PHARM Endocrine ATI Exam Questions: Diabetes, Insulin,
Thyroid & Adrenal Therapy
Educational Assessment & Practice Question Sets
Paper 1: PHARM Endocrine ATI Exam – Diabetes & Insulin Therapy Focus
Part I: Multiple Choice Questions (including NGN Items)
Question 1: A nurse is providing discharge instructions to a client who has a new prescription for Lispro
(Humalog) insulin. At what time should the nurse instruct the client to administer this insulin relative to
mealtime?
A. 30 to 45 minutes before eating
B. 15 minutes before eating or immediately with meals
C. 1 hour after completing a meal
D. At bedtime on an empty stomach
Answer & Rationale:
Correct Answer: B
Rationale: Lispro is a rapid-acting insulin with an onset of 15 to 30 minutes. It must be administered within 15
minutes before eating or immediately after meals to prevent acute hypoglycemia.
Question 2: A nurse is reviewing the medication record for a client scheduled for a CT scan with IV
iodinated contrast media. The client takes metformin daily for type 2 diabetes. Which action should the
nurse take?
A. Administer metformin as scheduled prior to the procedure.
B. Withhold metformin on the day of the procedure and for 48 hours afterward.
C. Double the metformin dose 1 hour prior to contrast administration.
D. Switch metformin to an IV formulation prior to imaging.
Answer & Rationale:
Correct Answer: B
Rationale: Combining iodinated contrast dye with metformin increases the risk of contrast-induced nephropathy and
severe lactic acidosis. Metformin must be held the day of the test and resumed 48 hours post-procedure only after
renal function is confirmed normal.
, Question 3: A client with type 1 diabetes is prescribed insulin glargine (Lantus) once daily at bedtime.
Which instruction regarding insulin glargine administration is correct?
A. Mix insulin glargine with NPH insulin in the same syringe to reduce injections.
B. Administer insulin glargine as a rapid IV bolus during hyperglycemic crises.
C. Do not mix insulin glargine with any other insulin in the same syringe.
D. Shake the vial vigorously until it appears uniformly cloudy.
Answer & Rationale:
Correct Answer: C
Rationale: Insulin glargine is a long-acting, peakless baseline insulin with a low pH. It must NEVER be mixed with any
other insulin or solution in the same syringe because mixing alters its absorption rate and solubility.
Question 4: [NGN Clinical Scenario] A nurse is caring for an unconscious client with type 1 diabetes whose
blood glucose reading is 38 mg/dL. The client does not have IV access. Which medication should the nurse
administer immediately?
A. Glipizide 10 mg PO
B. Glucagon 1 mg IM or SubQ
C. Regular insulin 10 units SubQ
D. 50% Dextrose IV push
Answer & Rationale:
Correct Answer: B
Rationale: For severe hypoglycemia in an unconscious client without IV access, subcutaneous or intramuscular
Glucagon is the drug of choice to stimulate hepatic glycogen breakdown. IV 50% Dextrose would be given if IV access
were already established.
Question 15: A nurse is teaching a client who has type 2 diabetes about taking exenatide (Byetta). Which
side effect should the nurse instruct the client to report immediately as a potential sign of pancreatitis?
A. Severe, persistent abdominal pain radiating to the back
B. Mild constipation relieved by fiber
C. Transient local injection site erythema
D. Increased urinary volume and nocturia
Answer & Rationale:
Correct Answer: A
Rationale: GLP-1 receptor agonists like exenatide carry a risk of severe acute pancreatitis. Clients should report
severe, continuous abdominal pain that radiates to the back, often accompanied by vomiting.
Thyroid & Adrenal Therapy
Educational Assessment & Practice Question Sets
Paper 1: PHARM Endocrine ATI Exam – Diabetes & Insulin Therapy Focus
Part I: Multiple Choice Questions (including NGN Items)
Question 1: A nurse is providing discharge instructions to a client who has a new prescription for Lispro
(Humalog) insulin. At what time should the nurse instruct the client to administer this insulin relative to
mealtime?
A. 30 to 45 minutes before eating
B. 15 minutes before eating or immediately with meals
C. 1 hour after completing a meal
D. At bedtime on an empty stomach
Answer & Rationale:
Correct Answer: B
Rationale: Lispro is a rapid-acting insulin with an onset of 15 to 30 minutes. It must be administered within 15
minutes before eating or immediately after meals to prevent acute hypoglycemia.
Question 2: A nurse is reviewing the medication record for a client scheduled for a CT scan with IV
iodinated contrast media. The client takes metformin daily for type 2 diabetes. Which action should the
nurse take?
A. Administer metformin as scheduled prior to the procedure.
B. Withhold metformin on the day of the procedure and for 48 hours afterward.
C. Double the metformin dose 1 hour prior to contrast administration.
D. Switch metformin to an IV formulation prior to imaging.
Answer & Rationale:
Correct Answer: B
Rationale: Combining iodinated contrast dye with metformin increases the risk of contrast-induced nephropathy and
severe lactic acidosis. Metformin must be held the day of the test and resumed 48 hours post-procedure only after
renal function is confirmed normal.
, Question 3: A client with type 1 diabetes is prescribed insulin glargine (Lantus) once daily at bedtime.
Which instruction regarding insulin glargine administration is correct?
A. Mix insulin glargine with NPH insulin in the same syringe to reduce injections.
B. Administer insulin glargine as a rapid IV bolus during hyperglycemic crises.
C. Do not mix insulin glargine with any other insulin in the same syringe.
D. Shake the vial vigorously until it appears uniformly cloudy.
Answer & Rationale:
Correct Answer: C
Rationale: Insulin glargine is a long-acting, peakless baseline insulin with a low pH. It must NEVER be mixed with any
other insulin or solution in the same syringe because mixing alters its absorption rate and solubility.
Question 4: [NGN Clinical Scenario] A nurse is caring for an unconscious client with type 1 diabetes whose
blood glucose reading is 38 mg/dL. The client does not have IV access. Which medication should the nurse
administer immediately?
A. Glipizide 10 mg PO
B. Glucagon 1 mg IM or SubQ
C. Regular insulin 10 units SubQ
D. 50% Dextrose IV push
Answer & Rationale:
Correct Answer: B
Rationale: For severe hypoglycemia in an unconscious client without IV access, subcutaneous or intramuscular
Glucagon is the drug of choice to stimulate hepatic glycogen breakdown. IV 50% Dextrose would be given if IV access
were already established.
Question 15: A nurse is teaching a client who has type 2 diabetes about taking exenatide (Byetta). Which
side effect should the nurse instruct the client to report immediately as a potential sign of pancreatitis?
A. Severe, persistent abdominal pain radiating to the back
B. Mild constipation relieved by fiber
C. Transient local injection site erythema
D. Increased urinary volume and nocturia
Answer & Rationale:
Correct Answer: A
Rationale: GLP-1 receptor agonists like exenatide carry a risk of severe acute pancreatitis. Clients should report
severe, continuous abdominal pain that radiates to the back, often accompanied by vomiting.
