, NURS 5334 EXAM 3
Advanced Pharmacology for Nurse Practitioners
University of Texas at Arlington (UTA)
100-Question Practice Examination | 2026/2027 Edition.
1. A patient with type 2 diabetes has persistent postprandial hyperglycemia despite acceptable fasting
glucose. Which drug class is especially useful for blunting meal-related glucose excursions when
taken with meals?
A) Thiazolidinediones
B) Basal insulin only
C) Meglitinides
D) DPP-4 inhibitors given at bedtime only
Correct Answer: Meglitinides
Rationale: Meglitinides stimulate rapid, short-duration insulin release and are timed with meals, making them useful for
postprandial glucose elevations. Thiazolidinediones mainly improve insulin sensitivity and act slowly. Basal insulin
primarily targets fasting glucose, while DPP-4 inhibitors are not restricted to bedtime dosing.
2. Which adverse effect is most characteristic of alpha-glucosidase inhibitors such as acarbose?
A) Severe bradycardia
B) Flatulence and abdominal discomfort
C) Tendon rupture
D) Urinary retention
Correct Answer: Flatulence and abdominal discomfort
Rationale: Alpha-glucosidase inhibitors delay intestinal carbohydrate absorption, leaving more carbohydrate available for
colonic fermentation. Gas, bloating, and abdominal discomfort are therefore common. Bradycardia, tendon rupture, and
urinary retention are not class-defining adverse effects of acarbose or miglitol.
3. A patient taking metformin develops acute kidney injury with rising creatinine. What is the most
appropriate medication-related concern?
A) Rapid thyroid hormone excess
B) Acute serotonin syndrome
C) Rebound hyperglycemia from beta-receptor blockade
D) Accumulation of metformin with increased risk of lactic acidosis
Correct Answer: Accumulation of metformin with increased risk of lactic acidosis
Rationale: Metformin is cleared renally, so acute kidney dysfunction can increase drug accumulation and the risk of lactic
acidosis. The other options describe unrelated pharmacologic syndromes. Renal function should be considered
whenever metformin is started, continued, or temporarily held during acute illness.
4. Which counseling point is most appropriate for a patient starting an SGLT2 inhibitor?
A) Report symptoms of genital or urinary infection and maintain adequate hydration
B) Expect profound sedation after each dose
C) Take the drug only with a high-fat meal
D) Avoid all dietary potassium
Correct Answer: Report symptoms of genital or urinary infection and maintain adequate hydration
Rationale: SGLT2 inhibitors increase urinary glucose excretion, which can predispose patients to genital mycotic
infections, urinary infections, and volume depletion. Hydration and infection awareness are therefore important. Profound
sedation, mandatory high-fat meals, and complete potassium avoidance are not routine class precautions.
5. A patient with type 1 diabetes uses a nonselective beta blocker. Which hypoglycemia issue
deserves special attention?
A) Adrenergic warning symptoms may be blunted and recovery from hypoglycemia may be impaired
NURS 5334 Exam 3 Practice Examination | 2026/2027 Edition Page 1
, B) Insulin absorption will stop completely
C) Glucagon becomes pharmacologically inactive
D) The beta blocker will always cause severe hyperglycemia
Correct Answer: Adrenergic warning symptoms may be blunted and recovery from hypoglycemia may be
impaired
Rationale: Nonselective beta blockers may mask adrenergic signs such as tremor and tachycardia and can interfere with
glycogenolysis, making hypoglycemia harder to recognize and recover from. They do not stop insulin absorption or
inactivate glucagon, and they do not invariably produce severe hyperglycemia.
6. Which medication class generally carries the greatest intrinsic risk of hypoglycemia when used
without careful dose adjustment?
A) SGLT2 inhibitors
B) GLP-1 receptor agonists
C) Sulfonylureas
D) Alpha-glucosidase inhibitors
Correct Answer: Sulfonylureas
Rationale: Sulfonylureas stimulate pancreatic insulin secretion regardless of the immediate glucose level, so
hypoglycemia is a recognized class risk. SGLT2 inhibitors, GLP-1 receptor agonists, and alpha-glucosidase inhibitors
generally have a lower intrinsic hypoglycemia risk when used without insulin or secretagogues.
