NR 565
FINAL EXAM
3 FULL SET EXAMS
(WEEKS 5 – 8 COVERED)
Verified Questions & Answers With Rationales
Advanced Pharmacology Fundamentals
Chamberlain
CONSISTING OF 225+ QUESTIONS
, NR 565 FINAL EXAM
PREVIEW PAGES BELOW
Get the Complete PDF
After Purchase
If you require further clarification or in need of
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PREVIEW + COMPLETE PDF
,Table of Contents
NR 565 FINAL EXAM SET 1 .................................................... 2
NR 565 FINAL EXAM SET 2 .................................................. 28
NR 565 FINAL EXAM SET 3 .................................................. 55
NR 565 FINAL EXAM SET 1
1. A 55-year-old with newly diagnosed type 2 diabetes has an A1C of 7.4% and
no significant comorbidities. Which initial pharmacologic approach is most
appropriate in addition to lifestyle changes?
A. Start basal insulin at bedtime
B. Begin metformin monotherapy
C. Initiate a sulfonylurea as first-line therapy
D. Start a GLP-1 receptor agonist and discontinue lifestyle measures
Correct Answer:
B. Begin metformin monotherapy
Expert Rationale:
Metformin is recommended as first-line pharmacologic therapy for most patients with
type 2 diabetes who have mild to moderate hyperglycemia and no contraindications,
in combination with diet and exercise.
2. A 62-year-old with type 2 diabetes and obesity is already on metformin. You
want to add a medication that promotes weight loss and improves glycemic
control without hypoglycemia. Which class best fits this goal?
A. Sulfonylurea
B. Thiazolidinedione
C. GLP-1 receptor agonist
D. DPP-4 inhibitor
, Correct Answer:
C. GLP-1 receptor agonist
Expert Rationale:
GLP-1 receptor agonists improve glycemic control, slow gastric emptying, decrease
appetite, and are associated with weight loss rather than weight gain.
3. A patient on canagliflozin reports increased urination and mild genital itching.
Which patient counseling point is most appropriate?
A. This may reflect euglycemic ketoacidosis and requires emergency care
B. These are expected effects related to glucosuria and mycotic infections
C. This indicates severe volume overload and the drug must be stopped
immediately
D. These symptoms occur only if the dose is too low
Correct Answer:
B. These are expected effects related to glucosuria and mycotic infections
Expert Rationale:
SGLT-2 inhibitors increase urinary glucose excretion, which can cause osmotic
diuresis and predispose to genital mycotic infections, so patients should be
counseled on hygiene and monitoring.
4. A 70-year-old with long-standing type 2 diabetes, advanced neuropathy, and
limited life expectancy asks about glycemic targets. Which A1C goal is most
appropriate?
A. <6.0%
B. <6.5%
C. <7.0%
D. <8.0%
Correct Answer:
D. <8.0%
Expert Rationale:
Less stringent A1C targets are reasonable in older adults with multiple complications
and limited life expectancy to reduce hypoglycemia risk and treatment burden.
5. A patient with type 2 diabetes is on metformin 1000 mg twice daily. The A1C
remains 9.8% after 4 months of triple oral therapy. Which next step is most
appropriate?
A. Increase metformin beyond the maximum recommended dose
B. Add basal insulin to the regimen
C. Switch all therapy to a thiazolidinedione alone
D. Discontinue medications and re-evaluate in a year
, Correct Answer:
B. Add basal insulin to the regimen
Expert Rationale:
When A1C remains markedly elevated despite maximized oral agents, guidelines
recommend adding basal insulin to improve fasting glucose control.
6. A patient on basal insulin has fasting glucose values within target but elevated
pre-dinner readings. Which adjustment is most appropriate?
A. Increase the basal insulin dose only
B. Add a rapid-acting insulin dose before lunch
C. Discontinue basal insulin and use sliding scale only
D. Move the basal dose to the morning
Correct Answer:
B. Add a rapid-acting insulin dose before lunch
Expert Rationale:
Post-prandial hyperglycemia despite controlled fasting values is best addressed by
adding or adjusting mealtime rapid-acting insulin rather than simply increasing basal
insulin.
7. A 36-year-old with frequent hypoglycemic episodes on prandial insulin admits
to skipping meals. Which intervention best addresses the primary problem?
