NCLEX-RN Pharmacology Endocrine
System Exam Questions & Answers |
20 Original ATI & NGN-Style Practice MCQs
with Detailed Rationales
Question 1
Clinical Scenario
A 52-year-old female with type 2 diabetes mellitus is
prescribed metformin. Her lab results show: HbA1c 9.2%,
creatinine 2.1 mg/dL. She reports fatigue and decreased
urine output.
Question Stem
Which action should the nurse take?
A. Administer metformin as prescribed
B. Hold the medication and notify the provider
C. Give the medication with food
D. Encourage increased fluid intake
,Correct Answer: B. Hold the medication and notify the
provider
Detailed Rationale
Metformin is contraindicated in patients with renal
impairment due to the risk of lactic acidosis, a rare but life-
threatening adverse effect. The elevated creatinine (2.1
mg/dL) indicates decreased renal function, meaning the
drug may accumulate in the body. Therefore, the nurse
should hold the medication and notify the provider.
Option A is incorrect because administering metformin in
renal impairment increases toxicity risk. Option C is correct
for GI side effects but does not address the safety concern.
Option D may be helpful generally but does not resolve the
contraindication.
Nurses must always assess renal function before
administering metformin. Patient teaching includes
reporting symptoms like weakness, dyspnea, and abdominal
discomfort.
Learning Objective
• Identify contraindications to metformin therapy
• Recognize signs of lactic acidosis risk
• Apply lab interpretation to medication safety
Medication Safety Focus: Contraindication
, Question 2
Clinical Scenario
A 28-year-old female with hypothyroidism is prescribed
levothyroxine. She asks how to take the medication.
Question Stem
Which statement indicates correct understanding?
A. “I will take this medication with breakfast.”
B. “I will take this medication at bedtime with milk.”
C. “I will take this medication on an empty stomach in the
morning.”
D. “I will take this medication only when I feel tired.”
Correct Answer: C. “I will take this medication on an empty
stomach in the morning.”
Detailed Rationale
Levothyroxine should be taken on an empty stomach,
ideally 30–60 minutes before breakfast, to maximize
absorption. Food, calcium, and iron interfere with its
absorption.
Option A is incorrect because food reduces effectiveness.
Option B is incorrect due to interference from calcium in
System Exam Questions & Answers |
20 Original ATI & NGN-Style Practice MCQs
with Detailed Rationales
Question 1
Clinical Scenario
A 52-year-old female with type 2 diabetes mellitus is
prescribed metformin. Her lab results show: HbA1c 9.2%,
creatinine 2.1 mg/dL. She reports fatigue and decreased
urine output.
Question Stem
Which action should the nurse take?
A. Administer metformin as prescribed
B. Hold the medication and notify the provider
C. Give the medication with food
D. Encourage increased fluid intake
,Correct Answer: B. Hold the medication and notify the
provider
Detailed Rationale
Metformin is contraindicated in patients with renal
impairment due to the risk of lactic acidosis, a rare but life-
threatening adverse effect. The elevated creatinine (2.1
mg/dL) indicates decreased renal function, meaning the
drug may accumulate in the body. Therefore, the nurse
should hold the medication and notify the provider.
Option A is incorrect because administering metformin in
renal impairment increases toxicity risk. Option C is correct
for GI side effects but does not address the safety concern.
Option D may be helpful generally but does not resolve the
contraindication.
Nurses must always assess renal function before
administering metformin. Patient teaching includes
reporting symptoms like weakness, dyspnea, and abdominal
discomfort.
Learning Objective
• Identify contraindications to metformin therapy
• Recognize signs of lactic acidosis risk
• Apply lab interpretation to medication safety
Medication Safety Focus: Contraindication
, Question 2
Clinical Scenario
A 28-year-old female with hypothyroidism is prescribed
levothyroxine. She asks how to take the medication.
Question Stem
Which statement indicates correct understanding?
A. “I will take this medication with breakfast.”
B. “I will take this medication at bedtime with milk.”
C. “I will take this medication on an empty stomach in the
morning.”
D. “I will take this medication only when I feel tired.”
Correct Answer: C. “I will take this medication on an empty
stomach in the morning.”
Detailed Rationale
Levothyroxine should be taken on an empty stomach,
ideally 30–60 minutes before breakfast, to maximize
absorption. Food, calcium, and iron interfere with its
absorption.
Option A is incorrect because food reduces effectiveness.
Option B is incorrect due to interference from calcium in
