NCLEX endocrine practice questions
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- Physiological adaptation test-plan category
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- August 2026 last updated
Endocrine items are pattern recognition under a clock: hypoglycaemia and DKA look nothing alike once you know the picture, and insulin questions turn on onset and peak rather than dose. Ten questions across diabetes, thyroid storm and myxoedema, adrenal insufficiency, and the pituitary disorders the exam still asks about.
Written and reviewed by Dana Whitfield, RN, MSN · Updated August 2026
Physiological adaptation
The endocrine set, all 10 free
Answer, check, and read why each of the four options wins or loses.
Endocrine
Question 1 of 10
A 19-year-old client with type 1 diabetes arrives in the emergency department with a blood glucose of 486 mg/dL, arterial pH 7.18, bicarbonate 12 mEq/L, potassium 5.6 mEq/L, and Kussmaul respirations. Which action should the nurse take first?
Not quite — the answer is C
Why each option is right or wrong
A. Administer subcutaneous insulin glargine as ordered
Long-acting glargine absorbs unpredictably in a volume-depleted client and does not correct the deficit; DKA requires a regular insulin infusion after fluids.
B. Give 1 ampule of sodium bicarbonate IV push
Bicarbonate is reserved for extreme acidemia near a pH of 6.9 and risks hypokalemia and paradoxical CNS acidosis without restoring perfusion.
C. Begin an IV infusion of 0.9% sodium chloride at 15 mL/kg/hr
Osmotic diuresis has depleted intravascular volume, so isotonic saline restores perfusion first and begins lowering glucose before the insulin infusion starts.
D. Start an IV potassium chloride infusion at 20 mEq/hr
Potassium is already 5.6 mEq/L, so infusing it now could trigger lethal dysrhythmias; replacement waits until levels fall during insulin therapy.
Key takeaway
Diabetic ketoacidosis causes profound osmotic diuresis, so isotonic fluid resuscitation is the first priority to restore circulating volume and tissue perfusion, consistent with the ABC/circulation framework. Long-acting subcutaneous insulin is inappropriate in DKA because absorption is unreliable in a volume-depleted client; regular insulin by continuous IV infusion is started after fluids are underway.
A client with type 2 diabetes receives NPH insulin at 0700 each morning and reports feeling shaky at work. At which time should the nurse teach the client that a hypoglycemic reaction is most likely to occur?
Not quite — the answer is A
Why each option is right or wrong
A. Between 1100 and 1900, when NPH reaches its peak action
NPH peaks roughly 4 to 12 hours after a 0700 dose, placing greatest hypoglycemia risk from late morning into early evening.
B. Between 0715 and 0745, when NPH begins to peak
NPH has not even reached onset by 15 to 45 minutes; its onset is about 1 to 2 hours, so peaking then is impossible.
C. Between 2200 and 2400, well after the evening meal
Late evening risk is lower after a morning NPH dose because the peak has already passed and the evening meal has been eaten.
D. Immediately after the injection, within 10 to 15 minutes
An effect within 10 to 15 minutes describes rapid-acting analogs such as lispro or aspart, not intermediate-acting NPH, so this timing is wrong.
Key takeaway
NPH is an intermediate-acting insulin with an onset of about 1 to 2 hours and a peak of roughly 4 to 12 hours, placing peak risk in the late morning through early evening after a 0700 dose. The 10-to-15-minute window describes rapid-acting analogs such as lispro, not NPH, so that option reflects the wrong pharmacokinetic profile.
A client who is alert and oriented reports dizziness and diaphoresis; a fingerstick glucose is 52 mg/dL. Which action should the nurse take first?
Not quite — the answer is D
Why each option is right or wrong
A. Administer 1 mg of glucagon intramuscularly
Glucagon is reserved for clients who are unconscious or cannot swallow safely; this client is alert, so an injection is unnecessary and delays simpler treatment.
B. Recheck the blood glucose in 30 minutes
Waiting 30 minutes leaves a symptomatic client hypoglycemic; the recheck happens 15 minutes after carbohydrate is given, not instead of giving it.
C. Give the client a peanut butter sandwich and whole milk
Protein and fat slow glucose absorption, so this snack belongs after the glucose is corrected and only if the next meal is delayed.
D. Provide 15 g of a fast-acting carbohydrate such as 4 oz of juice
The rule of 15 applies to a conscious hypoglycemic client: give 15 grams of fast-acting carbohydrate, then recheck the glucose in 15 minutes.
Key takeaway
For a conscious client with hypoglycemia, the rule of 15 applies: give 15 g of fast-acting carbohydrate, recheck in 15 minutes, and repeat as needed before adding a protein-containing snack. Glucagon is reserved for clients who are unconscious or unable to swallow safely, so giving it here is unnecessary and delays a simpler, safer intervention.