7. Why should a thiazolidinedione be used cautiously in a patient with symptomatic heart failure?
A) It causes irreversible bronchoconstriction
B) It directly suppresses thyroid-stimulating hormone
C) It produces acute opioid withdrawal
D) It can promote fluid retention and worsen edema
Correct Answer: It can promote fluid retention and worsen edema
Rationale: Thiazolidinediones can cause sodium and fluid retention, which may worsen peripheral edema and heart
failure. This class does not cause direct bronchoconstriction, TSH suppression, or opioid withdrawal. Heart-failure history
and signs of volume overload should therefore influence prescribing decisions.
8. A patient beginning a GLP-1 receptor agonist asks about common early adverse effects. Which
response is best?
A) Nausea and other gastrointestinal symptoms are common, especially during dose escalation
B) Permanent hearing loss is expected
C) Severe neutropenia is routine
D) Bradyarrhythmia occurs in nearly every patient
Correct Answer: Nausea and other gastrointestinal symptoms are common, especially during dose escalation
Rationale: GLP-1 receptor agonists commonly cause nausea, early satiety, vomiting, or diarrhea, particularly when
treatment begins or doses increase. These effects often lessen with time. Permanent hearing loss, routine severe
neutropenia, and near-universal bradyarrhythmia are not typical adverse effects of this class.
9. Which insulin formulation is designed primarily to provide basal coverage rather than mealtime
coverage?
A) Insulin lispro
B) Insulin glargine
C) Insulin aspart
D) Regular insulin used immediately before meals
Correct Answer: Insulin glargine
Rationale: Insulin glargine is a long-acting basal insulin intended to provide relatively steady background insulin. Lispro
and aspart are rapid-acting mealtime insulins. Regular insulin can also be used for prandial coverage when timed
appropriately, so it does not serve the same primary role as glargine.
NURS 5334 Exam 3 Practice Examination | 2026/2027 Edition Page 2
Advanced Pharmacology for Nurse Practitioners
University of Texas at Arlington (UTA)
100-Question Practice Examination | 2026/2027 Edition.
1. A patient with type 2 diabetes has persistent postprandial hyperglycemia despite acceptable fasting
glucose. Which drug class is especially useful for blunting meal-related glucose excursions when
taken with meals?
A) Thiazolidinediones
B) Basal insulin only
C) Meglitinides
D) DPP-4 inhibitors given at bedtime only
Correct Answer: Meglitinides
Rationale: Meglitinides stimulate rapid, short-duration insulin release and are timed with meals, making them useful for
postprandial glucose elevations. Thiazolidinediones mainly improve insulin sensitivity and act slowly. Basal insulin
primarily targets fasting glucose, while DPP-4 inhibitors are not restricted to bedtime dosing.
2. Which adverse effect is most characteristic of alpha-glucosidase inhibitors such as acarbose?
A) Severe bradycardia
B) Flatulence and abdominal discomfort
C) Tendon rupture
D) Urinary retention
Correct Answer: Flatulence and abdominal discomfort
Rationale: Alpha-glucosidase inhibitors delay intestinal carbohydrate absorption, leaving more carbohydrate available for
colonic fermentation. Gas, bloating, and abdominal discomfort are therefore common. Bradycardia, tendon rupture, and
urinary retention are not class-defining adverse effects of acarbose or miglitol.
3. A patient taking metformin develops acute kidney injury with rising creatinine. What is the most
appropriate medication-related concern?
A) Rapid thyroid hormone excess
B) Acute serotonin syndrome
C) Rebound hyperglycemia from beta-receptor blockade
D) Accumulation of metformin with increased risk of lactic acidosis
Correct Answer: Accumulation of metformin with increased risk of lactic acidosis
Rationale: Metformin is cleared renally, so acute kidney dysfunction can increase drug accumulation and the risk of lactic
acidosis. The other options describe unrelated pharmacologic syndromes. Renal function should be considered
whenever metformin is started, continued, or temporarily held during acute illness.
