortisol to meet the increased demand. Treatment: immediate IV hydrocortisone (100-300 mg), aggressive IV fluid replacement (NS), and glucose. This is a medical emergency with high mortality if untreated.
Addisonian crisis (acute adrenal insufficiency) is triggered by physiological stress (illness, surgery, trauma) in a client with Addison disease. The adrenal glands cannot produce sufficient cortisol to meet the increased demand. Treatment: immediate IV hydrocortisone (100-300 mg), aggressive IV fluid replacement (NS), and glucose. This is a medical emergency with high mortality if untreated.
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