Insulin lispro is ordered before breakfast for a ward patient. When should the nurse give it?

Within 15 minutes before the meal is eaten

At bedtime, whatever the patient has eaten

Only once the morning glucose is over 300 mg/dL

One hour before the breakfast tray arrives

Oral pantoprazole is prescribed once daily for a peptic ulcer. It is most effective when taken:

Together with a dose of antacid

Straight after the evening meal

Insulin, steroids, GI and respiratory drugs

18 AIIMS NORCET (Nursing Officer) practice questions on Insulin, steroids, GI and respiratory drugs, part of Pharmacology. The first 18 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Insulin lispro is ordered before breakfast for a ward patient. When should the nurse give it?
1. AAt bedtime, whatever the patient has eaten
2. BOnly once the morning glucose is over 300 mg/dL
3. CWithin 15 minutes before the meal is eaten
4. DOne hour before the breakfast tray arrives
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Answer: C · Within 15 minutes before the meal is eaten
Lispro is a rapid-acting analogue with an onset of about 15 minutes and a peak at about 1 hour. It is given within 15 minutes before a meal so that its action matches the rise in glucose from food. If the meal is delayed after the injection, the patient can become hypoglycaemic. The nurse therefore confirms the tray is ready before giving it.
- A: Bedtime dosing suits basal insulin, not a mealtime analogue.
- B: A mealtime dose is given to cover food, not withheld until glucose is very high.
- D: Giving it an hour early lets the insulin peak before food is absorbed.
Question 2 · Medium
Oral pantoprazole is prescribed once daily for a peptic ulcer. It is most effective when taken:
1. ATogether with a dose of antacid
2. BAt bedtime on an empty stomach
3. C30-60 minutes before breakfast
4. DStraight after the evening meal
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Answer: C · 30-60 minutes before breakfast
Proton-pump inhibitors block only the pumps that are active, and the most pumps are activated by the first meal after an overnight fast. Taken 30-60 minutes before breakfast, the drug is absorbed and reaches the parietal cells just as they are switched on. The tablet is swallowed whole, because it is enteric-coated against destruction by acid. Antacids are not needed with it.
- A: Antacids do not help and reduce acid stimulation of the pumps.
- B: Few pumps are active overnight, so a bedtime dose acts on fewer of them.
- D: After a meal the pumps are already active before the drug is absorbed.
Question 3 · Easy
Which oral antidiabetic drug lowers glucose by stimulating insulin release from pancreatic beta cells?
1. AAcarbose
2. BGlimepiride
3. CPioglitazone
4. DMetformin
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Answer: B · Glimepiride
Glimepiride is a sulfonylurea: it closes ATP-sensitive potassium channels on beta cells, which depolarises them and releases insulin. Because it raises insulin whatever the glucose level, its main risk is hypoglycaemia, especially when a meal is missed. It also causes weight gain. Sulfonylureas need working beta cells, so they do not help type 1 diabetes.
- A: Acarbose slows carbohydrate digestion in the gut.
- C: Pioglitazone improves insulin sensitivity in muscle and fat.
- D: Metformin reduces liver glucose output and does not release insulin.
Question 4 · Medium
A child with acute severe asthma has received salbutamol nebulisations every 20 minutes for an hour. Which electrolyte disturbance should the nurse watch for?
1. AHyperkalaemia
2. BHypokalaemia
3. CHypernatraemia
4. DHypocalcaemia
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Answer: B · Hypokalaemia
Beta-2 agonists stimulate the sodium-potassium pump and drive potassium into cells, so repeated or IV salbutamol lowers serum potassium. Hypokalaemia can cause muscle weakness and arrhythmias, especially with tachycardia already present. Steroids and theophylline, often given in the same attack, add to the potassium loss. Serum potassium is checked in children needing frequent or continuous nebulisation.
- A: Salbutamol shifts potassium into cells; it is even used to treat hyperkalaemia.
- C: Beta-2 agonists do not raise serum sodium.
- D: Calcium is not significantly changed by salbutamol.
Question 5 · Easy
Which rare but serious adverse effect is classically linked to metformin?
1. ASevere hypoglycaemia
2. BFluid retention
3. CMarked weight gain
4. DLactic acidosis
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Answer: D · Lactic acidosis
Metformin reduces hepatic glucose output and can raise lactate, so lactic acidosis is its classic serious adverse effect. The risk rises with renal failure, hypoxia, shock, sepsis, alcohol excess and iodinated contrast. That is why metformin is withheld before contrast studies and major surgery in at-risk patients. It does not cause hypoglycaemia when used alone and tends to cause weight loss.
