NLE Endocrine & Metabolic Nursing Reviewer 2026

Answer: B. Low serum sodium (dilutional hyponatremia)

Step 1 — Understand the hormone's job: ADH tells the kidney to RETAIN water. Step 2 — In SIADH, there is TOO MUCH ADH, so the body holds onto excess water. Step 3 — This excess water dilutes everything in the blood, including sodium — this is called DILUTIONAL HYPONATREMIA (low serum sodium). Step 4 — Why the other options are wrong: High serum sodium (hypernatremia) is the opposite — it occurs in Diabetes Insipidus (too little ADH, water is lost). Low urine specific gravity is wrong because in SIADH, the urine is concentrated (high specific gravity) since ADH is causing the kidney to retain water and excrete concentrated urine. High serum osmolality is wrong because excess water DILUTES the blood, so serum osmolality is LOW. Step 5 — Key memory hook: SIADH = SOAKED (retains water) → LOW sodium, LOW serum osmolality, HIGH urine specific gravity.

Answer: B. Administer desmopressin (DDAVP) as ordered and replace fluids

Step 1 — Understand DI: In central DI, the posterior pituitary does NOT release enough ADH, so the kidney cannot conserve water, resulting in massive dilute polyuria. Step 2 — The priority treatment is to REPLACE lost fluids (prevent dehydration/shock) AND give DDAVP (desmopressin), which is synthetic ADH, to treat the cause. Step 3 — Why the other options are wrong: Restricting fluids is DANGEROUS in DI — it will worsen dehydration and hypernatremia. In SIADH (not DI), fluid restriction is correct — do not confuse the two. Hypertonic saline (3% NaCl) is used in severe SIADH with symptomatic hyponatremia — the opposite condition. Seizure precautions are important but this option does not address the PRIORITY treatment, which is fluid replacement and DDAVP. Step 4 — Key point: In DI, sodium is already HIGH (hypernatremia) from water loss — giving MORE saline would make it worse. Step 5 — Memory trick: DI = DRY (loses water, high sodium) → REPLACE fluids + DDAVP.

Answer: B. SIADH causes low serum sodium; DI causes high serum sodium

Step 1 — SIADH = TOO MUCH ADH → body retains water → blood is diluted → LOW serum sodium (hyponatremia). Urine output is LOW because water is being retained; urine is concentrated (high specific gravity). Step 2 — DI = TOO LITTLE ADH → kidney cannot retain water → massive polyuria → water is lost from the blood → HIGH serum sodium (hypernatremia). Step 3 — Why the other options are wrong: Option A is backward — SIADH causes oliguria (low urine output) and DI causes polyuria (massive urine output). Option C is backward — DDAVP treats DI (not SIADH); fluid restriction treats SIADH (not DI). Option D is backward — SIADH = low urine output; DI = high urine output. Step 4 — The sodium derangement is the KEY differentiator: SIADH → LOW sodium, DI → HIGH sodium. Step 5 — Remember: Sodium and water move in the opposite pattern — too much water dilutes sodium (SIADH); too little water concentrates sodium (DI).

Answer: B. Weight loss, tachycardia, heat intolerance, diarrhea

Step 1 — Understand the mechanism: Thyroid hormone (T3/T4) sets the body's metabolic rate. In hyperthyroidism, there is TOO MUCH thyroid hormone — everything is SPED UP. Step 2 — Signs of hyperthyroidism follow the 'SPEED UP' pattern: Metabolism is faster → weight LOSS despite increased appetite. Heart rate is faster → TACHYCARDIA and palpitations. Body produces MORE heat → HEAT INTOLERANCE and diaphoresis. GI motility is faster → DIARRHEA. Step 3 — Why the other options are wrong: Option A (weight gain, bradycardia, cold intolerance, constipation) describes HYPOTHYROIDISM — the opposite condition (everything slowed down). Option C is mixed — exophthalmos is correct for Graves', but bradycardia and dry skin belong to hypothyroidism. Option D mixes signs from both conditions — bradycardia and cold intolerance belong to hypothyroidism. Step 4 — Graves'-specific findings to remember: EXOPHTHALMOS (bulging eyes) and GOITER (visible thyroid enlargement) — these are unique to Graves' disease. Step 5 — Memory trick: Hyperthyroidism = 'HYPER' active metabolism → weight loss, fast heart, hot, loose stools.

Answer: B. Report any sore throat, fever, or unusual bleeding immediately.

