NCLEX-RN Pharmacology Endocrine
System Practice Questions |
20 Original ATI & NGN-Style MCQs with
Rationales
Question 1
Clinical Scenario
A 65-year-old female client is newly diagnosed with primary
hypothyroidism. The healthcare provider prescribes
levothyroxine 50 mcg orally once daily. The nurse is providing
discharge teaching regarding the proper administration of
this medication.
Question Stem
Which statement by the client indicates understanding of
the teaching?
Options
A. "I will take this medication with my morning meal to
prevent stomach upset."
B. "I will take this medication on an empty stomach 30 to 60
,minutes before breakfast."
C. "If I forget a dose, I will take two pills the next day to make
up for it."
D. "I will stop taking the medication once my energy levels
return to normal."
Correct Answer
Correct Answer: B. "I will take this medication on an empty
stomach 30 to 60 minutes before breakfast."
Detailed Rationale
Levothyroxine is a synthetic thyroid hormone used to treat
hypothyroidism. Its gastrointestinal absorption is
significantly decreased by food, calcium supplements, iron,
and antacids. Therefore, the correct administration
instruction is to take the medication on an empty stomach
with a full glass of plain water, ideally 30 to 60 minutes
before breakfast, to ensure optimal bioavailability and
consistent therapeutic levels. Option A is incorrect because
taking it with food reduces absorption. Option C is incorrect
because doubling a missed dose can precipitate symptoms
of hyperthyroidism, such as tachycardia, palpitations, and
arrhythmias; a missed dose should be taken as soon as
remembered unless it is close to the next scheduled dose.
Option D is incorrect because hypothyroidism is typically a
chronic condition requiring lifelong therapy; stopping the
,medication abruptly will cause a return of hypothyroid
symptoms and potentially lead to myxedema coma. The
nurse must emphasize strict adherence and proper timing to
the patient to maintain a euthyroid status.
Learning Objective
• Identify the optimal timing and conditions for
levothyroxine administration to maximize absorption.
• Recognize the dangers of doubling missed doses or
abruptly discontinuing thyroid hormone replacement.
• Educate patients on the chronic nature of
hypothyroidism and the importance of medication
adherence.
Medication Safety Focus
Medication administration / Patient education
Question 2
Clinical Scenario
A 58-year-old male client with type 2 diabetes mellitus is
currently managed with metformin 1000 mg twice daily. He
is scheduled for an outpatient computed tomography (CT)
scan of the abdomen with intravenous (IV) iodine-based
contrast dye tomorrow morning.
, Question Stem
Which action should the nurse take regarding the client's
metformin therapy?
Options
A. Administer the morning dose of metformin with a small
sip of water before the procedure.
B. Increase the metformin dose to 1500 mg the day before
the procedure to prevent hyperglycemia.
C. Withhold the metformin on the day of the procedure and
for 48 hours afterward.
D. Check the client's hemoglobin A1c immediately before
the client enters the radiology department.
Correct Answer
Correct Answer: C. Withhold the metformin on the day of the
procedure and for 48 hours afterward.
Detailed Rationale
Metformin carries a risk of lactic acidosis, a rare but life-
threatening complication. When IV iodine-based contrast
dye is administered, it can cause contrast-induced
nephropathy (acute kidney injury). If renal function declines
acutely, metformin can accumulate in the body, drastically
increasing the risk of lactic acidosis. Therefore, standard
safety protocols dictate that metformin should be withheld
on the day of the procedure and for 48 hours afterward. It
System Practice Questions |
20 Original ATI & NGN-Style MCQs with
Rationales
Question 1
Clinical Scenario
A 65-year-old female client is newly diagnosed with primary
hypothyroidism. The healthcare provider prescribes
levothyroxine 50 mcg orally once daily. The nurse is providing
discharge teaching regarding the proper administration of
this medication.
Question Stem
Which statement by the client indicates understanding of
the teaching?
Options
A. "I will take this medication with my morning meal to
prevent stomach upset."
B. "I will take this medication on an empty stomach 30 to 60
,minutes before breakfast."
C. "If I forget a dose, I will take two pills the next day to make
up for it."
D. "I will stop taking the medication once my energy levels
return to normal."
Correct Answer
Correct Answer: B. "I will take this medication on an empty
stomach 30 to 60 minutes before breakfast."
Detailed Rationale
Levothyroxine is a synthetic thyroid hormone used to treat
hypothyroidism. Its gastrointestinal absorption is
significantly decreased by food, calcium supplements, iron,
and antacids. Therefore, the correct administration
instruction is to take the medication on an empty stomach
with a full glass of plain water, ideally 30 to 60 minutes
before breakfast, to ensure optimal bioavailability and
consistent therapeutic levels. Option A is incorrect because
taking it with food reduces absorption. Option C is incorrect
because doubling a missed dose can precipitate symptoms
of hyperthyroidism, such as tachycardia, palpitations, and
arrhythmias; a missed dose should be taken as soon as
remembered unless it is close to the next scheduled dose.
Option D is incorrect because hypothyroidism is typically a
chronic condition requiring lifelong therapy; stopping the
,medication abruptly will cause a return of hypothyroid
symptoms and potentially lead to myxedema coma. The
nurse must emphasize strict adherence and proper timing to
the patient to maintain a euthyroid status.
Learning Objective
• Identify the optimal timing and conditions for
levothyroxine administration to maximize absorption.
• Recognize the dangers of doubling missed doses or
abruptly discontinuing thyroid hormone replacement.
• Educate patients on the chronic nature of
hypothyroidism and the importance of medication
adherence.
Medication Safety Focus
Medication administration / Patient education
Question 2
Clinical Scenario
A 58-year-old male client with type 2 diabetes mellitus is
currently managed with metformin 1000 mg twice daily. He
is scheduled for an outpatient computed tomography (CT)
scan of the abdomen with intravenous (IV) iodine-based
contrast dye tomorrow morning.
, Question Stem
Which action should the nurse take regarding the client's
metformin therapy?
Options
A. Administer the morning dose of metformin with a small
sip of water before the procedure.
B. Increase the metformin dose to 1500 mg the day before
the procedure to prevent hyperglycemia.
C. Withhold the metformin on the day of the procedure and
for 48 hours afterward.
D. Check the client's hemoglobin A1c immediately before
the client enters the radiology department.
Correct Answer
Correct Answer: C. Withhold the metformin on the day of the
procedure and for 48 hours afterward.
Detailed Rationale
Metformin carries a risk of lactic acidosis, a rare but life-
threatening complication. When IV iodine-based contrast
dye is administered, it can cause contrast-induced
nephropathy (acute kidney injury). If renal function declines
acutely, metformin can accumulate in the body, drastically
increasing the risk of lactic acidosis. Therefore, standard
safety protocols dictate that metformin should be withheld
on the day of the procedure and for 48 hours afterward. It
