Four hours after a total thyroidectomy, a patient is restless and says the dressing feels tight. The neck is visibly swollen, there is inspiratory stridor and SpO2 has fallen to 89%. The most likely cause is:

Haematoma compressing the trachea

Hypocalcaemia from parathyroid removal

Thyroid storm from handling the gland

Unilateral recurrent laryngeal nerve injury

Six hours into DKA treatment, glucose has fallen to 190 mg/dL, but pH is 7.24 and HCO3 is 12 mmol/L. The insulin infusion is running. What is the correct adjustment?

Add dextrose to the IV fluid and continue the insulin infusion

Stop the insulin infusion because glucose is now controlled

Give IV sodium bicarbonate and stop the insulin

Switch to subcutaneous insulin and stop all IV fluids

A woman with known Addison disease has vomited for a day. BP 78/50 mmHg, pulse 122/min, sodium 124 mmol/L, potassium 6.1 mmol/L, glucose 54 mg/dL. Which treatment does the nurse prepare first?

IV hydrocortisone with 0.9% saline and dextrose

Oral fludrocortisone with salt tablets

IV insulin and dextrose to lower the potassium

Fluid restriction to correct the sodium

A 70-year-old with type 2 diabetes is confused after several days of polyuria. Glucose 880 mg/dL, serum osmolality 352 mOsm/kg, pH 7.36, HCO3 22 mmol/L, urine ketones trace. The most likely diagnosis is:

