1
HESI Exit Exam Endocrine Crisis
Bank: DKA, HHS, Thyroid & Diabetes
Emergencies
Table of Contents
Subtopic 1: Diabetic Ketoacidosis (DKA) – Recognition, Management, and
Complications..................................................................................................2
Subtopic 2: Hyperosmolar Hyperglycemic State (HHS) – Diagnosis,
Interventions, and Differences from DKA.......................................................10
Subtopic 3: Hypoglycemia in the Hospitalized Diabetic Patient – Recognition
and Emergency Response..............................................................................18
Subtopic 4: Thyroid Storm – Crisis Management and ICU Priorities...............27
Subtopic 5: Myxedema Coma – Emergency Management in Severe
Hypothyroidism..............................................................................................35
Subtopic 6: Diabetes Insipidus vs. SIADH – Differentiation and Fluid
Management..................................................................................................44
Subtopic 7: Hyperglycemic Hyperosmolar State (HHS) – Recognition and
Nursing Actions..............................................................................................52
Subtopic 8: Thyroid Storm – Recognition, Intervention, and Pharmacology...60
Subtopic 9: Adrenal-Thyroid Interactions and Mixed Emergencies.................69
Subtopic 10: Diagnostic Interpretation and Endocrine Crisis Case Scenarios 78
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Subtopic 1: Diabetic Ketoacidosis (DKA) –
Recognition, Management, and Complications
Question 1:
A 17-year-old patient with Type 1 Diabetes presents to the ED with fruity
breath, Kussmaul respirations, and altered mental status. What is the priority
nursing intervention?
A. Administer IV potassium
B. Initiate IV fluid resuscitation with normal saline
C. Administer subcutaneous insulin
D. Prepare the patient for dialysis
Correct Answer: B. Initiate IV fluid resuscitation with normal saline
Rationale: Fluid resuscitation is the first-line treatment in DKA to restore
circulatory volume and perfusion. Insulin therapy follows after initial fluid
replacement.
Question 2:
Which laboratory finding is most indicative of DKA?
A. Serum glucose 180 mg/dL
B. Serum osmolality 290 mOsm/kg
C. Serum bicarbonate 12 mEq/L
D. Urine ketones negative
Correct Answer: C. Serum bicarbonate 12 mEq/L
Rationale: A low bicarbonate level (<15 mEq/L) and metabolic acidosis with
ketonemia confirm DKA diagnosis.
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Question 3:
A patient with DKA has a potassium level of 5.6 mEq/L. What is the
appropriate action before initiating insulin therapy?
A. Administer potassium chloride
B. Begin insulin infusion and monitor potassium closely
C. Delay insulin until potassium is below 5.0 mEq/L
D. Restrict all fluids
Correct Answer: B. Begin insulin infusion and monitor potassium closely
Rationale: Although potassium appears elevated initially due to acidosis,
insulin drives potassium into cells, risking hypokalemia. Monitoring is
essential.
Question 4:
Which of the following is a hallmark sign of DKA but not Hyperosmolar
Hyperglycemic State (HHS)?
A. Severe dehydration
B. Serum glucose >600 mg/dL
C. Mental status changes
D. Ketonuria and metabolic acidosis
Correct Answer: D. Ketonuria and metabolic acidosis
Rationale: DKA features ketone production and metabolic acidosis; HHS does
not typically involve ketones or acidosis.
Question 5:
What insulin therapy is preferred in the acute management of DKA?
A. Long-acting subcutaneous insulin
, 4
B. Continuous IV infusion of regular insulin
C. Sliding scale insulin every 6 hours
D. Intramuscular insulin every 8 hours
Correct Answer: B. Continuous IV infusion of regular insulin
Rationale: IV regular insulin allows for precise control and rapid effect, critical
in managing DKA.
Question 6:
What is the expected anion gap in a patient with untreated DKA?
A. <10
B. 10–12
C. >12
D. Normal
Correct Answer: C. >12
Rationale: Elevated anion gap metabolic acidosis is characteristic of DKA due
to the accumulation of ketone bodies.
Question 7:
When treating DKA, at what blood glucose level should dextrose be added to
IV fluids?
