NCLEX-RN Pharmacology Endocrine
System Exam Questions & Answers |
20 Original ATI & NGN-Style Practice
Questions with Rationales
Question 1
Clinical Scenario
A 48-year-old female with newly diagnosed type 2 diabetes
mellitus is prescribed metformin. Her labs show eGFR 28
mL/min/1.73m². She reports mild fatigue but no other
symptoms.
Question Stem
Which action should the nurse take?
A. Administer the medication with food
B. Hold the medication and notify the provider
C. Encourage increased fluid intake
D. Administer the medication at bedtime
Correct Answer: B. Hold the medication and notify the
provider
,Detailed Rationale
Metformin is contraindicated in patients with significant
renal impairment (eGFR <30 mL/min/1.73m²) due to the risk
of lactic acidosis, a rare but life-threatening complication.
This patient’s eGFR of 28 places her at high risk, making it
unsafe to administer the medication. The nurse must hold
the drug and notify the provider to prevent harm.
Option A is incorrect because although metformin is taken
with food to reduce GI upset, renal function takes priority.
Option C does not address the underlying contraindication.
Option D is incorrect because timing does not mitigate the
risk.
Nurses must assess renal function before administering
metformin and educate patients about symptoms of lactic
acidosis (muscle pain, fatigue, dyspnea). Monitoring renal
labs regularly is essential.
Learning Objective
• Identify contraindications for metformin therapy
• Interpret renal function labs for medication safety
• Prioritize nursing actions in high-risk patients
Medication Safety Focus: Contraindication
, Question 2
Clinical Scenario
A 62-year-old client with hypothyroidism takes
levothyroxine daily. She also takes iron supplements and
drinks coffee immediately after medication.
Question Stem
Which statement indicates a need for further teaching?
A. “I take my medication before breakfast.”
B. “I drink coffee right after taking my pill.”
C. “I take this medication every day.”
D. “I should not skip doses.”
Correct Answer: B. “I drink coffee right after taking my pill.”
Detailed Rationale
Levothyroxine absorption is reduced by substances like
coffee, iron, calcium, and food. It should be taken on an
empty stomach with water, and patients should wait at least
30–60 minutes before consuming other substances.
Drinking coffee immediately after ingestion can significantly
decrease drug absorption and effectiveness.
Options A, C, and D reflect correct understanding of
medication adherence and timing.
System Exam Questions & Answers |
20 Original ATI & NGN-Style Practice
Questions with Rationales
Question 1
Clinical Scenario
A 48-year-old female with newly diagnosed type 2 diabetes
mellitus is prescribed metformin. Her labs show eGFR 28
mL/min/1.73m². She reports mild fatigue but no other
symptoms.
Question Stem
Which action should the nurse take?
A. Administer the medication with food
B. Hold the medication and notify the provider
C. Encourage increased fluid intake
D. Administer the medication at bedtime
Correct Answer: B. Hold the medication and notify the
provider
,Detailed Rationale
Metformin is contraindicated in patients with significant
renal impairment (eGFR <30 mL/min/1.73m²) due to the risk
of lactic acidosis, a rare but life-threatening complication.
This patient’s eGFR of 28 places her at high risk, making it
unsafe to administer the medication. The nurse must hold
the drug and notify the provider to prevent harm.
Option A is incorrect because although metformin is taken
with food to reduce GI upset, renal function takes priority.
Option C does not address the underlying contraindication.
Option D is incorrect because timing does not mitigate the
risk.
Nurses must assess renal function before administering
metformin and educate patients about symptoms of lactic
acidosis (muscle pain, fatigue, dyspnea). Monitoring renal
labs regularly is essential.
Learning Objective
• Identify contraindications for metformin therapy
• Interpret renal function labs for medication safety
• Prioritize nursing actions in high-risk patients
Medication Safety Focus: Contraindication
, Question 2
Clinical Scenario
A 62-year-old client with hypothyroidism takes
levothyroxine daily. She also takes iron supplements and
drinks coffee immediately after medication.
Question Stem
Which statement indicates a need for further teaching?
A. “I take my medication before breakfast.”
B. “I drink coffee right after taking my pill.”
C. “I take this medication every day.”
D. “I should not skip doses.”
Correct Answer: B. “I drink coffee right after taking my pill.”
Detailed Rationale
Levothyroxine absorption is reduced by substances like
coffee, iron, calcium, and food. It should be taken on an
empty stomach with water, and patients should wait at least
30–60 minutes before consuming other substances.
Drinking coffee immediately after ingestion can significantly
decrease drug absorption and effectiveness.
Options A, C, and D reflect correct understanding of
medication adherence and timing.
