NCLEX-RN Pharmacology Endocrine
System Practice Questions |
20 Original ATI & NGN Style MCQs with
Detailed Rationales
Question 1
Clinical Scenario
A 58-year-old male with type 2 diabetes mellitus is admitted
to the medical-surgical unit for management of
hyperglycemia. His morning blood glucose is 285 mg/dL. He
reports feeling "shaky and sweaty" approximately 2 hours
after his morning insulin dose. Current medications include
metformin 1000 mg twice daily, insulin glargine 20 units at
bedtime, and insulin lispro 5 units with meals. The patient's
hemoglobin A1c is 9.2%. He has a history of hypertension
controlled with lisinopril.
Question Stem
Which action should the nurse take FIRST based on the
patient's report?
,A. Administer 4 mg of ondansetron for nausea
B. Check the patient's current blood glucose level
C. Give 15 grams of fast-acting carbohydrate
D. Notify the healthcare provider immediately
Correct Answer: B. Check the patient's current blood
glucose level
Detailed Rationale
Correct Answer Analysis: The priority action is to obtain a
current blood glucose level to confirm hypoglycemia before
implementing treatment. The patient's symptoms of being
"shaky and sweaty" 2 hours after insulin lispro
administration are classic signs of hypoglycemia. Insulin
lispro has an onset of 15-30 minutes, peaks in 30-90
minutes, and duration of 3-5 hours, making hypoglycemia
most likely to occur during peak action. However, the nurse
must verify hypoglycemia through blood glucose testing
before intervening, as these symptoms could also indicate
other conditions such as anxiety or autonomic neuropathy.
The 2024 American Diabetes Association standards
emphasize "treat hypoglycemia only after confirmation with
a blood glucose reading" when possible.
,Incorrect Option Analysis:
A. Ondansetron is an antiemetic and is not indicated for
hypoglycemia symptoms. This would delay appropriate
treatment and does not address the underlying issue.
C. While 15 grams of fast-acting carbohydrate is the
appropriate treatment for confirmed hypoglycemia,
administering it without verification could dangerously
elevate blood glucose if the patient is actually
hyperglycemic. The "Rule of 15" (15g carbohydrate, recheck
in 15 minutes) should only be implemented after
confirmation.
D. Notifying the healthcare provider would delay immediate
intervention. While provider notification may be necessary if
the patient is unable to swallow, unconscious, or has
refractory hypoglycemia, the nurse should first assess and
treat according to standing hypoglycemia protocols.
Nursing Considerations: Insulin lispro should be
administered within 15 minutes before or immediately after
meals. Its rapid onset makes timing critical. Patients should
be educated to always carry a source of fast-acting glucose
and to recognize early signs of hypoglycemia. The nurse
should review the insulin regimen for potential adjustments,
as the patient's hemoglobin A1c of 9.2% indicates
suboptimal glycemic control requiring regimen evaluation.
, Learning Objective
After completing this question, the learner should be able
to:
• Recognize clinical manifestations of hypoglycemia in
patients receiving insulin therapy.
• Prioritize nursing assessment before implementing
hypoglycemia treatment.
• Apply the "Rule of 15" protocol for hypoglycemia
management.
• Identify appropriate nursing actions for rapid-acting
insulin administration safety.
Medication Safety Focus
High-alert medication (insulin), adverse effect recognition
(hypoglycemia), patient assessment
Question 2
Clinical Scenario
A 72-year-old female with type 2 diabetes, hypertension, and
chronic kidney disease (stage 3) is being evaluated for
System Practice Questions |
20 Original ATI & NGN Style MCQs with
Detailed Rationales
Question 1
Clinical Scenario
A 58-year-old male with type 2 diabetes mellitus is admitted
to the medical-surgical unit for management of
hyperglycemia. His morning blood glucose is 285 mg/dL. He
reports feeling "shaky and sweaty" approximately 2 hours
after his morning insulin dose. Current medications include
metformin 1000 mg twice daily, insulin glargine 20 units at
bedtime, and insulin lispro 5 units with meals. The patient's
hemoglobin A1c is 9.2%. He has a history of hypertension
controlled with lisinopril.
Question Stem
Which action should the nurse take FIRST based on the
patient's report?
,A. Administer 4 mg of ondansetron for nausea
B. Check the patient's current blood glucose level
C. Give 15 grams of fast-acting carbohydrate
D. Notify the healthcare provider immediately
Correct Answer: B. Check the patient's current blood
glucose level
Detailed Rationale
Correct Answer Analysis: The priority action is to obtain a
current blood glucose level to confirm hypoglycemia before
implementing treatment. The patient's symptoms of being
"shaky and sweaty" 2 hours after insulin lispro
administration are classic signs of hypoglycemia. Insulin
lispro has an onset of 15-30 minutes, peaks in 30-90
minutes, and duration of 3-5 hours, making hypoglycemia
most likely to occur during peak action. However, the nurse
must verify hypoglycemia through blood glucose testing
before intervening, as these symptoms could also indicate
other conditions such as anxiety or autonomic neuropathy.
The 2024 American Diabetes Association standards
emphasize "treat hypoglycemia only after confirmation with
a blood glucose reading" when possible.
,Incorrect Option Analysis:
A. Ondansetron is an antiemetic and is not indicated for
hypoglycemia symptoms. This would delay appropriate
treatment and does not address the underlying issue.
C. While 15 grams of fast-acting carbohydrate is the
appropriate treatment for confirmed hypoglycemia,
administering it without verification could dangerously
elevate blood glucose if the patient is actually
hyperglycemic. The "Rule of 15" (15g carbohydrate, recheck
in 15 minutes) should only be implemented after
confirmation.
D. Notifying the healthcare provider would delay immediate
intervention. While provider notification may be necessary if
the patient is unable to swallow, unconscious, or has
refractory hypoglycemia, the nurse should first assess and
treat according to standing hypoglycemia protocols.
Nursing Considerations: Insulin lispro should be
administered within 15 minutes before or immediately after
meals. Its rapid onset makes timing critical. Patients should
be educated to always carry a source of fast-acting glucose
and to recognize early signs of hypoglycemia. The nurse
should review the insulin regimen for potential adjustments,
as the patient's hemoglobin A1c of 9.2% indicates
suboptimal glycemic control requiring regimen evaluation.
, Learning Objective
After completing this question, the learner should be able
to:
• Recognize clinical manifestations of hypoglycemia in
patients receiving insulin therapy.
• Prioritize nursing assessment before implementing
hypoglycemia treatment.
• Apply the "Rule of 15" protocol for hypoglycemia
management.
• Identify appropriate nursing actions for rapid-acting
insulin administration safety.
Medication Safety Focus
High-alert medication (insulin), adverse effect recognition
(hypoglycemia), patient assessment
Question 2
Clinical Scenario
A 72-year-old female with type 2 diabetes, hypertension, and
chronic kidney disease (stage 3) is being evaluated for
