NCLEX-RN Endocrine System Pharmacology
Exam |
20 ATI & Next Gen NCLEX (NGN) Style Practice
Questions with Detailed Rationales |
Diabetes, Insulin, Thyroid, Corticosteroids,
Osteoporosis & Endocrine Medications |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 58-year-old woman with newly diagnosed type 2 diabetes
mellitus is admitted to a medical unit for hyperglycemia. Her
laboratory results include a fasting blood glucose of 232
mg/dL and an HbA1c of 9.1%. The provider prescribes
metformin 500 mg orally twice daily with meals. The nurse
reviews her history and notes hypertension, obesity, and
stage 3 chronic kidney disease. Her laboratory results show:
• Serum creatinine: 2.0 mg/dL
, • Estimated glomerular filtration rate (eGFR): 26
mL/min/1.73 m²
• ALT and AST within normal limits
• Vital signs stable
The client asks when she can begin taking her new
medication.
Question Stem
Which nursing action is most appropriate before
administering the first dose of metformin?
A. Administer the medication with breakfast as prescribed.
B. Hold the medication and notify the provider about the
client's renal function.
C. Administer the medication and encourage increased fluid
intake.
D. Delay administration until after the evening meal.
Correct Answer
Correct Answer: B. Hold the medication and notify the
provider about the client's renal function.
Detailed Rationale
Metformin is a first-line oral antihyperglycemic medication
that decreases hepatic glucose production and improves
,insulin sensitivity. Although it is generally safe, it is
contraindicated in clients with severe renal impairment
(eGFR below 30 mL/min/1.73 m²) because reduced drug
clearance increases the risk of lactic acidosis, a rare but
potentially fatal complication. This client's eGFR of 26
mL/min/1.73 m² requires the nurse to hold the medication
and notify the provider before administration. This action
demonstrates safe medication administration and
appropriate clinical judgment.
Option A is incorrect because administering metformin
despite severe renal impairment places the client at
unnecessary risk. Option C is incorrect because hydration
does not eliminate the contraindication. Option D is
incorrect because changing the administration time does
not address the underlying safety concern. Nurses must
review renal function before initiating or continuing
metformin therapy and educate patients to report symptoms
such as unexplained fatigue, muscle pain, abdominal
discomfort, or rapid breathing, which may indicate lactic
acidosis. The nurse should also anticipate alternative
glucose-lowering therapy appropriate for the client's renal
status.
Learning Objectives
, After completing this question, the learner should be able
to:
• Identify contraindications to metformin therapy.
• Interpret renal laboratory values before medication
administration.
• Recognize nursing actions that reduce the risk of
medication-related harm.
• Apply evidence-based medication safety principles.
Medication Safety Focus
Contraindication—Metformin use in severe renal
impairment
Question 2
Clinical Scenario
A 24-year-old client with type 1 diabetes mellitus receives
rapid-acting insulin lispro before lunch. Thirty minutes later,
the nurse finds the client pale, diaphoretic, anxious, and
complaining of shaking and dizziness. Vital signs are:
• BP: 118/74 mm Hg
• HR: 112/min
• RR: 18/min
Exam |
20 ATI & Next Gen NCLEX (NGN) Style Practice
Questions with Detailed Rationales |
Diabetes, Insulin, Thyroid, Corticosteroids,
Osteoporosis & Endocrine Medications |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 58-year-old woman with newly diagnosed type 2 diabetes
mellitus is admitted to a medical unit for hyperglycemia. Her
laboratory results include a fasting blood glucose of 232
mg/dL and an HbA1c of 9.1%. The provider prescribes
metformin 500 mg orally twice daily with meals. The nurse
reviews her history and notes hypertension, obesity, and
stage 3 chronic kidney disease. Her laboratory results show:
• Serum creatinine: 2.0 mg/dL
, • Estimated glomerular filtration rate (eGFR): 26
mL/min/1.73 m²
• ALT and AST within normal limits
• Vital signs stable
The client asks when she can begin taking her new
medication.
Question Stem
Which nursing action is most appropriate before
administering the first dose of metformin?
A. Administer the medication with breakfast as prescribed.
B. Hold the medication and notify the provider about the
client's renal function.
C. Administer the medication and encourage increased fluid
intake.
D. Delay administration until after the evening meal.
Correct Answer
Correct Answer: B. Hold the medication and notify the
provider about the client's renal function.
Detailed Rationale
Metformin is a first-line oral antihyperglycemic medication
that decreases hepatic glucose production and improves
,insulin sensitivity. Although it is generally safe, it is
contraindicated in clients with severe renal impairment
(eGFR below 30 mL/min/1.73 m²) because reduced drug
clearance increases the risk of lactic acidosis, a rare but
potentially fatal complication. This client's eGFR of 26
mL/min/1.73 m² requires the nurse to hold the medication
and notify the provider before administration. This action
demonstrates safe medication administration and
appropriate clinical judgment.
Option A is incorrect because administering metformin
despite severe renal impairment places the client at
unnecessary risk. Option C is incorrect because hydration
does not eliminate the contraindication. Option D is
incorrect because changing the administration time does
not address the underlying safety concern. Nurses must
review renal function before initiating or continuing
metformin therapy and educate patients to report symptoms
such as unexplained fatigue, muscle pain, abdominal
discomfort, or rapid breathing, which may indicate lactic
acidosis. The nurse should also anticipate alternative
glucose-lowering therapy appropriate for the client's renal
status.
Learning Objectives
, After completing this question, the learner should be able
to:
• Identify contraindications to metformin therapy.
• Interpret renal laboratory values before medication
administration.
• Recognize nursing actions that reduce the risk of
medication-related harm.
• Apply evidence-based medication safety principles.
Medication Safety Focus
Contraindication—Metformin use in severe renal
impairment
Question 2
Clinical Scenario
A 24-year-old client with type 1 diabetes mellitus receives
rapid-acting insulin lispro before lunch. Thirty minutes later,
the nurse finds the client pale, diaphoretic, anxious, and
complaining of shaking and dizziness. Vital signs are:
• BP: 118/74 mm Hg
• HR: 112/min
• RR: 18/min