A. Doubling all insulin doses
B. Switching to once-weekly injectable therapy
C. Reinforcing consistent carbohydrate intake with scheduled insulin doses
D. Starting a thiazolidinedione instead of insulin
Correct Answer:
C. Reinforcing consistent carbohydrate intake with scheduled insulin doses
Expert Rationale:
Recurrent hypoglycemia in the context of skipped meals reflects mismatch between
insulin and carbohydrate intake, so patient education about meal timing and dose
coordination is crucial.
8. A woman with newly diagnosed primary hypothyroidism has markedly
elevated TSH and low free T4. Which initial therapy is most appropriate?
A. Liothyronine once daily
B. Levothyroxine once daily
C. Methimazole twice daily
D. Radioactive iodine single dose
Correct Answer:
B. Levothyroxine once daily
, NR 565 FINAL EXAM SET 2
1. A 34-year-old female with Graves' disease is treated with radioactive iodine.
Two months later, she reports fatigue, weight gain, and cold intolerance. What is
the most likely cause?
A. Radiation sickness
B. Hypothyroidism
C. Thyroid storm
D. Bone marrow suppression
Correct Answer:
B. Hypothyroidism
Expert Rationale:
The most common outcome of radioactive iodine therapy is hypothyroidism due to
thyroid tissue destruction. Fatigue, weight gain, and cold intolerance are classic
hypothyroid symptoms.
2. A patient newly started on methimazole asks when they will feel better. What is
the best response?
A. "You should feel better within 24 hours."
B. "It may take several weeks to months."
C. "It works immediately but wears off quickly."
D. "It only works after surgery."
Correct Answer:
B. It may take several weeks to months
Expert Rationale:
Methimazole blocks new thyroid hormone synthesis but does not remove hormone
already stored in the thyroid gland. Symptom improvement usually takes several weeks.
3. A pregnant patient in the first trimester presents with hyperthyroidism. Which
medication is preferred?
A. Methimazole
B. Propylthiouracil (PTU)
C. Radioactive iodine
D. Levothyroxine
,Correct Answer:
B. Propylthiouracil (PTU)
Expert Rationale:
PTU is preferred during the first trimester because methimazole is associated with
teratogenic risk. Radioactive iodine is contraindicated in pregnancy.
4. A patient taking levothyroxine has a TSH of 8 mIU/L. What is the best action?
A. Decrease dose
B. Maintain dose
C. Increase dose
D. Stop medication
Correct Answer:
C. Increase dose
Expert Rationale:
An elevated TSH indicates under-treatment of hypothyroidism or inadequate thyroid
hormone replacement. The levothyroxine dose usually needs to be increased.
5. A patient takes levothyroxine with calcium supplements. What is the risk?
A. Increased toxicity
B. Reduced absorption
C. Increased metabolism
D. No interaction
Correct Answer:
B. Reduced absorption
Expert Rationale:
Calcium binds levothyroxine in the gastrointestinal tract and decreases absorption.
Levothyroxine should be separated from calcium by about 4 hours.
6. A 70-year-old patient is starting levothyroxine. What is the best approach?
A. Start high dose
B. Start low and titrate slowly
C. Give weekly dosing
D. Avoid therapy
Correct Answer:
B. Start low and titrate slowly
Expert Rationale:
Older adults are more vulnerable to cardiac stimulation from thyroid hormone. Starting
low and titrating slowly reduces the risk of angina, tachyarrhythmias, and cardiac strain.
, NR 565 FINAL EXAM SET 3
1. What is a possible result of untreated hypothyroidism during pregnancy?
A. Development problems such as decreased IQ
B. Fetal macrosomia
C. Gestational hypertension only
D. Maternal hyperglycemia
Correct Answer: A
Expert Rationale:
Untreated maternal hypothyroidism increases the risk of adverse neurodevelopmental
outcomes in the fetus, including decreased IQ. Thyroid hormone is critical for fetal brain
development, particularly in the first trimester before the fetal thyroid gland is functional.
Early detection and levothyroxine replacement are essential to prevent cognitive
impairment.
2. A 38-year-old has been diagnosed with hyperthyroidism. Which of the following
medications should the clinician prescribe to manage the symptoms associated
with tachycardia until the patient becomes euthyroid?
