CCRN Endocrine, Hematology, GI, Renal and Skin Practice Questions
Updated October 30, 2026
This is the largest clinical area on the CCRN (Adult) exam. It groups five systems into one domain: endocrine, hematology and immunology, gastrointestinal, renal and genitourinary, and integumentary. Expect electrolyte and acid-base clues in many of these questions, and expect to be asked what to give FIRST or what to hold.
The 12 questions below are original, written for this page in the style of the real exam. They are independent practice and are not official AACN material.
This area on the CCRN at a glance
| Item | Details |
|---|---|
| Share of the exam | 21% of the scored questions, about 26 of 125 |
| Test plan | Adult CCRN test plan for exams on or after November 12, 2025 |
| Split by system | AACN does not publish separate weights for endocrine, GI and the others |
| Previous share | 20% under the 2020 plan |
What this area covers
| System | Test plan topics |
|---|---|
| Endocrine | Adrenal insufficiency, diabetes insipidus, diabetes types 1 and 2, DKA, hyperglycemia, HHS, SIADH, thyroid disorders |
| Hematology and immunology | Anemia, autoimmune disorders such as myasthenia gravis and Guillain-Barre syndrome, coagulopathies such as ITP, DIC and HIT, myelosuppression, oncologic complications such as tumor lysis syndrome, transfusion reactions such as TRALI and TACO |
| Gastrointestinal | Abdominal compartment syndrome, abdominal trauma, GI hemorrhage, bowel infarction, obstruction and perforation, GI surgery, hepatic failure and liver disease, malnutrition, pancreatitis, peritonitis |
| Renal and genitourinary | AKI and ATN, CKD, infections such as urosepsis |
| Integumentary | Cellulitis, IV infiltration, necrotizing fasciitis, pressure injury, skin failure, wounds |
The nursing actions include managing transfusions including massive transfusion, bleeding and clotting disorders, enteral and parenteral nutrition, endoscopy, hemodialysis, CRRT and peritoneal dialysis, identifying nephrotoxic agents, and pressure injury prevention and wound devices.
Tips for this area
- Check potassium before insulin. DKA and HHS questions often hinge on it.
- Fluids come early. Hyperglycemic crises, rhabdomyolysis and many bleeding patients need volume before anything else.
- Tell look-alikes apart. TRALI versus TACO, central DI versus SIADH, and HIT versus other causes of low platelets are favorite pairs.
- Stabilize, shift, remove. For dangerous hyperkalemia, protect the heart first, then move potassium into cells, then remove it.
CCRN endocrine, heme, GI and renal practice questions
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A patient with DKA has a glucose of 540 mg/dL, pH 7.12, bicarbonate 8 mEq/L and potassium 3.0 mEq/L. A liter of isotonic fluid is infusing. Which action should the nurse take before starting the ordered insulin infusion?Answer: BInsulin drives potassium into the cells, so starting it with a potassium of 3.0 mEq/L can cause dangerous hypokalemia and dysrhythmias. Potassium is replaced first and insulin is started once it has risen to a safe level; bicarbonate is not routine, and dextrose is added later as glucose falls.
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A 78-year-old patient is confused, with dry mucous membranes, glucose 1,040 mg/dL, serum osmolality 362 mOsm/kg, pH 7.36 and only trace ketones. Which intervention is the PRIORITY?Answer: AThis is hyperosmolar hyperglycemic state, where the main problem is a profound water and sodium deficit. Restoring volume with isotonic fluid comes first and itself lowers the glucose; insulin follows, and bicarbonate has no role with a near-normal pH.
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A patient who has taken prednisone daily for years has emergency bowel surgery. Postoperatively BP stays at 76/44 mm Hg despite 4 L of fluid and a rising norepinephrine dose. Sodium is 128 mEq/L, potassium 5.6 mEq/L and glucose 58 mg/dL. Which medication should the nurse anticipate?Answer: CLong-term steroid use suppresses the adrenal glands, and surgical stress can trigger adrenal crisis, with refractory hypotension, low sodium, high potassium and low glucose. IV hydrocortisone treats the cause; another vasopressor or dextrose alone treats only the effects.
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Two days after a severe traumatic brain injury, a patient's urine output rises to 400 mL/h for 3 hours. Urine specific gravity is 1.001 and serum sodium is 152 mEq/L. Which medication should the nurse anticipate?Answer: DLarge volumes of very dilute urine with a rising serum sodium after brain injury point to central diabetes insipidus, a lack of antidiuretic hormone. Desmopressin replaces it. Conivaptan blocks ADH and is used for SIADH, and hypertonic saline would raise the sodium further.
