NCLEX-RN Pharmacology Exam |
Endocrine System |
20 Original ATI & NGN Style Practice
Questions with Detailed Rationales |
Nursing Study Guide
Question 1
Clinical Scenario
A 24-year-old woman with newly diagnosed type 1 diabetes
mellitus is prescribed insulin glargine and insulin lispro. She
tells the nurse, "I sometimes skip meals when I'm busy." Her
blood glucose is 142 mg/dL before lunch.
Question Stem
Which statement by the nurse is most appropriate regarding
insulin administration?
A. "Take insulin lispro even if you are not planning to eat."
B. "Administer insulin glargine immediately before meals."
C. "You should eat shortly after taking insulin lispro."
,D. "Mix insulin glargine with insulin lispro in the same
syringe."
Correct Answer
Correct Answer: C. "You should eat shortly after taking
insulin lispro."
Detailed Rationale
Insulin lispro is a rapid-acting insulin with an onset of
approximately 15 minutes. Because it begins lowering blood
glucose quickly, patients should eat shortly after
administration to reduce the risk of hypoglycemia. This
teaching is especially important for clients who occasionally
skip meals.
Option A is incorrect because administering rapid-acting
insulin without eating significantly increases hypoglycemia
risk. Option B is incorrect because insulin glargine is a long-
acting basal insulin intended for once-daily administration
and is not administered specifically before meals. Option D
is incorrect because insulin glargine should not be mixed
with other insulins due to alterations in its pharmacokinetic
profile.
Nurses should educate patients regarding timing of insulin
doses, recognition of hypoglycemia symptoms (tremors,
sweating, confusion), and the importance of meal
,consistency. Medication safety requires verifying insulin
type, dose, and timing before administration.
Learning Objective
After completing this question, the learner should be able
to:
• Differentiate rapid-acting and long-acting insulin
administration.
• Identify strategies to prevent hypoglycemia.
• Educate clients regarding insulin timing and meals.
• Apply medication safety principles to insulin therapy.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 68-year-old man with type 2 diabetes mellitus is
prescribed metformin. Laboratory results reveal a serum
creatinine of 2.4 mg/dL and an estimated GFR of 24
mL/min/1.73 m².
Question Stem
Which action should the nurse take?
, A. Administer the medication as prescribed.
B. Hold the medication and notify the provider.
C. Encourage increased dietary potassium intake.
D. Administer the medication with orange juice.
Correct Answer
Correct Answer: B. Hold the medication and notify the
provider.
Detailed Rationale
Metformin is generally contraindicated in severe renal
impairment because accumulation can increase the risk of
lactic acidosis, a rare but potentially fatal adverse effect. An
eGFR of 24 mL/min/1.73 m² indicates significant renal
dysfunction. The nurse should withhold the medication and
notify the provider for further evaluation.
Option A is unsafe because administering metformin despite
severe renal impairment places the client at risk. Option C is
unrelated to the primary concern. Option D does not
address the underlying contraindication and may create a
false sense of safety.
Nurses should monitor renal function regularly in patients
receiving metformin and be alert for symptoms of lactic
acidosis such as malaise, respiratory distress, abdominal
Endocrine System |
20 Original ATI & NGN Style Practice
Questions with Detailed Rationales |
Nursing Study Guide
Question 1
Clinical Scenario
A 24-year-old woman with newly diagnosed type 1 diabetes
mellitus is prescribed insulin glargine and insulin lispro. She
tells the nurse, "I sometimes skip meals when I'm busy." Her
blood glucose is 142 mg/dL before lunch.
Question Stem
Which statement by the nurse is most appropriate regarding
insulin administration?
A. "Take insulin lispro even if you are not planning to eat."
B. "Administer insulin glargine immediately before meals."
C. "You should eat shortly after taking insulin lispro."
,D. "Mix insulin glargine with insulin lispro in the same
syringe."
Correct Answer
Correct Answer: C. "You should eat shortly after taking
insulin lispro."
Detailed Rationale
Insulin lispro is a rapid-acting insulin with an onset of
approximately 15 minutes. Because it begins lowering blood
glucose quickly, patients should eat shortly after
administration to reduce the risk of hypoglycemia. This
teaching is especially important for clients who occasionally
skip meals.
Option A is incorrect because administering rapid-acting
insulin without eating significantly increases hypoglycemia
risk. Option B is incorrect because insulin glargine is a long-
acting basal insulin intended for once-daily administration
and is not administered specifically before meals. Option D
is incorrect because insulin glargine should not be mixed
with other insulins due to alterations in its pharmacokinetic
profile.
Nurses should educate patients regarding timing of insulin
doses, recognition of hypoglycemia symptoms (tremors,
sweating, confusion), and the importance of meal
,consistency. Medication safety requires verifying insulin
type, dose, and timing before administration.
Learning Objective
After completing this question, the learner should be able
to:
• Differentiate rapid-acting and long-acting insulin
administration.
• Identify strategies to prevent hypoglycemia.
• Educate clients regarding insulin timing and meals.
• Apply medication safety principles to insulin therapy.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 68-year-old man with type 2 diabetes mellitus is
prescribed metformin. Laboratory results reveal a serum
creatinine of 2.4 mg/dL and an estimated GFR of 24
mL/min/1.73 m².
Question Stem
Which action should the nurse take?
, A. Administer the medication as prescribed.
B. Hold the medication and notify the provider.
C. Encourage increased dietary potassium intake.
D. Administer the medication with orange juice.
Correct Answer
Correct Answer: B. Hold the medication and notify the
provider.
Detailed Rationale
Metformin is generally contraindicated in severe renal
impairment because accumulation can increase the risk of
lactic acidosis, a rare but potentially fatal adverse effect. An
eGFR of 24 mL/min/1.73 m² indicates significant renal
dysfunction. The nurse should withhold the medication and
notify the provider for further evaluation.
Option A is unsafe because administering metformin despite
severe renal impairment places the client at risk. Option C is
unrelated to the primary concern. Option D does not
address the underlying contraindication and may create a
false sense of safety.
Nurses should monitor renal function regularly in patients
receiving metformin and be alert for symptoms of lactic
acidosis such as malaise, respiratory distress, abdominal
