Endocrine & Metabolic NCLEX Practice Questions

DKA: predominantly Type 1, blood glucose >300, ketones present, Kussmaul breathing, fruity breath, and rapid onset. HHNKS: predominantly Type 2 (often elderly), blood glucose >600, no significant ketones, severe dehydration, altered LOC, and gradual onset. Both are emergencies requiring IV fluids and insulin therapy.

NCLEX tests insulin types (rapid, short, intermediate, long-acting), peak times for hypoglycemia risk assessment, the rule of 15 for hypoglycemia treatment (15g fast-acting carbs, recheck in 15 min), proper injection technique and rotation sites, and insulin drip management in DKA.

Hypothyroidism: fatigue, weight gain, cold intolerance, constipation, bradycardia, dry skin. Treatment: levothyroxine (take on empty stomach, monitor TSH). Hyperthyroidism: weight loss, heat intolerance, tachycardia, exophthalmos, tremors, diarrhea. Treatment: methimazole or PTU, radioactive iodine, or thyroidectomy. Thyroid storm: life-threatening — extreme tachycardia, hyperthermia, agitation. Priority: beta-blockers, cooling measures, and antithyroid medications.

Addison disease (adrenal insufficiency): low cortisol and aldosterone causing hypotension, hyperkalemia, hyponatremia, hypoglycemia, bronze skin pigmentation, and weight loss. Treatment: lifelong corticosteroid replacement. Cushing syndrome (excess cortisol): moon face, buffalo hump, truncal obesity, hyperglycemia, hypertension, hypokalemia, immunosuppression, and thin fragile skin. Causes include chronic steroid use or pituitary/adrenal tumors.

Hyperkalemia (in Addison disease, DKA, renal failure): peaked T waves on ECG, muscle weakness, cardiac arrhythmias. Hypokalemia (in Cushing syndrome, loop diuretics): flat T waves, U waves, muscle cramps, weakness. Hypocalcemia (post-thyroidectomy from parathyroid damage): Chvostek sign (facial twitching), Trousseau sign (carpopedal spasm), tetany, and numbness. Keep calcium gluconate at bedside post-thyroidectomy.

Sick day rules (never skip insulin, check glucose more frequently, stay hydrated), foot care (inspect daily, no walking barefoot, no heating pads, cut nails straight across), recognizing hypo vs hyperglycemia symptoms, rotating injection sites, proper sharps disposal, HbA1c goal (<7% for most adults), and the importance of annual eye exams and regular kidney function monitoring. Exercise lowers blood glucose — carry a fast-acting carbohydrate source.