GALEN PHARM EXAM 4 2026/2027 | 100% Correct Answers
with Complete Solutions | Endocrine, Respiratory, GI, GU,
Anti-Inflammatory, Chemotherapy | Pass Guaranteed - A+
Graded
Unit 1: Endocrine Pharmacology (20 Questions)
Q1
A 58-year-old client with type 2 diabetes mellitus is prescribed metformin 1000 mg
twice daily. The nurse reviews the client's laboratory results and notes a serum
creatinine of 1.8 mg/dL (eGFR 42 mL/min/1.73m²). Which action should the nurse take?
A. Administer the metformin as prescribed; this is a normal finding in diabetes
B. Hold the dose and notify the provider; metformin is contraindicated with eGFR <45
C. Reduce the dose to 500 mg twice daily and continue monitoring
D. Switch the client to insulin therapy immediately without consulting the provider
,Correct Answer: B
Rationale: Metformin is contraindicated in clients with eGFR <45 mL/min/1.73m² due to
increased risk of lactic acidosis. The FDA recommends discontinuing metformin when
eGFR falls below 45 and absolutely contraindicated below 30. This client requires
provider notification for medication adjustment. Continuing the dose (Option A) risks
life-threatening lactic acidosis. Dose reduction (Option C) is insufficient at this eGFR
level. Independent medication changes (Option D) exceed nursing scope.
Q2
A client with type 1 diabetes is prescribed insulin glargine 24 units at bedtime and
insulin lispro with meals using an insulin-to-carbohydrate ratio. The client asks why two
types of insulin are needed. Which explanation by the nurse is most accurate?
A. "The glargine covers your meals, and the lispro covers your baseline needs"
B. "Glargine provides basal coverage for 24 hours, while lispro is rapid-acting for
mealtime glucose control"
C. "Using two insulins reduces the risk of allergic reactions"
D. "The lispro is for emergencies only if your blood sugar gets too high"
Correct Answer: B
,Rationale: Basal-bolus insulin therapy mimics physiological insulin secretion. Glargine
(long-acting) provides steady basal coverage for approximately 24 hours without peaks.
Lispro (rapid-acting) has onset 15 minutes, peak 1 hour, duration 3-4 hours—ideal for
mealtime coverage and correction doses. Option A reverses the functions. Allergy
reduction (Option C) is incorrect. Lispro is for routine meal coverage, not just
emergencies (Option D).
Q3
A client taking levothyroxine 125 mcg daily reports palpitations, tremors, and insomnia.
The nurse suspects levothyroxine toxicity. Which laboratory value supports this
suspicion?
A. TSH 8.5 mIU/L (high)
B. TSH 0.15 mIU/L (low) with elevated free T4
C. T3 85 ng/dL (low-normal)
D. TSH 2.5 mIU/L (normal)
Correct Answer: B
Rationale: Levothyroxine toxicity causes iatrogenic hyperthyroidism: suppressed TSH
(<0.4 mIU/L) with elevated free T4. This pattern indicates excessive thyroid hormone
replacement. Elevated TSH (Option A) indicates hypothyroidism/undertreatment.
, Low-normal T3 (Option C) doesn't indicate toxicity. Normal TSH (Option D) indicates
appropriate dosing.
Q4
A client with hyperthyroidism is started on methimazole 10 mg three times daily. Which
adverse effect requires immediate discontinuation of the medication?
A. Mild gastric upset relieved by taking with food
B. Agranulocytosis with fever and sore throat
C. Transient hair loss
D. Weight gain of 3 pounds over one month
Correct Answer: B
Rationale: Agranulocytosis (neutrophils <500/μL) is a rare but life-threatening adverse
effect of thioamides (methimazole, PTU) occurring in 0.1-0.5% of patients, usually
within first 3 months. Fever and sore throat are warning symptoms requiring immediate
discontinuation and emergency CBC. Mild GI upset (Option A) is common and
manageable. Hair loss (Option C) and weight gain (Option D) are expected as thyroid
hormone levels normalize.
with Complete Solutions | Endocrine, Respiratory, GI, GU,
Anti-Inflammatory, Chemotherapy | Pass Guaranteed - A+
Graded
Unit 1: Endocrine Pharmacology (20 Questions)
Q1
A 58-year-old client with type 2 diabetes mellitus is prescribed metformin 1000 mg
twice daily. The nurse reviews the client's laboratory results and notes a serum
creatinine of 1.8 mg/dL (eGFR 42 mL/min/1.73m²). Which action should the nurse take?
