Endocrine disorders NCLEX-RN Practice Questions

Endocrine Disorders NCLEX-RN Practice Questions

Preparing for the NCLEX-RN requires strong command of endocrine concepts within the Physiological Adaptation domain. This targeted set of practice questions focuses on high-yield endocrine disorders—diabetes mellitus, thyroid and parathyroid conditions, adrenal and pituitary disorders, and fluid and electrolyte disturbances such as SIADH and diabetes insipidus. Each item reflects real NCLEX-level complexity, emphasizing assessment findings, lab interpretation, prioritization, medication safety, and evidence-based interventions. Whether you’re reinforcing care planning for DKA/HHS, recognizing thyroid storm or myxedema coma, or choosing appropriate post-thyroidectomy precautions, these questions aim to deepen clinical reasoning and safe practice. Use this set to strengthen rapid decision-making, understand pathophysiology-driven care, and improve readiness for managing acute and chronic endocrine conditions.

Q1. A client with type 1 diabetes presents with Kussmaul respirations, fruity breath, glucose 520 mg/dL, and serum potassium 5.8 mEq/L. Which initial provider prescription should the nurse prioritize?

• Administer IV regular insulin infusion and isotonic normal saline
• Administer IV sodium bicarbonate immediately
• Administer subcutaneous NPH insulin and encourage oral fluids
• Administer IV furosemide to reduce serum potassium

Correct Answer: Administer IV regular insulin infusion and isotonic normal saline

Q2. A client with suspected SIADH has serum sodium 122 mEq/L, urine specific gravity 1.032, and confusion. Which intervention is most appropriate?

• Encourage oral free water intake to correct hypernatremia
• Administer hypertonic 3% saline via central line
• Give desmopressin to increase water reabsorption
• Administer hypotonic 0.45% saline bolus

Correct Answer: Administer hypertonic 3% saline via central line

Q3. A client post-thyroidectomy reports tingling around the mouth and fingertips. Which assessment is the priority?

• Check for Chvostek’s sign indicating hypocalcemia
• Assess for rebound tenderness in the abdomen
• Auscultate for S3 heart sound
• Assess deep tendon reflexes of the patella

Correct Answer: Check for Chvostek’s sign indicating hypocalcemia

Q4. A client with Addison’s disease is admitted with severe hypotension, hyperkalemia, and hyponatremia. Which medication should the nurse anticipate administering first?

• IV hydrocortisone
• Oral fludrocortisone
• Subcutaneous insulin glargine
• IV levothyroxine

Correct Answer: IV hydrocortisone

Q5. A client with Graves’ disease develops agitation, tachycardia 150/min, temperature 40.2°C (104.4°F), and tremors. Which action is the highest priority?

• Administer acetaminophen and initiate cooling measures
• Administer IV propranolol as prescribed
• Prepare to administer PTU or methimazole as ordered
• Provide supplemental oxygen and continuous cardiac monitoring

Correct Answer: Provide supplemental oxygen and continuous cardiac monitoring

Q6. The nurse is educating a client about levothyroxine. Which statement indicates the need for further teaching?

• “I will take this medication in the morning on an empty stomach.”
• “I can expect improvement in energy within a few days.”
• “I will not stop taking it even if I feel better.”
• “I should avoid taking it with calcium or iron supplements together.”

Correct Answer: “I can expect improvement in energy within a few days.”

Q7. A client with type 2 diabetes on metformin is scheduled for a CT with IV contrast. Which instruction is correct?

• Continue metformin; contrast has no interaction
• Hold metformin 24–48 hours after contrast and resume after renal function is reassessed
• Increase fluids and take an extra dose of metformin the day of the scan
• Switch to glyburide 24 hours before the procedure

Correct Answer: Hold metformin 24–48 hours after contrast and resume after renal function is reassessed

Q8. The nurse is caring for a client with suspected diabetes insipidus. Which findings support this diagnosis?