A. 300 mg/dL
B. 200 mg/dL
C. 250 mg/dL
D. 100 mg/dL
Correct Answer: B. 200 mg/dL
HESI Exit Exam Endocrine Crisis
Bank: DKA, HHS, Thyroid & Diabetes
Emergencies
Table of Contents
Subtopic 1: Diabetic Ketoacidosis (DKA) – Recognition, Management, and
Complications..................................................................................................2
Subtopic 2: Hyperosmolar Hyperglycemic State (HHS) – Diagnosis,
Interventions, and Differences from DKA.......................................................10
Subtopic 3: Hypoglycemia in the Hospitalized Diabetic Patient – Recognition
and Emergency Response..............................................................................18
Subtopic 4: Thyroid Storm – Crisis Management and ICU Priorities...............27
Subtopic 5: Myxedema Coma – Emergency Management in Severe
Hypothyroidism..............................................................................................35
Subtopic 6: Diabetes Insipidus vs. SIADH – Differentiation and Fluid
Management..................................................................................................44
Subtopic 7: Hyperglycemic Hyperosmolar State (HHS) – Recognition and
Nursing Actions..............................................................................................52
Subtopic 8: Thyroid Storm – Recognition, Intervention, and Pharmacology...60
Subtopic 9: Adrenal-Thyroid Interactions and Mixed Emergencies.................69
Subtopic 10: Diagnostic Interpretation and Endocrine Crisis Case Scenarios 78
, 2
Subtopic 1: Diabetic Ketoacidosis (DKA) –
Recognition, Management, and Complications
Question 1:
A 17-year-old patient with Type 1 Diabetes presents to the ED with fruity
breath, Kussmaul respirations, and altered mental status. What is the priority
nursing intervention?
A. Administer IV potassium
B. Initiate IV fluid resuscitation with normal saline
C. Administer subcutaneous insulin
D. Prepare the patient for dialysis
Correct Answer: B. Initiate IV fluid resuscitation with normal saline
Rationale: Fluid resuscitation is the first-line treatment in DKA to restore
circulatory volume and perfusion. Insulin therapy follows after initial fluid
replacement.
Question 2:
Which laboratory finding is most indicative of DKA?
A. Serum glucose 180 mg/dL
B. Serum osmolality 290 mOsm/kg
C. Serum bicarbonate 12 mEq/L
D. Urine ketones negative
Correct Answer: C. Serum bicarbonate 12 mEq/L
Rationale: A low bicarbonate level (<15 mEq/L) and metabolic acidosis with
ketonemia confirm DKA diagnosis.
, 3
Question 3:
A patient with DKA has a potassium level of 5.6 mEq/L. What is the
appropriate action before initiating insulin therapy?
A. Administer potassium chloride
B. Begin insulin infusion and monitor potassium closely
C. Delay insulin until potassium is below 5.0 mEq/L
D. Restrict all fluids
Correct Answer: B. Begin insulin infusion and monitor potassium closely
Rationale: Although potassium appears elevated initially due to acidosis,
insulin drives potassium into cells, risking hypokalemia. Monitoring is
essential.
Question 4:
Which of the following is a hallmark sign of DKA but not Hyperosmolar
Hyperglycemic State (HHS)?
A. Severe dehydration
B. Serum glucose >600 mg/dL
C. Mental status changes
D. Ketonuria and metabolic acidosis
Correct Answer: D. Ketonuria and metabolic acidosis
Rationale: DKA features ketone production and metabolic acidosis; HHS does
not typically involve ketones or acidosis.
Question 5:
What insulin therapy is preferred in the acute management of DKA?
A. Long-acting subcutaneous insulin
, 4
B. Continuous IV infusion of regular insulin
C. Sliding scale insulin every 6 hours
D. Intramuscular insulin every 8 hours
Correct Answer: B. Continuous IV infusion of regular insulin
Rationale: IV regular insulin allows for precise control and rapid effect, critical
in managing DKA.
Question 6:
What is the expected anion gap in a patient with untreated DKA?
A. <10
B. 10–12
C. >12
D. Normal
Correct Answer: C. >12
Rationale: Elevated anion gap metabolic acidosis is characteristic of DKA due
to the accumulation of ketone bodies.
Question 7:
When treating DKA, at what blood glucose level should dextrose be added to
IV fluids?
A. 300 mg/dL
B. 200 mg/dL
C. 250 mg/dL
D. 100 mg/dL
Correct Answer: B. 200 mg/dL
