Endocrine Disorders 2026 Management of Diabetes & Thyroid

Endocrine Disorders: 2026 Management of Diabetes & Thyroid (Exam Prep) Question 1: A patient with Type 1 Diabetes is admitted with Diabetic Ketoacidosis (DKA). Which of the following initial nursing interventions is the highest priority? A) Administering a subcutaneous dose of long-acting insulin. B) Starting an infusion of 0.9% Normal Saline. C) Assessing the patient's hemoglobin A1C level. D) Administering intravenous sodium bicarbonate. Correct Answer: B Rationale: The immediate priority in DKA is fluid resuscitation to correct severe dehydration and hypovolemia caused by osmotic diuresis, before administering IV insulin. Question 2: A patient taking levothyroxine (Synthroid) for hypothyroidism asks the nurse how to properly take the medication. What is the best instruction? A) Take it with a high-protein breakfast. B) Take it right before going to bed with a glass of milk. C) Take it in the morning on an empty stomach, at least 30 to 60 minutes before eating. D) Take it with an antacid to prevent stomach upset. Correct Answer: C Rationale: Levothyroxine absorption is significantly decreased by food, calcium, and iron. It must be taken on an empty stomach with a full glass of water to ensure consistent absorption. Question 3: A patient recovering from a total thyroidectomy complains of tingling around the mouth and numbness in the fingers. Which medication should the nurse have readily available? A) Potassium chloride. B) Levothyroxine. C) Methimazole. D) IV Calcium Gluconate. Correct Answer: D Rationale: Tingling around the mouth (circumoral paresthesia) and fingertips are classic signs of hypocalcemia, often caused by accidental removal or damage to the parathyroid glands during thyroid surgery. IV calcium is the emergency treatment. Question 4: A patient is prescribed a GLP-1 receptor agonist (e.g., Semaglutide) for Type 2 Diabetes. The nurse should educate the patient to monitor for which common side effect? A) Severe hypoglycemia. B) Rapid weight gain. C) Nausea and gastrointestinal distress. D) Tachycardia and palpitations. Correct Answer: C Rationale: GLP-1 agonists slow gastric emptying, which helps with weight loss and glucose control but commonly causes nausea, vomiting, and diarrhea, especially when initiating therapy. Question 5: Which laboratory finding is the most reliable indicator of long-term glycemic control over the past 2 to 3 months? A) Fasting blood glucose. B) Oral glucose tolerance test (OGTT). C) Glycosylated hemoglobin (HbA1C). D) Urine ketones. Correct Answer: C Rationale: HbA1C measures the percentage of hemoglobin that is coated with glucose, reflecting the average blood glucose levels over the lifespan of a red blood cell (approx. 120 days). Question 6: A patient with Hyperthyroidism (Graves' disease) develops a temperature of 104°F (40°C), heart rate of 160 bpm, and severe agitation. The nurse suspects: A) Myxedema Coma. B) Thyroid Storm (Thyrotoxic Crisis). C) Diabetic Ketoacidosis. D) An allergic reaction to methimazole. Correct Answer: B Rationale: Thyroid storm is a life-threatening exacerbation of hyperthyroidism characterized by extreme hyperthermia, severe tachycardia, and altered mental status requiring immediate medical intervention. Question 7: A patient is receiving a continuous regular insulin IV infusion for DKA. The patient's blood glucose drops from 400 mg/dL to 250 mg/dL. What is the next anticipated nursing action? A) Stop the insulin drip completely. B) Switch the IV fluids to contain 5% Dextrose (e.g., D5 1/2 NS). C) Administer 1 ampule of D50W IV push. D) Transition the patient immediately to oral antidiabetic agents. Correct Answer: B Rationale: When blood glucose falls to approximately 250 mg/dL during DKA treatment, dextrose is added to the IV fluids to prevent hypoglycemia and cerebral edema while the insulin drip continues to clear the ketones. Question 8: Which clinical manifestation is a hallmark sign of Hypothyroidism? A) Heat intolerance. B) Unexplained weight loss. C) Cold intolerance and fatigue. D) Exophthalmos (bulging eyes). Correct Answer: C Rationale: