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NCLEX-RN · 8 Essential Terms
NCLEX endocrine medications and the hypoglycemia rule of 15: lispro, glargine, IV regular insulin, metformin, glipizide, levothyroxine, and prednisone. Study notes, not sliding-scale orders.
These are licensure study notes, not orders for patient care. Follow your program, your facility policy, and the current test plan.
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A rapid-acting insulin given with meals. Onset is minutes, so food needs to be present. It is not the insulin used as a long background dose.
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A rapid-acting insulin given with meals. Onset is minutes, so food needs to be present. It is not the insulin used as a long background dose.
Mnemonic. Lispro is the mealtime sprint. The tray should be there.
Exam trap. Giving lispro and then sending the tray away is the trap. Rapid insulin without carbohydrates is a hypoglycemia item. It is also not mixed casually with glargine.
A long-acting basal insulin with a relatively flat profile. It is given on a schedule and is not mixed in the same syringe with other insulins.
Mnemonic. Glargine is the background. It does not share a syringe.
Exam trap. The trap is drawing it up with lispro to save a poke. Glargine stays in its own syringe. It is also not the insulin a nurse reaches for to treat a glucose of 40.
Regular insulin is the insulin commonly given intravenously, including in hyperkalemia protocols paired with glucose and in diabetic ketoacidosis infusions.
Mnemonic. When the stem says IV insulin, think regular.
Exam trap. Lispro and glargine are not IV insulins. The trap is pushing any insulin the pharmacy sent by the IV route because the glucose is high.
A biguanide that lowers hepatic glucose output and improves insulin sensitivity. By itself it does not drive insulin release, so it does not cause hypoglycemia the way a sulfonylurea does.
Mnemonic. Metformin does not poke the pancreas. Hold it around iodinated contrast because of lactic acidosis.
Exam trap. The contrast question is the classic trap. The drug is held around the dye and restarted only when kidney function is acceptable. A client on metformin alone who feels shaky needs a different explanation than too much sulfonylurea.
A sulfonylurea that stimulates the pancreas to release insulin. Hypoglycemia is an expected risk, especially if the client skips a meal.
Mnemonic. Glipizide squeezes insulin out of the pancreas. No food means too much insulin for the moment.
Exam trap. The trap is treating every oral diabetes drug as if it cannot cause a low. Sulfonylureas can. Many clients with a sulfa allergy still need a careful allergy history before the drug is treated as interchangeable with every sulfa story.
Synthetic T4 used for hypothyroidism. It is taken on an empty stomach, often 30 to 60 minutes before breakfast, and not at the same moment as calcium or iron.
Mnemonic. Levothyroxine is dawn, empty stomach, away from the calcium tablet.
Exam trap. The trap is an evening multivitamin with minerals taken in the same swallow. Absorption drops, the TSH rises, and someone increases the dose for the wrong reason. Pulse and chest pain are the too-much-hormone story.
A corticosteroid used for inflammation and immune suppression. It raises blood glucose, increases infection risk, and is not stopped abruptly after longer use because the adrenal axis is suppressed.
Mnemonic. Prednisone borrows stress hormone. Do not cancel the loan overnight, and watch glucose and infection.
Exam trap. The trap is a client who feels better and stops the drug, or a nurse who ignores a rising glucose because steroids are not diabetes drugs. Mood and fluid changes are part of the same stem.
A teaching rule for mild hypoglycemia: take 15 grams of fast carbohydrate, recheck glucose in 15 minutes, and repeat if it is still low. Once it recovers, follow with a longer-acting snack if a meal is not due.
Mnemonic. Fifteen grams, fifteen minutes, then recheck. Juice is for a client who can swallow.
Exam trap. The trap is forcing juice into a client who cannot protect the airway. An unconscious client is a glucagon or IV dextrose item, not an oral rule. Chocolate is a poor first carbohydrate because the fat slows it.