NCLEX-RN Endocrine Pharmacology
Practice Exam |
20 NGN-Style Questions with Rationales |
Diabetes, Thyroid & Adrenal Medications
Review
Question 1
Clinical Scenario
A 52-year-old woman with newly diagnosed hypothyroidism
is prescribed levothyroxine 75 mcg orally daily. During a
follow-up visit, she reports taking the medication with
breakfast and her calcium supplement each morning. She
states she still feels fatigued and constipated.
Question Stem
Which nursing instruction is most appropriate?
A. Take levothyroxine with meals to reduce gastrointestinal
upset.
B. Take levothyroxine at bedtime with calcium supplements.
,C. Take levothyroxine on an empty stomach and separate it
from calcium supplements.
D. Discontinue levothyroxine if symptoms persist after 1
week.
Correct Answer
Correct Answer: C. Take levothyroxine on an empty
stomach and separate it from calcium supplements.
Detailed Rationale
Levothyroxine absorption is significantly reduced by calcium
supplements, iron supplements, antacids, and food. The
medication should be taken on an empty stomach, typically
30–60 minutes before breakfast, with water. Separating
calcium by at least 4 hours helps ensure adequate
absorption and therapeutic effectiveness.
Option A is incorrect because food decreases absorption.
Option B is incorrect because calcium interferes with
absorption regardless of administration time. Option D is
incorrect because thyroid replacement therapy often
requires several weeks before clinical improvement is
observed and dosage adjustments should be provider-
directed.
Nurses should teach patients that lifelong therapy may be
necessary and that consistent administration is critical.
,Monitoring includes TSH and free T4 levels, assessment of
symptom improvement, and evaluation for signs of
overreplacement such as tachycardia and weight loss.
Learning Objective
After completing this question, the learner should be able
to:
• Explain proper administration of levothyroxine.
• Identify medications that interfere with thyroid hormone
absorption.
• Evaluate therapeutic response to thyroid replacement
therapy.
Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 67-year-old client with type 2 diabetes mellitus receives
insulin glargine at bedtime. During medication
administration, a newly hired nurse prepares to mix the
insulin glargine with regular insulin in the same syringe.
Question Stem
, Which action should the charge nurse take?
A. Allow the mixture if administered immediately.
B. Instruct the nurse to administer glargine separately.
C. Add NPH insulin to stabilize the mixture.
D. Warm the insulin before mixing.
Correct Answer
Correct Answer: B. Instruct the nurse to administer
glargine separately.
Detailed Rationale
Insulin glargine is a long-acting insulin designed to provide a
steady, peakless effect over approximately 24 hours. It
should never be mixed with other insulins because mixing
alters its pharmacokinetic profile and may result in
unpredictable glucose control.
Option A is incorrect because immediate administration
does not eliminate the incompatibility. Option C is incorrect
because adding NPH increases the risk of altered action.
Option D is incorrect because warming insulin does not
make it compatible.
Medication administration errors involving insulin are high-
risk and can lead to severe hypo- or hyperglycemia. Nurses
Practice Exam |
20 NGN-Style Questions with Rationales |
Diabetes, Thyroid & Adrenal Medications
Review
Question 1
Clinical Scenario
A 52-year-old woman with newly diagnosed hypothyroidism
is prescribed levothyroxine 75 mcg orally daily. During a
follow-up visit, she reports taking the medication with
breakfast and her calcium supplement each morning. She
states she still feels fatigued and constipated.
Question Stem
Which nursing instruction is most appropriate?
A. Take levothyroxine with meals to reduce gastrointestinal
upset.
B. Take levothyroxine at bedtime with calcium supplements.
,C. Take levothyroxine on an empty stomach and separate it
from calcium supplements.
D. Discontinue levothyroxine if symptoms persist after 1
week.
Correct Answer
Correct Answer: C. Take levothyroxine on an empty
stomach and separate it from calcium supplements.
Detailed Rationale
Levothyroxine absorption is significantly reduced by calcium
supplements, iron supplements, antacids, and food. The
medication should be taken on an empty stomach, typically
30–60 minutes before breakfast, with water. Separating
calcium by at least 4 hours helps ensure adequate
absorption and therapeutic effectiveness.
Option A is incorrect because food decreases absorption.
Option B is incorrect because calcium interferes with
absorption regardless of administration time. Option D is
incorrect because thyroid replacement therapy often
requires several weeks before clinical improvement is
observed and dosage adjustments should be provider-
directed.
Nurses should teach patients that lifelong therapy may be
necessary and that consistent administration is critical.
,Monitoring includes TSH and free T4 levels, assessment of
symptom improvement, and evaluation for signs of
overreplacement such as tachycardia and weight loss.
Learning Objective
After completing this question, the learner should be able
to:
• Explain proper administration of levothyroxine.
• Identify medications that interfere with thyroid hormone
absorption.
• Evaluate therapeutic response to thyroid replacement
therapy.
Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 67-year-old client with type 2 diabetes mellitus receives
insulin glargine at bedtime. During medication
administration, a newly hired nurse prepares to mix the
insulin glargine with regular insulin in the same syringe.
Question Stem
, Which action should the charge nurse take?
A. Allow the mixture if administered immediately.
B. Instruct the nurse to administer glargine separately.
C. Add NPH insulin to stabilize the mixture.
D. Warm the insulin before mixing.
Correct Answer
Correct Answer: B. Instruct the nurse to administer
glargine separately.
Detailed Rationale
Insulin glargine is a long-acting insulin designed to provide a
steady, peakless effect over approximately 24 hours. It
should never be mixed with other insulins because mixing
alters its pharmacokinetic profile and may result in
unpredictable glucose control.
Option A is incorrect because immediate administration
does not eliminate the incompatibility. Option C is incorrect
because adding NPH increases the risk of altered action.
Option D is incorrect because warming insulin does not
make it compatible.
Medication administration errors involving insulin are high-
risk and can lead to severe hypo- or hyperglycemia. Nurses
