PHARMACOLOGY NURS 251 MODULE 9 EXAM 2026/2027 |
Portage Learning Verified Edition | Questions & Answers |
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Section 1: Endocrine Drugs - Diabetes & Thyroid (Questions 1-30)
Q1: A patient with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL. The physician
orders insulin to be administered intravenously. Which type of insulin should the nurse prepare?
A. Insulin glargine
B. Insulin lispro
C. Regular insulin **[CORRECT]**
D. Neutral protamine Hagedorn (NPH) insulin
Correct Answer: C
Rationale: Regular insulin is the only insulin formulation safe for intravenous administration,
making it essential for managing DKA due to its rapid onset and predictable pharmacokinetics.
Glargine, lispro, and NPH are strictly for subcutaneous use; using them intravenously can cause
severe hypoglycemia or dangerous precipitation. Module 9 Exam Insight: Portage Learning
frequently tests the IV exclusivity of regular insulin in acute emergency scenarios versus the
strict subcutaneous constraints of all other insulins.
Q2: A patient with Type 1 diabetes receives insulin aspart at 8:00 AM. At what time should the
nurse ensure the patient begins eating breakfast to prevent hypoglycemia?
A. 7:30 AM
B. 8:00 AM **[CORRECT]**
C. 8:30 AM
D. 9:00 AM
Correct Answer: B
Rationale: Rapid-acting insulins like aspart have an onset of 10 to 30 minutes, so they must be
administered immediately with or right before a meal to match the carbohydrate absorption.
Administering the dose 30 minutes before eating or delaying the meal by an hour creates a
mismatch, leading to dangerous hypoglycemia. Module 9 Exam Insight: Differentiating meal
timing between rapid-acting (administer with meals) and short-acting regular insulin (administer
30 minutes before meals) is a classic NURS 251 testing pattern.
Q3: A nurse is preparing to administer NPH insulin to a patient. The nurse observes that the
insulin appears clear. What is the most appropriate nursing action?
A. Administer the insulin as ordered
B. Discard the insulin and obtain a new vial **[CORRECT]**
C. Roll the vial gently between the hands to resuspend it
,D. Shake the vial vigorously until the solution becomes cloudy
Correct Answer: B
Rationale: NPH insulin is an intermediate-acting insulin that should inherently appear cloudy
due to the addition of protamine; a clear appearance indicates separation, improper mixing, or a
wrong insulin entirely. If a vial of NPH does not become uniformly cloudy after gentle rolling, it
must be discarded because the dose will be inaccurate. Module 9 Exam Insight: Recognizing
the physical characteristics of NPH (cloudy) versus long-acting insulins like glargine (clear) is a
foundational safety check heavily emphasized in Module 9.
Q4: A patient with Type 2 diabetes is prescribed insulin glargine. Which instruction should the
nurse include in the patient's teaching plan?
A. "Inject this medication directly into your muscle for faster absorption."
B. "Mix this insulin with your rapid-acting insulin in the same syringe."
C. "Administer this medication at the exact same time every day." **[CORRECT]**
D. "Expect this insulin to peak in 4 to 8 hours to prevent postprandial hypoglycemia."
Correct Answer: C
Rationale: Insulin glargine is a long-acting insulin with no peak and a duration of 24 hours or
more, requiring strict once-daily timing to maintain steady basal coverage. It must never be
mixed with other insulins, must be injected subcutaneously, and does not require peak
monitoring since its flat profile eliminates peak-related hypoglycemia. Module 9 Exam Insight:
Portage Learning tests the "do not mix" rule and "no peak" pharmacokinetics of long-acting
insulins to ensure safety in basal dosing regimens.
Q5: A nurse is preparing to administer 20 units of NPH insulin and 10 units of insulin lispro to a
patient. Which action demonstrates the correct technique?
