NCLEX-RN Endocrine Pharmacology
Practice Questions |
20 Original ATI & NGN-Style NCLEX MCQs
with Detailed Rationales
Question 1
Clinical Scenario
A 58-year-old man with newly diagnosed type 2 diabetes
mellitus is admitted for hyperglycemia. His history includes
hypertension and stage 3 chronic kidney disease (eGFR 42
mL/min/1.73 m²). Current medications include lisinopril and
atorvastatin. The provider prescribes metformin 500 mg
orally twice daily. Before administering the first dose, the
nurse reviews the patient's record and notes that he is
scheduled for a contrast-enhanced CT scan later today.
Question Stem
Which action should the nurse take first regarding the
metformin prescription?
,A. Administer the medication as prescribed because the
dose is low.
B. Hold the metformin and notify the provider about the
scheduled contrast study.
C. Encourage the client to increase oral fluid intake before
taking the medication.
D. Administer the medication with food to decrease
gastrointestinal discomfort.
Correct Answer
Correct Answer: B. Hold the metformin and notify the
provider about the scheduled contrast study.
Detailed Rationale
Metformin is a first-line medication for type 2 diabetes
because it decreases hepatic glucose production and
improves insulin sensitivity. However, it carries a rare but
serious risk of lactic acidosis, particularly in patients with
impaired renal function or situations that may further reduce
kidney function. Iodinated contrast media can cause
contrast-associated acute kidney injury, temporarily
increasing the risk of metformin accumulation. Therefore,
the nurse should hold the medication and notify the
provider so that metformin can be withheld according to
,institutional policy and restarted only after renal function is
reassessed.
Option A is incorrect because a lower dose does not
eliminate the risk associated with impaired renal function
and contrast administration.
Option C is incorrect because hydration may help reduce
contrast nephropathy risk but does not replace withholding
metformin when indicated.
Option D is true regarding minimizing gastrointestinal side
effects, but it does not address the priority patient safety
issue.
The nurse should also review the patient's renal function,
educate the client about the temporary interruption of
therapy, and monitor blood glucose while the medication is
withheld.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify situations requiring temporary discontinuation
of metformin.
• Recognize factors that increase the risk of metformin-
associated lactic acidosis.
, • Prioritize nursing actions before administering oral
antidiabetic medications.
• Apply medication safety principles related to contrast
procedures.
Medication Safety Focus
Monitoring and prevention of metformin-associated
lactic acidosis
Question 2
Clinical Scenario
A 24-year-old woman with type 1 diabetes mellitus is
admitted with nausea, vomiting, and abdominal pain after
forgetting to take several insulin doses. Laboratory results
reveal:
• Blood glucose: 486 mg/dL
• Serum potassium: 5.6 mEq/L
• Arterial pH: 7.18
• Positive serum ketones
The provider prescribes a continuous intravenous infusion of
regular insulin.
Question Stem
Practice Questions |
20 Original ATI & NGN-Style NCLEX MCQs
with Detailed Rationales
Question 1
Clinical Scenario
A 58-year-old man with newly diagnosed type 2 diabetes
mellitus is admitted for hyperglycemia. His history includes
hypertension and stage 3 chronic kidney disease (eGFR 42
mL/min/1.73 m²). Current medications include lisinopril and
atorvastatin. The provider prescribes metformin 500 mg
orally twice daily. Before administering the first dose, the
nurse reviews the patient's record and notes that he is
scheduled for a contrast-enhanced CT scan later today.
Question Stem
Which action should the nurse take first regarding the
metformin prescription?
,A. Administer the medication as prescribed because the
dose is low.
B. Hold the metformin and notify the provider about the
scheduled contrast study.
C. Encourage the client to increase oral fluid intake before
taking the medication.
D. Administer the medication with food to decrease
gastrointestinal discomfort.
Correct Answer
Correct Answer: B. Hold the metformin and notify the
provider about the scheduled contrast study.
Detailed Rationale
Metformin is a first-line medication for type 2 diabetes
because it decreases hepatic glucose production and
improves insulin sensitivity. However, it carries a rare but
serious risk of lactic acidosis, particularly in patients with
impaired renal function or situations that may further reduce
kidney function. Iodinated contrast media can cause
contrast-associated acute kidney injury, temporarily
increasing the risk of metformin accumulation. Therefore,
the nurse should hold the medication and notify the
provider so that metformin can be withheld according to
,institutional policy and restarted only after renal function is
reassessed.
Option A is incorrect because a lower dose does not
eliminate the risk associated with impaired renal function
and contrast administration.
Option C is incorrect because hydration may help reduce
contrast nephropathy risk but does not replace withholding
metformin when indicated.
Option D is true regarding minimizing gastrointestinal side
effects, but it does not address the priority patient safety
issue.
The nurse should also review the patient's renal function,
educate the client about the temporary interruption of
therapy, and monitor blood glucose while the medication is
withheld.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify situations requiring temporary discontinuation
of metformin.
• Recognize factors that increase the risk of metformin-
associated lactic acidosis.
, • Prioritize nursing actions before administering oral
antidiabetic medications.
• Apply medication safety principles related to contrast
procedures.
Medication Safety Focus
Monitoring and prevention of metformin-associated
lactic acidosis
Question 2
Clinical Scenario
A 24-year-old woman with type 1 diabetes mellitus is
admitted with nausea, vomiting, and abdominal pain after
forgetting to take several insulin doses. Laboratory results
reveal:
• Blood glucose: 486 mg/dL
• Serum potassium: 5.6 mEq/L
• Arterial pH: 7.18
• Positive serum ketones
The provider prescribes a continuous intravenous infusion of
regular insulin.
Question Stem