The nurse is caring for a client on the first postoperative day after a subtotal thyroidectomy. Which assessment finding requires immediate follow-up?
Not quite — the answer is B
Why each option is right or wrong
A. Hoarseness and a weak voice when speaking
Hoarseness and a weak voice are expected after airway manipulation and are usually transient; they are monitored rather than treated as an emergency.
B. Temperature 103.4 F, heart rate 148, and increasing agitation
Hyperthermia, a heart rate of 148, and agitation signal thyroid storm, a life-threatening hormone surge needing cooling, beta-blockade, and antithyroid therapy.
C. Complaints of a sore throat when swallowing liquids
A sore throat with swallowing is expected after intubation and a neck incision, so it calls for comfort measures rather than immediate follow-up.
D. A small amount of serosanguineous drainage on the neck dressing
A small amount of serosanguineous drainage is normal; only copious drainage or pooling behind the neck would suggest hemorrhage requiring urgent action.
Key takeaway
Hyperthermia, extreme tachycardia, and agitation suggest thyroid storm, a life-threatening surge of thyroid hormone requiring immediate provider notification, cooling, beta-blockade, and antithyroid therapy. Hoarseness is common after thyroidectomy from airway manipulation or transient laryngeal nerve irritation and is monitored rather than treated emergently.
Eight hours after a total thyroidectomy, a client reports tingling around the mouth and in the fingertips, and the nurse elicits facial twitching when tapping over the facial nerve. Which action should the nurse anticipate?
Not quite — the answer is A
Why each option is right or wrong
A. Administering IV calcium gluconate as ordered
A positive Chvostek sign with perioral and digital tingling indicates hypocalcemia from parathyroid injury, and IV calcium gluconate prevents laryngospasm and tetany.
B. Encouraging the client to breathe into a paper bag
Rebreathing treats paresthesias caused by hyperventilation-induced respiratory alkalosis; here the serum calcium itself is low, so this would delay definitive replacement.
C. Administering a dose of levothyroxine
Levothyroxine replaces thyroid hormone, which is not the deficiency producing these symptoms, and it takes days to act on an acute calcium problem.
D. Applying an ice collar to the surgical site
An ice collar eases incisional swelling and pain but has no effect on the calcium deficit causing the twitching and paresthesias.
Key takeaway
A positive Chvostek sign with perioral and digital paresthesias indicates hypocalcemia from inadvertent parathyroid injury or removal, and IV calcium gluconate is the treatment to prevent laryngospasm and tetany. Rebreathing into a bag treats respiratory alkalosis from hyperventilation and would not correct the underlying calcium deficit, delaying definitive therapy.
A client with Addison disease is admitted after two days of vomiting. Blood pressure is 78/44, heart rate 124, sodium 126 mEq/L, and potassium 5.9 mEq/L. Which prescription should the nurse implement first?
Not quite — the answer is C
Why each option is right or wrong
A. Oral fludrocortisone 0.1 mg daily
Oral fludrocortisone cannot be absorbed reliably in a vomiting client and acts far too slowly to reverse shock-level hypotension in adrenal crisis.
B. Sodium polystyrene sulfonate 15 g orally
Sodium polystyrene sulfonate lowers potassium over hours and is oral, which is unsafe with active vomiting; hydrocortisone corrects the hyperkalemia at its source.
C. IV hydrocortisone with 0.9% sodium chloride infusion
IV hydrocortisone with isotonic saline replaces missing cortisol and volume, simultaneously reversing the hypotension, hyponatremia, and hyperkalemia of Addisonian crisis.
D. Regular insulin 10 units IV push
Insulin shifts potassium intracellularly but is not indicated here; without glucose it risks hypoglycemia and ignores the cortisol deficiency driving the crisis.
Key takeaway
Addisonian crisis is a shock state caused by cortisol and aldosterone deficiency, and IV glucocorticoid replacement with isotonic saline simultaneously treats the hypotension, hyponatremia, and hyperkalemia. An oral agent such as fludrocortisone acts too slowly and cannot be relied on in a vomiting, hypotensive client, so it does not address the immediate circulatory threat.
The nurse is teaching a client newly diagnosed with Cushing syndrome. Which client statement indicates correct understanding of self-care?
Not quite — the answer is B
Why each option is right or wrong
A. I should add extra salt to my food to keep my blood pressure up
Cortisol excess already causes sodium and water retention with hypertension and edema, so adding salt would worsen fluid overload rather than help.
B. I will report any fever or sore throat right away because infections may be masked
Excess cortisol blunts the inflammatory response and can mask infection, so any fever or sore throat must be reported promptly.