A. Administer the metformin as prescribed; this is a normal finding in diabetes
B. Hold the dose and notify the provider; metformin is contraindicated with eGFR <45
C. Reduce the dose to 500 mg twice daily and continue monitoring
D. Switch the client to insulin therapy immediately without consulting the provider
,Correct Answer: B
Rationale: Metformin is contraindicated in clients with eGFR <45 mL/min/1.73m² due to
increased risk of lactic acidosis. The FDA recommends discontinuing metformin when
eGFR falls below 45 and absolutely contraindicated below 30. This client requires
provider notification for medication adjustment. Continuing the dose (Option A) risks
life-threatening lactic acidosis. Dose reduction (Option C) is insufficient at this eGFR
level. Independent medication changes (Option D) exceed nursing scope.
Q2
A client with type 1 diabetes is prescribed insulin glargine 24 units at bedtime and
insulin lispro with meals using an insulin-to-carbohydrate ratio. The client asks why two
types of insulin are needed. Which explanation by the nurse is most accurate?
A. "The glargine covers your meals, and the lispro covers your baseline needs"
B. "Glargine provides basal coverage for 24 hours, while lispro is rapid-acting for
mealtime glucose control"
C. "Using two insulins reduces the risk of allergic reactions"
D. "The lispro is for emergencies only if your blood sugar gets too high"
Correct Answer: B
,Rationale: Basal-bolus insulin therapy mimics physiological insulin secretion. Glargine
(long-acting) provides steady basal coverage for approximately 24 hours without peaks.
Lispro (rapid-acting) has onset 15 minutes, peak 1 hour, duration 3-4 hours—ideal for
mealtime coverage and correction doses. Option A reverses the functions. Allergy
reduction (Option C) is incorrect. Lispro is for routine meal coverage, not just
emergencies (Option D).
Q3
A client taking levothyroxine 125 mcg daily reports palpitations, tremors, and insomnia.
The nurse suspects levothyroxine toxicity. Which laboratory value supports this
suspicion?
A. TSH 8.5 mIU/L (high)
B. TSH 0.15 mIU/L (low) with elevated free T4
C. T3 85 ng/dL (low-normal)
D. TSH 2.5 mIU/L (normal)
Correct Answer: B
Rationale: Levothyroxine toxicity causes iatrogenic hyperthyroidism: suppressed TSH
(<0.4 mIU/L) with elevated free T4. This pattern indicates excessive thyroid hormone
replacement. Elevated TSH (Option A) indicates hypothyroidism/undertreatment.
, Low-normal T3 (Option C) doesn't indicate toxicity. Normal TSH (Option D) indicates
appropriate dosing.
Q4
A client with hyperthyroidism is started on methimazole 10 mg three times daily. Which
adverse effect requires immediate discontinuation of the medication?
A. Mild gastric upset relieved by taking with food
B. Agranulocytosis with fever and sore throat
C. Transient hair loss
D. Weight gain of 3 pounds over one month
Correct Answer: B
Rationale: Agranulocytosis (neutrophils <500/μL) is a rare but life-threatening adverse
effect of thioamides (methimazole, PTU) occurring in 0.1-0.5% of patients, usually
within first 3 months. Fever and sore throat are warning symptoms requiring immediate
discontinuation and emergency CBC. Mild GI upset (Option A) is common and
manageable. Hair loss (Option C) and weight gain (Option D) are expected as thyroid
hormone levels normalize.