A. Inject 10 units of air into the NPH vial, then 20 units of air into the lispro vial
B. Draw up 10 units of lispro first, then draw up 20 units of NPH **[CORRECT]**
C. Draw up 20 units of NPH first, then draw up 10 units of lispro
D. Draw up the medications into two separate syringes
Correct Answer: B
Rationale: When mixing insulins, the clear (short or rapid-acting) insulin must always be drawn
up first to prevent contamination of the clear vial with the cloudy NPH suspension. Injecting air
into the NPH vial first without withdrawing, then injecting air into the lispro vial and withdrawing
the clear lispro, followed by the NPH, maintains sterility and accuracy. Module 9 Exam Insight:
This insulin mixing sequence (clear before cloudy, air into cloudy first) is a high-yield procedural
error-identification question on the NURS 251 Module 9 Exam.
Q6: A patient receiving insulin reports feeling jittery, anxious, and diaphoretic. Their blood
glucose is 58 mg/dL. The patient is conscious and able to swallow. What is the priority nursing
intervention?
A. Administer 1 mg of glucagon intramuscularly
B. Provide 4 ounces of orange juice or regular soda **[CORRECT]**
C. Initiate a 50% dextrose intravenous bolus
D. Encourage the patient to eat a high-protein snack
,Correct Answer: B
Rationale: For a conscious patient with mild to moderate hypoglycemia, the Rule of 15 applies:
administer 15 grams of fast-acting carbohydrates (like 4 oz of juice), recheck in 15 minutes, and
repeat if needed. Glucagon and IV dextrose are reserved for unconscious patients or those
unable to swallow, while protein does not raise blood sugar quickly enough. Module 9 Exam
Insight: Distinguishing between conscious hypoglycemia management (oral carbohydrates) and
unconscious management (glucagon/IV dextrose) is a critical application requirement.
Q7: A nurse is educating a patient on insulin degludec storage. How long can an opened vial of
insulin degludec be kept at room temperature?
A. 14 days
B. 28 days
C. 42 days
D. 56 days **[CORRECT]**
Correct Answer: D
Rationale: Insulin degludec has the longest room-temperature shelf life of any opened insulin,
stable for up to 56 days once punctured, compared to 28 days for most others (like glargine) or
42 days for detemir. Unopened vials of all insulins must be refrigerated until their expiration date
to maintain efficacy. Module 9 Exam Insight: Memorizing the specific room-temperature
expiration timelines (28 vs 42 vs 56 days) for long-acting insulins is a frequent recall question in
this module.
Q8: A patient with Type 2 diabetes is scheduled for a computed tomography (CT) scan with
iodinated contrast dye. The nurse notes the patient takes metformin. What is the priority action?
A. Hold the metformin the evening before the procedure and for 48 hours after **[CORRECT]**
B. Administer the metformin immediately after the CT scan to prevent hyperglycemia
C. Increase the metformin dose to counteract the hyperglycemic effects of the contrast dye
D. Switch the patient to a sulfonylurea permanently due to contrast interactions
Correct Answer: A
Rationale: Metformin carries a black box warning for lactic acidosis, and the risk increases
significantly if renal impairment occurs due to iodinated contrast dye. The standard protocol is to
hold metformin at the time of the procedure and for 48 hours afterward, reassessing renal
function before resuming. Module 9 Exam Insight: The intersection of metformin's black box
warning (lactic acidosis) and diagnostic procedures (contrast dye) is a heavily tested safety
protocol in NURS 251.
Q9: An 80-year-old patient with Type 2 diabetes and chronic kidney disease requires an oral
hypoglycemic agent. The healthcare provider is considering a sulfonylurea. Which agent is
safest for this patient?
A. Glyburide
B. Glipizide **[CORRECT]**
C. Chlorpropamide
D. Tolbutamide
Correct Answer: B
, Rationale: Glipizide is the preferred sulfonylurea in elderly patients and those with renal
impairment because it has a shorter half-life, is metabolized by the liver to inactive metabolites,
and carries a lower risk of prolonged hypoglycemia. Glyburide has a long half-life and active
renal metabolites, making it highly dangerous for elderly or renally compromised patients due to
severe hypoglycemia risk. Module 9 Exam Insight: Portage Learning heavily emphasizes
selecting glipizide over glyburide in geriatric and renal failure populations due to
pharmacokinetic differences.