• High urine specific gravity and hyponatremia
• Low urine specific gravity and hypernatremia
• Oliguria and low serum osmolality
• Edema and elevated urine osmolality

Correct Answer: Low urine specific gravity and hypernatremia

Q9. Which insulin has no peak and should not be mixed with other insulins?

• NPH insulin
• Regular insulin
• Insulin glargine
• Insulin lispro

Correct Answer: Insulin glargine

Q10. A client on long-term prednisone for adrenal insufficiency presents with acute vomiting and diarrhea. Which instruction is most appropriate?

• “Double or triple your steroid dose during this illness and seek medical care.”
• “Stop steroids until vomiting subsides to prevent ulcers.”
• “Take steroids only every other day until you are eating normally.”
• “Replace prednisone with NSAIDs for pain during illness.”

Correct Answer: “Double or triple your steroid dose during this illness and seek medical care.”

Q11. A client receiving desmopressin for central DI reports headache and drowsiness; labs show serum sodium 127 mEq/L. What is the priority action?

• Increase the dose of desmopressin
• Hold desmopressin and notify the provider
• Encourage the client to drink more water
• Administer loop diuretics

Correct Answer: Hold desmopressin and notify the provider

Q12. Which teaching is appropriate for a client receiving radioactive iodine therapy for hyperthyroidism?

• Share utensils to prevent exposure to family members
• Sleep in the same bed as partner to minimize isolation
• Use separate bathroom if possible and flush twice
• Stop all antithyroid medications 4 weeks after therapy

Correct Answer: Use separate bathroom if possible and flush twice

Q13. The nurse evaluates a client with DKA on an insulin infusion. Which finding best indicates resolution of DKA?

• Serum glucose less than 250 mg/dL
• Urine ketones negative
• Bicarbonate 20 mEq/L and anion gap closed
• pH rises from 7.10 to 7.25

Correct Answer: Bicarbonate 20 mEq/L and anion gap closed

Q14. A client with Cushing syndrome is most at risk for which complication?

• Hyperkalemia and hyponatremia
• Hypokalemia and hypernatremia
• Weight loss and hypotension
• Hypoglycemia and skin thickening

Correct Answer: Hypokalemia and hypernatremia

Q15. A nurse prepares to administer morning insulin: 10 units regular and 20 units NPH. Which step is correct?

• Draw NPH insulin into syringe before regular insulin
• Draw regular insulin into syringe before NPH insulin
• Mix glargine with NPH to extend duration
• Shake both vials vigorously before drawing up

Correct Answer: Draw regular insulin into syringe before NPH insulin

Q16. A client with hyperparathyroidism is being educated on preventing complications. Which advice is appropriate?

• Increase weight-bearing exercise and maintain hydration
• Restrict fluids to prevent hypercalciuria
• Increase vitamin D and calcium supplements
• Stay on strict bed rest during exacerbations

Correct Answer: Increase weight-bearing exercise and maintain hydration

Q17. A post-op transsphenoidal hypophysectomy client suddenly has clear nasal drainage. Which is the nurse’s first action?

• Send the drainage for glucose testing for CSF
• Elevate HOB to 90 degrees
• Irrigate the nasal passages gently
• Apply pressure and pack the nares

Correct Answer: Send the drainage for glucose testing for CSF

Q18. A client with pheochromocytoma has severe hypertension and headache. What nursing action is essential?

• Palpate the abdomen to assess tumor size
• Avoid abdominal palpation and minimize stressors
• Administer beta-blocker before alpha-blockade
• Encourage Valsalva maneuvers to reduce BP

Correct Answer: Avoid abdominal palpation and minimize stressors

Q19. Which foot care instruction is appropriate for a client with long-standing diabetes?

• Soak feet daily in hot water to soften calluses
• Walk barefoot at home to improve circulation
• Inspect feet daily with a mirror and keep skin moisturized (not between toes)
• Trim toenails rounded to prevent ingrown nails

Correct Answer: Inspect feet daily with a mirror and keep skin moisturized (not between toes)

Q20. A client with severe hypothyroidism becomes lethargic, bradycardic, and hypothermic. Which provider order should the nurse anticipate?

