NCLEX-RN Endocrine System
Pharmacology Practice Questions |
20 Original NCLEX NGN MCQs with
Detailed Rationales |
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 68-year-old male with type 2 diabetes mellitus is admitted
to the medical-surgical unit with fever, productive cough,
and confusion. His blood glucose level is 412 mg/dL, serum
sodium is 128 mEq/L, and serum potassium is 5.8 mEq/L.
The healthcare provider prescribes intravenous insulin
therapy. The nurse notes that the client's medication
reconciliation includes metformin 1000 mg twice daily,
lisinopril 10 mg daily, and atorvastatin 40 mg daily.
Question Stem
Which action should the nurse take first when initiating
intravenous insulin therapy for this client?
,A. Administer the insulin as a rapid IV push to achieve
immediate glycemic control
B. Hold the metformin due to the client's elevated potassium
level
C. Obtain a prescription for serum glucose monitoring every
1-2 hours
D. Discontinue the lisinopril due to risk of hyperkalemia
Correct Answer: C. Obtain a prescription for serum
glucose monitoring every 1-2 hours
Detailed Rationale
The correct answer is to obtain a prescription for frequent
serum glucose monitoring. When initiating IV insulin therapy,
particularly in a client with hyperglycemic hyperosmolar
state (HHS) or diabetic ketoacidosis (DKA), close monitoring
of blood glucose is essential to prevent rapid glucose
fluctuations and hypoglycemia. The client's presentation
with fever, productive cough, confusion, and significantly
elevated glucose (412 mg/dL) suggests a hyperglycemic
crisis potentially precipitated by infection. IV insulin has a
rapid onset and short half-life, requiring frequent monitoring
to titrate the infusion rate appropriately.
,Option A is incorrect because IV insulin should never be
administered as a rapid IV push except in specific
emergency protocols; it is typically given as a continuous
infusion. Rapid IV push can cause severe hypoglycemia and
hypokalemia. Option B is incorrect because metformin is not
contraindicated in hyperkalemia; however, it should be held
in clients with renal impairment or conditions that
predispose to lactic acidosis, such as sepsis or severe
dehydration. Option D is incorrect because while lisinopril
(an ACE inhibitor) can contribute to hyperkalemia, the
priority is glycemic management. The potassium level of 5.8
mEq/L requires monitoring, but discontinuing lisinopril is not
the first action; insulin therapy will actually help shift
potassium into cells, reducing serum potassium levels.
Pharmacology Principles: Insulin promotes cellular uptake
of glucose and potassium. Frequent monitoring prevents
iatrogenic hypoglycemia and allows for timely adjustments.
The nurse must also monitor for signs of hypokalemia as
insulin drives potassium into cells.
Nursing Considerations: Obtain baseline labs including
serum glucose, potassium, and renal function. Monitor for
signs of hypoglycemia (tremors, diaphoresis, confusion).
Assess for resolution of hyperglycemic symptoms including
polyuria, polydipsia, and confusion.
, Learning Objective
After completing this question, the learner should be able
to:
• Identify priority nursing actions when initiating IV insulin
therapy
• Recognize the importance of frequent glucose
monitoring during IV insulin administration
• Understand the rationale for holding metformin in acute
illness
• Distinguish between appropriate and inappropriate
medication adjustments based on laboratory findings
Medication Safety Focus
High-alert medication - Insulin is a high-alert medication
requiring careful administration, verification, and monitoring
to prevent severe hypoglycemia.
Question 2
Clinical Scenario
Pharmacology Practice Questions |
20 Original NCLEX NGN MCQs with
Detailed Rationales |
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 68-year-old male with type 2 diabetes mellitus is admitted
to the medical-surgical unit with fever, productive cough,
and confusion. His blood glucose level is 412 mg/dL, serum
sodium is 128 mEq/L, and serum potassium is 5.8 mEq/L.
The healthcare provider prescribes intravenous insulin
therapy. The nurse notes that the client's medication
reconciliation includes metformin 1000 mg twice daily,
lisinopril 10 mg daily, and atorvastatin 40 mg daily.
Question Stem
Which action should the nurse take first when initiating
intravenous insulin therapy for this client?
,A. Administer the insulin as a rapid IV push to achieve
immediate glycemic control
B. Hold the metformin due to the client's elevated potassium
level
C. Obtain a prescription for serum glucose monitoring every
1-2 hours
D. Discontinue the lisinopril due to risk of hyperkalemia
Correct Answer: C. Obtain a prescription for serum
glucose monitoring every 1-2 hours
Detailed Rationale
The correct answer is to obtain a prescription for frequent
serum glucose monitoring. When initiating IV insulin therapy,
particularly in a client with hyperglycemic hyperosmolar
state (HHS) or diabetic ketoacidosis (DKA), close monitoring
of blood glucose is essential to prevent rapid glucose
fluctuations and hypoglycemia. The client's presentation
with fever, productive cough, confusion, and significantly
elevated glucose (412 mg/dL) suggests a hyperglycemic
crisis potentially precipitated by infection. IV insulin has a
rapid onset and short half-life, requiring frequent monitoring
to titrate the infusion rate appropriately.
,Option A is incorrect because IV insulin should never be
administered as a rapid IV push except in specific
emergency protocols; it is typically given as a continuous
infusion. Rapid IV push can cause severe hypoglycemia and
hypokalemia. Option B is incorrect because metformin is not
contraindicated in hyperkalemia; however, it should be held
in clients with renal impairment or conditions that
predispose to lactic acidosis, such as sepsis or severe
dehydration. Option D is incorrect because while lisinopril
(an ACE inhibitor) can contribute to hyperkalemia, the
priority is glycemic management. The potassium level of 5.8
mEq/L requires monitoring, but discontinuing lisinopril is not
the first action; insulin therapy will actually help shift
potassium into cells, reducing serum potassium levels.
Pharmacology Principles: Insulin promotes cellular uptake
of glucose and potassium. Frequent monitoring prevents
iatrogenic hypoglycemia and allows for timely adjustments.
The nurse must also monitor for signs of hypokalemia as
insulin drives potassium into cells.
Nursing Considerations: Obtain baseline labs including
serum glucose, potassium, and renal function. Monitor for
signs of hypoglycemia (tremors, diaphoresis, confusion).
Assess for resolution of hyperglycemic symptoms including
polyuria, polydipsia, and confusion.
, Learning Objective
After completing this question, the learner should be able
to:
• Identify priority nursing actions when initiating IV insulin
therapy
• Recognize the importance of frequent glucose
monitoring during IV insulin administration
• Understand the rationale for holding metformin in acute
illness
• Distinguish between appropriate and inappropriate
medication adjustments based on laboratory findings
Medication Safety Focus
High-alert medication - Insulin is a high-alert medication
requiring careful administration, verification, and monitoring
to prevent severe hypoglycemia.
Question 2
Clinical Scenario
