NURS 5334 Advanced Pharmacology Quiz 3 | Questions and
Answers + Rationales | 2026/27 Updates | 100% Correct | UTA
According to the American Diabetes Association (ADA), which A1C value is diagnostic for
diabetes mellitus?
A) 5.7% to 6.4%
B) Greater than 6.5%
C) 7.0% or greater
D) Less than 5.7%
Correct Answer: Greater than 6.5%
Rationale: An A1C value of 6.5% or greater is diagnostic for diabetes mellitus according to ADA
guidelines . An A1C of 5.7% to 6.4% indicates prediabetes. Values of 7% or greater are an
indication for treatment intensification, not the initial diagnostic threshold.
A patient with type 2 diabetes is started on metformin. What is the primary mechanism of
action of this medication?
A) Increases insulin secretion from pancreatic beta cells
B) Decreases glucose production in the liver and increases peripheral insulin sensitivity
C) Slows the absorption of carbohydrates from the gastrointestinal tract
D) Increases the excretion of glucose in the urine
Correct Answer: Decreases glucose production in the liver and increases peripheral insulin
sensitivity
Rationale: Metformin reduces hepatic glucose production and sensitizes insulin receptors in
skeletal muscle and fat, increasing glucose uptake . It does not increase insulin secretion,
making hypoglycemia less likely. SGLT2 inhibitors increase urinary glucose excretion.
,A patient with type 2 diabetes has an A1C of 7.8% on metformin monotherapy. According to the
4-step approach, what is the next most appropriate step?
A) Initiate basal insulin therapy
B) Add a second oral or injectable agent
C) Switch to a sulfonylurea
D) Add a third agent before adding insulin
Correct Answer: Add a second oral or injectable agent
Rationale: The stepwise approach for type 2 diabetes involves lifestyle changes and metformin
initially. If A1C remains above goal on metformin alone, adding a second agent (e.g.,
sulfonylurea, DPP-4 inhibitor, SGLT-2 inhibitor, GLP-1 receptor agonist) is recommended before
progressing to insulin . Insulin is added if triple therapy fails.
Which of the following is a complication of insulin therapy that results from repeated injections
at the same site?
A) Lipohypertrophy
B) Lipodystrophy
C) Hypertrophy
D) Necrosis
Correct Answer: Lipohypertrophy
Rationale: Lipohypertrophy is the accumulation of subcutaneous fat at injection sites due to
repeated insulin injections in the same area . This can lead to erratic insulin absorption. Rotation
of injection sites is essential to prevent this complication.
,A patient with diabetes is prescribed a beta-blocker. The nurse practitioner should be aware of
which effect of beta-blockers on insulin therapy?
A) They increase insulin sensitivity, requiring a dose reduction
B) They mask the symptoms of hypoglycemia and impair glycogenolysis
C) They increase the risk of diabetic ketoacidosis
D) They have no significant interaction with insulin
Correct Answer: They mask the symptoms of hypoglycemia and impair glycogenolysis
Rationale: Beta-blockers can delay the awareness and response to hypoglycemia by masking
adrenergic symptoms like tachycardia and tremor . They also impair glycogenolysis, the body's
counter-regulatory response to low blood sugar.
What is the goal A1C for most non-pregnant adults with diabetes?
A) Less than 6.0%
B) Less than 7.0%
C) Less than 8.0%
D) Less than 9.0%
Correct Answer: Less than 7.0%
Rationale: The ADA recommends a general A1C goal of less than 7% for most non-pregnant
adults with diabetes . This goal may be individualized; a less stringent goal (e.g., <8%) may be
appropriate for patients with severe hypoglycemia risk or limited life expectancy.
A patient with type 2 diabetes and established cardiovascular disease is started on an SGLT-2
inhibitor. What is the primary advantage of this drug class in this patient population?
A) It stimulates insulin release
, B) It reduces the risk of heart failure hospitalization and cardiovascular death
C) It is more effective at lowering A1C than metformin
D) It has no effect on weight
Correct Answer: It reduces the risk of heart failure hospitalization and cardiovascular death
Rationale: SGLT-2 inhibitors have demonstrated cardiovascular benefits, including reduced risk
of heart failure hospitalization and cardiovascular death, in patients with type 2 diabetes and
established cardiovascular disease or multiple risk factors . They are preferred agents in this
high-risk population.
Which of the following insulins is classified as a rapid-acting insulin?
A) Regular insulin (Humulin R)
B) NPH insulin
C) Insulin lispro (Humalog)
D) Insulin glargine (Lantus)
Correct Answer: Insulin lispro (Humalog)
Rationale: Insulin lispro, aspart, and glulisine are rapid-acting insulins that have an onset of
action of about 15 minutes and are administered in association with meals to control
postprandial glucose spikes . Regular insulin is short-acting, NPH is intermediate-acting, and
glargine is long-acting.
A patient with type 1 diabetes is prescribed an initial insulin dose. What is the typical starting
dose range in units per kilogram per day?
