Diabetes, endocrine, renal and fluid-electrolyte care

52 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Diabetes, endocrine, renal and fluid-electrolyte care, part of Adult Health 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.

1. Question 1 · Medium

   A 30-year-old woman with sickle cell disease has monthly red cell transfusions and type 2 diabetes. Why is her HbA1c an unreliable measure of glucose control?

   1. AHydroxyurea raises the glucose in the sample
   2. BSickle cells take up glucose after sampling
   3. CTransfused and short-lived red cells distort HbA1c
   4. DHer diabetes is too recent for HbA1c to rise

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   Answer: C · Transfused and short-lived red cells distort HbA1c

   HbA1c depends on how long red cells have been exposed to glucose, so anything that shortens red cell survival or replaces cells gives a falsely low result. Haemolysis, sickle cell disease, thalassaemia and recent transfusion all do this, and some HbA1c methods are affected by haemoglobin variants. These conditions are common in Gulf populations. Capillary glucose profiles, continuous glucose monitoring or fructosamine are used instead.

   • A: Hydroxyurea does not raise measured glucose in the sample.
   • B: Glucose use by cells after sampling lowers plasma glucose, not HbA1c.
   • D: HbA1c can be used soon after diagnosis; the problem is red cell turnover.

2. Question 2 · Medium

   A patient on IV vancomycin has a rising creatinine. When should the trough level be drawn?

   1. AHalfway through the infusion
   2. BJust before the next scheduled dose
   3. COne hour after the infusion ends
   4. DAt any time of day, unrelated to the dose

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   Answer: B · Just before the next scheduled dose

   The trough is the lowest level, so it is drawn within about 30 minutes before the next dose. A high trough means the drug is accumulating, which raises the risk of nephrotoxicity, especially when kidney function is falling. The nurse holds the dose until the result or prescriber's advice is known if the level is high. Many units now use AUC-guided dosing, but timing is still recorded exactly.

   • A: A mid-infusion sample gives neither a peak nor a trough.
   • C: A sample after the infusion ends is used for a peak, not a trough.
   • D: A random level cannot be read as a trough.

3. Question 3 · Medium

   Thyroid results in a lethargic patient with known hypopituitarism read: TSH 0.3 mIU/L (0.4-4.0), free T4 7 pmol/L (12-22). These results are best explained by:

   1. ASecondary (pituitary) hypothyroidism
   2. BSubclinical hypothyroidism
   3. CPrimary hyperthyroidism
   4. DPrimary hypothyroidism

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   Answer: A · Secondary (pituitary) hypothyroidism

   A low free T4 should make the pituitary raise TSH; a low or inappropriately normal TSH means the pituitary cannot respond. With pituitary disease this is secondary hypothyroidism, and the free T4, not the TSH, is used to adjust the levothyroxine dose. Other pituitary hormones may also be lost, so cortisol is checked and replaced before thyroxine to avoid adrenal crisis. Primary hypothyroidism would give a high TSH.

   • B: Subclinical disease has a raised TSH with a normal free T4.
   • C: Hyperthyroidism gives a high free T4.
   • D: Primary thyroid failure gives a high TSH, not a low one.

4. Question 4 · Medium

   A man with diabetic neuropathy works outdoors in the Gulf summer and prays in a courtyard. Which foot-care advice is most important for him?

   1. ACut his toenails short into the corners
   2. BSoak his feet in hot water each evening
   3. CNever walk barefoot on hot ground or floors
   4. DUse a corn plaster on any hard skin

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   Answer: C · Never walk barefoot on hot ground or floors

   Neuropathy removes the warning sensation of heat and pain, so hot sand, tiles or paving can burn the soles without the patient noticing. He should always wear protective footwear, use a shaded area or mat, and inspect his feet daily, using a mirror if needed. Burns and blisters in a neuropathic foot can become ulcers and lead to amputation. Any wound is reported early.

   • A: Cutting into the corners causes ingrown nails and infection.
   • B: Hot soaks can scald numb feet and macerate the skin.
   • D: Medicated corn plasters contain acid that can ulcerate diabetic skin.