- A: Metformin alone does not stimulate insulin release, so it rarely causes hypoglycaemia.
- B: Fluid retention and oedema are adverse effects of pioglitazone.
- C: Weight gain is typical of sulfonylureas, insulin and glitazones, not metformin.
Question 6 · Hard
A 20 kg child is to receive IV ondansetron 0.15 mg/kg before chemotherapy. The ampoule contains 2 mg/mL. What volume should the nurse draw up?
1. A1.5 mL
2. B0.15 mL
3. C6 mL
4. D3 mL
Answer and explanation in LearnFree account
Question 7 · Medium
A nurse is preparing regular insulin and NPH insulin in the same syringe. Which step is correct?
1. ADraw up the cloudy NPH insulin first
2. BDraw up the clear regular insulin first
3. CShake the NPH vial hard before drawing it
4. DInject air into the regular vial first
Answer and explanation in LearnFree account
Question 8 · Medium
Six weeks into carbimazole therapy, a woman phones the clinic with mouth ulcers, painful swallowing and a temperature of 38.5 °C. What is the nurse's priority advice?
1. ATake paracetamol and keep the next clinic visit
2. BUse salt-water gargles and carry on the tablets
3. CDouble the tablets, as fever means thyrotoxicosis
4. DStop the tablets and come in today for a blood count
Answer and explanation in LearnFree account
Question 9 · Medium
A patient with a flare of ulcerative colitis is started on high-dose IV hydrocortisone. Which change should the nurse expect and monitor for?
1. AA fall in serum sodium
2. BA fall in the total WBC count
3. CA rise in blood glucose
4. DA rise in serum potassium
Answer and explanation in LearnFree account
Question 10 · Easy
A patient is started on levothyroxine for hypothyroidism. The nurse teaches that the tablet is best taken:
1. AWith the calcium or iron tablet at breakfast
2. BIn two halves, one with each main meal
3. COn an empty stomach, 30-60 minutes before breakfast
4. DAt bedtime, together with the evening meal
Answer and explanation in LearnFree account
Question 11 · Hard
A 74-year-old woman on glibenclamide with chronic kidney disease is brought in confused; capillary glucose is 40 mg/dL. After 25% dextrose IV she becomes alert and her glucose is 140 mg/dL. What is the most appropriate plan?
1. AGive her next glibenclamide dose with a meal
2. BSend her home once a second reading is normal
3. CAdmit, infuse dextrose and check glucose hourly for 24 hours
4. DGive glucagon IM now to prevent a second episode
Answer and explanation in LearnFree account
Question 12 · Hard
A patient in thyroid storm has orders for propranolol, propylthiouracil, Lugol's iodine and hydrocortisone. What timing rule should the nurse follow?
1. AGive the iodine at least 1 hour after propylthiouracil
2. BGive propranolol only after the iodine has acted
3. CGive the iodine at least 1 hour before propylthiouracil
4. DGive the iodine and propylthiouracil in one syringe
Answer and explanation in LearnFree account
Question 13 · Easy
Ondansetron prevents chemotherapy-induced vomiting by acting as a:
1. AMuscarinic receptor antagonist
2. B5-HT3 receptor antagonist
3. CHistamine H1 receptor antagonist
4. DDopamine D2 receptor antagonist
Answer and explanation in LearnFree account
Question 14 · Medium
A patient receives NPH (isophane) insulin subcutaneously at 7 AM. At about what time is the risk of hypoglycaemia from this dose greatest?
1. ABefore breakfast next morning
2. BAround midnight that night
3. CMid-morning, around 8 AM
4. DMid-afternoon, around 3 PM
Answer and explanation in LearnFree account
Question 15 · Medium
A patient who has taken prednisolone 30 mg daily for three months feels well and wants to stop the tablets today. Stopping suddenly puts him at risk of:
1. AAcute adrenal insufficiency
2. BRebound hyperglycaemia
3. CSevere hypertensive crisis
4. DA flare of Cushing syndrome
Answer and explanation in LearnFree account
Question 16 · Easy
After each dose from a budesonide inhaler, the patient should rinse the mouth and spit out the water to prevent:
1. ATremor and palpitations
2. BLoss of taste for food
3. COropharyngeal candidiasis
4. DReflex bronchospasm
Answer and explanation in LearnFree account
Question 17 · Hard
A man arrives with DKA: glucose 480 mg/dL, pH 7.12, bicarbonate 9 mmol/L and potassium 3.0 mmol/L (normal 3.5-5.0). IV saline has been started. According to standard DKA protocols, what is the next step?
1. AGive a 10-unit insulin bolus, then start potassium
2. BReplace potassium and hold insulin until K is at least 3.3
3. CGive IV sodium bicarbonate to correct the acidosis first
4. DStart the insulin infusion at once and recheck K in 4 hours
Answer and explanation in LearnFree account
Question 18 · Medium
A woman with Graves disease is found to be 7 weeks pregnant. Which antithyroid drug is preferred during the first trimester?
1. APropylthiouracil
2. BMethimazole
3. CRadioactive iodine
4. DCarbimazole
Answer and explanation in LearnFree account

