NCLEX-RN Endocrine Pharmacology
Practice Questions |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales, Clinical Judgment &
Medication Safety
Question 1
Clinical Scenario
A 58-year-old male with type 2 diabetes mellitus is
prescribed metformin. His lab results show eGFR 28
mL/min/1.73m². He reports fatigue and decreased appetite.
Question Stem
Which action should the nurse take?
A. Administer metformin as prescribed
B. Hold the medication and notify the provider
C. Encourage increased protein intake
D. Administer the medication with food
Correct Answer: B. Hold the medication and notify the
provider
,Detailed Rationale
Metformin is contraindicated in patients with severe renal
impairment (eGFR <30 mL/min/1.73m²) due to the increased
risk of lactic acidosis, a rare but potentially fatal
complication. This patient’s eGFR of 28 indicates significant
renal dysfunction, making continuation of metformin unsafe.
The nurse’s priority is to hold the medication and notify the
provider for alternative therapy.
Option A is incorrect because administering metformin in
this context increases the risk of toxicity. Option C is
unrelated to the immediate safety concern. Option D is
generally correct for GI tolerance but does not address the
contraindication.
Nurses must always review renal function before
administering medications cleared renally. Patient teaching
includes reporting symptoms such as muscle pain, fatigue,
or difficulty breathing, which may indicate lactic acidosis.
Monitoring includes renal labs and assessing for metabolic
acidosis.
Learning Objective
• Identify contraindications for metformin therapy
• Recognize the significance of renal function in medication
safety
, • Prioritize nursing actions when lab abnormalities are
present
Medication Safety Focus: Contraindication
Question 2
Clinical Scenario
A 45-year-old female with hypothyroidism is prescribed
levothyroxine. She reports taking the medication with
breakfast and calcium supplements.
Question Stem
Which statement indicates a need for further teaching?
A. “I will take this medication on an empty stomach.”
B. “I will take calcium supplements at the same time.”
C. “I should take this medication in the morning.”
D. “I may need lifelong therapy.”
Correct Answer: B. “I will take calcium supplements at the
same time.”
Detailed Rationale
Levothyroxine absorption is significantly reduced when
taken with calcium supplements, iron, or certain foods. It
should be taken on an empty stomach, ideally 30–60
minutes before breakfast, with other medications spaced by
at least 4 hours. Taking calcium concurrently reduces
Practice Questions |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales, Clinical Judgment &
Medication Safety
Question 1
Clinical Scenario
A 58-year-old male with type 2 diabetes mellitus is
prescribed metformin. His lab results show eGFR 28
mL/min/1.73m². He reports fatigue and decreased appetite.
Question Stem
Which action should the nurse take?
A. Administer metformin as prescribed
B. Hold the medication and notify the provider
C. Encourage increased protein intake
D. Administer the medication with food
Correct Answer: B. Hold the medication and notify the
provider
,Detailed Rationale
Metformin is contraindicated in patients with severe renal
impairment (eGFR <30 mL/min/1.73m²) due to the increased
risk of lactic acidosis, a rare but potentially fatal
complication. This patient’s eGFR of 28 indicates significant
renal dysfunction, making continuation of metformin unsafe.
The nurse’s priority is to hold the medication and notify the
provider for alternative therapy.
Option A is incorrect because administering metformin in
this context increases the risk of toxicity. Option C is
unrelated to the immediate safety concern. Option D is
generally correct for GI tolerance but does not address the
contraindication.
Nurses must always review renal function before
administering medications cleared renally. Patient teaching
includes reporting symptoms such as muscle pain, fatigue,
or difficulty breathing, which may indicate lactic acidosis.
Monitoring includes renal labs and assessing for metabolic
acidosis.
Learning Objective
• Identify contraindications for metformin therapy
• Recognize the significance of renal function in medication
safety
, • Prioritize nursing actions when lab abnormalities are
present
Medication Safety Focus: Contraindication
Question 2
Clinical Scenario
A 45-year-old female with hypothyroidism is prescribed
levothyroxine. She reports taking the medication with
breakfast and calcium supplements.
Question Stem
Which statement indicates a need for further teaching?
A. “I will take this medication on an empty stomach.”
B. “I will take calcium supplements at the same time.”
C. “I should take this medication in the morning.”
D. “I may need lifelong therapy.”
Correct Answer: B. “I will take calcium supplements at the
same time.”
Detailed Rationale
Levothyroxine absorption is significantly reduced when
taken with calcium supplements, iron, or certain foods. It
should be taken on an empty stomach, ideally 30–60
minutes before breakfast, with other medications spaced by
at least 4 hours. Taking calcium concurrently reduces