A. Levothyroxine
B. Propranolol
C. Radioactive iodine
D. Methimazole alone
Correct Answer: B
Expert Rationale:
Propranolol is a non-selective beta-blocker used as adjunctive therapy in
hyperthyroidism to control adrenergic symptoms such as tachycardia, tremors, and
anxiety. It does not treat the underlying thyroid hormone excess but provides
symptomatic relief until antithyroid medications (e.g., methimazole) or radioactive iodine
restore euthyroid status.
,3. Which of the following fasting plasma glucose (FPG) levels meets the American
Diabetes Association (ADA) diagnostic criteria for diabetes?
A. 100 mg/dL
B. 110 mg/dL
C. 126 mg/dL
D. 128 mg/dL
Correct Answer: D
Expert Rationale:
The ADA diagnostic criteria for diabetes include a fasting plasma glucose (FPG) level of
≥126 mg/dL (7.0 mmol/L) or higher. A value of 128 mg/dL meets this threshold. Other
diagnostic criteria include a 2-hour plasma glucose ≥200 mg/dL during a 75-g OGTT, a
random plasma glucose ≥200 mg/dL with classic symptoms, or an HbA1c ≥6.5%.
4. Match the following diabetes medication classes to their representative agents:
Class I: Biguanides
Class II: Glucagon-like Peptide-1 (GLP-1) Receptor Agonists
Class III: Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitors
Class IV: Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
Class V: Thiazolidinediones
Class VI: Sulfonylureas
Representative Agents:
1. Metformin
2. Exenatide (Byetta), Liraglutide (Victoza), Dulaglutide (Trulicity)
3. Canagliflozin (Invokana), Dapagliflozin (Farxiga)
4. Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta)
5. Pioglitazone, Rosiglitazone
6. Glyburide, Glimepiride, Glipizide
Correct Matching:
I-1, II-2, III-3, IV-4, V-5, VI-6
, NR 565
FINAL EXAM
3 FULL SET EXAMS
(WEEKS 5 – 8 COVERED)
Verified Questions & Answers With Rationales
Advanced Pharmacology Fundamentals
Chamberlain
CONSISTING OF 225+ QUESTIONS
FINAL EXAM
3 FULL SET EXAMS
(WEEKS 5 – 8 COVERED)
Verified Questions & Answers With Rationales
Advanced Pharmacology Fundamentals
Chamberlain
CONSISTING OF 225+ QUESTIONS
, NR 565 FINAL EXAM
PREVIEW PAGES BELOW
Get the Complete PDF
After Purchase
If you require further clarification or in need of
any study resources, feel free to Message me.
PREVIEW + COMPLETE PDF
,Table of Contents
NR 565 FINAL EXAM SET 1 .................................................... 2
NR 565 FINAL EXAM SET 2 .................................................. 28
NR 565 FINAL EXAM SET 3 .................................................. 55
NR 565 FINAL EXAM SET 1
1. A 55-year-old with newly diagnosed type 2 diabetes has an A1C of 7.4% and
no significant comorbidities. Which initial pharmacologic approach is most
appropriate in addition to lifestyle changes?
A. Start basal insulin at bedtime
B. Begin metformin monotherapy
C. Initiate a sulfonylurea as first-line therapy
D. Start a GLP-1 receptor agonist and discontinue lifestyle measures
Correct Answer:
B. Begin metformin monotherapy
Expert Rationale:
Metformin is recommended as first-line pharmacologic therapy for most patients with
type 2 diabetes who have mild to moderate hyperglycemia and no contraindications,
in combination with diet and exercise.
2. A 62-year-old with type 2 diabetes and obesity is already on metformin. You
want to add a medication that promotes weight loss and improves glycemic
control without hypoglycemia. Which class best fits this goal?
A. Sulfonylurea
B. Thiazolidinedione
C. GLP-1 receptor agonist
D. DPP-4 inhibitor
, Correct Answer:
C. GLP-1 receptor agonist
Expert Rationale:
GLP-1 receptor agonists improve glycemic control, slow gastric emptying, decrease
appetite, and are associated with weight loss rather than weight gain.
3. A patient on canagliflozin reports increased urination and mild genital itching.
Which patient counseling point is most appropriate?
