NUR 521 Advanced Pharmacology – Exam 4 Blueprint Test Bank
|Complete Practice Questions with correct answers and
Detailed Rationales 2026/2027 Update- University of Alabama
Question 1. A patient with type 2 diabetes is prescribed metformin. Which
mechanism best describes the primary glucose-lowering effect of metformin?
A. Stimulates pancreatic insulin secretion
B. Decreases hepatic glucose production and improves insulin sensitivity
C. Blocks intestinal glucose absorption completely
D. Directly replaces endogenous insulin
Correct Answer: B
Rationale: Metformin primarily decreases hepatic gluconeogenesis and
improves peripheral insulin sensitivity. It does not normally stimulate
substantial insulin secretion, so hypoglycemia is less likely when metformin is
used alone.
Question 2. Which adverse effect is most commonly associated with
metformin when therapy is initiated?
A. Severe hypoglycemia
B. Gastrointestinal upset
C. Ototoxicity
D. Urinary retention
Correct Answer: B
Rationale: Nausea, diarrhea, abdominal discomfort, and other
gastrointestinal effects are common when metformin is started. Taking the
medication with meals and using gradual dose titration can improve
tolerability.
Question 3. A patient taking metformin is scheduled for a procedure
involving iodinated contrast. Why may metformin need to be temporarily
withheld?
pg. 1
,A. To prevent severe hypoglycemia in every patient
B. Because contrast-associated kidney injury could increase metformin
accumulation
C. Because metformin causes contrast allergy
D. Because metformin directly interferes with iodine absorption
Correct Answer: B
Rationale: Metformin is eliminated primarily through the kidneys. If kidney
function deteriorates significantly, metformin can accumulate and increase
the risk of lactic acidosis. Appropriate renal-function assessment and
medication management are therefore important around certain contrast
procedures.
Question 4. Which serious adverse effect is associated with metformin
accumulation in patients with significant renal dysfunction?
A. Lactic acidosis
B. Hyperthyroidism
C. Pulmonary embolism
D. Severe neutropenia
Correct Answer: A
Rationale: Metformin-associated lactic acidosis is rare but potentially life-
threatening. Risk increases when significant renal dysfunction or other
conditions that promote tissue hypoxia or impaired lactate clearance are
present.
Question 5. Which medication class stimulates pancreatic beta cells to release
insulin?
A. Sulfonylureas
B. Biguanides
C. SGLT2 inhibitors
D. Alpha-glucosidase inhibitors
pg. 2
,Correct Answer: A
Rationale: Sulfonylureas stimulate pancreatic beta cells to release insulin.
Because their action depends on insulin secretion, they can cause
hypoglycemia and weight gain.
Question 6. A patient taking glipizide becomes sweaty, shaky, and confused.
What is the most likely cause?
A. Hypercalcemia
B. Hypoglycemia
C. Hypernatremia
D. Hypertension
Correct Answer: B
Rationale: Glipizide is a sulfonylurea that increases insulin secretion and can
cause hypoglycemia. Sweating, tremor, confusion, weakness, and tachycardia
are common manifestations of low blood glucose.
Question 7. Which patient teaching is most appropriate for a patient taking a
sulfonylurea?
A. Skip meals whenever glucose is normal.
B. Recognize and promptly treat symptoms of hypoglycemia.
C. Double the dose after missing a meal.
D. Avoid checking blood glucose.
Correct Answer: B
Rationale: Sulfonylureas can cause hypoglycemia, particularly when food
intake is inadequate or the medication dose is excessive. Patients should
understand hypoglycemia symptoms and appropriate treatment.
Question 8. Which medication is a GLP-1 receptor agonist?
pg. 3
, A. Semaglutide
B. Glipizide
C. Metformin
D. Pioglitazone
Correct Answer: A
Rationale: Semaglutide is a GLP-1 receptor agonist. These medications
enhance glucose-dependent insulin secretion, suppress inappropriate
glucagon secretion, slow gastric emptying, and increase satiety.
Question 9. Which additional effect is commonly associated with GLP-1
receptor agonists?
A. Increased appetite
B. Weight loss
C. Severe potassium retention in all patients
D. Increased gastric emptying
Correct Answer: B
Rationale: GLP-1 receptor agonists can reduce appetite and increase satiety,
commonly resulting in weight loss. Gastrointestinal effects such as nausea can
also occur, especially during treatment initiation or dose escalation.
Question 10. Which symptom in a patient receiving a GLP-1 receptor agonist
should prompt evaluation for pancreatitis?
