NCLEX-RN Pharmacology Endocrine
System Practice Questions |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales, Nursing Study Guide
& Exam Prep
Question 1
Clinical Scenario
A 24-year-old woman with type 1 diabetes mellitus is
admitted with nausea and poor oral intake due to viral
gastroenteritis. She normally administers insulin glargine at
bedtime and insulin lispro before meals. Her blood glucose
is 248 mg/dL. The nurse reviews her medication
administration record.
Question Stem
Which action should the nurse take regarding the client's
insulin therapy?
A. Hold all insulin until the client resumes normal eating
B. Administer insulin glargine as prescribed
,C. Hold insulin glargine and administer only insulin lispro
D. Discontinue insulin therapy for 24 hours
Correct Answer
Correct Answer: B. Administer insulin glargine as
prescribed
Detailed Rationale
Insulin glargine is a long-acting basal insulin that provides
continuous glucose control and should generally not be
withheld in clients with type 1 diabetes, even when oral
intake is reduced. Omitting basal insulin increases the risk
of hyperglycemia and diabetic ketoacidosis (DKA). The nurse
should continue glargine while monitoring blood glucose
closely and adjusting rapid-acting insulin based on intake
and glucose levels.
Option A is incorrect because withholding all insulin can
precipitate DKA. Option C is incorrect because basal insulin
is essential for preventing ketosis. Option D is unsafe
because insulin discontinuation in type 1 diabetes can
rapidly lead to severe metabolic complications.
Nursing care includes monitoring glucose, assessing
hydration status, checking for ketones if indicated, and
reinforcing sick-day management. Patients should
,understand that illness often increases insulin requirements
despite decreased food intake.
Learning Objective
After completing this question, the learner should be able
to:
• Differentiate basal and prandial insulin therapy.
• Apply sick-day management principles.
• Prevent diabetic ketoacidosis.
• Monitor insulin therapy safely during illness.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 68-year-old client with type 2 diabetes takes metformin
1,000 mg twice daily. The client is scheduled for a contrast-
enhanced CT scan tomorrow. Laboratory results show
serum creatinine 1.9 mg/dL.
Question Stem
Which nursing action is most appropriate?
, A. Administer metformin as scheduled
B. Increase oral fluid intake and continue metformin
C. Hold metformin and notify the provider
D. Administer metformin immediately after the scan
Correct Answer
Correct Answer: C. Hold metformin and notify the
provider
Detailed Rationale
Metformin is associated with a rare but serious risk of lactic
acidosis, particularly in clients with impaired renal function.
Iodinated contrast can further reduce kidney function,
increasing this risk. Current practice often requires
temporary discontinuation of metformin before or at the
time of contrast administration and reassessment of renal
function before restarting therapy.
Option A ignores the potential renal risk. Option B may help
hydration but does not address the medication safety
concern. Option D is unsafe because renal function should
be reassessed before resuming treatment.
Nurses should review laboratory values, identify nephrotoxic
risks, verify medication reconciliation before procedures,
and educate clients regarding temporary medication holds.
System Practice Questions |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales, Nursing Study Guide
& Exam Prep
Question 1
Clinical Scenario
A 24-year-old woman with type 1 diabetes mellitus is
admitted with nausea and poor oral intake due to viral
gastroenteritis. She normally administers insulin glargine at
bedtime and insulin lispro before meals. Her blood glucose
is 248 mg/dL. The nurse reviews her medication
administration record.
Question Stem
Which action should the nurse take regarding the client's
insulin therapy?
A. Hold all insulin until the client resumes normal eating
B. Administer insulin glargine as prescribed
,C. Hold insulin glargine and administer only insulin lispro
D. Discontinue insulin therapy for 24 hours
Correct Answer
Correct Answer: B. Administer insulin glargine as
prescribed
Detailed Rationale
Insulin glargine is a long-acting basal insulin that provides
continuous glucose control and should generally not be
withheld in clients with type 1 diabetes, even when oral
intake is reduced. Omitting basal insulin increases the risk
of hyperglycemia and diabetic ketoacidosis (DKA). The nurse
should continue glargine while monitoring blood glucose
closely and adjusting rapid-acting insulin based on intake
and glucose levels.
Option A is incorrect because withholding all insulin can
precipitate DKA. Option C is incorrect because basal insulin
is essential for preventing ketosis. Option D is unsafe
because insulin discontinuation in type 1 diabetes can
rapidly lead to severe metabolic complications.
Nursing care includes monitoring glucose, assessing
hydration status, checking for ketones if indicated, and
reinforcing sick-day management. Patients should
,understand that illness often increases insulin requirements
despite decreased food intake.
Learning Objective
After completing this question, the learner should be able
to:
• Differentiate basal and prandial insulin therapy.
• Apply sick-day management principles.
• Prevent diabetic ketoacidosis.
• Monitor insulin therapy safely during illness.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 68-year-old client with type 2 diabetes takes metformin
1,000 mg twice daily. The client is scheduled for a contrast-
enhanced CT scan tomorrow. Laboratory results show
serum creatinine 1.9 mg/dL.
Question Stem
Which nursing action is most appropriate?
, A. Administer metformin as scheduled
B. Increase oral fluid intake and continue metformin
C. Hold metformin and notify the provider
D. Administer metformin immediately after the scan
Correct Answer
Correct Answer: C. Hold metformin and notify the
provider
Detailed Rationale
Metformin is associated with a rare but serious risk of lactic
acidosis, particularly in clients with impaired renal function.
Iodinated contrast can further reduce kidney function,
increasing this risk. Current practice often requires
temporary discontinuation of metformin before or at the
time of contrast administration and reassessment of renal
function before restarting therapy.
Option A ignores the potential renal risk. Option B may help
hydration but does not address the medication safety
concern. Option D is unsafe because renal function should
be reassessed before resuming treatment.
Nurses should review laboratory values, identify nephrotoxic
risks, verify medication reconciliation before procedures,
and educate clients regarding temporary medication holds.
