BSN 315 Pharmacology HESI V3 —
COMPREHENSIVE EXAM QUESTIONS AND
ANSWERS|NEW 2026-2027 UPDATE
Question 1
A patient with type 2 diabetes is prescribed metformin 1000 mg BID. The nurse
teaches the patient that the primary mechanism of action is:
A. Stimulation of insulin secretion from pancreatic beta cells
B. Decreased hepatic glucose production and improved peripheral insulin sensitivity
C. Delay of carbohydrate absorption in the intestine
D. Increased renal glucose excretion
Correct Answer: B
Rationale: Metformin is a biguanide that primarily decreases hepatic
gluconeogenesis (glucose production by the liver) and improves peripheral insulin
sensitivity in muscle and adipose tissue. It does NOT stimulate insulin secretion
(sulfonylureas do), delay carb absorption (alpha-glucosidase inhibitors), or increase
renal glucose excretion (SGLT2 inhibitors). It is weight-neutral or causes modest
weight loss.
Question 2
A patient with type 1 diabetes uses an insulin pump. At 0200, the patient's blood
glucose is 320 mg/dL with moderate ketones. The most likely cause and appropriate
nursing action are:
A. Too much basal insulin; decrease basal rate
B. Infusion set failure or insulin deficiency; check site, change set, deliver correction
bolus, hydrate
C. Dawn phenomenon; increase basal rate starting at 0300
D. Somogyi effect; decrease basal rate
Correct Answer: B
1
, Rationale: Hyperglycemia with ketones in a pump user strongly suggests infusion set
failure (kinked catheter, dislodged cannula, air bubble, expired insulin) or insufficient
insulin delivery. The nurse should: check the infusion site, change the
set/tubing/insulin reservoir, deliver a correction bolus (via injection if pump failure is
suspected), hydrate with water, and recheck glucose/ketones every 1-2 hours. Too
much insulin would cause hypoglycemia, not hyperglycemia with ketones.
Question 3
A patient with type 2 diabetes and established ASCVD has an HbA1c of 8.2% on
metformin 2000 mg. Which add-on agent has the strongest evidence for
cardiovascular benefit?
A. Glipizide
B. Pioglitazone
C. Empagliflozin or liraglutide
D. Sitagliptin
Correct Answer: C
Rationale: Empagliflozin (SGLT2i, EMPA-REG) and liraglutide (GLP-1 RA, LEADER)
have demonstrated significant reductions in major adverse cardiovascular events
(MACE), CV death, and heart failure hospitalization in patients with T2DM and
established ASCVD. ADA guidelines strongly recommend adding SGLT2i or GLP-1 RA
with proven CV benefit in this population. Glipizide, pioglitazone, and sitagliptin do
not have this evidence.
Question 4
A patient with hypothyroidism is started on levothyroxine 125 mcg daily. The nurse
instructs the patient that TSH should be rechecked:
A. In 1 week
B. In 4-6 weeks
C. In 3 months
2
COMPREHENSIVE EXAM QUESTIONS AND
ANSWERS|NEW 2026-2027 UPDATE
Question 1
A patient with type 2 diabetes is prescribed metformin 1000 mg BID. The nurse
teaches the patient that the primary mechanism of action is:
A. Stimulation of insulin secretion from pancreatic beta cells
B. Decreased hepatic glucose production and improved peripheral insulin sensitivity
C. Delay of carbohydrate absorption in the intestine
D. Increased renal glucose excretion
Correct Answer: B
Rationale: Metformin is a biguanide that primarily decreases hepatic
gluconeogenesis (glucose production by the liver) and improves peripheral insulin
sensitivity in muscle and adipose tissue. It does NOT stimulate insulin secretion
(sulfonylureas do), delay carb absorption (alpha-glucosidase inhibitors), or increase
renal glucose excretion (SGLT2 inhibitors). It is weight-neutral or causes modest
weight loss.
Question 2
A patient with type 1 diabetes uses an insulin pump. At 0200, the patient's blood
glucose is 320 mg/dL with moderate ketones. The most likely cause and appropriate
nursing action are:
A. Too much basal insulin; decrease basal rate
B. Infusion set failure or insulin deficiency; check site, change set, deliver correction
bolus, hydrate
C. Dawn phenomenon; increase basal rate starting at 0300
D. Somogyi effect; decrease basal rate
Correct Answer: B
1
, Rationale: Hyperglycemia with ketones in a pump user strongly suggests infusion set
failure (kinked catheter, dislodged cannula, air bubble, expired insulin) or insufficient
insulin delivery. The nurse should: check the infusion site, change the
set/tubing/insulin reservoir, deliver a correction bolus (via injection if pump failure is
suspected), hydrate with water, and recheck glucose/ketones every 1-2 hours. Too
much insulin would cause hypoglycemia, not hyperglycemia with ketones.
Question 3
A patient with type 2 diabetes and established ASCVD has an HbA1c of 8.2% on
metformin 2000 mg. Which add-on agent has the strongest evidence for
cardiovascular benefit?
A. Glipizide
B. Pioglitazone
C. Empagliflozin or liraglutide
D. Sitagliptin
Correct Answer: C
Rationale: Empagliflozin (SGLT2i, EMPA-REG) and liraglutide (GLP-1 RA, LEADER)
have demonstrated significant reductions in major adverse cardiovascular events
(MACE), CV death, and heart failure hospitalization in patients with T2DM and
established ASCVD. ADA guidelines strongly recommend adding SGLT2i or GLP-1 RA
with proven CV benefit in this population. Glipizide, pioglitazone, and sitagliptin do
not have this evidence.
Question 4
A patient with hypothyroidism is started on levothyroxine 125 mcg daily. The nurse
instructs the patient that TSH should be rechecked:
A. In 1 week
B. In 4-6 weeks
C. In 3 months
2