5. Question 5 · Medium

   A patient has a tunnelled central venous catheter used for haemodialysis. A ward nurse wants to use it to give IV antibiotics. The correct response is that the catheter:

   1. AIs kept for dialysis use by trained staff
   2. BIs suitable for routine blood sampling
   3. CShould be flushed with saline and left unlocked
   4. DCan be used for any infusion once flushed

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   Answer: A · Is kept for dialysis use by trained staff

   Dialysis catheters are locked with heparin or citrate between sessions, and the lock must be withdrawn before use or the patient receives a bolus of anticoagulant. Each extra access raises the risk of bloodstream infection and clotting, and the line is the patient's lifeline for dialysis. It is therefore used only by trained dialysis staff, and other IV therapy goes through separate access. Local policy may allow exceptions only with renal team approval.

   • B: Repeated sampling raises infection and occlusion risk.
   • C: Leaving it without a lock lets it clot off.
   • D: Routine use risks infection, clotting and a heparin bolus.

6. Question 6 · Easy

   Primary hyperaldosteronism (Conn syndrome) classically presents with:

   1. AWeight loss and heat intolerance
   2. BHypoglycaemia and hyponatraemia
   3. CHypertension and hypokalaemia
   4. DHypotension and hyperkalaemia

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7. Question 7 · Medium

   A patient with type 2 diabetes takes dapagliflozin and is booked for elective major surgery. The usual advice is to stop it:

   1. AOnly if glucose exceeds 15 mmol/L
   2. BOn the morning of surgery only
   3. CTwo weeks before surgery
   4. DAt least 3 days before surgery

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8. Question 8 · Medium

   A patient's glucose readings are erratic. The nurse finds soft, rubbery lumps on the abdomen where he always injects his insulin. The best teaching is to:

   1. ADouble the dose given into the lumps
   2. BKeep injecting into the lumps as usual
   3. CMassage the lumps before every injection
   4. DRotate to healthy skin and watch for lows

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9. Question 9 · Easy

   The deep, rapid Kussmaul breathing seen in diabetic ketoacidosis is the body's attempt to:

   1. ABlow off carbon dioxide to offset the acidosis
   2. BCorrect a respiratory alkalosis
   3. CRemove acetone vapour from the lungs
   4. DTake in more oxygen for the brain

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10. Question 10 · Hard

    At the 07:00 handover on an endocrine ward, four results are reported. Whose bedside does the nurse go to first?

    1. AType 2 diabetic before breakfast; glucose 14.5 mmol/L
    2. BAddison disease on oral hydrocortisone; BP 118/76 mmHg
    3. CCKD patient due for dialysis today; potassium 5.4 mmol/L
    4. DInsulin infusion; glucose now 3.2 mmol/L, falling

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11. Question 11 · Hard

    A 58-year-old woman with type 2 diabetes on empagliflozin and metformin is nauseated on day 2 after bowel surgery and has eaten little. RR 28/min. Results: glucose 11.2 mmol/L (202 mg/dL), pH 7.18, bicarbonate 10 mmol/L, blood beta-hydroxybutyrate 4.8 mmol/L (normal below 0.6), lactate 1.6 mmol/L (below 2.0). What is the most likely cause?

    1. ASimple starvation ketosis after surgery
    2. BEuglycaemic DKA linked to the SGLT2 inhibitor
    3. CHyperosmolar hyperglycaemic state
    4. DMetformin-associated lactic acidosis

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12. Question 12 · Hard

    A 24-year-old with type 1 diabetes has these results: sodium 136 mmol/L, chloride 100 mmol/L, bicarbonate 8 mmol/L, glucose 28 mmol/L (504 mg/dL). Using anion gap = Na - (Cl + HCO3), what is the anion gap and what does it show?

    1. A28 mmol/L, a raised-gap acidosis
    2. B44 mmol/L, a raised-gap acidosis
    3. C36 mmol/L, a raised-gap acidosis
    4. D12 mmol/L, a normal-gap acidosis

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13. Question 13 · Hard

    A patient with severe diarrhoea has received 80 mmol of IV potassium chloride over 24 hours, yet his potassium has only risen from 2.6 to 2.8 mmol/L (3.5-5.0). Magnesium is 0.45 mmol/L (0.7-1.0). What is the most likely reason, and the next step?

