,NU 636 Quiz 5 Advanced Pharmacology |
1. A patient with type 2 diabetes mellitus and a history of heart failure is being evaluated for
pharmacotherapy. Which oral antidiabetic agent is contraindicated in this population due to an
increased risk of lactic acidosis?
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.
2. 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.
,3. A 52-year-old male with a TSH level of 7.2 mIU/L was started on levothyroxine 112.5 mcg daily
three weeks ago. He now reports intermittent chest pain and has a heart rate of 128 beats per minute.
Which action is most appropriate?
A) Making no changes in the levothyroxine dose and ordering a TSH and EKG
B) Decreasing the levothyroxine dose and ordering a TSH and EKG
C) Ordering a stress test because of family history
D) Discontinuing levothyroxine because chest pain is an adverse event
Correct Answer: Decreasing the levothyroxine dose and ordering a TSH and EKG
Rationale: The patient is exhibiting signs of excessive thyroid hormone replacement, including
tachycardia and chest pain. The dose should be decreased and thyroid function reassessed.
Levothyroxine is a lifelong therapy and should not be discontinued. A stress test is not the immediate
priority.
4. A 73-year-old patient on chronic thyroid hormone replacement therapy is at risk for developing
which condition?
A) Osteoporosis
B) Tachycardia
C) Insomnia
D) Diaphoresis
Correct Answer: Osteoporosis
Rationale: Chronic excessive thyroid hormone replacement increases bone turnover and can lead to
osteoporosis, particularly in postmenopausal women. Tachycardia, insomnia, and diaphoresis are
symptoms of hyperthyroidism but are not long-term complications of therapy. Bone density
monitoring is recommended.
5. A 93-year-old female is on 88 mcg of levothyroxine daily for hypothyroidism. Which medication
interaction is most clinically significant with thyroid hormone replacement?
A) Concurrent use with acetaminophen
, B) Concurrent use with calcium carbonate
C) Concurrent use with loratadine
D) Concurrent use with vitamin C
Correct Answer: Concurrent use with calcium carbonate
Rationale: Calcium carbonate binds levothyroxine in the gastrointestinal tract, significantly reducing
its absorption. Acetaminophen, loratadine, and vitamin C do not have clinically significant interactions
with levothyroxine. Separating administration by at least four hours is recommended.
6. A patient is prescribed levothyroxine for hypothyroidism. Which instruction is most important for
the advanced practice nurse to provide?
A) Take the medication with food to reduce gastrointestinal upset
B) Take the medication on an empty stomach 30 to 60 minutes before breakfast
C) Take the medication at bedtime with a glass of milk
D) Take the medication with calcium supplements to enhance absorption
Correct Answer: Take the medication on an empty stomach 30 to 60 minutes before breakfast
Rationale: Levothyroxine absorption is enhanced when taken on an empty stomach. Food, calcium,
and iron can significantly reduce absorption. Bedtime administration with milk is not optimal.
Consistency in timing is essential for stable thyroid hormone levels.
7. A patient is prescribed a medication that requires monitoring of serum drug levels due to its narrow
therapeutic index. Which medication is most likely being administered?
A) Amoxicillin
B) Lisinopril
C) Digoxin
D) Atorvastatin
Correct Answer: Digoxin
1. A patient with type 2 diabetes mellitus and a history of heart failure is being evaluated for
pharmacotherapy. Which oral antidiabetic agent is contraindicated in this population due to an
increased risk of lactic acidosis?
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.
2. 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.
,3. A 52-year-old male with a TSH level of 7.2 mIU/L was started on levothyroxine 112.5 mcg daily
three weeks ago. He now reports intermittent chest pain and has a heart rate of 128 beats per minute.
Which action is most appropriate?
A) Making no changes in the levothyroxine dose and ordering a TSH and EKG
B) Decreasing the levothyroxine dose and ordering a TSH and EKG
C) Ordering a stress test because of family history
D) Discontinuing levothyroxine because chest pain is an adverse event
Correct Answer: Decreasing the levothyroxine dose and ordering a TSH and EKG
Rationale: The patient is exhibiting signs of excessive thyroid hormone replacement, including
tachycardia and chest pain. The dose should be decreased and thyroid function reassessed.
Levothyroxine is a lifelong therapy and should not be discontinued. A stress test is not the immediate
priority.
4. A 73-year-old patient on chronic thyroid hormone replacement therapy is at risk for developing
which condition?
A) Osteoporosis
B) Tachycardia
C) Insomnia
D) Diaphoresis
Correct Answer: Osteoporosis
Rationale: Chronic excessive thyroid hormone replacement increases bone turnover and can lead to
osteoporosis, particularly in postmenopausal women. Tachycardia, insomnia, and diaphoresis are
symptoms of hyperthyroidism but are not long-term complications of therapy. Bone density
monitoring is recommended.
5. A 93-year-old female is on 88 mcg of levothyroxine daily for hypothyroidism. Which medication
interaction is most clinically significant with thyroid hormone replacement?
A) Concurrent use with acetaminophen
, B) Concurrent use with calcium carbonate
C) Concurrent use with loratadine
D) Concurrent use with vitamin C
Correct Answer: Concurrent use with calcium carbonate
Rationale: Calcium carbonate binds levothyroxine in the gastrointestinal tract, significantly reducing
its absorption. Acetaminophen, loratadine, and vitamin C do not have clinically significant interactions
with levothyroxine. Separating administration by at least four hours is recommended.
6. A patient is prescribed levothyroxine for hypothyroidism. Which instruction is most important for
the advanced practice nurse to provide?
A) Take the medication with food to reduce gastrointestinal upset
B) Take the medication on an empty stomach 30 to 60 minutes before breakfast
C) Take the medication at bedtime with a glass of milk
D) Take the medication with calcium supplements to enhance absorption
Correct Answer: Take the medication on an empty stomach 30 to 60 minutes before breakfast
Rationale: Levothyroxine absorption is enhanced when taken on an empty stomach. Food, calcium,
and iron can significantly reduce absorption. Bedtime administration with milk is not optimal.
Consistency in timing is essential for stable thyroid hormone levels.
7. A patient is prescribed a medication that requires monitoring of serum drug levels due to its narrow
therapeutic index. Which medication is most likely being administered?
A) Amoxicillin
B) Lisinopril
C) Digoxin
D) Atorvastatin
Correct Answer: Digoxin