Step 1 — Understand PTU's mechanism: Propylthiouracil (PTU) blocks the synthesis of thyroid hormones (T3 and T4) in the thyroid gland. Step 2 — The most serious side effect of antithyroid drugs (PTU and methimazole) is AGRANULOCYTOSIS — a dangerous drop in white blood cells (WBCs), specifically granulocytes that fight infection. Step 3 — Signs of agranulocytosis include: sore throat, fever, mouth ulcers, and unusual bleeding — these are early signs of bone marrow suppression and must be reported IMMEDIATELY as this is life-threatening. Step 4 — Why the other options are wrong: Taking PTU on an empty stomach is the instruction for LEVOTHYROXINE (for hypothyroidism), not PTU. PTU does NOT work immediately — effects take WEEKS because it only blocks new hormone synthesis, not already-circulating hormone. Avoiding dairy products is not a PTU instruction — this applies to levothyroxine (dairy/calcium impairs absorption). Step 5 — Additional key point: PTU is the preferred antithyroid drug in the FIRST TRIMESTER of pregnancy. Methimazole is preferred otherwise.

Answer: B. Tracheostomy set, oxygen, and suction equipment

Step 1 — Understand the post-thyroidectomy risk: The thyroid gland is located in the NECK, just in front of the trachea. Surgery in this area creates a risk of airway compromise from hemorrhage (swelling/hematoma compresses the trachea) or laryngeal edema. Step 2 — AIRWAY is the TOP PRIORITY (Maslow's hierarchy — physiologic/survival needs first). If the airway is obstructed, the patient can die within minutes. Step 3 — A TRACHEOSTOMY SET must be at the bedside in case emergency airway access is needed. Oxygen and suction are also essential for airway management. Step 4 — Why the other options are wrong: An NGT is not a priority post-thyroidectomy for airway safety. A defibrillator addresses cardiac arrest, not the most immediate post-op risk. Blood glucose monitoring is important but is NOT the priority bedside equipment — the airway comes first. Step 5 — Additional post-thyroidectomy priorities: Check for hemorrhage BEHIND the neck (blood pools there by gravity, not just in front), monitor for hoarseness (laryngeal nerve damage), and watch for tingling/spasms (hypocalcemia if parathyroids were accidentally removed).

Answer: B. Thyroid storm (thyrotoxic crisis)

Step 1 — Recognize the crisis: This client has HIGH FEVER (hyperpyrexia), SEVERE TACHYCARDIA, and EXTREME AGITATION — the classic triad of THYROID STORM (thyrotoxic crisis). Step 2 — Thyroid storm is a LIFE-THREATENING surge of thyroid hormone, commonly triggered by surgery, infection, or stress in a poorly controlled hyperthyroid patient. Step 3 — Why the other options are wrong: Myxedema coma is the OPPOSITE crisis — it presents with HYPOTHERMIA, bradycardia, hypotension, and decreased consciousness (the exact opposite of thyroid storm). Hypocalcemic tetany would present with tingling, muscle cramps, positive Chvostek's/Trousseau's signs — not high fever and tachycardia. Malignant hyperthermia from anesthesia typically occurs DURING anesthesia, not the day after surgery, and has a specific pattern. Step 4 — Key management of thyroid storm: Cooling (NOT aspirin — aspirin displaces thyroid hormone and worsens the crisis), IV fluids, propranolol (beta-blocker), PTU or methimazole, iodine, and corticosteroids. Step 5 — Memory: Thyroid storm = HYPER everything: Hyperpyrexia, severe tachycardia, hypertension, agitation.

Answer: B. Take levothyroxine on an empty stomach every morning, 30–60 minutes before breakfast.

Step 1 — Understand levothyroxine absorption: Levothyroxine (synthetic T4) must be taken on an EMPTY STOMACH in the MORNING for optimal absorption. Food, especially calcium-rich foods like milk, and medications like antacids or iron supplements significantly REDUCE its absorption. Step 2 — The correct instruction is: Take every morning, 30–60 minutes BEFORE breakfast, at the SAME TIME each day. Step 3 — Why the other options are wrong: Taking with milk or food is INCORRECT — dairy, calcium, iron, and antacids impair absorption. This is a common and dangerous patient error. Stopping the medication when symptoms improve is WRONG and DANGEROUS — hypothyroidism (e.g., Hashimoto's thyroiditis) requires LIFELONG therapy; stopping abruptly can cause myxedema coma. Taking at bedtime is not the preferred instruction — the morning timing ensures consistent absorption and allows monitoring for signs of over-replacement during the day. Step 4 — Additional important teaching: Start at a LOW dose, especially in elderly and cardiac patients (rapid correction raises myocardial oxygen demand → angina/arrhythmia). Report signs of OVER-REPLACEMENT: palpitations, chest pain, weight loss, heat intolerance (hyperthyroid symptoms). Step 5 — This is a LIFELONG medication — never stop abruptly.

