NCLEX-RN Pharmacology Practice
Questions: 20 Endocrine System
Medication Safety MCQs with Detailed
Rationales |
ATI & NGN Style Nursing Exam Prep
Question 1
Clinical Scenario
A 45-year-old female client with a history of primary
hypothyroidism is admitted to the medical-surgical unit. She
was prescribed levothyroxine 100 mcg PO daily upon
discharge from an outpatient clinic two weeks ago. During
the morning assessment, the client reports feeling "very
wired," having heart palpitations, and experiencing difficulty
sleeping. Her vital signs are: temperature 37.6°C (99.7°F),
heart rate 112 bpm (irregular), respirations 20 breaths/min,
and blood pressure 138/86 mmHg.
Question Stem
Which action should the nurse take first?
,A. Hold the morning dose of levothyroxine and notify the
healthcare provider. B. Obtain an electrocardiogram (ECG)
and assess for chest pain. C. Reassure the client that these
are common, temporary side effects of starting thyroid
replacement. D. Request a prescription for a serum thyroid-
stimulating hormone (TSH) level.
Correct Answer
B. Obtain an electrocardiogram (ECG) and assess for
chest pain.
Detailed Rationale
Levothyroxine is a synthetic thyroid hormone used to treat
hypothyroidism. It has a narrow therapeutic index. An
overdose or rapid titration can induce a state of
hyperthyroidism (thyrotoxicosis). The client's symptoms—
tachycardia (112 bpm, irregular), heart palpitations, and
insomnia—strongly suggest thyroid hormone-induced
cardiotoxicity or thyrotoxicosis.
In this clinical scenario, the nurse's first priority must
address life-threatening complications. Tachycardia and an
irregular heart rate put the client at high risk for cardiac
dysrhythmias (such as atrial fibrillation) and myocardial
ischemia. Therefore, the nurse must first obtain an ECG and
assess for chest pain to evaluate cardiac electrical activity
and perfusion.
,While holding the medication (Option A) and notifying the
provider are necessary subsequent steps, they do not take
precedence over immediate cardiovascular assessment.
Reassuring the client (Option C) is incorrect and unsafe, as
these symptoms indicate a toxic reaction rather than benign,
temporary side effects. Requesting a TSH level (Option D)
will be necessary to evaluate long-term therapy, but TSH
levels take several weeks to reflect changes in levothyroxine
dosing and will not help manage this acute cardiac situation.
Learning Objectives
After completing this question, the learner should be able
to:
• Recognize the signs and symptoms of levothyroxine
toxicity (hyperthyroidism).
• Prioritize nursing assessments for a patient
experiencing acute cardiac symptoms secondary to
thyroid hormone replacement.
• Identify the potential cardiovascular complications
associated with thyroid hormone therapy.
Medication Safety Focus
Adverse effect / Monitoring
Question 2
, Clinical Scenario
A 52-year-old male client with type 2 diabetes mellitus is
scheduled for a cardiac catheterization with contrast media
tomorrow morning at 0800. His current home medications
include metformin 1,000 mg PO twice daily, empagliflozin 10
mg PO daily, and lisinopril 10 mg PO daily. His baseline
serum creatinine is 1.1 mg/dL.
Question Stem
Which instruction should the nurse provide to the client
regarding his diabetic medications?
A. "Take both metformin and empagliflozin as scheduled
tomorrow morning with a small sip of water." B. "Skip your
metformin dose tomorrow morning, but take your
empagliflozin as prescribed." C. "Hold your metformin
starting tomorrow morning and do not resume it until 48
hours after the procedure, pending normal kidney function."
D. "Hold both metformin and empagliflozin starting
tomorrow morning, and resume metformin immediately
after the procedure is finished."
Correct Answer
C. "Hold your metformin starting tomorrow morning and
do not resume it until 48 hours after the procedure,
pending normal kidney function."
Questions: 20 Endocrine System
Medication Safety MCQs with Detailed
Rationales |
ATI & NGN Style Nursing Exam Prep
Question 1
Clinical Scenario
A 45-year-old female client with a history of primary
hypothyroidism is admitted to the medical-surgical unit. She
was prescribed levothyroxine 100 mcg PO daily upon
discharge from an outpatient clinic two weeks ago. During
the morning assessment, the client reports feeling "very
wired," having heart palpitations, and experiencing difficulty
sleeping. Her vital signs are: temperature 37.6°C (99.7°F),
heart rate 112 bpm (irregular), respirations 20 breaths/min,
and blood pressure 138/86 mmHg.
Question Stem
Which action should the nurse take first?
,A. Hold the morning dose of levothyroxine and notify the
healthcare provider. B. Obtain an electrocardiogram (ECG)
and assess for chest pain. C. Reassure the client that these
are common, temporary side effects of starting thyroid
replacement. D. Request a prescription for a serum thyroid-
stimulating hormone (TSH) level.
Correct Answer
B. Obtain an electrocardiogram (ECG) and assess for
chest pain.
Detailed Rationale
Levothyroxine is a synthetic thyroid hormone used to treat
hypothyroidism. It has a narrow therapeutic index. An
overdose or rapid titration can induce a state of
hyperthyroidism (thyrotoxicosis). The client's symptoms—
tachycardia (112 bpm, irregular), heart palpitations, and
insomnia—strongly suggest thyroid hormone-induced
cardiotoxicity or thyrotoxicosis.
In this clinical scenario, the nurse's first priority must
address life-threatening complications. Tachycardia and an
irregular heart rate put the client at high risk for cardiac
dysrhythmias (such as atrial fibrillation) and myocardial
ischemia. Therefore, the nurse must first obtain an ECG and
assess for chest pain to evaluate cardiac electrical activity
and perfusion.
,While holding the medication (Option A) and notifying the
provider are necessary subsequent steps, they do not take
precedence over immediate cardiovascular assessment.
Reassuring the client (Option C) is incorrect and unsafe, as
these symptoms indicate a toxic reaction rather than benign,
temporary side effects. Requesting a TSH level (Option D)
will be necessary to evaluate long-term therapy, but TSH
levels take several weeks to reflect changes in levothyroxine
dosing and will not help manage this acute cardiac situation.
Learning Objectives
After completing this question, the learner should be able
to:
• Recognize the signs and symptoms of levothyroxine
toxicity (hyperthyroidism).
• Prioritize nursing assessments for a patient
experiencing acute cardiac symptoms secondary to
thyroid hormone replacement.
• Identify the potential cardiovascular complications
associated with thyroid hormone therapy.
Medication Safety Focus
Adverse effect / Monitoring
Question 2
, Clinical Scenario
A 52-year-old male client with type 2 diabetes mellitus is
scheduled for a cardiac catheterization with contrast media
tomorrow morning at 0800. His current home medications
include metformin 1,000 mg PO twice daily, empagliflozin 10
mg PO daily, and lisinopril 10 mg PO daily. His baseline
serum creatinine is 1.1 mg/dL.
Question Stem
Which instruction should the nurse provide to the client
regarding his diabetic medications?
A. "Take both metformin and empagliflozin as scheduled
tomorrow morning with a small sip of water." B. "Skip your
metformin dose tomorrow morning, but take your
empagliflozin as prescribed." C. "Hold your metformin
starting tomorrow morning and do not resume it until 48
hours after the procedure, pending normal kidney function."
D. "Hold both metformin and empagliflozin starting
tomorrow morning, and resume metformin immediately
after the procedure is finished."
Correct Answer
C. "Hold your metformin starting tomorrow morning and
do not resume it until 48 hours after the procedure,
pending normal kidney function."