A) 0.1 to 0.2 units/kg/day
B) 0.3 to 0.4 units/kg/day
Answers + Rationales | 2026/27 Updates | 100% Correct | UTA
According to the American Diabetes Association (ADA), which A1C value is diagnostic for
diabetes mellitus?
A) 5.7% to 6.4%
B) Greater than 6.5%
C) 7.0% or greater
D) Less than 5.7%
Correct Answer: Greater than 6.5%
Rationale: An A1C value of 6.5% or greater is diagnostic for diabetes mellitus according to ADA
guidelines . An A1C of 5.7% to 6.4% indicates prediabetes. Values of 7% or greater are an
indication for treatment intensification, not the initial diagnostic threshold.
A patient with type 2 diabetes is started on metformin. What is the primary mechanism of
action of this medication?
A) Increases insulin secretion from pancreatic beta cells
B) Decreases glucose production in the liver and increases peripheral insulin sensitivity
C) Slows the absorption of carbohydrates from the gastrointestinal tract
D) Increases the excretion of glucose in the urine
Correct Answer: Decreases glucose production in the liver and increases peripheral insulin
sensitivity
Rationale: Metformin reduces hepatic glucose production and sensitizes insulin receptors in
skeletal muscle and fat, increasing glucose uptake . It does not increase insulin secretion,
making hypoglycemia less likely. SGLT2 inhibitors increase urinary glucose excretion.
,A patient with type 2 diabetes has an A1C of 7.8% on metformin monotherapy. According to the
4-step approach, what is the next most appropriate step?
A) Initiate basal insulin therapy
B) Add a second oral or injectable agent
C) Switch to a sulfonylurea
D) Add a third agent before adding insulin
Correct Answer: Add a second oral or injectable agent
Rationale: The stepwise approach for type 2 diabetes involves lifestyle changes and metformin
initially. If A1C remains above goal on metformin alone, adding a second agent (e.g.,
sulfonylurea, DPP-4 inhibitor, SGLT-2 inhibitor, GLP-1 receptor agonist) is recommended before
progressing to insulin . Insulin is added if triple therapy fails.
Which of the following is a complication of insulin therapy that results from repeated injections
at the same site?
A) Lipohypertrophy
B) Lipodystrophy
C) Hypertrophy
D) Necrosis
Correct Answer: Lipohypertrophy
Rationale: Lipohypertrophy is the accumulation of subcutaneous fat at injection sites due to
repeated insulin injections in the same area . This can lead to erratic insulin absorption. Rotation
of injection sites is essential to prevent this complication.
,A patient with diabetes is prescribed a beta-blocker. The nurse practitioner should be aware of
which effect of beta-blockers on insulin therapy?
A) They increase insulin sensitivity, requiring a dose reduction
B) They mask the symptoms of hypoglycemia and impair glycogenolysis
C) They increase the risk of diabetic ketoacidosis
D) They have no significant interaction with insulin
Correct Answer: They mask the symptoms of hypoglycemia and impair glycogenolysis
Rationale: Beta-blockers can delay the awareness and response to hypoglycemia by masking
adrenergic symptoms like tachycardia and tremor . They also impair glycogenolysis, the body's
counter-regulatory response to low blood sugar.
What is the goal A1C for most non-pregnant adults with diabetes?
A) Less than 6.0%
B) Less than 7.0%
C) Less than 8.0%
D) Less than 9.0%
Correct Answer: Less than 7.0%
Rationale: The ADA recommends a general A1C goal of less than 7% for most non-pregnant
adults with diabetes . This goal may be individualized; a less stringent goal (e.g., <8%) may be
appropriate for patients with severe hypoglycemia risk or limited life expectancy.
A patient with type 2 diabetes and established cardiovascular disease is started on an SGLT-2
inhibitor. What is the primary advantage of this drug class in this patient population?
A) It stimulates insulin release
, B) It reduces the risk of heart failure hospitalization and cardiovascular death
C) It is more effective at lowering A1C than metformin
D) It has no effect on weight
Correct Answer: It reduces the risk of heart failure hospitalization and cardiovascular death
Rationale: SGLT-2 inhibitors have demonstrated cardiovascular benefits, including reduced risk
of heart failure hospitalization and cardiovascular death, in patients with type 2 diabetes and
established cardiovascular disease or multiple risk factors . They are preferred agents in this
high-risk population.
Which of the following insulins is classified as a rapid-acting insulin?
A) Regular insulin (Humulin R)
B) NPH insulin
C) Insulin lispro (Humalog)
D) Insulin glargine (Lantus)
Correct Answer: Insulin lispro (Humalog)
Rationale: Insulin lispro, aspart, and glulisine are rapid-acting insulins that have an onset of
action of about 15 minutes and are administered in association with meals to control
postprandial glucose spikes . Regular insulin is short-acting, NPH is intermediate-acting, and
glargine is long-acting.
A patient with type 1 diabetes is prescribed an initial insulin dose. What is the typical starting
dose range in units per kilogram per day?
A) 0.1 to 0.2 units/kg/day
B) 0.3 to 0.4 units/kg/day
