NCLEX-RN Endocrine Pharmacology
Practice Questions |
20 Original ATI & NGN Style MCQs with
Detailed Rationales |
Nursing Exam Study Guide
Question 1
Clinical Scenario
A 55-year-old male with type 2 diabetes is admitted to the
medical-surgical unit for a right great toe amputation due to
a diabetic foot ulcer. His home medications include
metformin 850 mg TID, glipizide 10 mg BID, and atorvastatin
20 mg daily. The patient reports adherence to his medication
regimen and follows a diabetic diet. His admission
laboratory results show: fasting blood glucose 184 mg/dL,
HbA1c 9.2%, creatinine 0.9 mg/dL, and eGFR 89
mL/min/1.73m². The healthcare provider orders the patient's
home medications to be continued. On the second hospital
,day, the patient receives IV contrast dye for a CT angiography
of his lower extremities. The nurse reviews the medication
administration record.
Question Stem
Which action should the nurse take regarding the metformin
order?
A. Administer the metformin as ordered with breakfast
B. Hold the metformin and notify the healthcare provider
C. Administer half the metformin dose and monitor blood
glucose
D. Hold the metformin and restart in 12 hours
Correct Answer: B. Hold the metformin and notify the
healthcare provider
Detailed Rationale
The correct answer is to hold the metformin and notify the
healthcare provider. The patient received IV contrast dye for
a CT angiography, which creates a significant risk for
contrast-induced nephropathy. Metformin is excreted
unchanged by the kidneys, and if the patient develops acute
kidney injury from the contrast dye, metformin can
accumulate to toxic levels, increasing the risk of lactic
,acidosis. Current guidelines recommend holding metformin
at the time of or before the procedure and for 48 hours after
the procedure, with re-evaluation of renal function before
restarting. The patient's baseline renal function is normal,
but the combination of contrast dye and metformin creates
a potentially dangerous situation that requires proactive
nursing intervention.
Option A is incorrect and unsafe. Administering metformin
as ordered after contrast dye administration could lead to
drug accumulation if renal injury occurs. The nurse must
recognize this drug-dye interaction and intervene
appropriately.
Option C is incorrect. There is no rationale for administering
half the dose, and this does not address the underlying
safety concern. Partial dosing does not eliminate the risk of
accumulation if acute kidney injury develops.
Option D is incorrect because holding for only 12 hours is
insufficient. Guidelines recommend holding metformin for
48 hours after IV contrast administration and reassessing
renal function before resuming. The specific timeframe may
vary based on institutional policy, but 12 hours is not
adequate.
The nurse should notify the healthcare provider that the
patient received contrast dye, hold the metformin, and
, ensure that renal function is reassessed after 48 hours
before resuming the medication. The patient should also
receive appropriate glycemic management during this time,
which may include insulin therapy if needed.
Learning Objective
After completing this question, the learner should be able
to:
• Identify drug-dye interactions with metformin and IV
contrast
• Implement appropriate nursing interventions to prevent
contrast-induced nephropathy
• Understand metformin safety guidelines related to renal
function
• Recognize the importance of medication reconciliation
and timing with diagnostic procedures
Medication Safety Focus: Drug interaction (Metformin and
IV contrast)
Practice Questions |
20 Original ATI & NGN Style MCQs with
Detailed Rationales |
Nursing Exam Study Guide
Question 1
Clinical Scenario
A 55-year-old male with type 2 diabetes is admitted to the
medical-surgical unit for a right great toe amputation due to
a diabetic foot ulcer. His home medications include
metformin 850 mg TID, glipizide 10 mg BID, and atorvastatin
20 mg daily. The patient reports adherence to his medication
regimen and follows a diabetic diet. His admission
laboratory results show: fasting blood glucose 184 mg/dL,
HbA1c 9.2%, creatinine 0.9 mg/dL, and eGFR 89
mL/min/1.73m². The healthcare provider orders the patient's
home medications to be continued. On the second hospital
,day, the patient receives IV contrast dye for a CT angiography
of his lower extremities. The nurse reviews the medication
administration record.
Question Stem
Which action should the nurse take regarding the metformin
order?
A. Administer the metformin as ordered with breakfast
B. Hold the metformin and notify the healthcare provider
C. Administer half the metformin dose and monitor blood
glucose
D. Hold the metformin and restart in 12 hours
Correct Answer: B. Hold the metformin and notify the
healthcare provider
Detailed Rationale
The correct answer is to hold the metformin and notify the
healthcare provider. The patient received IV contrast dye for
a CT angiography, which creates a significant risk for
contrast-induced nephropathy. Metformin is excreted
unchanged by the kidneys, and if the patient develops acute
kidney injury from the contrast dye, metformin can
accumulate to toxic levels, increasing the risk of lactic
,acidosis. Current guidelines recommend holding metformin
at the time of or before the procedure and for 48 hours after
the procedure, with re-evaluation of renal function before
restarting. The patient's baseline renal function is normal,
but the combination of contrast dye and metformin creates
a potentially dangerous situation that requires proactive
nursing intervention.
Option A is incorrect and unsafe. Administering metformin
as ordered after contrast dye administration could lead to
drug accumulation if renal injury occurs. The nurse must
recognize this drug-dye interaction and intervene
appropriately.
Option C is incorrect. There is no rationale for administering
half the dose, and this does not address the underlying
safety concern. Partial dosing does not eliminate the risk of
accumulation if acute kidney injury develops.
Option D is incorrect because holding for only 12 hours is
insufficient. Guidelines recommend holding metformin for
48 hours after IV contrast administration and reassessing
renal function before resuming. The specific timeframe may
vary based on institutional policy, but 12 hours is not
adequate.
The nurse should notify the healthcare provider that the
patient received contrast dye, hold the metformin, and
, ensure that renal function is reassessed after 48 hours
before resuming the medication. The patient should also
receive appropriate glycemic management during this time,
which may include insulin therapy if needed.
Learning Objective
After completing this question, the learner should be able
to:
• Identify drug-dye interactions with metformin and IV
contrast
• Implement appropriate nursing interventions to prevent
contrast-induced nephropathy
• Understand metformin safety guidelines related to renal
function
• Recognize the importance of medication reconciliation
and timing with diagnostic procedures
Medication Safety Focus: Drug interaction (Metformin and
IV contrast)
