APEA ENDOCRINE PHARMACOLOGY – 150
QUESTIONS & ANSWERS Latest 2026 Revised |
Verified Complete Solutions | A+ Grade
📋 EXAM OVERVIEW
| Detail | Information |
|:|:|
| Exam | APEA Endocrine Pharmacology |
| Latest Version | 2025 Revised |
| Total Questions | 150 |
| Format | Multiple Choice, Clinical Scenarios |
| Includes | Verified Answers with Detailed Rationales |
| Target Audience | Nurse Practitioners (FNPs, AGNPs) |
INSTRUCTIONS FOR STUDENTS
Select the best answer for each question. Each question is worth 1 mark.
Answers and detailed rationales are provided immediately after each question.
SECTION 1: DIABETES MELLITUS – BIGUANIDES & METFORMIN (Questions 1–15)
QUESTION 1
The mechanism of action by which metformin (Glucophage) improves glucose tolerance is:
A) Increased fasting insulin levels
B) Decreased intestinal absorption of glucose
C) Decreased peripheral glucose uptake and utilization
D) Increased insulin secretion
Correct Answer: B
Rationale: Metformin decreases hepatic glucose production, decreases intestinal absorption of
glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
QUESTION 2
What is the black box warning for metformin?
A) Hepatotoxicity
,B) Lactic acidosis
C) Nephrotoxicity
D) Cardiotoxicity
Correct Answer: B
Rationale: Metformin carries a black box warning for lactic acidosis, a rare but serious
complication that can occur in patients with renal impairment, hepatic disease, or conditions
predisposing to hypoxia.
QUESTION 3
Metformin should be held in which of the following situations?
A) Before surgery with general anesthesia
B) Before a dental procedure
C) Before an MRI without contrast
D) Before a routine physical exam
Correct Answer: A
Rationale: Metformin should be held before surgery with general anesthesia and for 48 hours
after to prevent lactic acidosis. It should also be held before contrast dye studies.
QUESTION 4
Common side effects of metformin include:
A) Weight gain and hyperglycemia
B) Nausea, diarrhea, and metallic taste
C) Hypertension and tachycardia
D) Hypoglycemia and weight loss
Correct Answer: B
Rationale: Common side effects of metformin include nausea, vomiting, diarrhea, GI discomfort,
indigestion, headache, and metallic taste. These are often dose-related and can be minimized
by starting with a low dose and titrating slowly.
QUESTION 5
Metformin should be used with caution in patients with:
A) Hepatic impairment
B) Renal impairment (eGFR < 30 mL/min)
C) Both A and B
D) Neither A nor B
Correct Answer: C
Rationale: Metformin is contraindicated in patients with severe renal impairment (eGFR < 30
mL/min) and should be used with caution in hepatic impairment due to the risk of lactic acidosis.
QUESTION 6
,The combination of metformin (Glucophage) and glyburide (Diabeta) for the treatment of Type 2
diabetes is:
A) Moderately efficacious with low risk of hypoglycemia
B) Moderately efficacious with high risk of hypoglycemia
C) Highly efficacious with moderate risk of hypoglycemia
D) Highly efficacious with low risk of hypoglycemia
Correct Answer: C
Rationale: The combination of metformin and glyburide is highly efficacious with a moderate risk
of hypoglycemia. Glyburide (a sulfonylurea) can cause hypoglycemia, while metformin does not.
QUESTION 7
Metformin's effect on weight is:
A) Causes weight gain
B) Weight neutral or causes modest weight loss
C) Causes significant weight gain
D) No effect on weight
Correct Answer: B
Rationale: Metformin is weight neutral or may cause modest weight loss, making it a preferred
first-line agent for type 2 diabetes, especially in overweight patients.
QUESTION 8
Metformin should be temporarily discontinued before administration of:
A) Oral antibiotics
B) IV contrast dye
C) Oral contraceptives
D) Antihypertensives
Correct Answer: B
Rationale: Metformin should be held before and for 48 hours after administration of IV contrast
dye to prevent lactic acidosis in patients with renal impairment.
QUESTION 9
In addition to elevated blood glucose levels, the initial laboratory findings in a patient with DKA
would include:
A) Increased bicarbonate levels
B) Decreased bicarbonate levels
C) Increased pH
D) Normal potassium levels
Correct Answer: B
Rationale: In DKA, metabolic acidosis results in decreased bicarbonate levels. Other findings
include elevated blood glucose, ketonemia, and anion gap metabolic acidosis.
, QUESTION 10
The first-line pharmacologic treatment for Type 2 diabetes is:
A) Sulfonylureas
B) Metformin
C) Insulin
D) GLP-1 agonists
Correct Answer: B
Rationale: Metformin is the first-line pharmacologic treatment for Type 2 diabetes. It is preferred
due to its efficacy, safety profile, and lack of weight gain.
QUESTION 11
Metformin should be initiated at what dose?
A) 500 mg twice daily or 850 mg once daily
B) 1000 mg twice daily
C) 2000 mg daily
D) 250 mg once daily
Correct Answer: A
Rationale: Metformin is typically initiated at a low dose (500 mg twice daily or 850 mg once
daily) and titrated slowly to minimize GI side effects.
QUESTION 12
The maximum daily dose of metformin is:
A) 1000 mg
B) 1500 mg
C) 2000 mg
D) 2550 mg
Correct Answer: D
Rationale: The maximum daily dose of metformin is 2550 mg (immediate-release) or 2000 mg
(extended-release).
QUESTION 13
Which of the following is NOT a mechanism of action of metformin?