Hyperosmolar hyperglycaemic state

Endocrine: diabetes, DKA and thyroid

26 AIIMS NORCET (Nursing Officer) practice questions on Endocrine: diabetes, DKA and thyroid, part of Medical-Surgical Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
Four hours after a total thyroidectomy, a patient is restless and says the dressing feels tight. The neck is visibly swollen, there is inspiratory stridor and SpO2 has fallen to 89%. The most likely cause is:
1. AHypocalcaemia from parathyroid removal
2. BThyroid storm from handling the gland
3. CUnilateral recurrent laryngeal nerve injury
4. DHaematoma compressing the trachea
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Answer: D · Haematoma compressing the trachea
Rising neck swelling, a tight dressing, stridor and falling saturation within hours of thyroid surgery point to a bleed in the closed neck space compressing the airway. This is an emergency: the surgeon is called at once, and the wound clips or sutures may have to be opened at the bedside to release the clot. This is why a suture or clip remover and a tracheostomy set are kept at the bedside. The patient is nursed semi-upright with the head and neck supported.
- A: Hypocalcaemia usually appears after 24-48 hours, with tingling and tetany, not neck swelling.
- B: Thyroid storm causes fever and tachycardia, not local neck swelling.
- C: One injured recurrent laryngeal nerve causes hoarseness, not neck swelling with stridor.
Question 2 · Easy
Subcutaneous insulin is absorbed fastest from which injection site?
1. AUpper arm
2. BButtock
3. CThigh
4. DAbdomen
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Answer: D · Abdomen
Absorption is fastest from the abdomen, intermediate from the upper arm, and slowest from the thigh and buttock. Patients are taught to rotate injections within one area rather than switching randomly between areas, so absorption stays predictable. Rotating within the area also prevents lipohypertrophy, which slows and scatters absorption. Exercise of a limb speeds absorption from that limb.
- A: The upper arm is intermediate, slower than the abdomen.
- B: The buttock gives the slowest absorption.
- C: The thigh is one of the slowest sites.
Question 3 · Hard
Six hours into DKA treatment, glucose has fallen to 190 mg/dL, but pH is 7.24 and HCO3 is 12 mmol/L. The insulin infusion is running. What is the correct adjustment?
1. AStop the insulin infusion because glucose is now controlled
2. BGive IV sodium bicarbonate and stop the insulin
3. CAdd dextrose to the IV fluid and continue the insulin infusion
4. DSwitch to subcutaneous insulin and stop all IV fluids
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Answer: C · Add dextrose to the IV fluid and continue the insulin infusion
In DKA the insulin infusion treats ketoacidosis, not only hyperglycaemia. Glucose usually corrects before the ketosis, so when it falls to about 200-250 mg/dL, 5-10% dextrose is added while insulin continues until the acidosis resolves (pH above 7.30, bicarbonate at least 15-18 mmol/L, anion gap closed). Stopping insulin early lets ketogenesis restart. Subcutaneous insulin is started 1-2 hours before the infusion is stopped, to avoid a gap.
- A: Stopping insulin now leaves the ketoacidosis untreated.
- B: Bicarbonate is not indicated at this pH, and insulin must continue.
- D: The acidosis has not resolved, so it is too early to switch to subcutaneous insulin.
Question 4 · Hard
A woman with known Addison disease has vomited for a day. BP 78/50 mmHg, pulse 122/min, sodium 124 mmol/L, potassium 6.1 mmol/L, glucose 54 mg/dL. Which treatment does the nurse prepare first?
1. AIV hydrocortisone with 0.9% saline and dextrose
2. BOral fludrocortisone with salt tablets
3. CIV insulin and dextrose to lower the potassium
4. DFluid restriction to correct the sodium
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Answer: A · IV hydrocortisone with 0.9% saline and dextrose
Hypotension, hyponatraemia, hyperkalaemia and hypoglycaemia in a patient with Addison disease who cannot keep tablets down is an adrenal (Addisonian) crisis. The life-saving step is IV hydrocortisone (for example 100 mg bolus) with rapid 0.9% saline and dextrose. Hydrocortisone in high dose also has mineralocorticoid action, which corrects sodium and potassium. Vital signs, glucose and electrolytes are checked often, and the cause, here vomiting, is treated.
- B: Oral drugs cannot be relied on in a vomiting, shocked patient.
- C: Insulin-dextrose treats potassium but not the cortisol deficit causing shock.
- D: The low sodium is from salt loss, so fluid restriction would worsen shock.
Question 5 · Hard
A 70-year-old with type 2 diabetes is confused after several days of polyuria. Glucose 880 mg/dL, serum osmolality 352 mOsm/kg, pH 7.36, HCO3 22 mmol/L, urine ketones trace. The most likely diagnosis is:
1. AHyperosmolar hyperglycaemic state
2. BLactic acidosis from metformin
3. CCentral diabetes insipidus
4. DDiabetic ketoacidosis
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Answer: A · Hyperosmolar hyperglycaemic state
HHS is defined by very high glucose (above 600 mg/dL), high serum osmolality (above 320 mOsm/kg) and severe dehydration, without significant ketoacidosis (pH above 7.30, bicarbonate above about 15-18 mmol/L). It usually affects older type 2 diabetics, whose residual insulin prevents ketogenesis. Fluid replacement with isotonic saline is the priority, and the sodium and osmolality are lowered slowly to avoid cerebral oedema. Mortality is higher than in DKA.
- B: Lactic acidosis causes a low pH and bicarbonate, which are normal here.
- C: Diabetes insipidus causes polyuria without hyperglycaemia.
- D: DKA needs acidosis with a low bicarbonate and marked ketones, which are absent.
Question 6 · Easy
Which serum electrolyte pattern is typical of primary adrenal insufficiency (Addison disease)?
1. AHigh sodium and high potassium
2. BLow sodium and high potassium
3. CHigh sodium and low potassium
4. DLow sodium and low potassium