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A patient with SIADH from small cell lung cancer has had a serum sodium of 116 mEq/L for several days and is being treated. Which complication is the nurse MOST concerned about if the sodium is corrected too quickly?Answer: BWhen chronic hyponatremia is corrected too fast, the brain cannot adjust its solute content quickly enough, which can cause osmotic demyelination with dysarthria, dysphagia, paralysis or a locked-in state. Cerebral edema is a risk of the low sodium itself or of correcting high sodium too fast.
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On day 7 of a heparin infusion, a patient's platelet count has fallen from 280,000 to 110,000/mm3, and a new cold, pale left foot is found to have an arterial clot. Which order should the nurse anticipate?Answer: AA platelet fall of more than half, 5 to 10 days into heparin, with new thrombosis, suggests heparin-induced thrombocytopenia. All heparin, including flushes and low molecular weight heparin, must stop, and a non-heparin anticoagulant such as argatroban is started because the clotting risk is high. Platelet transfusion is generally avoided.
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Forty minutes into a unit of fresh frozen plasma, a patient develops severe dyspnea, SpO2 84%, BP 86/50 mm Hg and a temperature of 38.4 °C. Neck veins are flat, and the chest x-ray shows new bilateral infiltrates. Which reaction is MOST LIKELY?Answer: CAcute hypoxemia with bilateral infiltrates, fever and hypotension within hours of a plasma-rich product, without signs of volume overload, fits TRALI. TACO usually causes hypertension, distended neck veins and signs of fluid excess, and anaphylaxis typically brings urticaria, wheezing or angioedema.
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A patient with cirrhosis vomits a large amount of bright red blood. BP is 84/50 mm Hg and HR 124. Two large-bore IVs are in place and blood is being prepared. Which therapy should the nurse anticipate next?Answer: DSuspected variceal bleeding is treated with a vasoactive drug such as octreotide to lower portal pressure, plus urgent endoscopy with banding; antibiotic prophylaxis is also standard. A beta blocker is used for prevention later, not during hypotensive bleeding.
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On day 2 of acute pancreatitis, a patient reports numbness around the mouth and has carpopedal spasm when a BP cuff is inflated. The QTc has lengthened. Which treatment should the nurse anticipate?Answer: APancreatitis can lower serum calcium as calcium binds to areas of fat necrosis. Perioral numbness, carpopedal spasm and a prolonged QT are signs of symptomatic hypocalcemia, treated with IV calcium. Bicarbonate would lower ionized calcium further.
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A patient with acute kidney injury has a potassium of 7.1 mEq/L, peaked T waves and a QRS that has widened to 0.16 seconds. Which medication should the nurse give FIRST?Answer: DWith ECG changes, the first step is to stabilize the heart muscle with IV calcium, which acts within minutes. Insulin with dextrose and albuterol shift potassium into cells next, and binders and dialysis remove it, but none of these protect the heart as quickly.
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After massive fluid resuscitation for a ruptured abdominal aortic aneurysm, a ventilated patient has a tense, distended abdomen, rising peak airway pressures and urine output that has fallen to 10 mL/h. Which assessment should the nurse anticipate?Answer: CA tense abdomen with rising airway pressures and falling urine output after large-volume resuscitation suggests abdominal compartment syndrome. Bladder pressure is the standard way to measure intra-abdominal pressure. Girth is unreliable, and sending a ventilated, unstable patient for oral contrast CT delays diagnosis.
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A sacral wound shows full-thickness skin loss with visible subcutaneous fat. Bone, tendon and muscle are not visible, and slough covers only a small part of the wound bed. How should the nurse stage this pressure injury?Answer: BFull-thickness skin loss with visible fat but no exposed bone, tendon, muscle or cartilage is stage 3. Stage 2 is partial thickness, stage 4 exposes deeper structures, and a wound is unstageable only when slough or eschar hides the base.
Keep practicing
Our practice exam for this area has 26 questions, the same share as the real exam, and the full practice exams mix all six areas into 125 scored questions with 83 to pass. Start from the home page.
Next, try the neuro, musculoskeletal and behavioral questions or the multisystem questions, or see the CCRN exam guide.
Pass the CCRN exam on your first try
- All 338 questions across every area of the 2025 Adult CCRN test plan
- A rationale for every answer, including why the tempting choice is wrong
- Unlimited full 125-question practice exams, scored like the real one (83 to pass)