NCLEX-RN Pharmacology Endocrine
System Exam |
20 Original ATI & NGN Style Practice
Questions with Detailed Rationales |
Nursing Study Guide
Question 1
Clinical Scenario
A 24-year-old woman with newly diagnosed type 1 diabetes
mellitus is admitted with hyperglycemia. The provider
prescribes insulin glargine 20 units subcutaneously every
evening and insulin lispro before meals. The nursing student
asks why both insulins are ordered.
Question Stem
Which explanation by the nurse is most accurate?
A. Insulin glargine rapidly lowers glucose after meals, while
insulin lispro prevents overnight hypoglycemia.
B. Insulin glargine provides basal glucose control, while
insulin lispro controls postprandial glucose elevations.
,C. Insulin glargine and insulin lispro should always be mixed
together before administration.
D. Insulin lispro has a longer duration of action than insulin
glargine.
Correct Answer
Correct Answer: B. Insulin glargine provides basal
glucose control, while insulin lispro controls
postprandial glucose elevations.
Detailed Rationale
Insulin glargine is a long-acting insulin that provides
continuous basal insulin coverage for approximately 24
hours with minimal peak effect. It helps maintain glucose
control between meals and overnight. Insulin lispro is a
rapid-acting insulin that begins working within minutes and
is administered before meals to manage postprandial
glucose increases. Together, they mimic normal physiologic
insulin secretion.
Option A is incorrect because insulin glargine is not a rapid-
acting insulin. Option C is incorrect because insulin glargine
should not be mixed with other insulins due to alterations in
its pharmacokinetic profile. Option D is incorrect because
insulin glargine has a much longer duration of action than
insulin lispro.
,Nurses should verify meal availability before administering
rapid-acting insulin to reduce hypoglycemia risk. Monitoring
blood glucose trends helps evaluate therapeutic
effectiveness. Patient education should include recognizing
symptoms of hypoglycemia and understanding the different
roles of basal and bolus insulin therapy.
Learning Objective
After completing this question, the learner should be able
to:
• Differentiate basal and bolus insulin therapy.
• Identify the onset and duration characteristics of
common insulin types.
• Educate patients regarding insulin administration
timing.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 67-year-old man with type 2 diabetes takes metformin
twice daily. He is scheduled for a contrast-enhanced CT
scan tomorrow. Serum creatinine is mildly elevated.
, Question Stem
Which nursing action is most appropriate?
A. Administer metformin as prescribed and encourage
fluids.
B. Hold metformin on the day of contrast administration and
follow facility guidelines regarding renal function
reassessment.
C. Double the metformin dose after the procedure.
D. Administer insulin instead of metformin without a
provider prescription.
Correct Answer
Correct Answer: B. Hold metformin on the day of contrast
administration and follow facility guidelines regarding
renal function reassessment.
Detailed Rationale
Metformin is associated with a rare but serious risk of lactic
acidosis, particularly in patients with impaired renal
function. Iodinated contrast agents can temporarily worsen
kidney function, increasing the risk of metformin
accumulation. Current practice typically involves holding
metformin at the time of contrast administration and
reassessing renal function before restarting therapy.
System Exam |
20 Original ATI & NGN Style Practice
Questions with Detailed Rationales |
Nursing Study Guide
Question 1
Clinical Scenario
A 24-year-old woman with newly diagnosed type 1 diabetes
mellitus is admitted with hyperglycemia. The provider
prescribes insulin glargine 20 units subcutaneously every
evening and insulin lispro before meals. The nursing student
asks why both insulins are ordered.
Question Stem
Which explanation by the nurse is most accurate?
A. Insulin glargine rapidly lowers glucose after meals, while
insulin lispro prevents overnight hypoglycemia.
B. Insulin glargine provides basal glucose control, while
insulin lispro controls postprandial glucose elevations.
,C. Insulin glargine and insulin lispro should always be mixed
together before administration.
D. Insulin lispro has a longer duration of action than insulin
glargine.
Correct Answer
Correct Answer: B. Insulin glargine provides basal
glucose control, while insulin lispro controls
postprandial glucose elevations.
Detailed Rationale
Insulin glargine is a long-acting insulin that provides
continuous basal insulin coverage for approximately 24
hours with minimal peak effect. It helps maintain glucose
control between meals and overnight. Insulin lispro is a
rapid-acting insulin that begins working within minutes and
is administered before meals to manage postprandial
glucose increases. Together, they mimic normal physiologic
insulin secretion.
Option A is incorrect because insulin glargine is not a rapid-
acting insulin. Option C is incorrect because insulin glargine
should not be mixed with other insulins due to alterations in
its pharmacokinetic profile. Option D is incorrect because
insulin glargine has a much longer duration of action than
insulin lispro.
,Nurses should verify meal availability before administering
rapid-acting insulin to reduce hypoglycemia risk. Monitoring
blood glucose trends helps evaluate therapeutic
effectiveness. Patient education should include recognizing
symptoms of hypoglycemia and understanding the different
roles of basal and bolus insulin therapy.
Learning Objective
After completing this question, the learner should be able
to:
• Differentiate basal and bolus insulin therapy.
• Identify the onset and duration characteristics of
common insulin types.
• Educate patients regarding insulin administration
timing.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 67-year-old man with type 2 diabetes takes metformin
twice daily. He is scheduled for a contrast-enhanced CT
scan tomorrow. Serum creatinine is mildly elevated.
, Question Stem
Which nursing action is most appropriate?
A. Administer metformin as prescribed and encourage
fluids.
B. Hold metformin on the day of contrast administration and
follow facility guidelines regarding renal function
reassessment.
C. Double the metformin dose after the procedure.
D. Administer insulin instead of metformin without a
provider prescription.
Correct Answer
Correct Answer: B. Hold metformin on the day of contrast
administration and follow facility guidelines regarding
renal function reassessment.
Detailed Rationale
Metformin is associated with a rare but serious risk of lactic
acidosis, particularly in patients with impaired renal
function. Iodinated contrast agents can temporarily worsen
kidney function, increasing the risk of metformin
accumulation. Current practice typically involves holding
metformin at the time of contrast administration and
reassessing renal function before restarting therapy.
