NCLEX-RN Pharmacology Practice Exam |
Endocrine System |
20 Next-Gen (NGN) NCLEX-Style Questions with
Detailed Rationales |
Insulin, Diabetes, Thyroid, Corticosteroids,
Osteoporosis Drugs |
ATI Pharmacology Review for Nursing Students
Question 1
Clinical Scenario
A 58-year-old woman with newly diagnosed primary
hypothyroidism is prescribed levothyroxine 75 mcg orally
once daily. She reports increasing fatigue, constipation,
cold intolerance, and weight gain over the past several
months. Her history includes hypertension treated with
lisinopril and iron-deficiency anemia treated with ferrous
sulfate. Laboratory results reveal a TSH of 12.8 mIU/L
(elevated) and a low free T4 level. During discharge teaching,
the nurse reviews medication administration instructions.
Question Stem
,Which statement by the client indicates correct
understanding of how to take levothyroxine?
A. "I will take my levothyroxine with breakfast and my iron
supplement."
B. "I should stop taking the medication once my symptoms
improve."
C. "I will take the medication every morning on an empty
stomach and wait before eating."
D. "If I miss one dose, I should double the next day's dose."
Correct Answer
Correct Answer: C. "I will take the medication every
morning on an empty stomach and wait before eating."
Detailed Rationale
Levothyroxine is a synthetic thyroid hormone used as
lifelong replacement therapy for hypothyroidism. Optimal
absorption occurs when it is taken consistently on an empty
stomach, ideally 30–60 minutes before breakfast with water.
Iron supplements, calcium products, antacids, and certain
foods reduce levothyroxine absorption and should be
separated by at least 4 hours. Regular monitoring of TSH and
free T4 helps determine dosage adjustments, which should
never be based solely on symptom improvement.
,Option A is incorrect because iron significantly decreases
levothyroxine absorption. Option B is incorrect because
primary hypothyroidism usually requires lifelong therapy;
discontinuing treatment can result in recurrent
hypothyroidism and severe complications such as
myxedema coma. Option D is incorrect because doubling
doses increases the risk of excessive thyroid hormone
effects, including tachycardia, palpitations, and angina,
particularly in older adults and those with cardiovascular
disease.
The nurse should emphasize adherence, consistency in
administration time, recognition of symptoms of over- and
under-replacement, and the importance of periodic
laboratory monitoring rather than self-adjusting doses.
Learning Objectives
After completing this question, the learner should be able
to:
• Explain proper administration of levothyroxine.
• Identify medications that interfere with thyroid hormone
absorption.
• Educate patients regarding lifelong adherence.
• Recognize the need for laboratory monitoring.
Medication Safety Focus
, Patient education and medication administration
Question 2
Clinical Scenario
A 67-year-old man with type 2 diabetes mellitus receives
his scheduled dose of insulin glargine every evening. During
morning rounds, the nurse finds that a newly hired nurse has
prepared the glargine in the same syringe as rapid-acting
insulin lispro to reduce the number of injections. The client
is alert, has a blood glucose of 162 mg/dL, and has eaten
breakfast.
Question Stem
Which action should the charge nurse take first?
A. Administer the mixed insulin as prepared.
B. Discard the mixed insulin and prepare the medications
correctly.
C. Delay all insulin administration until the provider is
notified.
D. Administer only the lispro and omit the glargine dose.
Correct Answer
Endocrine System |
20 Next-Gen (NGN) NCLEX-Style Questions with
Detailed Rationales |
Insulin, Diabetes, Thyroid, Corticosteroids,
Osteoporosis Drugs |
ATI Pharmacology Review for Nursing Students
Question 1
Clinical Scenario
A 58-year-old woman with newly diagnosed primary
hypothyroidism is prescribed levothyroxine 75 mcg orally
once daily. She reports increasing fatigue, constipation,
cold intolerance, and weight gain over the past several
months. Her history includes hypertension treated with
lisinopril and iron-deficiency anemia treated with ferrous
sulfate. Laboratory results reveal a TSH of 12.8 mIU/L
(elevated) and a low free T4 level. During discharge teaching,
the nurse reviews medication administration instructions.
Question Stem
,Which statement by the client indicates correct
understanding of how to take levothyroxine?
A. "I will take my levothyroxine with breakfast and my iron
supplement."
B. "I should stop taking the medication once my symptoms
improve."
C. "I will take the medication every morning on an empty
stomach and wait before eating."
D. "If I miss one dose, I should double the next day's dose."
Correct Answer
Correct Answer: C. "I will take the medication every
morning on an empty stomach and wait before eating."
Detailed Rationale
Levothyroxine is a synthetic thyroid hormone used as
lifelong replacement therapy for hypothyroidism. Optimal
absorption occurs when it is taken consistently on an empty
stomach, ideally 30–60 minutes before breakfast with water.
Iron supplements, calcium products, antacids, and certain
foods reduce levothyroxine absorption and should be
separated by at least 4 hours. Regular monitoring of TSH and
free T4 helps determine dosage adjustments, which should
never be based solely on symptom improvement.
,Option A is incorrect because iron significantly decreases
levothyroxine absorption. Option B is incorrect because
primary hypothyroidism usually requires lifelong therapy;
discontinuing treatment can result in recurrent
hypothyroidism and severe complications such as
myxedema coma. Option D is incorrect because doubling
doses increases the risk of excessive thyroid hormone
effects, including tachycardia, palpitations, and angina,
particularly in older adults and those with cardiovascular
disease.
The nurse should emphasize adherence, consistency in
administration time, recognition of symptoms of over- and
under-replacement, and the importance of periodic
laboratory monitoring rather than self-adjusting doses.
Learning Objectives
After completing this question, the learner should be able
to:
• Explain proper administration of levothyroxine.
• Identify medications that interfere with thyroid hormone
absorption.
• Educate patients regarding lifelong adherence.
• Recognize the need for laboratory monitoring.
Medication Safety Focus
, Patient education and medication administration
Question 2
Clinical Scenario
A 67-year-old man with type 2 diabetes mellitus receives
his scheduled dose of insulin glargine every evening. During
morning rounds, the nurse finds that a newly hired nurse has
prepared the glargine in the same syringe as rapid-acting
insulin lispro to reduce the number of injections. The client
is alert, has a blood glucose of 162 mg/dL, and has eaten
breakfast.
Question Stem
Which action should the charge nurse take first?
A. Administer the mixed insulin as prepared.
B. Discard the mixed insulin and prepare the medications
correctly.
C. Delay all insulin administration until the provider is
notified.
D. Administer only the lispro and omit the glargine dose.
Correct Answer