Hypothyroidism slows down the basal metabolic rate, leading to decreased heat production (cold intolerance), profound fatigue, weight gain, and bradycardia. Question 9: A patient is diagnosed with Hyperosmolar Hyperglycemic Syndrome (HHS). How does HHS primarily differ from DKA? A) HHS has profound ketosis and acidosis. B) HHS occurs primarily in patients with Type 1 Diabetes. C) HHS features severe hyperglycemia and dehydration without significant ketosis. D) HHS requires much less fluid resuscitation than DKA. Correct Answer: C Rationale: In HHS (common in Type 2 DM), there is enough circulating insulin to prevent fat breakdown and ketosis, but not enough to prevent severe hyperglycemia, leading to extreme osmotic diuresis and profound dehydration. Question 10: The nurse is assessing a patient with a history of Type 2 diabetes. Which finding indicates the patient is experiencing a microvascular complication of diabetes? A) A recent myocardial infarction. B) Decreased visual acuity (Diabetic Retinopathy). C) Development of a deep vein thrombosis. D) A cerebrovascular accident (Stroke). Correct Answer: B Rationale: Microvascular complications affect tiny blood vessels and include retinopathy (eyes), nephropathy (kidneys), and neuropathy (nerves). Macrovascular complications include heart attacks and strokes. Question 11: Which action demonstrates the correct technique for administering a subcutaneous injection of NPH and Regular insulin mixed in the same syringe? A) Draw up the NPH (cloudy) first, then the Regular (clear). B) Draw up the Regular (clear) first, then the NPH (cloudy). C) Shake the NPH vial vigorously before drawing it up. D) Administer the injection intramuscularly for faster absorption. Correct Answer: B Rationale: The mnemonic "Clear before Cloudy" is used. Regular insulin is clear and drawn first to prevent contaminating the Regular insulin vial with the longer-acting NPH (cloudy) insulin. Question 12: A patient with continuous glucose monitoring (CGM) is alarming for a glucose of 52 mg/dL. The patient is awake and complaining of shakiness. Priority action? A) Administer IV Glucagon. B) Provide 15 grams of a fast-acting oral carbohydrate. C) Administer a complex carbohydrate like a peanut butter sandwich. D) Retest the glucose in one hour. Correct Answer: B Rationale: The "Rule of 15" dictates giving 15g of simple, fast-acting carbs (like 4 oz of juice) to a conscious, hypoglycemic patient, then rechecking in 15 minutes. Question 13: A patient is taking Methimazole for hyperthyroidism. The nurse should instruct the patient to immediately report which symptom? A) Mild weight gain. B) Sore throat and fever. C) Increased frequency of bowel movements. D) Dry skin. Correct Answer: B Rationale: Methimazole can cause agranulocytosis (a severe drop in white blood cells). A sore throat and fever are early signs of infection and require immediate discontinuation of the drug and CBC evaluation. Question 14: Which statement by a patient with Type 1 diabetes indicates a need for further teaching regarding sick-day rules? A) "I will check my blood sugar every 3 to 4 hours. " B) "I will stop taking my insulin if I am vomiting and can't eat. " C) "I will check my urine for ketones if my blood sugar is over 240 mg/dL. " D) "I will drink plenty of sugar-free fluids to stay hydrated. " Correct Answer: B Rationale: Illness causes the body to release stress hormones (like cortisol) that raise blood sugar. Patients must NEVER stop their insulin when sick, even if not eating, as this rapidly leads to DKA. Question 15: A patient presents to the ER with profound lethargy, a core temperature of 94°F (34.4°C), and a heart rate of 48 bpm. The family reports the patient stopped taking their thyroid medication months ago. The nurse suspects: A) Thyroid Storm. B) Myxedema Coma. C) Hypoglycemic unresponsiveness. D) Cushing's crisis. Correct Answer: B Rationale: Myxedema coma is the extreme, life-threatening manifestation of hypothyroidism, characterized by hypothermia, bradycardia, hypoventilation, and cardiovascular collapse. Question 6: Wait, to maintain sequencing without losing track, let's