NCLEX-RN Endocrine Pharmacology
Practice Questions with Detailed
Rationales |
20 Original NGN-Style MCQs
Question 1
Clinical Scenario
A 58-year-old woman with newly diagnosed type 2 diabetes
mellitus is admitted for diabetes education. Her medical
history includes hypertension and obesity. Current
medications include lisinopril and hydrochlorothiazide.
Laboratory results show: fasting blood glucose 228 mg/dL,
HbA1c 9.2%, serum creatinine 0.9 mg/dL, and eGFR 92
mL/min/1.73 m². The provider prescribes metformin 500 mg
orally twice daily.
Question Stem
Which nursing instruction is the priority when teaching the
client about metformin therapy?
,A. Take the medication on an empty stomach to improve
absorption.
B. Stop taking the medication if mild diarrhea develops.
C. Take the medication with meals and report symptoms
such as unusual muscle pain or rapid breathing.
D. Increase carbohydrate intake whenever taking the
medication.
Correct Answer
C. Take the medication with meals and report symptoms
such as unusual muscle pain or rapid breathing.
Detailed Rationale
Metformin is the recommended first-line medication for
many adults with type 2 diabetes because it decreases
hepatic glucose production and improves insulin sensitivity.
Taking metformin with meals minimizes common
gastrointestinal adverse effects such as nausea, abdominal
discomfort, and diarrhea. Although lactic acidosis is rare, it
is a serious adverse reaction requiring prompt recognition.
Symptoms include unusual muscle pain, weakness, rapid
breathing, persistent fatigue, abdominal discomfort, and
increasing somnolence. Early reporting of these findings is
essential.
,Option A is incorrect because taking metformin on an empty
stomach often worsens gastrointestinal side effects without
improving therapeutic outcomes.
Option B is incorrect because mild diarrhea is common
during therapy initiation and frequently improves over time.
Clients should notify the provider if symptoms are severe or
persistent rather than stopping the medication
independently.
Option D is incorrect because metformin alone rarely
causes hypoglycemia. Increasing carbohydrate intake
routinely is unnecessary and may worsen glycemic control.
Carbohydrates should be used only when treating confirmed
hypoglycemia caused by other medications or specific
clinical situations.
Nurses should also assess renal function before initiating
therapy and before administration of iodinated contrast
because temporary discontinuation may be indicated to
reduce the risk of lactic acidosis.
Learning Objectives
After completing this question, the learner should be able
to:
• Explain safe administration of metformin.
, • Recognize symptoms requiring evaluation for lactic
acidosis.
• Educate patients regarding gastrointestinal adverse
effects.
• Identify appropriate monitoring before and during
therapy.
Medication Safety Focus
Monitoring and patient education
Question 2
Clinical Scenario
A 72-year-old man with type 2 diabetes receives insulin
glargine every evening and insulin lispro before meals.
Before breakfast he reports feeling shaky, sweaty, and
confused. His capillary blood glucose is 52 mg/dL.
Question Stem
Which nursing action should be performed first?
A. Administer the scheduled insulin glargine.
B. Provide 15 g of rapid-acting carbohydrate and reassess
blood glucose in approximately 15 minutes.
C. Notify the provider before treating the client.
Practice Questions with Detailed
Rationales |
20 Original NGN-Style MCQs
Question 1
Clinical Scenario
A 58-year-old woman with newly diagnosed type 2 diabetes
mellitus is admitted for diabetes education. Her medical
history includes hypertension and obesity. Current
medications include lisinopril and hydrochlorothiazide.
Laboratory results show: fasting blood glucose 228 mg/dL,
HbA1c 9.2%, serum creatinine 0.9 mg/dL, and eGFR 92
mL/min/1.73 m². The provider prescribes metformin 500 mg
orally twice daily.
Question Stem
Which nursing instruction is the priority when teaching the
client about metformin therapy?
,A. Take the medication on an empty stomach to improve
absorption.
B. Stop taking the medication if mild diarrhea develops.
C. Take the medication with meals and report symptoms
such as unusual muscle pain or rapid breathing.
D. Increase carbohydrate intake whenever taking the
medication.
Correct Answer
C. Take the medication with meals and report symptoms
such as unusual muscle pain or rapid breathing.
Detailed Rationale
Metformin is the recommended first-line medication for
many adults with type 2 diabetes because it decreases
hepatic glucose production and improves insulin sensitivity.
Taking metformin with meals minimizes common
gastrointestinal adverse effects such as nausea, abdominal
discomfort, and diarrhea. Although lactic acidosis is rare, it
is a serious adverse reaction requiring prompt recognition.
Symptoms include unusual muscle pain, weakness, rapid
breathing, persistent fatigue, abdominal discomfort, and
increasing somnolence. Early reporting of these findings is
essential.
,Option A is incorrect because taking metformin on an empty
stomach often worsens gastrointestinal side effects without
improving therapeutic outcomes.
Option B is incorrect because mild diarrhea is common
during therapy initiation and frequently improves over time.
Clients should notify the provider if symptoms are severe or
persistent rather than stopping the medication
independently.
Option D is incorrect because metformin alone rarely
causes hypoglycemia. Increasing carbohydrate intake
routinely is unnecessary and may worsen glycemic control.
Carbohydrates should be used only when treating confirmed
hypoglycemia caused by other medications or specific
clinical situations.
Nurses should also assess renal function before initiating
therapy and before administration of iodinated contrast
because temporary discontinuation may be indicated to
reduce the risk of lactic acidosis.
Learning Objectives
After completing this question, the learner should be able
to:
• Explain safe administration of metformin.
, • Recognize symptoms requiring evaluation for lactic
acidosis.
• Educate patients regarding gastrointestinal adverse
effects.
• Identify appropriate monitoring before and during
therapy.
Medication Safety Focus
Monitoring and patient education
Question 2
Clinical Scenario
A 72-year-old man with type 2 diabetes receives insulin
glargine every evening and insulin lispro before meals.
Before breakfast he reports feeling shaky, sweaty, and
confused. His capillary blood glucose is 52 mg/dL.
Question Stem
Which nursing action should be performed first?
A. Administer the scheduled insulin glargine.
B. Provide 15 g of rapid-acting carbohydrate and reassess
blood glucose in approximately 15 minutes.
C. Notify the provider before treating the client.
