,NU 636 Quiz 4 Advanced Pharmacology |
1. A patient with type 2 diabetes mellitus is prescribed metformin. Which statement accurately
describes the primary mechanism of action of this medication?
A) Stimulation of pancreatic beta cells to increase insulin secretion
B) Reduction of hepatic glucose production and improvement of insulin sensitivity
C) Inhibition of carbohydrate absorption in the small intestine
D) Enhancement of renal glucose excretion through SGLT2 inhibition
Correct Answer: Reduction of hepatic glucose production and improvement of insulin sensitivity
Rationale: Metformin decreases hepatic gluconeogenesis and improves peripheral insulin sensitivity,
making it the first-line agent for type 2 diabetes. Sulfonylureas stimulate insulin secretion. Alpha-
glucosidase inhibitors slow carbohydrate absorption. SGLT2 inhibitors increase urinary glucose
excretion.
2. Which adverse effect is most commonly associated with metformin therapy and often resolves with
continued treatment?
A) Hypoglycemia
B) Gastrointestinal upset
C) Weight gain
D) Peripheral edema
Correct Answer: Gastrointestinal upset
Rationale: Diarrhea, nausea, and abdominal bloating occur in approximately 30% of patients initiating
metformin and typically resolve with continued therapy. Hypoglycemia is rare with metformin
monotherapy. Weight gain and peripheral edema are not characteristic of metformin.
3. A patient with an estimated glomerular filtration rate of 25 mL/min/1.73 m² is currently prescribed
metformin. Which action is most appropriate?
A) Continue metformin at the current dose
,B) Reduce metformin dose by 50%
C) Discontinue metformin and consider alternative therapy
D) Add a sulfonylurea to the regimen
Correct Answer: Discontinue metformin and consider alternative therapy
Rationale: Metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² due to increased
risk of lactic acidosis. Dose reduction is not sufficient. Adding a sulfonylurea does not address the
contraindication. Alternative agents with renal safety should be considered.
4. A 67-year-old male with type 2 diabetes has an HbA1c of 6.7% while taking metformin 1000 mg
twice daily. Which intervention does the advanced practice nurse anticipate?
A) Adding a sulfonylurea to the regimen
B) Making no change in the metformin dose
C) Decreasing metformin to 500 mg twice daily
D) Initiating basal insulin therapy
Correct Answer: Making no change in the metformin dose
Rationale: An HbA1c of 6.7% is at or below the target of less than 7.0% for most patients with type 2
diabetes. The current regimen is effective and should be continued. Adding a sulfonylurea or initiating
insulin is not indicated when the target is met without adverse effects.
5. An 82-year-old male with type 2 diabetes has an HbA1c of 10.9%, renal insufficiency, and moderate
cardiac ischemia. He is currently taking glipizide. Which intervention is most appropriate?
A) Adding sitagliptin to the regimen
B) Discontinuing glipizide and starting insulin
C) Adding metformin to the regimen
D) Adding pioglitazone to the regimen
Correct Answer: Discontinuing glipizide and starting insulin
, Rationale: The patient has severely uncontrolled diabetes with comorbidities that make sulfonylureas
less safe and effective. Insulin is the most appropriate therapy for significant hyperglycemia with renal
and cardiac disease. Metformin is contraindicated with renal insufficiency. Sitagliptin and pioglitazone
are less effective for this degree of hyperglycemia.
6. A patient with type 2 diabetes and heart failure requires pharmacotherapy. Which oral agent is
contraindicated in this population?
A) Sitagliptin
B) Metformin
C) Empagliflozin
D) Linagliptin
Correct Answer: Metformin
Rationale: Metformin is contraindicated in patients with heart failure because of the increased risk of
lactic acidosis, particularly when tissue hypoperfusion is present. Sitagliptin and linagliptin are DPP-4
inhibitors that do not carry this contraindication. Empagliflozin has demonstrated benefit in heart
failure.
7. Which medication is a GLP-1 receptor agonist that is associated with weight loss and is available in
both injectable and oral formulations?
A) Glipizide
B) Semaglutide
C) Pioglitazone
D) Sitagliptin
Correct Answer: Semaglutide
Rationale: Semaglutide is a GLP-1 receptor agonist available as a weekly injection and as an oral
tablet. It promotes weight loss and has cardiovascular benefits. Glipizide is a sulfonylurea associated
with weight gain. Pioglitazone is a thiazolidinedione that causes weight gain. Sitagliptin is a DPP-4
inhibitor that is weight-neutral.