Q10: A patient with Type 2 diabetes is prescribed repaglinide. Which statement by the patient
indicates a need for further teaching?
A. "I will take this medication right before I eat my meals."
B. "If I skip a meal, I will also skip my dose of this medication." **[CORRECT]**
C. "I will take this medication every morning regardless of my meal schedule."
D. "I might experience some low blood sugar while taking this drug."
Correct Answer: C
Rationale: Meglitinides like repaglinide have a very short onset and duration, designed
specifically to stimulate insulin secretion only in response to carbohydrate intake. Taking the
medication without eating, such as every morning regardless of a meal, will cause severe
hypoglycemia; therefore, doses must strictly correlate with meals. Module 9 Exam Insight: The
"skip meal, skip dose" rule is a unique pharmacokinetic characteristic of meglitinides frequently
tested to contrast them with sulfonylureas.
Q11: A patient with Type 2 diabetes and New York Heart Association (NYHA) Class III heart
failure is prescribed an antidiabetic medication. The nurse knows to question a prescription for
which drug class?
A. DPP-4 inhibitors
B. Sulfonylureas
C. Thiazolidinediones (TZDs) **[CORRECT]**
D. Biguanides
Correct Answer: C
Rationale: Thiazolidinediones (like pioglitazone) carry a black box warning for heart failure
because they cause fluid retention and peripheral edema, which can exacerbate or precipitate
cardiac decompensation. They are strictly contraindicated in patients with NYHA Class III or IV
heart failure. Module 9 Exam Insight: Associating TZDs with fluid retention/heart failure and
recognizing their black box warning is a mandatory clinical judgment point in Module 9.
Q12: A nurse is providing discharge teaching to a patient newly prescribed liraglutide. Which
adverse effect should the nurse prioritize in the teaching?
A. Hypoglycemia when taken alone
B. Medullary thyroid carcinoma risk **[CORRECT]**
C. Severe constipation
D. Weight gain
Correct Answer: B
Portage Learning Verified Edition | Questions & Answers |
Pass Guaranteed - A+ Graded
Section 1: Endocrine Drugs - Diabetes & Thyroid (Questions 1-30)
Q1: A patient with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL. The physician
orders insulin to be administered intravenously. Which type of insulin should the nurse prepare?
A. Insulin glargine
B. Insulin lispro
C. Regular insulin **[CORRECT]**
D. Neutral protamine Hagedorn (NPH) insulin
Correct Answer: C
Rationale: Regular insulin is the only insulin formulation safe for intravenous administration,
making it essential for managing DKA due to its rapid onset and predictable pharmacokinetics.
Glargine, lispro, and NPH are strictly for subcutaneous use; using them intravenously can cause
severe hypoglycemia or dangerous precipitation. Module 9 Exam Insight: Portage Learning
frequently tests the IV exclusivity of regular insulin in acute emergency scenarios versus the
strict subcutaneous constraints of all other insulins.
Q2: A patient with Type 1 diabetes receives insulin aspart at 8:00 AM. At what time should the
nurse ensure the patient begins eating breakfast to prevent hypoglycemia?
A. 7:30 AM
B. 8:00 AM **[CORRECT]**
C. 8:30 AM
D. 9:00 AM
Correct Answer: B
Rationale: Rapid-acting insulins like aspart have an onset of 10 to 30 minutes, so they must be
administered immediately with or right before a meal to match the carbohydrate absorption.
Administering the dose 30 minutes before eating or delaying the meal by an hour creates a
mismatch, leading to dangerous hypoglycemia. Module 9 Exam Insight: Differentiating meal
timing between rapid-acting (administer with meals) and short-acting regular insulin (administer
30 minutes before meals) is a classic NURS 251 testing pattern.
Q3: A nurse is preparing to administer NPH insulin to a patient. The nurse observes that the
insulin appears clear. What is the most appropriate nursing action?