    1. ALaboratory error; stop KCl until a repeat result
    2. BLow magnesium; give magnesium replacement
    3. CPotassium is too slow; double the KCl infusion rate
    4. DAldosterone excess; start spironolactone

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14. Question 14 · Medium

    Three days after desmopressin was begun for central diabetes insipidus, which finding suggests excess dosing?

    1. AA steadily rising serum sodium
    2. BThirst with pale, dilute urine
    3. CUrine output above 300 mL/h
    4. DWeight gain with a falling sodium

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15. Question 15 · Easy

    Which of these IV solutions is hypotonic?

    1. A0.9% sodium chloride
    2. B3% sodium chloride
    3. C0.45% sodium chloride
    4. DCompound sodium lactate (Hartmann's)

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16. Question 16 · Easy

    An adult with type 1 diabetes is found unconscious at home with a glucose of 1.8 mmol/L (32 mg/dL), and there is no IV access. The family should give:

    1. ASweetened juice through a cup
    2. BHoney placed inside the cheek
    3. CInsulin lispro 2 units subcutaneously
    4. DGlucagon 1 mg intramuscularly

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17. Question 17 · Medium

    A patient with untreated hypothyroidism needs pain relief after surgery. Why does the nurse give opioids with special care?

    1. AOpioids can trigger thyroid storm
    2. BSlow metabolism prolongs sedation and respiratory depression
    3. CHypothyroidism makes opioid pain relief ineffective
    4. DOpioids block the absorption of levothyroxine

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18. Question 18 · Hard

    A 34-year-old construction worker drank about 10 L of plain water during a long shift in 45 °C heat. He arrives confused and vomiting and then has a generalised seizure. Sodium is 118 mmol/L (135-145). Which order should the nurse expect first?

    1. AA bolus of 3% hypertonic saline
    2. BOral rehydration with more plain water
    3. CFluid restriction to 1 L a day only
    4. DAn infusion of 0.45% sodium chloride

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19. Question 19 · Hard

    Ordered: fixed-rate IV insulin 0.1 units/kg/h for a man in DKA weighing 85 kg. Supplied: 50 units of soluble insulin made up to 100 mL with 0.9% saline. What pump setting is correct?

    1. A17 mL/h
    2. B8.5 mL/h
    3. C34 mL/h
    4. D4.3 mL/h

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20. Question 20 · Medium

    A patient with CKD has started subcutaneous epoetin for anaemia. Which adverse effect should the nurse check for at every visit?

    1. AA fall in serum potassium
    2. BLow blood glucose
    3. CA rise in blood pressure
    4. DBradycardia below 50/min

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21. Question 21 · Easy

    Which fasting plasma glucose result, confirmed on a repeat test, meets the criterion for diagnosing diabetes?

    1. A6.2 mmol/L (112 mg/dL)
    2. B5.4 mmol/L (97 mg/dL)
    3. C7.4 mmol/L (133 mg/dL)
    4. D6.8 mmol/L (122 mg/dL)

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22. Question 22 · Medium

    An older woman with chronic hypernatraemia (sodium 162 mmol/L) is receiving hypotonic fluid. Why is the sodium lowered slowly, by no more than about 10 mmol/L in 24 hours?

    1. AFast correction causes severe hyperkalaemia
    2. BRapid lowering can cause cerebral oedema
    3. CThe kidneys cannot excrete sodium faster
    4. DRapid lowering causes osmotic demyelination

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23. Question 23 · Medium

    A patient with CKD stage 4 and a serum potassium of 5.7 mmol/L (3.5-5.0) plans her Ramadan iftar. Which traditional food should she limit most?

    1. AGrilled chicken breast
    2. BCucumber and lettuce salad
    3. CSeveral dates with milk
    4. DPlain white rice

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24. Question 24 · Medium

    A patient on haemodialysis is due amlodipine 10 mg at 08:00, and his dialysis session starts at 08:30. The nurse should usually:

    1. AWithhold it until after dialysis, as ordered
    2. BGive twice the dose after dialysis
    3. CGive it now, with a sip of water, as scheduled
    4. DCrush it and give it during dialysis

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25. Question 25 · Easy

    By KDIGO criteria, acute kidney injury is present when the serum creatinine rises by at least 26.5 µmol/L (0.3 mg/dL) within:

    1. A3 months
    2. B6 hours
    3. C7 days
    4. D48 hours

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