Endocrine questions
12 questions. Choose an answer to see the rationale.
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When mixing regular and NPH insulin in one syringe, which insulin is drawn up first?
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Answer A: Regular (clear) Clear before cloudy: draw up regular first so that NPH (which contains protamine) does not contaminate the regular insulin vial.
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A patient received NPH insulin at 0700. At what time is hypoglycemia most likely?
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Answer A: Early to mid-afternoon NPH peaks about 4 to 12 hours after injection, so a morning dose peaks in the afternoon.
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Which insulin can be given by continuous IV infusion?
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Answer D: Regular Regular insulin is the insulin routinely used for IV infusions. Glargine, NPH and premixed insulins are subcutaneous only.
Oral and non-insulin antidiabetic drugs
Which test result should the nurse check before giving metformin to a patient scheduled for a CT scan with IV contrast?
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Answer A: eGFR or serum creatinine Iodinated contrast can impair kidney function, and metformin builds up in kidney impairment, raising the risk of lactic acidosis.
Oral and non-insulin antidiabetic drugs
Which drug is most likely to cause hypoglycemia when used alone?
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Answer D: Glipizide Sulfonylureas stimulate insulin release regardless of the glucose level, so hypoglycemia is their main risk.
Oral and non-insulin antidiabetic drugs
A patient taking empagliflozin should be taught to watch for which effect?
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Answer B: Genital yeast infections SGLT2 inhibitors put glucose into the urine, which raises the risk of genital fungal infections and urinary infections.
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When should a patient take levothyroxine?
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Answer B: On an empty stomach 30 to 60 minutes before breakfast Food, calcium and iron reduce absorption. Taking it consistently on an empty stomach gives stable levels.
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A patient taking methimazole reports fever and a sore throat. What is the priority?
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Answer C: Notify the provider and check the CBC: possible agranulocytosis Agranulocytosis is a serious adverse effect of thioamides; fever and sore throat are the warning signs.
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Which finding suggests the levothyroxine dose is too high?
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Answer A: Palpitations and insomnia Too much thyroid hormone causes signs of hyperthyroidism, such as palpitations, nervousness and insomnia.
Corticosteroids (glucocorticoids)
A patient has taken prednisone for 3 months. Why must it be tapered rather than stopped?
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Answer D: To prevent acute adrenal insufficiency Long-term steroids suppress the adrenal glands. Stopping suddenly can cause adrenal crisis: hypotension, weakness, hypoglycemia and shock.
Corticosteroids (glucocorticoids)
Which lab value is most likely to rise in a patient on high-dose corticosteroids?
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Answer A: Blood glucose Glucocorticoids increase glucose production and insulin resistance. Potassium tends to fall.
Corticosteroids (glucocorticoids)
Why may a patient on long-term corticosteroids have an infection without a high fever?
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Answer B: Steroids suppress inflammation and mask signs of infection Steroids blunt the inflammatory response, so fever, redness and swelling may be minimal even in serious infection.