Answer and explanation in LearnFree account
Question 7 · Easy
Moon face, buffalo hump and purple abdominal striae are features of excess:
1. ACortisol
2. BThyroxine
3. CGrowth hormone
4. DAldosterone
Answer and explanation in LearnFree account
Question 8 · Medium
A type 1 diabetic has high fasting glucose every morning. To tell the Somogyi effect from the dawn phenomenon, the nurse should check blood glucose at:
1. ABefore lunch
2. BBedtime
3. C2 am to 3 am
4. DTwo hours after breakfast
Answer and explanation in LearnFree account
Question 9 · Hard
A 19-year-old with DKA has glucose 520 mg/dL and has received one litre of 0.9% saline. Serum potassium is 3.0 mmol/L (3.5-5.0). An insulin infusion has been ordered. What should the nurse do first?
1. AStart the ordered potassium and hold insulin until K is at least 3.3
2. BStart the insulin infusion and recheck potassium in 4 hours
3. CChange the IV fluid to 5% dextrose
4. DGive an IV bolus of sodium bicarbonate
Answer and explanation in LearnFree account
Question 10 · Easy
Under the 'rule of 15' for a conscious adult with hypoglycaemia, the nurse gives 15 g of fast-acting carbohydrate and rechecks the blood glucose after:
1. A30 minutes
2. B60 minutes
3. C5 minutes
4. D15 minutes
Answer and explanation in LearnFree account
Question 11 · Hard
A 22-year-old is admitted drowsy with Kussmaul breathing. Glucose 480 mg/dL, pH 7.16, HCO3 9 mmol/L, urine ketones 3+, pulse 126/min, BP 90/58 mmHg. What is the priority intervention?
1. AOral fluids with glucose-free drinks
2. BIV bolus of regular insulin before any fluid
3. CRapid IV infusion of 0.9% sodium chloride
4. DIV sodium bicarbonate to correct the pH
Answer and explanation in LearnFree account
Question 12 · Medium
Two days after a head injury, a patient has serum sodium 122 mmol/L (135-145), concentrated urine and a falling urine output. The nurse expects which order?
1. AFluid restriction
2. BIntranasal desmopressin
3. CIncreased oral water intake
4. DRapid infusion of 5% dextrose
Answer and explanation in LearnFree account
Question 13 · Medium
When regular and NPH insulin are mixed in one syringe, the correct step is to:
1. AInject air into the regular vial only
2. BDraw up the clear regular insulin first
3. CDraw up the cloudy NPH insulin first
4. DShake the NPH vial hard before drawing
Answer and explanation in LearnFree account
Question 14 · Medium
A patient who has taken prednisolone 20 mg daily for a year runs out of tablets and stops them suddenly. The complication the nurse should fear most is:
1. AAcute adrenal crisis
2. BDiabetic ketoacidosis
3. CThyroid storm
4. DRebound hypertension
Answer and explanation in LearnFree account
Question 15 · Medium
A young man with type 1 diabetes has fever and vomiting and is eating little. He asks whether he should skip his insulin. The best advice is to:
1. ASkip insulin until he can eat normal meals again
2. BKeep taking insulin and check glucose and ketones every 3-4 hours
3. CTake only half the dose and stop testing until he is well
4. DChange to oral glucose tablets in place of insulin
Answer and explanation in LearnFree account
Question 16 · Easy
Tapping over the facial nerve just in front of the ear makes the corner of the mouth twitch. This sign of hypocalcaemia is called:
1. AKernig sign
2. BChvostek sign
3. CHomans sign
4. DTrousseau sign
Answer and explanation in LearnFree account
Question 17 · Medium
A patient receives NPH insulin subcutaneously at 7 am. The nurse should watch most closely for hypoglycaemia at about:
1. AAround midnight
2. BBefore breakfast the next day
3. CMid-afternoon, around 1 pm to 3 pm
4. DWithin 30 minutes of the injection
Answer and explanation in LearnFree account
Question 18 · Easy
Insulin lispro, a rapid-acting analogue, is best injected:
1. ATwo hours before the meal
2. BOne hour after finishing the meal
3. COnce at bedtime regardless of meals
4. DWithin about 15 minutes before a meal
Answer and explanation in LearnFree account
Question 19 · Medium
Levothyroxine is started in a 72-year-old woman with hypothyroidism and known ischaemic heart disease. The nurse watches especially for:
1. AChest pain and tachycardia
2. BWeight gain and oedema
3. CHypoglycaemia and sweating
4. DBradycardia and hypothermia
Answer and explanation in LearnFree account
Question 20 · Easy
A patient in myxoedema coma is to receive IV levothyroxine. Which drug is usually given with it until coexisting adrenal insufficiency has been ruled out?
1. AIV furosemide
2. BIV propranolol
3. CIV hydrocortisone
4. DOral Lugol's iodine
Answer and explanation in LearnFree account
Question 21 · Easy
A patient with diabetes insipidus typically passes large volumes of urine with a specific gravity of:
1. AFixed at about 1.010
2. BMore than 1.030
3. CBetween 1.015 and 1.025
4. DLess than 1.005
Answer and explanation in LearnFree account
Question 22 · Medium
The correct advice on storing insulin at home is to:
1. AStore all vials, opened or not, in the freezer compartment
2. BKeep unopened vials in a refrigerator at 2-8 °C and never freeze them
3. CKeep unopened vials on a sunny window sill
4. DThrow away an opened vial after 48 hours at room temperature
Answer and explanation in LearnFree account
Question 23 · Medium
On the night after transsphenoidal pituitary surgery, a patient passes 350 mL of urine an hour with a specific gravity of 1.002 and complains of thirst. Which drug should the nurse expect to give?
1. ADesmopressin
2. BFurosemide
3. CTolvaptan
4. DFludrocortisone
Answer and explanation in LearnFree account
Question 24 · Medium
After a thyroidectomy the nurse asks the patient to speak every few hours. This check is mainly for injury to the:
1. AHypoglossal nerve
2. BParathyroid glands
3. CRecurrent laryngeal nerve
4. DPhrenic nerve
Answer and explanation in LearnFree account
Question 25 · Medium
A patient in thyroid storm has a temperature of 40.2 °C. Which antipyretic should be avoided?
1. AParacetamol
2. BAspirin
3. CTepid sponging
4. DCooling blanket
Answer and explanation in LearnFree account

