,1. A patient newly diagnosed with type 2 diabetes mellitus is being evaluated for
initiation of pharmacologic therapy. The healthcare provider reviews the patient’s
medical history and asks about lifestyle factors, alcohol use, and other conditions
that may affect medication safety. In which patient population is metformin
contraindicated due to an increased risk of a serious adverse effect?
A. Diabetics with an HbA1c level below 7.0%
B. Patients older than 50 years of age
C. Patients with chronic alcohol use disorder
D. Women experiencing infertility
Correct Answer: C. Patients with chronic alcohol use disorder
Rationale:
Metformin is contraindicated in patients with significant alcohol use because
excessive alcohol intake increases the risk of lactic acidosis, a rare but potentially life-
threatening complication associated with metformin accumulation.
Alcohol interferes with lactate metabolism in the liver, and when combined with
metformin, it can increase lactate levels and impair the body’s ability to clear lactic
acid.
Age alone, controlled HbA1c levels, and infertility do not represent contraindications
for metformin therapy unless another underlying medical condition is present.
2. A provider is preparing to prescribe metformin for a patient newly diagnosed
with type 2 diabetes mellitus. The nurse reviews laboratory results before
administering the medication. Which laboratory finding indicates that metformin
therapy may be contraindicated?
A. Estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m²
B. Serum creatinine level of 0.8 mg/dL
C. White blood cell count of 7.8 × 10⁹/L
D. Blood urea nitrogen (BUN) level of 17 mg/dL
Correct Answer: A. Estimated glomerular filtration rate (eGFR) of less than 30
mL/min/1.73 m²
,Rationale:
Metformin is contraindicated in patients with significantly impaired renal function,
particularly those with an eGFR below 30 mL/min/1.73 m², because reduced kidney
function prevents adequate elimination of the medication.
Accumulation of metformin can increase the risk of metformin-associated lactic
acidosis, which may become life-threatening if untreated.
A normal creatinine level, normal white blood cell count, and normal BUN level do
not indicate renal impairment that would require withholding metformin.
3. A 68-year-old patient with type 2 diabetes mellitus and a history of heart disease
is being evaluated for additional glucose-lowering therapy. The patient’s
echocardiogram reveals a cardiac ejection fraction of 40%. Which medication class
should the provider avoid because it may worsen the patient’s cardiac condition?
A. Second-generation sulfonylureas
B. Thiazolidinediones
C. Dopamine agonists
D. Alpha-glucosidase inhibitors
Correct Answer: B. Thiazolidinediones
Rationale:
Thiazolidinediones (TZDs), such as pioglitazone, are contraindicated or avoided in
patients with reduced ejection fraction or heart failure because they cause fluid
retention and increased plasma volume.
Fluid retention can worsen heart failure symptoms, increase edema, and contribute
to further cardiac stress in patients with compromised ventricular function.
Other medication classes listed do not have the same significant risk of worsening
heart failure through fluid retention.
4. Sabrina is a 35-year-old female who presents to the clinic reporting fatigue,
anxiety, difficulty sleeping, and frequent episodes of feeling overheated. She states
, that she has unintentionally lost 23 pounds over the last 2 months despite having
no major dietary changes. Her husband reports that she keeps the home unusually
cold because she feels excessively warm. Physical examination reveals tachycardia
with a heart rate of 104 beats/min and a slightly enlarged thyroid gland. Laboratory
testing confirms hyperthyroidism consistent with Graves’ disease.
Which medication should the provider prescribe as the first-line treatment for
Graves’ disease to reduce thyroid hormone production?
A. Methimazole
B. Metoprolol
C. Allopurinol
D. Levothyroxine
Correct Answer: A. Methimazole
Rationale:
Methimazole is considered a first-line antithyroid medication for most patients with
Graves’ disease because it inhibits thyroid hormone synthesis by blocking thyroid
peroxidase activity.
Reducing thyroid hormone production helps improve symptoms such as weight loss,
tachycardia, anxiety, and heat intolerance caused by excessive thyroid activity.
Metoprolol may be used as an adjunct medication to control symptoms such as rapid
heart rate but does not treat the underlying thyroid hormone overproduction.
Levothyroxine would worsen hyperthyroidism because it replaces thyroid hormone.
5. A 52-year-old patient is newly diagnosed with type 2 diabetes mellitus. The
patient has adequate kidney and liver function and has not previously received
diabetes medications. The provider discusses lifestyle modifications and begins
planning initial pharmacologic therapy.