C. Bruising easily means my platelet count is dangerously low
Easy bruising in Cushing syndrome comes from cortisol-induced capillary fragility and thinned skin, not from thrombocytopenia, so this belief is factually inaccurate.
D. I can stop my medication once my face returns to its normal shape
Therapy is not stopped once moon facies improves; abruptly discontinuing steroid replacement after treatment can precipitate a life-threatening adrenal crisis.
Key takeaway
Excess cortisol suppresses the inflammatory response, so classic signs of infection may be blunted and any fever or sore throat warrants prompt reporting; this reflects a safety and infection-prevention priority. Adding salt is incorrect because cortisol excess already promotes sodium and water retention with resulting hypertension and edema.
A client with small cell lung cancer has a serum sodium of 118 mEq/L, urine specific gravity of 1.032, and is increasingly lethargic. Which intervention should the nurse expect to implement?
Not quite — the answer is D
Why each option is right or wrong
A. Encourage oral fluids to 3,000 mL per day
Pushing 3,000 mL daily would deepen the dilutional hyponatremia and increase the risk of cerebral edema and seizures in this lethargic client.
B. Administer desmopressin intranasally
Desmopressin is synthetic ADH used for diabetes insipidus; giving it in SIADH adds to the excess antidiuretic hormone already causing water retention.
C. Infuse 5% dextrose in water at 125 mL/hr
Dextrose in water becomes free water once the dextrose is metabolized, so it would dilute serum sodium further and worsen the neurologic decline.
D. Restrict fluids to approximately 800 to 1,000 mL per day
Restricting intake to roughly 800 to 1,000 mL daily reverses the water retention of SIADH and gradually raises the serum sodium.
Key takeaway
The dilutional hyponatremia with concentrated urine is characteristic of SIADH, and fluid restriction is the cornerstone of treatment to raise serum sodium and prevent cerebral edema and seizures. Encouraging fluids would worsen the water retention and drop sodium further, increasing the risk of neurologic deterioration.
A client is being monitored after transsphenoidal pituitary surgery. Which finding should the nurse report to the provider immediately?
Not quite — the answer is B
Why each option is right or wrong
A. Urine output of 60 mL/hr with a specific gravity of 1.018
Sixty milliliters per hour with a specific gravity of 1.018 is normal output and concentration, requiring routine monitoring rather than immediate reporting.
B. Urine output of 380 mL/hr with a specific gravity of 1.002 and rising serum sodium
Massive dilute diuresis with a rising serum sodium indicates central diabetes insipidus after pituitary surgery, risking rapid hypovolemia and requiring desmopressin.
C. Complaints of a mild frontal headache relieved by acetaminophen
A mild frontal headache relieved by acetaminophen is expected after this approach; severe headache with a stiff neck would instead suggest a leak.
D. Nasal packing that is dry and intact with no drainage
Dry, intact nasal packing is the desired finding; clear drainage or persistent postnasal drip would be the concerning sign of a CSF leak.
Key takeaway
Massive dilute diuresis with a very low specific gravity and rising serum sodium indicates central diabetes insipidus from disrupted ADH secretion, which can rapidly cause hypovolemia and hypernatremia and requires desmopressin. A urine output of 60 mL/hr with a mid-range specific gravity is a normal expected finding and needs only continued monitoring.
An 82-year-old nursing home resident with type 2 diabetes has a blood glucose of 792 mg/dL, serum osmolality of 340 mOsm/kg, negative serum ketones, and is difficult to arouse. Which nursing action takes priority?
Not quite — the answer is A
Why each option is right or wrong
A. Establishing IV access and initiating 0.9% sodium chloride as prescribed
Hyperglycemic hyperosmolar state creates fluid deficits that can exceed 8 liters, so IV access and isotonic fluid resuscitation are the priority.
B. Obtaining a urine specimen for culture and sensitivity
A urine culture may identify the precipitating infection, but obtaining it does not treat the profound dehydration currently threatening tissue perfusion.
C. Teaching the family about sick-day management rules
Sick-day teaching helps prevent recurrence but is inappropriate while the resident is difficult to arouse and hemodynamically unstable from severe dehydration.
D. Administering the client's usual oral metformin dose
Metformin is contraindicated in acute dehydration because of lactic acidosis risk, and an oral drug is unsafe in a barely arousable client.
Key takeaway
Hyperglycemic hyperosmolar state produces extreme dehydration with fluid deficits that may exceed 8 to 10 L, so restoring intravascular volume is the priority intervention before other measures. Metformin is contraindicated in an acutely dehydrated, hyperosmolar client because of the risk of lactic acidosis and would not address the volume deficit.
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