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Endocrine: diabetes, DKA and thyroid

Four hours after a total thyroidectomy, a patient is restless and says the dressing feels tight. The neck is visibly swollen, there is inspiratory stridor and SpO2 has fallen to 89%. The most likely cause is:

Subcutaneous insulin is absorbed fastest from which injection site?

Six hours into DKA treatment, glucose has fallen to 190 mg/dL, but pH is 7.24 and HCO3 is 12 mmol/L. The insulin infusion is running. What is the correct adjustment?

A woman with known Addison disease has vomited for a day. BP 78/50 mmHg, pulse 122/min, sodium 124 mmol/L, potassium 6.1 mmol/L, glucose 54 mg/dL. Which treatment does the nurse prepare first?

A 70-year-old with type 2 diabetes is confused after several days of polyuria. Glucose 880 mg/dL, serum osmolality 352 mOsm/kg, pH 7.36, HCO3 22 mmol/L, urine ketones trace. The most likely diagnosis is:

Which serum electrolyte pattern is typical of primary adrenal insufficiency (Addison disease)?

Moon face, buffalo hump and purple abdominal striae are features of excess:

A type 1 diabetic has high fasting glucose every morning. To tell the Somogyi effect from the dawn phenomenon, the nurse should check blood glucose at:

A 19-year-old with DKA has glucose 520 mg/dL and has received one litre of 0.9% saline. Serum potassium is 3.0 mmol/L (3.5-5.0). An insulin infusion has been ordered. What should the nurse do first?

Under the 'rule of 15' for a conscious adult with hypoglycaemia, the nurse gives 15 g of fast-acting carbohydrate and rechecks the blood glucose after:

A 22-year-old is admitted drowsy with Kussmaul breathing. Glucose 480 mg/dL, pH 7.16, HCO3 9 mmol/L, urine ketones 3+, pulse 126/min, BP 90/58 mmHg. What is the priority intervention?

Two days after a head injury, a patient has serum sodium 122 mmol/L (135-145), concentrated urine and a falling urine output. The nurse expects which order?

When regular and NPH insulin are mixed in one syringe, the correct step is to:

A patient who has taken prednisolone 20 mg daily for a year runs out of tablets and stops them suddenly. The complication the nurse should fear most is:

A young man with type 1 diabetes has fever and vomiting and is eating little. He asks whether he should skip his insulin. The best advice is to:

Tapping over the facial nerve just in front of the ear makes the corner of the mouth twitch. This sign of hypocalcaemia is called:

A patient receives NPH insulin subcutaneously at 7 am. The nurse should watch most closely for hypoglycaemia at about:

Insulin lispro, a rapid-acting analogue, is best injected:

Levothyroxine is started in a 72-year-old woman with hypothyroidism and known ischaemic heart disease. The nurse watches especially for:

A patient in myxoedema coma is to receive IV levothyroxine. Which drug is usually given with it until coexisting adrenal insufficiency has been ruled out?

A patient with diabetes insipidus typically passes large volumes of urine with a specific gravity of:

The correct advice on storing insulin at home is to:

On the night after transsphenoidal pituitary surgery, a patient passes 350 mL of urine an hour with a specific gravity of 1.002 and complains of thirst. Which drug should the nurse expect to give?

After a thyroidectomy the nurse asks the patient to speak every few hours. This check is mainly for injury to the:

A patient in thyroid storm has a temperature of 40.2 °C. Which antipyretic should be avoided?