NCLEX-RN Endocrine System
Pharmacology Exam |
20 Original NGN Practice Questions with
Rationales |
Nursing Test Bank & Study Guide
Question 1
Clinical Scenario
A 52-year-old woman with newly diagnosed type 2 diabetes
mellitus is prescribed metformin 500 mg orally twice
daily. She has hypertension treated with lisinopril. Her
laboratory results include: HbA1c 9.2%, serum creatinine
0.9 mg/dL, eGFR 92 mL/min/1.73 m², and fasting blood
glucose 226 mg/dL. She tells the nurse she has a computed
tomography (CT) scan with intravenous contrast scheduled
tomorrow.
Question Stem
Which action by the nurse is the priority?
,A. Encourage the client to take metformin immediately
before the CT scan.
B. Instruct the client to withhold metformin before and after
the contrast procedure until renal function is reassessed.
C. Increase the metformin dose the evening before the CT
scan.
D. Tell the client to skip breakfast but continue taking
metformin as prescribed.
Correct Answer
Correct Answer: B. Instruct the client to withhold
metformin before and after the contrast procedure until
renal function is reassessed.
Detailed Rationale
Metformin decreases hepatic glucose production and
improves insulin sensitivity. Although it is generally safe,
iodinated contrast media may cause acute kidney injury in
susceptible individuals. Because metformin is eliminated
primarily through the kidneys, impaired renal function can
increase the risk of metformin accumulation and the rare
but serious complication of lactic acidosis. Current
practice recommends temporarily withholding metformin
around contrast administration in patients for whom renal
,function may be affected and restarting it after renal
function has been reassessed and found to be stable.
Option A is incorrect because continuing metformin
immediately before contrast exposure may increase risk if
renal function declines. Option C is incorrect because
increasing the dose provides no benefit and increases
adverse-effect risk. Option D is incorrect because fasting
before some imaging procedures may be appropriate, but
continuing metformin without considering contrast-related
precautions is unsafe.
The nurse should also educate the client to report
symptoms such as unusual fatigue, muscle pain, difficulty
breathing, or persistent nausea after contrast exposure.
Monitoring renal function, hydration status, and blood
glucose remains an important component of safe diabetes
management.
Learning Objective
After completing this question, the learner should be able
to:
• Explain why metformin may need to be withheld around
contrast procedures.
• Identify factors that increase the risk of lactic acidosis.
, • Apply medication safety principles when planning
diagnostic procedures.
• Recognize the importance of monitoring renal function.
Medication Safety Focus
Medication administration and monitoring
Question 2
Clinical Scenario
A 23-year-old woman with type 1 diabetes mellitus
receives insulin glargine every evening and insulin lispro
before meals. Before lunch, her capillary blood glucose is 58
mg/dL. She is awake, alert, anxious, diaphoretic, and reports
feeling shaky.
Question Stem
Which nursing action is most appropriate?
A. Administer the scheduled insulin lispro.
B. Give 15 g of a rapid-acting carbohydrate and recheck the
blood glucose in 15 minutes.
C. Notify the provider before treating the client.
D. Administer glucagon intramuscularly immediately.
Correct Answer
Pharmacology Exam |
20 Original NGN Practice Questions with
Rationales |
Nursing Test Bank & Study Guide
Question 1
Clinical Scenario
A 52-year-old woman with newly diagnosed type 2 diabetes
mellitus is prescribed metformin 500 mg orally twice
daily. She has hypertension treated with lisinopril. Her
laboratory results include: HbA1c 9.2%, serum creatinine
0.9 mg/dL, eGFR 92 mL/min/1.73 m², and fasting blood
glucose 226 mg/dL. She tells the nurse she has a computed
tomography (CT) scan with intravenous contrast scheduled
tomorrow.
Question Stem
Which action by the nurse is the priority?
,A. Encourage the client to take metformin immediately
before the CT scan.
B. Instruct the client to withhold metformin before and after
the contrast procedure until renal function is reassessed.
C. Increase the metformin dose the evening before the CT
scan.
D. Tell the client to skip breakfast but continue taking
metformin as prescribed.
Correct Answer
Correct Answer: B. Instruct the client to withhold
metformin before and after the contrast procedure until
renal function is reassessed.
Detailed Rationale
Metformin decreases hepatic glucose production and
improves insulin sensitivity. Although it is generally safe,
iodinated contrast media may cause acute kidney injury in
susceptible individuals. Because metformin is eliminated
primarily through the kidneys, impaired renal function can
increase the risk of metformin accumulation and the rare
but serious complication of lactic acidosis. Current
practice recommends temporarily withholding metformin
around contrast administration in patients for whom renal
,function may be affected and restarting it after renal
function has been reassessed and found to be stable.
Option A is incorrect because continuing metformin
immediately before contrast exposure may increase risk if
renal function declines. Option C is incorrect because
increasing the dose provides no benefit and increases
adverse-effect risk. Option D is incorrect because fasting
before some imaging procedures may be appropriate, but
continuing metformin without considering contrast-related
precautions is unsafe.
The nurse should also educate the client to report
symptoms such as unusual fatigue, muscle pain, difficulty
breathing, or persistent nausea after contrast exposure.
Monitoring renal function, hydration status, and blood
glucose remains an important component of safe diabetes
management.
Learning Objective
After completing this question, the learner should be able
to:
• Explain why metformin may need to be withheld around
contrast procedures.
• Identify factors that increase the risk of lactic acidosis.
, • Apply medication safety principles when planning
diagnostic procedures.
• Recognize the importance of monitoring renal function.
Medication Safety Focus
Medication administration and monitoring
Question 2
Clinical Scenario
A 23-year-old woman with type 1 diabetes mellitus
receives insulin glargine every evening and insulin lispro
before meals. Before lunch, her capillary blood glucose is 58
mg/dL. She is awake, alert, anxious, diaphoretic, and reports
feeling shaky.
Question Stem
Which nursing action is most appropriate?
A. Administer the scheduled insulin lispro.
B. Give 15 g of a rapid-acting carbohydrate and recheck the
blood glucose in 15 minutes.
C. Notify the provider before treating the client.
D. Administer glucagon intramuscularly immediately.
Correct Answer