A. Persistent severe abdominal pain
B. Mild hunger before meals
C. Increased urination after drinking water
D. Occasional sneezing
Correct Answer: A
pg. 4
|Complete Practice Questions with correct answers and
Detailed Rationales 2026/2027 Update- University of Alabama
Question 1. A patient with type 2 diabetes is prescribed metformin. Which
mechanism best describes the primary glucose-lowering effect of metformin?
A. Stimulates pancreatic insulin secretion
B. Decreases hepatic glucose production and improves insulin sensitivity
C. Blocks intestinal glucose absorption completely
D. Directly replaces endogenous insulin
Correct Answer: B
Rationale: Metformin primarily decreases hepatic gluconeogenesis and
improves peripheral insulin sensitivity. It does not normally stimulate
substantial insulin secretion, so hypoglycemia is less likely when metformin is
used alone.
Question 2. Which adverse effect is most commonly associated with
metformin when therapy is initiated?
A. Severe hypoglycemia
B. Gastrointestinal upset
C. Ototoxicity
D. Urinary retention
Correct Answer: B
Rationale: Nausea, diarrhea, abdominal discomfort, and other
gastrointestinal effects are common when metformin is started. Taking the
medication with meals and using gradual dose titration can improve
tolerability.
Question 3. A patient taking metformin is scheduled for a procedure
involving iodinated contrast. Why may metformin need to be temporarily
withheld?
pg. 1
,A. To prevent severe hypoglycemia in every patient
B. Because contrast-associated kidney injury could increase metformin
accumulation
C. Because metformin causes contrast allergy
D. Because metformin directly interferes with iodine absorption
Correct Answer: B
Rationale: Metformin is eliminated primarily through the kidneys. If kidney
function deteriorates significantly, metformin can accumulate and increase
the risk of lactic acidosis. Appropriate renal-function assessment and
medication management are therefore important around certain contrast
procedures.
Question 4. Which serious adverse effect is associated with metformin
accumulation in patients with significant renal dysfunction?
A. Lactic acidosis
B. Hyperthyroidism
C. Pulmonary embolism
D. Severe neutropenia
Correct Answer: A
Rationale: Metformin-associated lactic acidosis is rare but potentially life-
threatening. Risk increases when significant renal dysfunction or other
conditions that promote tissue hypoxia or impaired lactate clearance are
present.
Question 5. Which medication class stimulates pancreatic beta cells to release
insulin?
A. Sulfonylureas
B. Biguanides
C. SGLT2 inhibitors
D. Alpha-glucosidase inhibitors
pg. 2
,Correct Answer: A
Rationale: Sulfonylureas stimulate pancreatic beta cells to release insulin.
Because their action depends on insulin secretion, they can cause
hypoglycemia and weight gain.
Question 6. A patient taking glipizide becomes sweaty, shaky, and confused.
What is the most likely cause?
A. Hypercalcemia
B. Hypoglycemia
C. Hypernatremia
D. Hypertension
Correct Answer: B
Rationale: Glipizide is a sulfonylurea that increases insulin secretion and can
cause hypoglycemia. Sweating, tremor, confusion, weakness, and tachycardia
are common manifestations of low blood glucose.
Question 7. Which patient teaching is most appropriate for a patient taking a
sulfonylurea?
A. Skip meals whenever glucose is normal.
B. Recognize and promptly treat symptoms of hypoglycemia.
C. Double the dose after missing a meal.
D. Avoid checking blood glucose.
Correct Answer: B
Rationale: Sulfonylureas can cause hypoglycemia, particularly when food
intake is inadequate or the medication dose is excessive. Patients should
understand hypoglycemia symptoms and appropriate treatment.
Question 8. Which medication is a GLP-1 receptor agonist?
pg. 3
, A. Semaglutide
B. Glipizide
C. Metformin
D. Pioglitazone
Correct Answer: A
Rationale: Semaglutide is a GLP-1 receptor agonist. These medications
enhance glucose-dependent insulin secretion, suppress inappropriate
glucagon secretion, slow gastric emptying, and increase satiety.
Question 9. Which additional effect is commonly associated with GLP-1
receptor agonists?
A. Increased appetite
B. Weight loss
C. Severe potassium retention in all patients
D. Increased gastric emptying
Correct Answer: B
Rationale: GLP-1 receptor agonists can reduce appetite and increase satiety,
commonly resulting in weight loss. Gastrointestinal effects such as nausea can
also occur, especially during treatment initiation or dose escalation.
Question 10. Which symptom in a patient receiving a GLP-1 receptor agonist
should prompt evaluation for pancreatitis?
A. Persistent severe abdominal pain
B. Mild hunger before meals
C. Increased urination after drinking water
D. Occasional sneezing
Correct Answer: A
pg. 4