A. This may reflect euglycemic ketoacidosis and requires emergency care
B. These are expected effects related to glucosuria and mycotic infections
C. This indicates severe volume overload and the drug must be stopped
immediately
D. These symptoms occur only if the dose is too low
Correct Answer:
B. These are expected effects related to glucosuria and mycotic infections
Expert Rationale:
SGLT-2 inhibitors increase urinary glucose excretion, which can cause osmotic
diuresis and predispose to genital mycotic infections, so patients should be
counseled on hygiene and monitoring.
4. A 70-year-old with long-standing type 2 diabetes, advanced neuropathy, and
limited life expectancy asks about glycemic targets. Which A1C goal is most
appropriate?
A. <6.0%
B. <6.5%
C. <7.0%
D. <8.0%
Correct Answer:
D. <8.0%
Expert Rationale:
Less stringent A1C targets are reasonable in older adults with multiple complications
and limited life expectancy to reduce hypoglycemia risk and treatment burden.
5. A patient with type 2 diabetes is on metformin 1000 mg twice daily. The A1C
remains 9.8% after 4 months of triple oral therapy. Which next step is most
appropriate?
A. Increase metformin beyond the maximum recommended dose
B. Add basal insulin to the regimen
C. Switch all therapy to a thiazolidinedione alone
D. Discontinue medications and re-evaluate in a year
, Correct Answer:
B. Add basal insulin to the regimen
Expert Rationale:
When A1C remains markedly elevated despite maximized oral agents, guidelines
recommend adding basal insulin to improve fasting glucose control.
6. A patient on basal insulin has fasting glucose values within target but elevated
pre-dinner readings. Which adjustment is most appropriate?
A. Increase the basal insulin dose only
B. Add a rapid-acting insulin dose before lunch
C. Discontinue basal insulin and use sliding scale only
D. Move the basal dose to the morning
Correct Answer:
B. Add a rapid-acting insulin dose before lunch
Expert Rationale:
Post-prandial hyperglycemia despite controlled fasting values is best addressed by
adding or adjusting mealtime rapid-acting insulin rather than simply increasing basal
insulin.
7. A 36-year-old with frequent hypoglycemic episodes on prandial insulin admits
to skipping meals. Which intervention best addresses the primary problem?
A. Doubling all insulin doses
B. Switching to once-weekly injectable therapy
C. Reinforcing consistent carbohydrate intake with scheduled insulin doses
D. Starting a thiazolidinedione instead of insulin
Correct Answer:
C. Reinforcing consistent carbohydrate intake with scheduled insulin doses
Expert Rationale:
Recurrent hypoglycemia in the context of skipped meals reflects mismatch between
insulin and carbohydrate intake, so patient education about meal timing and dose
coordination is crucial.
8. A woman with newly diagnosed primary hypothyroidism has markedly
elevated TSH and low free T4. Which initial therapy is most appropriate?
A. Liothyronine once daily
B. Levothyroxine once daily
C. Methimazole twice daily
D. Radioactive iodine single dose
Correct Answer:
B. Levothyroxine once daily
, NR 565 FINAL EXAM SET 2
1. A 34-year-old female with Graves' disease is treated with radioactive iodine.
Two months later, she reports fatigue, weight gain, and cold intolerance. What is
the most likely cause?
A. Radiation sickness
B. Hypothyroidism
C. Thyroid storm
D. Bone marrow suppression
Correct Answer:
B. Hypothyroidism
Expert Rationale:
The most common outcome of radioactive iodine therapy is hypothyroidism due to
thyroid tissue destruction. Fatigue, weight gain, and cold intolerance are classic
hypothyroid symptoms.
2. A patient newly started on methimazole asks when they will feel better. What is
the best response?
A. "You should feel better within 24 hours."
B. "It may take several weeks to months."
C. "It works immediately but wears off quickly."
D. "It only works after surgery."
Correct Answer:
B. It may take several weeks to months
Expert Rationale:
Methimazole blocks new thyroid hormone synthesis but does not remove hormone
already stored in the thyroid gland. Symptom improvement usually takes several weeks.
3. A pregnant patient in the first trimester presents with hyperthyroidism. Which
medication is preferred?
A. Methimazole
B. Propylthiouracil (PTU)
C. Radioactive iodine
D. Levothyroxine
,Correct Answer:
B. Propylthiouracil (PTU)
Expert Rationale:
PTU is preferred during the first trimester because methimazole is associated with
teratogenic risk. Radioactive iodine is contraindicated in pregnancy.
