CCRN Plan

Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary: practice questions

4 original questions · 4 editor-approved · every choice explained.

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Blueprint-mapped questions with full rationales for every choice.

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Endocrine, Hematology/Immunology, GI, Renal/GU, IntegumentaryDifficulty 3/5

A patient in diabetic ketoacidosis has a serum potassium of 3.1 mEq/L. What is the priority before starting an insulin infusion?

  1. AWithhold all fluids until the potassium has returned to the normal range
  2. BBegin insulin immediately, because correcting the acidosis will restore potassium
  3. CReplace potassium first, because insulin will drive it further down
  4. DAdminister sodium bicarbonate to correct the acidosis before any electrolyte therapy
Show answer and rationale

Correct: C. Insulin shifts potassium into cells. Starting insulin in a patient who is already hypokalaemic risks dangerous arrhythmia, so potassium replacement comes first while fluid resuscitation continues.

  • B — Insulin lowers serum potassium further rather than restoring it.
  • D — Bicarbonate is not routine in DKA and does not address the potassium risk.
  • A — Fluid resuscitation is the first priority in DKA and should not be withheld.
Endocrine, Hematology/Immunology, GI, Renal/GU, IntegumentaryDifficulty 3/5

Two hours into a transfusion a patient develops hypoxaemia and bilateral pulmonary infiltrates with a normal central venous pressure and no response to diuretics. What is the most likely reaction?

  1. AAcute haemolytic transfusion reaction from ABO incompatibility
  2. BFebrile non-haemolytic reaction to donor leukocytes
  3. CTransfusion-associated circulatory overload from excessive volume
  4. DTransfusion-related acute lung injury, an immune non-cardiogenic oedema
Show answer and rationale

Correct: D. TRALI produces non-cardiogenic pulmonary oedema within about six hours of transfusion, with normal filling pressures and no diuretic response. TACO is volume overload with raised filling pressures that improves with diuresis.

  • C — Circulatory overload raises filling pressures and responds to diuretics.
  • A — Haemolysis presents with fever, flank pain, haemoglobinuria and shock rather than isolated infiltrates.
  • B — A febrile reaction causes fever without pulmonary infiltrates.
Endocrine, Hematology/Immunology, GI, Renal/GU, IntegumentaryDifficulty 3/5

Which laboratory pattern best supports disseminated intravascular coagulation?

  1. ALow platelets, prolonged PT and aPTT, low fibrinogen, raised D-dimer
  2. BNormal platelets, prolonged PT alone and a normal fibrinogen with no D-dimer rise
  3. CHigh platelets, shortened clotting times and depressed D-dimer values
  4. DIsolated thrombocytopenia with normal coagulation studies and normal fibrinogen
Show answer and rationale

Correct: A. DIC consumes platelets and clotting factors while generating fibrin degradation products: low platelets, prolonged PT and aPTT, falling fibrinogen and a raised D-dimer. Isolated thrombocytopenia with normal studies suggests another cause.

  • B — An isolated PT prolongation suggests factor VII deficiency or warfarin effect.
  • C — That pattern describes a hypercoagulable laboratory picture, not consumption.
  • D — Isolated thrombocytopenia with normal coagulation is not DIC.
Endocrine, Hematology/Immunology, GI, Renal/GU, IntegumentaryDifficulty 2/5

A patient has serum sodium 118 mEq/L, serum osmolality 250 mOsm/kg, concentrated urine and no oedema. Which condition is most consistent?

  1. ADiabetes insipidus with excessive free water loss
  2. BSIADH, because water is retained while urine stays concentrated
  3. CHypovolaemic hyponatraemia from gastrointestinal losses
  4. DCerebral salt wasting with a contracted intravascular volume
Show answer and rationale

Correct: B. SIADH retains water: dilutional hyponatraemia, low serum osmolality, inappropriately concentrated urine and euvolaemia. Diabetes insipidus produces the opposite picture, and salt wasting is accompanied by volume depletion.

  • A — Diabetes insipidus causes hypernatraemia with dilute urine.
  • C — Gastrointestinal losses produce signs of volume depletion.
  • D — Cerebral salt wasting presents with hypovolaemia rather than euvolaemia.

Primary references

  1. CCRN Exam Handbook — Direct Care (July 2026) — AACN Certification Corporation · primary · retrieved 2026-09-22, verified 2026-09-22