1. A patient with type 2 diabetes mellitus is prescribed metformin. Which statement accurately
describes the primary mechanism of action of this medication?
A) Stimulation of pancreatic beta cells to increase insulin secretion
B) Reduction of hepatic glucose production and improvement of insulin sensitivity
C) Inhibition of carbohydrate absorption in the small intestine
D) Enhancement of renal glucose excretion through SGLT2 inhibition
Correct Answer: Reduction of hepatic glucose production and improvement of insulin sensitivity
Rationale: Metformin decreases hepatic gluconeogenesis and improves peripheral insulin sensitivity,
making it the first-line agent for type 2 diabetes. Sulfonylureas stimulate insulin secretion. Alpha-
glucosidase inhibitors slow carbohydrate absorption. SGLT2 inhibitors increase urinary glucose
excretion.
2. Which adverse effect is most commonly associated with metformin therapy and often resolves with
continued treatment?
A) Hypoglycemia
B) Gastrointestinal upset
C) Weight gain
D) Peripheral edema
Correct Answer: Gastrointestinal upset
Rationale: Diarrhea, nausea, and abdominal bloating occur in approximately 30% of patients initiating
metformin and typically resolve with continued therapy. Hypoglycemia is rare with metformin
monotherapy. Weight gain and peripheral edema are not characteristic of metformin.
3. A patient with an estimated glomerular filtration rate of 25 mL/min/1.73 m² is currently prescribed
metformin. Which action is most appropriate?
A) Continue metformin at the current dose
,B) Reduce metformin dose by 50%
C) Discontinue metformin and consider alternative therapy
D) Add a sulfonylurea to the regimen
Correct Answer: Discontinue metformin and consider alternative therapy
Rationale: Metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² due to increased
risk of lactic acidosis. Dose reduction is not sufficient. Adding a sulfonylurea does not address the
contraindication. Alternative agents with renal safety should be considered.
4. A 67-year-old male with type 2 diabetes has an HbA1c of 6.7% while taking metformin 1000 mg
twice daily. Which intervention does the advanced practice nurse anticipate?
A) Adding a sulfonylurea to the regimen
B) Making no change in the metformin dose
C) Decreasing metformin to 500 mg twice daily
D) Initiating basal insulin therapy
Correct Answer: Making no change in the metformin dose
Rationale: An HbA1c of 6.7% is at or below the target of less than 7.0% for most patients with type 2
diabetes. The current regimen is effective and should be continued. Adding a sulfonylurea or initiating
insulin is not indicated when the target is met without adverse effects.
5. An 82-year-old male with type 2 diabetes has an HbA1c of 10.9%, renal insufficiency, and moderate
cardiac ischemia. He is currently taking glipizide. Which intervention is most appropriate?
A) Adding sitagliptin to the regimen
B) Discontinuing glipizide and starting insulin
C) Adding metformin to the regimen
D) Adding pioglitazone to the regimen
Correct Answer: Discontinuing glipizide and starting insulin
, Rationale: The patient has severely uncontrolled diabetes with comorbidities that make sulfonylureas
less safe and effective. Insulin is the most appropriate therapy for significant hyperglycemia with renal
and cardiac disease. Metformin is contraindicated with renal insufficiency. Sitagliptin and pioglitazone
are less effective for this degree of hyperglycemia.
6. A patient with type 2 diabetes and heart failure requires pharmacotherapy. Which oral agent is
contraindicated in this population?
A) Sitagliptin
B) Metformin
C) Empagliflozin
D) Linagliptin
Correct Answer: Metformin
Rationale: Metformin is contraindicated in patients with heart failure because of the increased risk of
lactic acidosis, particularly when tissue hypoperfusion is present. Sitagliptin and linagliptin are DPP-4
inhibitors that do not carry this contraindication. Empagliflozin has demonstrated benefit in heart
failure.
7. Which medication is a GLP-1 receptor agonist that is associated with weight loss and is available in
both injectable and oral formulations?
A) Glipizide
B) Semaglutide
C) Pioglitazone
D) Sitagliptin
Correct Answer: Semaglutide
Rationale: Semaglutide is a GLP-1 receptor agonist available as a weekly injection and as an oral
tablet. It promotes weight loss and has cardiovascular benefits. Glipizide is a sulfonylurea associated
with weight gain. Pioglitazone is a thiazolidinedione that causes weight gain. Sitagliptin is a DPP-4
inhibitor that is weight-neutral.