4. A patient taking levothyroxine has a TSH of 8 mIU/L. What is the best action?
A. Decrease dose
B. Maintain dose
C. Increase dose
D. Stop medication
Correct Answer:
C. Increase dose
Expert Rationale:
An elevated TSH indicates under-treatment of hypothyroidism or inadequate thyroid
hormone replacement. The levothyroxine dose usually needs to be increased.
5. A patient takes levothyroxine with calcium supplements. What is the risk?
A. Increased toxicity
B. Reduced absorption
C. Increased metabolism
D. No interaction
Correct Answer:
B. Reduced absorption
Expert Rationale:
Calcium binds levothyroxine in the gastrointestinal tract and decreases absorption.
Levothyroxine should be separated from calcium by about 4 hours.
6. A 70-year-old patient is starting levothyroxine. What is the best approach?
A. Start high dose
B. Start low and titrate slowly
C. Give weekly dosing
D. Avoid therapy
Correct Answer:
B. Start low and titrate slowly
Expert Rationale:
Older adults are more vulnerable to cardiac stimulation from thyroid hormone. Starting
low and titrating slowly reduces the risk of angina, tachyarrhythmias, and cardiac strain.
, NR 565 FINAL EXAM SET 3
1. What is a possible result of untreated hypothyroidism during pregnancy?
A. Development problems such as decreased IQ
B. Fetal macrosomia
C. Gestational hypertension only
D. Maternal hyperglycemia
Correct Answer: A
Expert Rationale:
Untreated maternal hypothyroidism increases the risk of adverse neurodevelopmental
outcomes in the fetus, including decreased IQ. Thyroid hormone is critical for fetal brain
development, particularly in the first trimester before the fetal thyroid gland is functional.
Early detection and levothyroxine replacement are essential to prevent cognitive
impairment.
2. A 38-year-old has been diagnosed with hyperthyroidism. Which of the following
medications should the clinician prescribe to manage the symptoms associated
with tachycardia until the patient becomes euthyroid?
A. Levothyroxine
B. Propranolol
C. Radioactive iodine
D. Methimazole alone
Correct Answer: B
Expert Rationale:
Propranolol is a non-selective beta-blocker used as adjunctive therapy in
hyperthyroidism to control adrenergic symptoms such as tachycardia, tremors, and
anxiety. It does not treat the underlying thyroid hormone excess but provides
symptomatic relief until antithyroid medications (e.g., methimazole) or radioactive iodine
restore euthyroid status.
,3. Which of the following fasting plasma glucose (FPG) levels meets the American
Diabetes Association (ADA) diagnostic criteria for diabetes?
A. 100 mg/dL
B. 110 mg/dL
C. 126 mg/dL
D. 128 mg/dL
Correct Answer: D
Expert Rationale:
The ADA diagnostic criteria for diabetes include a fasting plasma glucose (FPG) level of
≥126 mg/dL (7.0 mmol/L) or higher. A value of 128 mg/dL meets this threshold. Other
diagnostic criteria include a 2-hour plasma glucose ≥200 mg/dL during a 75-g OGTT, a
random plasma glucose ≥200 mg/dL with classic symptoms, or an HbA1c ≥6.5%.
4. Match the following diabetes medication classes to their representative agents:
Class I: Biguanides
Class II: Glucagon-like Peptide-1 (GLP-1) Receptor Agonists
Class III: Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitors
Class IV: Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
Class V: Thiazolidinediones
Class VI: Sulfonylureas
Representative Agents:
1. Metformin
2. Exenatide (Byetta), Liraglutide (Victoza), Dulaglutide (Trulicity)
3. Canagliflozin (Invokana), Dapagliflozin (Farxiga)
4. Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta)
5. Pioglitazone, Rosiglitazone
6. Glyburide, Glimepiride, Glipizide
Correct Matching:
I-1, II-2, III-3, IV-4, V-5, VI-6
, NR 565
FINAL EXAM
3 FULL SET EXAMS
(WEEKS 5 – 8 COVERED)
Verified Questions & Answers With Rationales
Advanced Pharmacology Fundamentals
Chamberlain
CONSISTING OF 225+ QUESTIONS