A) Decreases hepatic glucose production
B) Increases insulin secretion from the pancreas
C) Decreases intestinal absorption of glucose
D) Increases peripheral glucose uptake and utilization
Correct Answer: B
QUESTIONS & ANSWERS Latest 2026 Revised |
Verified Complete Solutions | A+ Grade
📋 EXAM OVERVIEW
| Detail | Information |
|:|:|
| Exam | APEA Endocrine Pharmacology |
| Latest Version | 2025 Revised |
| Total Questions | 150 |
| Format | Multiple Choice, Clinical Scenarios |
| Includes | Verified Answers with Detailed Rationales |
| Target Audience | Nurse Practitioners (FNPs, AGNPs) |
INSTRUCTIONS FOR STUDENTS
Select the best answer for each question. Each question is worth 1 mark.
Answers and detailed rationales are provided immediately after each question.
SECTION 1: DIABETES MELLITUS – BIGUANIDES & METFORMIN (Questions 1–15)
QUESTION 1
The mechanism of action by which metformin (Glucophage) improves glucose tolerance is:
A) Increased fasting insulin levels
B) Decreased intestinal absorption of glucose
C) Decreased peripheral glucose uptake and utilization
D) Increased insulin secretion
Correct Answer: B
Rationale: Metformin decreases hepatic glucose production, decreases intestinal absorption of
glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
QUESTION 2
What is the black box warning for metformin?
A) Hepatotoxicity
,B) Lactic acidosis
C) Nephrotoxicity
D) Cardiotoxicity
Correct Answer: B
Rationale: Metformin carries a black box warning for lactic acidosis, a rare but serious
complication that can occur in patients with renal impairment, hepatic disease, or conditions
predisposing to hypoxia.
QUESTION 3
Metformin should be held in which of the following situations?
A) Before surgery with general anesthesia
B) Before a dental procedure
C) Before an MRI without contrast
D) Before a routine physical exam
Correct Answer: A
Rationale: Metformin should be held before surgery with general anesthesia and for 48 hours
after to prevent lactic acidosis. It should also be held before contrast dye studies.
QUESTION 4
Common side effects of metformin include:
A) Weight gain and hyperglycemia
B) Nausea, diarrhea, and metallic taste
C) Hypertension and tachycardia
D) Hypoglycemia and weight loss
Correct Answer: B
Rationale: Common side effects of metformin include nausea, vomiting, diarrhea, GI discomfort,
indigestion, headache, and metallic taste. These are often dose-related and can be minimized
by starting with a low dose and titrating slowly.
QUESTION 5
Metformin should be used with caution in patients with:
A) Hepatic impairment
B) Renal impairment (eGFR < 30 mL/min)
C) Both A and B
D) Neither A nor B
Correct Answer: C
Rationale: Metformin is contraindicated in patients with severe renal impairment (eGFR < 30
mL/min) and should be used with caution in hepatic impairment due to the risk of lactic acidosis.
QUESTION 6
,The combination of metformin (Glucophage) and glyburide (Diabeta) for the treatment of Type 2
diabetes is:
A) Moderately efficacious with low risk of hypoglycemia
B) Moderately efficacious with high risk of hypoglycemia
C) Highly efficacious with moderate risk of hypoglycemia
D) Highly efficacious with low risk of hypoglycemia
Correct Answer: C
Rationale: The combination of metformin and glyburide is highly efficacious with a moderate risk
of hypoglycemia. Glyburide (a sulfonylurea) can cause hypoglycemia, while metformin does not.
QUESTION 7
Metformin's effect on weight is:
A) Causes weight gain
B) Weight neutral or causes modest weight loss
C) Causes significant weight gain
D) No effect on weight
Correct Answer: B
Rationale: Metformin is weight neutral or may cause modest weight loss, making it a preferred
first-line agent for type 2 diabetes, especially in overweight patients.
QUESTION 8
Metformin should be temporarily discontinued before administration of:
A) Oral antibiotics
B) IV contrast dye
C) Oral contraceptives
D) Antihypertensives
Correct Answer: B
Rationale: Metformin should be held before and for 48 hours after administration of IV contrast
dye to prevent lactic acidosis in patients with renal impairment.
QUESTION 9
In addition to elevated blood glucose levels, the initial laboratory findings in a patient with DKA
would include:
A) Increased bicarbonate levels
B) Decreased bicarbonate levels
C) Increased pH
D) Normal potassium levels
Correct Answer: B
Rationale: In DKA, metabolic acidosis results in decreased bicarbonate levels. Other findings
include elevated blood glucose, ketonemia, and anion gap metabolic acidosis.
, QUESTION 10
The first-line pharmacologic treatment for Type 2 diabetes is:
A) Sulfonylureas
B) Metformin
C) Insulin
D) GLP-1 agonists
Correct Answer: B
Rationale: Metformin is the first-line pharmacologic treatment for Type 2 diabetes. It is preferred
due to its efficacy, safety profile, and lack of weight gain.
QUESTION 11
Metformin should be initiated at what dose?
A) 500 mg twice daily or 850 mg once daily
B) 1000 mg twice daily
C) 2000 mg daily
D) 250 mg once daily
Correct Answer: A
Rationale: Metformin is typically initiated at a low dose (500 mg twice daily or 850 mg once
daily) and titrated slowly to minimize GI side effects.
QUESTION 12
The maximum daily dose of metformin is:
A) 1000 mg
B) 1500 mg
C) 2000 mg
D) 2550 mg
Correct Answer: D
Rationale: The maximum daily dose of metformin is 2550 mg (immediate-release) or 2000 mg
(extended-release).
QUESTION 13
Which of the following is NOT a mechanism of action of metformin?
A) Decreases hepatic glucose production
B) Increases insulin secretion from the pancreas
C) Decreases intestinal absorption of glucose
D) Increases peripheral glucose uptake and utilization
Correct Answer: B
