NCLEX-RN Endocrine System Pharmacology
Exam |
20 NGN Practice Questions with Detailed
Rationales |
ATI Style Nursing Test Bank
Question 1
Clinical Scenario
A 56-year-old man with type 2 diabetes mellitus is admitted
with community-acquired pneumonia. His home
medications include metformin 1,000 mg twice daily and
lisinopril 10 mg daily. He is scheduled for a contrast-
enhanced CT scan of the chest. Laboratory findings include
serum creatinine 1.8 mg/dL (baseline 1.0 mg/dL) and
estimated glomerular filtration rate (eGFR) of 42
mL/min/1.73 m². Vital signs are stable.
Question Stem
,Which nursing action is the priority regarding the client's
metformin therapy?
A. Administer metformin with the morning meal before the
CT scan.
B. Hold metformin before the contrast study and notify the
provider.
C. Increase the metformin dose after the CT scan.
D. Administer metformin with an antacid to reduce
gastrointestinal effects.
Correct Answer
Correct Answer: B. Hold metformin before the contrast
study and notify the provider.
Detailed Rationale
Metformin decreases hepatic glucose production and
improves insulin sensitivity, making it a first-line medication
for type 2 diabetes. Although generally safe, metformin
carries a rare but serious risk of lactic acidosis, particularly
in patients with renal impairment or conditions that reduce
tissue perfusion. Iodinated contrast media may temporarily
worsen kidney function, increasing metformin accumulation
and the risk of lactic acidosis.
,The nurse should hold metformin before or at the time of
contrast administration according to institutional policy and
notify the provider. Renal function should be reassessed
before restarting therapy.
Option A is incorrect because administering metformin
before contrast exposure may increase risk if renal function
declines afterward.
Option C is incorrect because increasing the dose is
inappropriate and potentially dangerous in renal
impairment.
Option D is incorrect because antacids do not prevent the
major safety concern associated with contrast exposure.
Nursing care includes monitoring renal function, hydration
status, blood glucose levels, and educating the patient
about temporary medication interruption and signs of lactic
acidosis such as unusual fatigue, muscle pain, rapid
breathing, and abdominal discomfort.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify situations requiring temporary discontinuation
of metformin.
, • Recognize risk factors for metformin-associated lactic
acidosis.
• Prioritize nursing actions before contrast
administration.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 22-year-old woman with newly diagnosed type 1 diabetes
mellitus is learning to self-administer insulin glargine and
insulin lispro. Before lunch, her capillary blood glucose is
268 mg/dL.
Question Stem
Which statement by the client demonstrates correct
understanding of her insulin regimen?
A. "I will mix glargine with lispro in the same syringe."
B. "If I skip lunch, I should still take my mealtime lispro."
C. "Glargine provides steady background insulin throughout
the day."
Exam |
20 NGN Practice Questions with Detailed
Rationales |
ATI Style Nursing Test Bank
Question 1
Clinical Scenario
A 56-year-old man with type 2 diabetes mellitus is admitted
with community-acquired pneumonia. His home
medications include metformin 1,000 mg twice daily and
lisinopril 10 mg daily. He is scheduled for a contrast-
enhanced CT scan of the chest. Laboratory findings include
serum creatinine 1.8 mg/dL (baseline 1.0 mg/dL) and
estimated glomerular filtration rate (eGFR) of 42
mL/min/1.73 m². Vital signs are stable.
Question Stem
,Which nursing action is the priority regarding the client's
metformin therapy?
A. Administer metformin with the morning meal before the
CT scan.
B. Hold metformin before the contrast study and notify the
provider.
C. Increase the metformin dose after the CT scan.
D. Administer metformin with an antacid to reduce
gastrointestinal effects.
Correct Answer
Correct Answer: B. Hold metformin before the contrast
study and notify the provider.
Detailed Rationale
Metformin decreases hepatic glucose production and
improves insulin sensitivity, making it a first-line medication
for type 2 diabetes. Although generally safe, metformin
carries a rare but serious risk of lactic acidosis, particularly
in patients with renal impairment or conditions that reduce
tissue perfusion. Iodinated contrast media may temporarily
worsen kidney function, increasing metformin accumulation
and the risk of lactic acidosis.
,The nurse should hold metformin before or at the time of
contrast administration according to institutional policy and
notify the provider. Renal function should be reassessed
before restarting therapy.
Option A is incorrect because administering metformin
before contrast exposure may increase risk if renal function
declines afterward.
Option C is incorrect because increasing the dose is
inappropriate and potentially dangerous in renal
impairment.
Option D is incorrect because antacids do not prevent the
major safety concern associated with contrast exposure.
Nursing care includes monitoring renal function, hydration
status, blood glucose levels, and educating the patient
about temporary medication interruption and signs of lactic
acidosis such as unusual fatigue, muscle pain, rapid
breathing, and abdominal discomfort.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify situations requiring temporary discontinuation
of metformin.
, • Recognize risk factors for metformin-associated lactic
acidosis.
• Prioritize nursing actions before contrast
administration.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 22-year-old woman with newly diagnosed type 1 diabetes
mellitus is learning to self-administer insulin glargine and
insulin lispro. Before lunch, her capillary blood glucose is
268 mg/dL.
Question Stem
Which statement by the client demonstrates correct
understanding of her insulin regimen?
A. "I will mix glargine with lispro in the same syringe."
B. "If I skip lunch, I should still take my mealtime lispro."
C. "Glargine provides steady background insulin throughout
the day."