A. Administer the insulin as ordered
B. Discard the insulin and obtain a new vial **[CORRECT]**
C. Roll the vial gently between the hands to resuspend it
,D. Shake the vial vigorously until the solution becomes cloudy
Correct Answer: B
Rationale: NPH insulin is an intermediate-acting insulin that should inherently appear cloudy
due to the addition of protamine; a clear appearance indicates separation, improper mixing, or a
wrong insulin entirely. If a vial of NPH does not become uniformly cloudy after gentle rolling, it
must be discarded because the dose will be inaccurate. Module 9 Exam Insight: Recognizing
the physical characteristics of NPH (cloudy) versus long-acting insulins like glargine (clear) is a
foundational safety check heavily emphasized in Module 9.
Q4: A patient with Type 2 diabetes is prescribed insulin glargine. Which instruction should the
nurse include in the patient's teaching plan?
A. "Inject this medication directly into your muscle for faster absorption."
B. "Mix this insulin with your rapid-acting insulin in the same syringe."
C. "Administer this medication at the exact same time every day." **[CORRECT]**
D. "Expect this insulin to peak in 4 to 8 hours to prevent postprandial hypoglycemia."
Correct Answer: C
Rationale: Insulin glargine is a long-acting insulin with no peak and a duration of 24 hours or
more, requiring strict once-daily timing to maintain steady basal coverage. It must never be
mixed with other insulins, must be injected subcutaneously, and does not require peak
monitoring since its flat profile eliminates peak-related hypoglycemia. Module 9 Exam Insight:
Portage Learning tests the "do not mix" rule and "no peak" pharmacokinetics of long-acting
insulins to ensure safety in basal dosing regimens.
Q5: A nurse is preparing to administer 20 units of NPH insulin and 10 units of insulin lispro to a
patient. Which action demonstrates the correct technique?
A. Inject 10 units of air into the NPH vial, then 20 units of air into the lispro vial
B. Draw up 10 units of lispro first, then draw up 20 units of NPH **[CORRECT]**
C. Draw up 20 units of NPH first, then draw up 10 units of lispro
D. Draw up the medications into two separate syringes
Correct Answer: B
Rationale: When mixing insulins, the clear (short or rapid-acting) insulin must always be drawn
up first to prevent contamination of the clear vial with the cloudy NPH suspension. Injecting air
into the NPH vial first without withdrawing, then injecting air into the lispro vial and withdrawing
the clear lispro, followed by the NPH, maintains sterility and accuracy. Module 9 Exam Insight:
This insulin mixing sequence (clear before cloudy, air into cloudy first) is a high-yield procedural
error-identification question on the NURS 251 Module 9 Exam.
Q6: A patient receiving insulin reports feeling jittery, anxious, and diaphoretic. Their blood
glucose is 58 mg/dL. The patient is conscious and able to swallow. What is the priority nursing
intervention?
A. Administer 1 mg of glucagon intramuscularly
B. Provide 4 ounces of orange juice or regular soda **[CORRECT]**
C. Initiate a 50% dextrose intravenous bolus
D. Encourage the patient to eat a high-protein snack
,Correct Answer: B
Rationale: For a conscious patient with mild to moderate hypoglycemia, the Rule of 15 applies:
administer 15 grams of fast-acting carbohydrates (like 4 oz of juice), recheck in 15 minutes, and
repeat if needed. Glucagon and IV dextrose are reserved for unconscious patients or those
unable to swallow, while protein does not raise blood sugar quickly enough. Module 9 Exam
Insight: Distinguishing between conscious hypoglycemia management (oral carbohydrates) and
unconscious management (glucagon/IV dextrose) is a critical application requirement.
Q7: A nurse is educating a patient on insulin degludec storage. How long can an opened vial of
insulin degludec be kept at room temperature?
A. 14 days
B. 28 days
C. 42 days
D. 56 days **[CORRECT]**
Correct Answer: D
Rationale: Insulin degludec has the longest room-temperature shelf life of any opened insulin,
stable for up to 56 days once punctured, compared to 28 days for most others (like glargine) or
42 days for detemir. Unopened vials of all insulins must be refrigerated until their expiration date
to maintain efficacy. Module 9 Exam Insight: Memorizing the specific room-temperature
expiration timelines (28 vs 42 vs 56 days) for long-acting insulins is a frequent recall question in
this module.
