1
NCLEX RN Exam Bank: Endocrine Agents, Insulin,
Thyroid, and Diabetic Emergencies
Table of Contents
Subtopic 1: Insulin Types, Actions, and Nursing Considerations ....................................... 2
Subtopic 2: Thyroid Medications—Hypothyroidism and Hyperthyroidism Management .... 10
Subtopic 3: Diabetic Emergencies—DKA, HHS, and Hypoglycemia Crisis Management
(Q41–Q60) .................................................................................................................. 18
Subtopic 4: Patient Education, Monitoring, and Insulin Pump Therapy (Q61–Q80) ............ 25
Subtopic 5: Patient Teaching and Medication Safety in Endocrine Pharmacotherapy ........ 33
Subtopic 6: Emergency Endocrine Interventions—DKA, HHS, and Myxedema Coma........ 41
Subtopic 7: Advanced Insulin Management in Critical Care and Surgical Settings ............ 49
, 2
Subtopic 1: Insulin Types, Actions, and Nursing
Considerations
1. A nurse is administering insulin to a patient with type 1 diabetes. Which type of insulin
has the fastest onset of action?
A) Regular insulin
B) NPH insulin
C) Lispro insulin (Humalog)
D) Glargine insulin (Lantus)
Correct answer: C) Lispro insulin (Humalog)
Rationale: Lispro insulin is a rapid-acting insulin with an onset of about 15 minutes, making
it the fastest among the common insulin types. Regular insulin has a slower onset (30-60
minutes), NPH is intermediate-acting, and Glargine is long-acting.
2. When teaching a patient about insulin glargine (Lantus), the nurse should emphasize
which characteristic?
A) It has a peak effect at 2-4 hours
B) It must be mixed with regular insulin before injection
C) It provides a steady basal insulin level without a pronounced peak
D) It is used only for correction doses
Correct answer: C) It provides a steady basal insulin level without a pronounced peak
Rationale: Glargine is a long-acting insulin designed to provide a steady basal level over 24
hours without significant peaks, reducing hypoglycemia risk.
3. Which of the following insulins is classified as intermediate-acting?
A) Lispro (Humalog)
, 3
B) NPH (Neutral Protamine Hagedorn)
C) Glargine (Lantus)
D) Aspart (Novolog)
Correct answer: B) NPH (Neutral Protamine Hagedorn)
Rationale: NPH insulin has an onset of 1-2 hours, peaks at 4-12 hours, and lasts 14-24
hours, classifying it as intermediate-acting.
4. A nurse is preparing to administer regular insulin to a patient. What is the correct timing
for this insulin relative to meals?
A) Immediately after meals
B) 2 hours before meals
C) 30 minutes before meals
D) 1 hour after meals
Correct answer: C) 30 minutes before meals
Rationale: Regular insulin has an onset of 30-60 minutes, so administering it 30 minutes
before meals helps control postprandial glucose levels effectively.
5. Which of the following is an important nursing consideration when mixing insulin?
A) Mix glargine with regular insulin in the same syringe
B) Draw up clear (rapid-acting or regular) insulin before cloudy (NPH) insulin
C) Shake both insulins vigorously before mixing
D) Store mixed insulin at room temperature indefinitely
Correct answer: B) Draw up clear (rapid-acting or regular) insulin before cloudy (NPH)
insulin
, 4
Rationale: To avoid contamination, clear insulin is drawn first, then cloudy. Glargine should
never be mixed.
6. A patient on insulin therapy is experiencing sweating, shakiness, and confusion. What is
the nurse’s priority action?
A) Administer glucagon IM immediately
B) Check the patient’s blood glucose level
C) Give a dose of insulin
D) Call the healthcare provider
Correct answer: B) Check the patient’s blood glucose level
Rationale: These are symptoms of hypoglycemia; blood glucose should be confirmed
before treatment is started.
7. Which of the following insulins cannot be mixed with other insulins?
A) Regular insulin
B) NPH insulin
C) Glargine insulin (Lantus)
D) Lispro insulin
Correct answer: C) Glargine insulin (Lantus)
Rationale: Glargine is a long-acting insulin and should never be mixed with any other
insulin as it changes its absorption profile.
8. A patient asks why insulin doses vary throughout the day. What is the best nurse
explanation?
A) "Your body requires insulin only when you are eating."