Insulin, steroids, GI and respiratory drugs

Insulin lispro is ordered before breakfast for a ward patient. When should the nurse give it?

Oral pantoprazole is prescribed once daily for a peptic ulcer. It is most effective when taken:

Which oral antidiabetic drug lowers glucose by stimulating insulin release from pancreatic beta cells?

A child with acute severe asthma has received salbutamol nebulisations every 20 minutes for an hour. Which electrolyte disturbance should the nurse watch for?

Which rare but serious adverse effect is classically linked to metformin?

A 20 kg child is to receive IV ondansetron 0.15 mg/kg before chemotherapy. The ampoule contains 2 mg/mL. What volume should the nurse draw up?

A nurse is preparing regular insulin and NPH insulin in the same syringe. Which step is correct?

Six weeks into carbimazole therapy, a woman phones the clinic with mouth ulcers, painful swallowing and a temperature of 38.5 °C. What is the nurse's priority advice?

A patient with a flare of ulcerative colitis is started on high-dose IV hydrocortisone. Which change should the nurse expect and monitor for?

A patient is started on levothyroxine for hypothyroidism. The nurse teaches that the tablet is best taken:

A 74-year-old woman on glibenclamide with chronic kidney disease is brought in confused; capillary glucose is 40 mg/dL. After 25% dextrose IV she becomes alert and her glucose is 140 mg/dL. What is the most appropriate plan?

A patient in thyroid storm has orders for propranolol, propylthiouracil, Lugol's iodine and hydrocortisone. What timing rule should the nurse follow?

Ondansetron prevents chemotherapy-induced vomiting by acting as a:

A patient receives NPH (isophane) insulin subcutaneously at 7 AM. At about what time is the risk of hypoglycaemia from this dose greatest?

A patient who has taken prednisolone 30 mg daily for three months feels well and wants to stop the tablets today. Stopping suddenly puts him at risk of:

After each dose from a budesonide inhaler, the patient should rinse the mouth and spit out the water to prevent:

A man arrives with DKA: glucose 480 mg/dL, pH 7.12, bicarbonate 9 mmol/L and potassium 3.0 mmol/L (normal 3.5-5.0). IV saline has been started. According to standard DKA protocols, what is the next step?

A woman with Graves disease is found to be 7 weeks pregnant. Which antithyroid drug is preferred during the first trimester?