• IV levothyroxine and passive rewarming
• Propranolol and aggressive external cooling
• Methimazole and fluid restriction
• Radioactive iodine therapy

Correct Answer: IV levothyroxine and passive rewarming

Q21. The nurse is teaching about beta-blockers prescribed for hyperthyroidism. Which caution is important?

• They may mask signs of hypoglycemia in clients with diabetes
• They cause severe hyperkalemia in all clients
• They directly reduce T4 to T3 conversion like PTU
• They are contraindicated in thyroid storm

Correct Answer: They may mask signs of hypoglycemia in clients with diabetes

Q22. A client with type 1 diabetes has fasting morning hyperglycemia. Nighttime glucose at 2 AM is 48 mg/dL. What is the likely cause?

• Dawn phenomenon
• Somogyi effect
• Insufficient carbohydrate with breakfast
• Excess morning insulin dose

Correct Answer: Somogyi effect

Q23. A client with HHS is admitted. Which finding differentiates HHS from DKA?

• Metabolic acidosis and high anion gap
• Marked ketosis and Kussmaul respirations
• Severe hyperglycemia with profound dehydration and minimal ketosis
• Onset in younger clients with type 1 diabetes

Correct Answer: Severe hyperglycemia with profound dehydration and minimal ketosis

Q24. The nurse notes a newly diagnosed hypothyroid client has TSH elevated and free T4 low. Which interpretation is correct?

• Primary hypothyroidism
• Secondary (pituitary) hypothyroidism
• Tertiary (hypothalamic) hyperthyroidism
• Euthyroid sick syndrome

Correct Answer: Primary hypothyroidism

Q25. Which meal plan best supports glycemic control for a client taking pre-meal rapid-acting insulin?

• Administer insulin lispro and delay meal for 45–60 minutes
• Administer insulin lispro immediately before eating and consume the meal
• Take insulin lispro at bedtime for dawn phenomenon
• Take insulin lispro only if bedtime glucose is >180 mg/dL

Correct Answer: Administer insulin lispro immediately before eating and consume the meal

Q26. A client with SIADH is on fluid restriction. Which assessment indicates therapy effectiveness?

• Serum sodium decreases to 126 mEq/L
• Urine specific gravity increases to 1.035
• Serum sodium rises to 134 mEq/L
• Weight increases by 2 kg in 24 hours

Correct Answer: Serum sodium rises to 134 mEq/L

Q27. After total thyroidectomy, which nursing intervention has highest priority during the first 24 hours?

• Maintain client in prone position to reduce edema
• Keep tracheostomy tray and suction equipment at bedside
• Encourage vigorous coughing and deep breathing every 30 minutes
• Ambulate within 2 hours post-op

Correct Answer: Keep tracheostomy tray and suction equipment at bedside

Q28. A client with Addison’s disease is receiving teaching. Which statement indicates understanding?

• “I will stop steroids if I have swelling or weight gain.”
• “I will carry an emergency hydrocortisone injection kit.”
• “I should avoid wearing a medical alert bracelet.”
• “I need to limit salt intake strictly.”

Correct Answer: “I will carry an emergency hydrocortisone injection kit.”

Q29. Which finding is expected in hypoparathyroidism after thyroid surgery?

• Hypercalcemia and hypertension
• Hypocalcemia and muscle cramps
• Hyperphosphatemia and hyperreflexia suppression
• Polyuria and polydipsia

Correct Answer: Hypocalcemia and muscle cramps

Q30. A client with long-standing type 2 diabetes has A1C of 9.2%. Which statement by the nurse is most appropriate?

• “This reflects good control over the last 3 months.”
• “This indicates average blood glucose has been above target; we should adjust your plan.”
• “A1C measures only fasting glucose control.”
• “This means your insulin must be stopped immediately.”

Correct Answer: “This indicates average blood glucose has been above target; we should adjust your plan.”

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