Which medication is considered the first-line treatment for this newly diagnosed
diabetic patient?
initiation of pharmacologic therapy. The healthcare provider reviews the patient’s
medical history and asks about lifestyle factors, alcohol use, and other conditions
that may affect medication safety. In which patient population is metformin
contraindicated due to an increased risk of a serious adverse effect?
A. Diabetics with an HbA1c level below 7.0%
B. Patients older than 50 years of age
C. Patients with chronic alcohol use disorder
D. Women experiencing infertility
Correct Answer: C. Patients with chronic alcohol use disorder
Rationale:
Metformin is contraindicated in patients with significant alcohol use because
excessive alcohol intake increases the risk of lactic acidosis, a rare but potentially life-
threatening complication associated with metformin accumulation.
Alcohol interferes with lactate metabolism in the liver, and when combined with
metformin, it can increase lactate levels and impair the body’s ability to clear lactic
acid.
Age alone, controlled HbA1c levels, and infertility do not represent contraindications
for metformin therapy unless another underlying medical condition is present.
2. A provider is preparing to prescribe metformin for a patient newly diagnosed
with type 2 diabetes mellitus. The nurse reviews laboratory results before
administering the medication. Which laboratory finding indicates that metformin
therapy may be contraindicated?
A. Estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m²
B. Serum creatinine level of 0.8 mg/dL
C. White blood cell count of 7.8 × 10⁹/L
D. Blood urea nitrogen (BUN) level of 17 mg/dL
Correct Answer: A. Estimated glomerular filtration rate (eGFR) of less than 30
mL/min/1.73 m²
,Rationale:
Metformin is contraindicated in patients with significantly impaired renal function,
particularly those with an eGFR below 30 mL/min/1.73 m², because reduced kidney
function prevents adequate elimination of the medication.
Accumulation of metformin can increase the risk of metformin-associated lactic
acidosis, which may become life-threatening if untreated.
A normal creatinine level, normal white blood cell count, and normal BUN level do
not indicate renal impairment that would require withholding metformin.
3. A 68-year-old patient with type 2 diabetes mellitus and a history of heart disease
is being evaluated for additional glucose-lowering therapy. The patient’s
echocardiogram reveals a cardiac ejection fraction of 40%. Which medication class
should the provider avoid because it may worsen the patient’s cardiac condition?
A. Second-generation sulfonylureas
B. Thiazolidinediones
C. Dopamine agonists
D. Alpha-glucosidase inhibitors
Correct Answer: B. Thiazolidinediones
Rationale:
Thiazolidinediones (TZDs), such as pioglitazone, are contraindicated or avoided in
patients with reduced ejection fraction or heart failure because they cause fluid
retention and increased plasma volume.
Fluid retention can worsen heart failure symptoms, increase edema, and contribute
to further cardiac stress in patients with compromised ventricular function.
Other medication classes listed do not have the same significant risk of worsening
heart failure through fluid retention.
4. Sabrina is a 35-year-old female who presents to the clinic reporting fatigue,
anxiety, difficulty sleeping, and frequent episodes of feeling overheated. She states
, that she has unintentionally lost 23 pounds over the last 2 months despite having
no major dietary changes. Her husband reports that she keeps the home unusually
cold because she feels excessively warm. Physical examination reveals tachycardia
with a heart rate of 104 beats/min and a slightly enlarged thyroid gland. Laboratory
testing confirms hyperthyroidism consistent with Graves’ disease.
Which medication should the provider prescribe as the first-line treatment for
Graves’ disease to reduce thyroid hormone production?
A. Methimazole
B. Metoprolol
C. Allopurinol
D. Levothyroxine
Correct Answer: A. Methimazole
Rationale:
Methimazole is considered a first-line antithyroid medication for most patients with
Graves’ disease because it inhibits thyroid hormone synthesis by blocking thyroid
peroxidase activity.
Reducing thyroid hormone production helps improve symptoms such as weight loss,
tachycardia, anxiety, and heat intolerance caused by excessive thyroid activity.
Metoprolol may be used as an adjunct medication to control symptoms such as rapid
heart rate but does not treat the underlying thyroid hormone overproduction.
Levothyroxine would worsen hyperthyroidism because it replaces thyroid hormone.
5. A 52-year-old patient is newly diagnosed with type 2 diabetes mellitus. The
patient has adequate kidney and liver function and has not previously received
diabetes medications. The provider discusses lifestyle modifications and begins
planning initial pharmacologic therapy.
Which medication is considered the first-line treatment for this newly diagnosed
diabetic patient?
