NCLEX-RN Endocrine Pharmacology
Practice Questions |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales |
Nursing Exam Study Guide
Question 1
Clinical Scenario
A 24-year-old woman with type 1 diabetes mellitus is
admitted with nausea and vomiting due to viral
gastroenteritis. Her blood glucose is 238 mg/dL. She
normally takes insulin glargine once daily and insulin lispro
before meals. She reports she has not eaten since yesterday.
Question Stem
Which action should the nurse take regarding the client's
insulin therapy?
A. Hold both insulin glargine and insulin lispro
,B. Administer insulin glargine and hold insulin lispro until the
client eats
C. Hold insulin glargine and administer insulin lispro
D. Hold all insulin until blood glucose exceeds 300 mg/dL
Correct Answer
Correct Answer: B. Administer insulin glargine and hold
insulin lispro until the client eats
Detailed Rationale
Insulin glargine is a long-acting basal insulin that helps
prevent ketosis and maintains baseline glucose control.
Even when a client is not eating, basal insulin is generally
continued unless specifically prescribed otherwise. Holding
basal insulin in a patient with type 1 diabetes increases the
risk of diabetic ketoacidosis (DKA), a potentially life-
threatening complication.
Insulin lispro is a rapid-acting insulin intended to cover
carbohydrate intake at meals and correct hyperglycemia.
Because the client is not eating, administering lispro could
increase the risk of hypoglycemia.
Option A is incorrect because withholding all insulin can
precipitate DKA. Option C is incorrect because basal insulin
should not routinely be withheld while rapid-acting insulin is
given without food intake. Option D is incorrect because
,insulin therapy should not be based solely on a glucose
threshold of 300 mg/dL, particularly in type 1 diabetes.
The nurse should continue monitoring blood glucose,
hydration status, and signs of ketosis. Patient education
should emphasize that illness often increases insulin
requirements even when oral intake decreases.
Learning Objective
After completing this question, the learner should be able
to:
• Differentiate basal and prandial insulin therapy.
• Identify appropriate insulin management during illness.
• Recognize strategies to prevent DKA.
• Apply medication safety principles to insulin
administration.
Medication Safety Focus
High-alert medication
Question 2
Clinical Scenario
, A 68-year-old man with type 2 diabetes mellitus takes
glyburide. During morning assessment, he is diaphoretic,
confused, and shaky. Blood glucose is 48 mg/dL.
Question Stem
Which nursing action is the priority?
A. Administer 15 g of rapid-acting carbohydrate
B. Recheck blood glucose in 2 hours
C. Administer the next scheduled dose of glyburide
D. Encourage ambulation
Correct Answer
Correct Answer: A. Administer 15 g of rapid-acting
carbohydrate
Detailed Rationale
The client is experiencing symptomatic hypoglycemia.
Immediate treatment is required to prevent seizures, loss of
consciousness, or neurologic injury. Administration of
approximately 15 g of rapid-acting carbohydrate (such as
glucose tablets or juice) is recommended for a conscious
patient able to swallow safely.
Glyburide, a sulfonylurea, stimulates insulin release and is
associated with prolonged hypoglycemia, especially in older
Practice Questions |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales |
Nursing Exam Study Guide
Question 1
Clinical Scenario
A 24-year-old woman with type 1 diabetes mellitus is
admitted with nausea and vomiting due to viral
gastroenteritis. Her blood glucose is 238 mg/dL. She
normally takes insulin glargine once daily and insulin lispro
before meals. She reports she has not eaten since yesterday.
Question Stem
Which action should the nurse take regarding the client's
insulin therapy?
A. Hold both insulin glargine and insulin lispro
,B. Administer insulin glargine and hold insulin lispro until the
client eats
C. Hold insulin glargine and administer insulin lispro
D. Hold all insulin until blood glucose exceeds 300 mg/dL
Correct Answer
Correct Answer: B. Administer insulin glargine and hold
insulin lispro until the client eats
Detailed Rationale
Insulin glargine is a long-acting basal insulin that helps
prevent ketosis and maintains baseline glucose control.
Even when a client is not eating, basal insulin is generally
continued unless specifically prescribed otherwise. Holding
basal insulin in a patient with type 1 diabetes increases the
risk of diabetic ketoacidosis (DKA), a potentially life-
threatening complication.
Insulin lispro is a rapid-acting insulin intended to cover
carbohydrate intake at meals and correct hyperglycemia.
Because the client is not eating, administering lispro could
increase the risk of hypoglycemia.
Option A is incorrect because withholding all insulin can
precipitate DKA. Option C is incorrect because basal insulin
should not routinely be withheld while rapid-acting insulin is
given without food intake. Option D is incorrect because
,insulin therapy should not be based solely on a glucose
threshold of 300 mg/dL, particularly in type 1 diabetes.
The nurse should continue monitoring blood glucose,
hydration status, and signs of ketosis. Patient education
should emphasize that illness often increases insulin
requirements even when oral intake decreases.
Learning Objective
After completing this question, the learner should be able
to:
• Differentiate basal and prandial insulin therapy.
• Identify appropriate insulin management during illness.
• Recognize strategies to prevent DKA.
• Apply medication safety principles to insulin
administration.
Medication Safety Focus
High-alert medication
Question 2
Clinical Scenario
, A 68-year-old man with type 2 diabetes mellitus takes
glyburide. During morning assessment, he is diaphoretic,
confused, and shaky. Blood glucose is 48 mg/dL.
Question Stem
Which nursing action is the priority?
A. Administer 15 g of rapid-acting carbohydrate
B. Recheck blood glucose in 2 hours
C. Administer the next scheduled dose of glyburide
D. Encourage ambulation
Correct Answer
Correct Answer: A. Administer 15 g of rapid-acting
carbohydrate
Detailed Rationale
The client is experiencing symptomatic hypoglycemia.
Immediate treatment is required to prevent seizures, loss of
consciousness, or neurologic injury. Administration of
approximately 15 g of rapid-acting carbohydrate (such as
glucose tablets or juice) is recommended for a conscious
patient able to swallow safely.
Glyburide, a sulfonylurea, stimulates insulin release and is
associated with prolonged hypoglycemia, especially in older