continue with Question 16. A patient has been prescribed Metformin for Type 2 Diabetes. The nurse should hold the medication and contact the provider if the patient is scheduled for: A) A routine dental cleaning. B) A physical therapy evaluation. C) A CT scan with intravenous iodinated contrast dye. D) An electrocardiogram (ECG). Correct Answer: C Rationale: Metformin must be withheld before and for 48 hours after procedures using IV contrast dye due to the risk of acute kidney injury and subsequent lactic acidosis. Question 17: Which physical assessment finding is highly specific to Graves' disease (Hyperthyroidism)? A) A buffalo hump. B) Exophthalmos. C) Moon face. D) Purple striae on the abdomen. Correct Answer: B Rationale: Exophthalmos (protrusion of the eyeballs) is a classic sign of Graves' disease due to immune-mediated accumulation of fluid and fat behind the eyes. Question 18: The nurse is assessing a patient with diabetic peripheral neuropathy. What is the most critical patient teaching point? A) "Soak your feet in hot water daily to improve circulation. " B) "Walk barefoot at home to let your feet breathe. " C) "Inspect your feet daily for cuts, blisters, or red spots. " D) "Use a heating pad on your feet if they feel cold at night. " Correct Answer: C Rationale: Neuropathy causes loss of sensation. Patients may sustain an injury to their foot and not feel it, leading to severe ulcers and amputation. Daily visual inspection is mandatory. Question 19: What is the primary mechanism of action of an SGLT2 inhibitor (e.g., Empagliflozin)? A) It stimulates the pancreas to release more insulin. B) It decreases hepatic glucose production. C) It blocks the reabsorption of glucose in the kidneys, causing it to be excreted in the urine. D) It slows carbohydrate absorption in the gut. Correct Answer: C Rationale: SGLT2 inhibitors work in the renal tubules to promote the excretion of excess glucose via the urine. (Note: This increases the risk for UTIs and yeast infections). Question 20: A patient is receiving Glargine (Lantus) insulin. The nurse knows this insulin is unique because: A) It peaks in exactly 2 hours. B) It has no pronounced peak and provides a steady basal level of insulin for 24 hours. C) It must be given intravenously. D) It is taken only with meals. Correct Answer: B Rationale: Glargine is a long-acting "basal" insulin that is released slowly over 24 hours without a distinct peak, reducing the risk of hypoglycemic episodes compared to older intermediate insulins. Question 21: A patient post-thyroidectomy exhibits a positive Trousseau’s sign. How did the nurse elicit this sign? A) By inflating a blood pressure cuff above systolic pressure for 3 minutes. B) By tapping the patient's facial nerve just in front of the ear. C) By asking the patient to smile and puff out their cheeks. D) By assessing the deep tendon reflexes. Correct Answer: B Rationale: Trousseau's sign is elicited with a BP cuff, but tapping the facial nerve causing facial twitching is Chvostek's sign. Correction in option mapping: Tapping the facial nerve is Chvostek's. Trousseau's is the BP cuff. Let me re-ask this accurately. Revised Question 21: A patient post-thyroidectomy exhibits a positive Chvostek’s sign. How did the nurse elicit this sign? A) By inflating a blood pressure cuff above systolic pressure for 3 minutes. B) By tapping the patient's facial nerve just in front of the ear. C) By extending the patient's leg. D) By illuminating the pupil. Correct Answer: B Rationale: Chvostek's sign (facial twitching upon tapping the facial nerve) indicates hypocalcemia. Trousseau's sign is carpal spasm induced by a blood pressure cuff. Question 22: The physician orders regular insulin 10 units IV push. The nurse knows that regular insulin: A) Is the only type of insulin that can be administered intravenously. B) Must be mixed with NPH before IV administration. C) Is a long-acting insulin. D) Should only be given via an insulin pump. Correct Answer: A Rationale: Regular insulin (short-acting) is the only insulin formulation approved for intravenous administration, typically used in DKA and HHS management.