Q8: A patient with Type 2 diabetes is scheduled for a computed tomography (CT) scan with
iodinated contrast dye. The nurse notes the patient takes metformin. What is the priority action?
A. Hold the metformin the evening before the procedure and for 48 hours after **[CORRECT]**
B. Administer the metformin immediately after the CT scan to prevent hyperglycemia
C. Increase the metformin dose to counteract the hyperglycemic effects of the contrast dye
D. Switch the patient to a sulfonylurea permanently due to contrast interactions
Correct Answer: A
Rationale: Metformin carries a black box warning for lactic acidosis, and the risk increases
significantly if renal impairment occurs due to iodinated contrast dye. The standard protocol is to
hold metformin at the time of the procedure and for 48 hours afterward, reassessing renal
function before resuming. Module 9 Exam Insight: The intersection of metformin's black box
warning (lactic acidosis) and diagnostic procedures (contrast dye) is a heavily tested safety
protocol in NURS 251.
Q9: An 80-year-old patient with Type 2 diabetes and chronic kidney disease requires an oral
hypoglycemic agent. The healthcare provider is considering a sulfonylurea. Which agent is
safest for this patient?
A. Glyburide
B. Glipizide **[CORRECT]**
C. Chlorpropamide
D. Tolbutamide
Correct Answer: B
, Rationale: Glipizide is the preferred sulfonylurea in elderly patients and those with renal
impairment because it has a shorter half-life, is metabolized by the liver to inactive metabolites,
and carries a lower risk of prolonged hypoglycemia. Glyburide has a long half-life and active
renal metabolites, making it highly dangerous for elderly or renally compromised patients due to
severe hypoglycemia risk. Module 9 Exam Insight: Portage Learning heavily emphasizes
selecting glipizide over glyburide in geriatric and renal failure populations due to
pharmacokinetic differences.
Q10: A patient with Type 2 diabetes is prescribed repaglinide. Which statement by the patient
indicates a need for further teaching?
A. "I will take this medication right before I eat my meals."
B. "If I skip a meal, I will also skip my dose of this medication." **[CORRECT]**
C. "I will take this medication every morning regardless of my meal schedule."
D. "I might experience some low blood sugar while taking this drug."
Correct Answer: C
Rationale: Meglitinides like repaglinide have a very short onset and duration, designed
specifically to stimulate insulin secretion only in response to carbohydrate intake. Taking the
medication without eating, such as every morning regardless of a meal, will cause severe
hypoglycemia; therefore, doses must strictly correlate with meals. Module 9 Exam Insight: The
"skip meal, skip dose" rule is a unique pharmacokinetic characteristic of meglitinides frequently
tested to contrast them with sulfonylureas.
Q11: A patient with Type 2 diabetes and New York Heart Association (NYHA) Class III heart
failure is prescribed an antidiabetic medication. The nurse knows to question a prescription for
which drug class?
A. DPP-4 inhibitors
B. Sulfonylureas
C. Thiazolidinediones (TZDs) **[CORRECT]**
D. Biguanides
Correct Answer: C
Rationale: Thiazolidinediones (like pioglitazone) carry a black box warning for heart failure
because they cause fluid retention and peripheral edema, which can exacerbate or precipitate
cardiac decompensation. They are strictly contraindicated in patients with NYHA Class III or IV
heart failure. Module 9 Exam Insight: Associating TZDs with fluid retention/heart failure and
recognizing their black box warning is a mandatory clinical judgment point in Module 9.
Q12: A nurse is providing discharge teaching to a patient newly prescribed liraglutide. Which
adverse effect should the nurse prioritize in the teaching?
A. Hypoglycemia when taken alone
B. Medullary thyroid carcinoma risk **[CORRECT]**
C. Severe constipation
D. Weight gain
Correct Answer: B
