NCLEX-RN Pharmacology Endocrine
System Practice Questions |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales
Question 1
Clinical Scenario
A 52-year-old client with newly diagnosed type 2 diabetes
mellitus is prescribed metformin. The client asks how the
medication helps control blood glucose levels.
Question Stem
Which explanation by the nurse is most accurate regarding
metformin's mechanism of action?
A. It stimulates pancreatic beta cells to release insulin.
B. It decreases hepatic glucose production and improves
insulin sensitivity.
C. It replaces endogenous insulin production.
D. It increases glucose absorption from the gastrointestinal
tract.
,Correct Answer
Correct Answer: B. It decreases hepatic glucose
production and improves insulin sensitivity.
Detailed Rationale
Metformin is a biguanide and is considered first-line therapy
for type 2 diabetes. It primarily works by decreasing hepatic
gluconeogenesis, reducing glucose production by the liver,
and improving peripheral insulin sensitivity, allowing tissues
to use glucose more effectively. Unlike sulfonylureas,
metformin does not stimulate insulin release and therefore
has a low risk of hypoglycemia.
Option A describes the mechanism of sulfonylureas such as
glipizide. Option C is incorrect because metformin does not
replace insulin; insulin therapy may be necessary for some
patients but is a separate treatment. Option D is incorrect
because metformin actually decreases intestinal glucose
absorption rather than increasing it.
Nurses should monitor renal function before and during
therapy because impaired kidney function increases the risk
of lactic acidosis, a rare but serious adverse effect. Patients
should also be educated to take metformin with meals to
minimize gastrointestinal side effects.
Learning Objective
,After completing this question, the learner should be able
to:
• Explain the mechanism of action of metformin.
• Identify appropriate nursing monitoring for metformin
therapy.
• Recognize the low hypoglycemia risk associated with
metformin.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 68-year-old client with type 2 diabetes is prescribed
glyburide. Before administering the morning dose, the nurse
reviews the blood glucose level, which is 58 mg/dL.
Question Stem
Which action should the nurse take first?
A. Administer the medication with orange juice.
B. Hold the medication and treat the hypoglycemia.
C. Notify the provider after administering the medication.
D. Give half the prescribed dose.
, Correct Answer
Correct Answer: B. Hold the medication and treat the
hypoglycemia.
Detailed Rationale
A blood glucose level of 58 mg/dL indicates significant
hypoglycemia. Glyburide, a sulfonylurea, stimulates insulin
secretion and can worsen hypoglycemia. The priority action
is to hold the medication and immediately treat the low
glucose according to facility protocol.
Option A could worsen hypoglycemia management because
the medication should not be administered while glucose
remains low. Option C delays appropriate intervention and
may place the client at risk. Option D is unsafe because
medication adjustment requires provider guidance.
Nurses should assess symptoms such as diaphoresis,
confusion, tremors, and tachycardia. Older adults are
particularly vulnerable to prolonged hypoglycemia from
sulfonylureas due to decreased renal clearance and altered
drug metabolism.
Learning Objective
After completing this question, the learner should be able
to:
• Recognize hypoglycemia requiring intervention.
System Practice Questions |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales
Question 1
Clinical Scenario
A 52-year-old client with newly diagnosed type 2 diabetes
mellitus is prescribed metformin. The client asks how the
medication helps control blood glucose levels.
Question Stem
Which explanation by the nurse is most accurate regarding
metformin's mechanism of action?
A. It stimulates pancreatic beta cells to release insulin.
B. It decreases hepatic glucose production and improves
insulin sensitivity.
C. It replaces endogenous insulin production.
D. It increases glucose absorption from the gastrointestinal
tract.
,Correct Answer
Correct Answer: B. It decreases hepatic glucose
production and improves insulin sensitivity.
Detailed Rationale
Metformin is a biguanide and is considered first-line therapy
for type 2 diabetes. It primarily works by decreasing hepatic
gluconeogenesis, reducing glucose production by the liver,
and improving peripheral insulin sensitivity, allowing tissues
to use glucose more effectively. Unlike sulfonylureas,
metformin does not stimulate insulin release and therefore
has a low risk of hypoglycemia.
Option A describes the mechanism of sulfonylureas such as
glipizide. Option C is incorrect because metformin does not
replace insulin; insulin therapy may be necessary for some
patients but is a separate treatment. Option D is incorrect
because metformin actually decreases intestinal glucose
absorption rather than increasing it.
Nurses should monitor renal function before and during
therapy because impaired kidney function increases the risk
of lactic acidosis, a rare but serious adverse effect. Patients
should also be educated to take metformin with meals to
minimize gastrointestinal side effects.
Learning Objective
,After completing this question, the learner should be able
to:
• Explain the mechanism of action of metformin.
• Identify appropriate nursing monitoring for metformin
therapy.
• Recognize the low hypoglycemia risk associated with
metformin.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 68-year-old client with type 2 diabetes is prescribed
glyburide. Before administering the morning dose, the nurse
reviews the blood glucose level, which is 58 mg/dL.
Question Stem
Which action should the nurse take first?
A. Administer the medication with orange juice.
B. Hold the medication and treat the hypoglycemia.
C. Notify the provider after administering the medication.
D. Give half the prescribed dose.
, Correct Answer
Correct Answer: B. Hold the medication and treat the
hypoglycemia.
Detailed Rationale
A blood glucose level of 58 mg/dL indicates significant
hypoglycemia. Glyburide, a sulfonylurea, stimulates insulin
secretion and can worsen hypoglycemia. The priority action
is to hold the medication and immediately treat the low
glucose according to facility protocol.
Option A could worsen hypoglycemia management because
the medication should not be administered while glucose
remains low. Option C delays appropriate intervention and
may place the client at risk. Option D is unsafe because
medication adjustment requires provider guidance.
Nurses should assess symptoms such as diaphoresis,
confusion, tremors, and tachycardia. Older adults are
particularly vulnerable to prolonged hypoglycemia from
sulfonylureas due to decreased renal clearance and altered
drug metabolism.
Learning Objective
After completing this question, the learner should be able
to:
• Recognize hypoglycemia requiring intervention.