4. Which counseling point is most appropriate for a patient starting an SGLT2 inhibitor?
A) Report symptoms of genital or urinary infection and maintain adequate hydration
B) Expect profound sedation after each dose
C) Take the drug only with a high-fat meal
D) Avoid all dietary potassium
Correct Answer: Report symptoms of genital or urinary infection and maintain adequate hydration
Rationale: SGLT2 inhibitors increase urinary glucose excretion, which can predispose patients to genital mycotic
infections, urinary infections, and volume depletion. Hydration and infection awareness are therefore important. Profound
sedation, mandatory high-fat meals, and complete potassium avoidance are not routine class precautions.
5. A patient with type 1 diabetes uses a nonselective beta blocker. Which hypoglycemia issue
deserves special attention?
A) Adrenergic warning symptoms may be blunted and recovery from hypoglycemia may be impaired
NURS 5334 Exam 3 Practice Examination | 2026/2027 Edition Page 1
, B) Insulin absorption will stop completely
C) Glucagon becomes pharmacologically inactive
D) The beta blocker will always cause severe hyperglycemia
Correct Answer: Adrenergic warning symptoms may be blunted and recovery from hypoglycemia may be
impaired
Rationale: Nonselective beta blockers may mask adrenergic signs such as tremor and tachycardia and can interfere with
glycogenolysis, making hypoglycemia harder to recognize and recover from. They do not stop insulin absorption or
inactivate glucagon, and they do not invariably produce severe hyperglycemia.
6. Which medication class generally carries the greatest intrinsic risk of hypoglycemia when used
without careful dose adjustment?
A) SGLT2 inhibitors
B) GLP-1 receptor agonists
C) Sulfonylureas
D) Alpha-glucosidase inhibitors
Correct Answer: Sulfonylureas
Rationale: Sulfonylureas stimulate pancreatic insulin secretion regardless of the immediate glucose level, so
hypoglycemia is a recognized class risk. SGLT2 inhibitors, GLP-1 receptor agonists, and alpha-glucosidase inhibitors
generally have a lower intrinsic hypoglycemia risk when used without insulin or secretagogues.
7. Why should a thiazolidinedione be used cautiously in a patient with symptomatic heart failure?
A) It causes irreversible bronchoconstriction
B) It directly suppresses thyroid-stimulating hormone
C) It produces acute opioid withdrawal
D) It can promote fluid retention and worsen edema
Correct Answer: It can promote fluid retention and worsen edema
Rationale: Thiazolidinediones can cause sodium and fluid retention, which may worsen peripheral edema and heart
failure. This class does not cause direct bronchoconstriction, TSH suppression, or opioid withdrawal. Heart-failure history
and signs of volume overload should therefore influence prescribing decisions.
8. A patient beginning a GLP-1 receptor agonist asks about common early adverse effects. Which
response is best?
A) Nausea and other gastrointestinal symptoms are common, especially during dose escalation
B) Permanent hearing loss is expected
C) Severe neutropenia is routine
D) Bradyarrhythmia occurs in nearly every patient
Correct Answer: Nausea and other gastrointestinal symptoms are common, especially during dose escalation
Rationale: GLP-1 receptor agonists commonly cause nausea, early satiety, vomiting, or diarrhea, particularly when
treatment begins or doses increase. These effects often lessen with time. Permanent hearing loss, routine severe
neutropenia, and near-universal bradyarrhythmia are not typical adverse effects of this class.
9. Which insulin formulation is designed primarily to provide basal coverage rather than mealtime
coverage?
A) Insulin lispro
B) Insulin glargine
C) Insulin aspart
D) Regular insulin used immediately before meals
Correct Answer: Insulin glargine
Rationale: Insulin glargine is a long-acting basal insulin intended to provide relatively steady background insulin. Lispro
and aspart are rapid-acting mealtime insulins. Regular insulin can also be used for prandial coverage when timed
appropriately, so it does not serve the same primary role as glargine.
NURS 5334 Exam 3 Practice Examination | 2026/2027 Edition Page 2