Answer: B. Maintain airway and administer IV levothyroxine as ordered.

Step 1 — Recognize MYXEDEMA COMA: This is a life-threatening emergency from severe decompensated hypothyroidism. The hallmark signs are the 'HYPO' cluster: HYPOthermia (low temperature), HYPOtension (low BP), HYPOglycemia (low blood sugar), HYPOventilation (slow breathing), and decreased consciousness/coma. Step 2 — PRIORITY: Airway first (Maslow's hierarchy — survival), then treat the cause with IV LEVOTHYROXINE (since the patient cannot take oral medications). Step 3 — Why the other options are wrong: Active external warming (heating blankets) is DANGEROUS in myxedema coma — rapid warming causes peripheral vasodilation → sudden drop in BP → cardiovascular collapse. Use PASSIVE, GRADUAL warming instead (blankets, warm room). Aspirin is CONTRAINDICATED in thyroid-related crises — in thyroid storm, aspirin displaces thyroid hormone and worsens the crisis; in myxedema, it is not indicated and is harmful. Fluid restriction is not indicated here — the patient needs IV fluids and glucose (IV dextrose for hypoglycemia), not restriction. Step 4 — Full management: IV levothyroxine, airway/ventilation support, GRADUAL passive warming, IV fluids, IV glucose (for hypoglycemia), corticosteroids, and treat the triggering factor. Step 5 — Memory: Myxedema coma = 'HYPO everything' — treat the opposite of each problem.

Answer: B. Positive Chvostek's and Trousseau's signs

Step 1 — Understand why hypocalcemia occurs post-thyroidectomy: The parathyroid glands sit behind the thyroid. During thyroidectomy, they can be accidentally removed or damaged → insufficient PTH → low calcium (hypocalcemia). Step 2 — CHVOSTEK'S SIGN: Tap the facial nerve just in front of the ear (over the cheek). A POSITIVE result is twitching of the facial muscles — a sign of hypocalcemic neuromuscular irritability. Step 3 — TROUSSEAU'S SIGN: Inflate a blood pressure cuff on the arm above systolic BP for 3 minutes. A POSITIVE result is carpal spasm (hand/wrist contracts in a characteristic shape) — also a sign of hypocalcemia. Step 4 — Why the other options are wrong: Homans' sign and calf tenderness are associated with deep vein thrombosis (DVT) — not hypocalcemia. Kernig's and Brudzinski's signs are meningeal irritation signs — used to assess meningitis. Murphy's sign = gallbladder pain; McBurney's point = appendicitis — these are abdominal assessment signs, unrelated to calcium. Step 5 — Nursing action: Keep CALCIUM GLUCONATE at the bedside after any neck surgery (thyroidectomy or parathyroidectomy). Administer IV calcium gluconate for acute tetany.

Answer: A. Hyperglycemia, hypertension, and hypokalemia

Step 1 – Understand what excess cortisol does: Cortisol is a glucocorticoid that raises blood glucose (→ hyperglycemia) and also has mineralocorticoid effects that cause sodium and water retention (→ hypertension) and potassium loss (→ hypokalemia). Step 2 – Eliminate Option B: Hypoglycemia, hypotension, and hyperkalemia are the classic findings of Addison's disease (too little cortisol/aldosterone) — the exact OPPOSITE of Cushing's. Step 3 – Eliminate Option C: Hypertension is correct, but hyperkalemia is wrong for Cushing's; cortisol causes potassium LOSS, not retention. Step 4 – Eliminate Option D: Hypoglycemia is wrong; excess cortisol drives glucose UP. Step 5 – Key memory tip: Cushing's = 'High everything except potassium' — HIGH glucose, HIGH BP, LOW potassium. This is a favorite NLE trio to memorize.

Answer: A. Moon face, buffalo hump, and truncal obesity with thin extremities

Step 1 – Recall the pathophysiology: Excess cortisol causes abnormal fat redistribution — fat accumulates in the face (moon face), upper back (buffalo hump), and abdomen (truncal obesity), while the limbs become thin because muscle is wasted. Step 2 – Eliminate Option B: Bronze skin pigmentation and weight loss are hallmarks of Addison's disease (primary adrenal insufficiency), NOT Cushing's. Step 3 – Eliminate Option C: Pretibial edema and exophthalmos are associated with Graves' disease (hyperthyroidism), a different endocrine disorder. Step 4 – Eliminate Option D: Tetany and Chvostek's sign indicate hypocalcemia, which is associated with hypoparathyroidism. Step 5 – NLE tip: The triad 'moon face + buffalo hump + truncal obesity with thin limbs' is the classic visual presentation of Cushing's syndrome — memorize all three together.