NCLEX RN Exam Bank: Endocrine Agents, Insulin,
Thyroid, and Diabetic Emergencies
Table of Contents
Subtopic 1: Insulin Types, Actions, and Nursing Considerations ....................................... 2
Subtopic 2: Thyroid Medications—Hypothyroidism and Hyperthyroidism Management .... 10
Subtopic 3: Diabetic Emergencies—DKA, HHS, and Hypoglycemia Crisis Management
(Q41–Q60) .................................................................................................................. 18
Subtopic 4: Patient Education, Monitoring, and Insulin Pump Therapy (Q61–Q80) ............ 25
Subtopic 5: Patient Teaching and Medication Safety in Endocrine Pharmacotherapy ........ 33
Subtopic 6: Emergency Endocrine Interventions—DKA, HHS, and Myxedema Coma........ 41
Subtopic 7: Advanced Insulin Management in Critical Care and Surgical Settings ............ 49
, 2
Subtopic 1: Insulin Types, Actions, and Nursing
Considerations
1. A nurse is administering insulin to a patient with type 1 diabetes. Which type of insulin
has the fastest onset of action?
A) Regular insulin
B) NPH insulin
C) Lispro insulin (Humalog)
D) Glargine insulin (Lantus)
Correct answer: C) Lispro insulin (Humalog)
Rationale: Lispro insulin is a rapid-acting insulin with an onset of about 15 minutes, making
it the fastest among the common insulin types. Regular insulin has a slower onset (30-60
minutes), NPH is intermediate-acting, and Glargine is long-acting.
2. When teaching a patient about insulin glargine (Lantus), the nurse should emphasize
which characteristic?
A) It has a peak effect at 2-4 hours
B) It must be mixed with regular insulin before injection
C) It provides a steady basal insulin level without a pronounced peak
D) It is used only for correction doses
Correct answer: C) It provides a steady basal insulin level without a pronounced peak
Rationale: Glargine is a long-acting insulin designed to provide a steady basal level over 24
hours without significant peaks, reducing hypoglycemia risk.
3. Which of the following insulins is classified as intermediate-acting?
A) Lispro (Humalog)
, 3
B) NPH (Neutral Protamine Hagedorn)
C) Glargine (Lantus)
D) Aspart (Novolog)
Correct answer: B) NPH (Neutral Protamine Hagedorn)
Rationale: NPH insulin has an onset of 1-2 hours, peaks at 4-12 hours, and lasts 14-24
hours, classifying it as intermediate-acting.
4. A nurse is preparing to administer regular insulin to a patient. What is the correct timing
for this insulin relative to meals?
A) Immediately after meals
B) 2 hours before meals
C) 30 minutes before meals
D) 1 hour after meals
Correct answer: C) 30 minutes before meals
Rationale: Regular insulin has an onset of 30-60 minutes, so administering it 30 minutes
before meals helps control postprandial glucose levels effectively.
5. Which of the following is an important nursing consideration when mixing insulin?
A) Mix glargine with regular insulin in the same syringe
B) Draw up clear (rapid-acting or regular) insulin before cloudy (NPH) insulin
C) Shake both insulins vigorously before mixing
D) Store mixed insulin at room temperature indefinitely
Correct answer: B) Draw up clear (rapid-acting or regular) insulin before cloudy (NPH)
insulin
, 4
Rationale: To avoid contamination, clear insulin is drawn first, then cloudy. Glargine should
never be mixed.
6. A patient on insulin therapy is experiencing sweating, shakiness, and confusion. What is
the nurse’s priority action?
A) Administer glucagon IM immediately
B) Check the patient’s blood glucose level
C) Give a dose of insulin
D) Call the healthcare provider
Correct answer: B) Check the patient’s blood glucose level
Rationale: These are symptoms of hypoglycemia; blood glucose should be confirmed
before treatment is started.
7. Which of the following insulins cannot be mixed with other insulins?
A) Regular insulin
B) NPH insulin
C) Glargine insulin (Lantus)
D) Lispro insulin
Correct answer: C) Glargine insulin (Lantus)
Rationale: Glargine is a long-acting insulin and should never be mixed with any other
insulin as it changes its absorption profile.
8. A patient asks why insulin doses vary throughout the day. What is the best nurse
explanation?
A) "Your body requires insulin only when you are eating."
