NR 601
FINAL EXAM
Verified Questions & Answers With Rationales
(Primary Care of the Maturing and
Aged Family Practicum)
Chamberlain
CONSISTS OF 150 QUESTIONS
WEEKS 5 – 8 COVERED
,1. A 58-year-old reports polyuria and blurred vision. Fasting glucose is 131 mg/dL
today and 128 mg/dL last week. Best next step?
A. Repeat fasting glucose in 1 year
B. Diagnose type 2 diabetes mellitus and begin management
C. Diagnose impaired fasting glucose only
D. Order no further testing
Correct Answer:
B. Diagnose type 2 diabetes mellitus and begin management
Rationale:
Two fasting plasma glucose values ≥126 mg/dL confirm diabetes. Polyuria and blurred
vision are classic hyperglycemia symptoms, so management should begin.
2. A 60-year-old has random glucose 225 mg/dL and classic symptoms (polyuria,
polydipsia). What is most accurate?
A. Diabetes can be diagnosed now
B. Diabetes cannot be diagnosed without A1C
C. This represents normal aging
D. Repeat testing is required for 6 months
Correct Answer:
A. Diabetes can be diagnosed now
Rationale:
Random plasma glucose ≥200 mg/dL with classic symptoms is diagnostic of diabetes.
3. A newly diagnosed T2DM patient asks for first-line medication. Most
appropriate?
A. Metformin
B. Methimazole
C. Donepezil
D. Tamsulosin
Correct Answer:
A. Metformin
Rationale:
Metformin is commonly used as initial therapy for type 2 diabetes unless
contraindicated, especially when no cardiorenal indication requires another first-line
agent.
4. A patient asks how metformin works. Best explanation?
A. Increases hepatic glucose output
B. Reduces hepatic glucose production and improves insulin sensitivity
C. Stimulates thyroid hormone production
D. Blocks dopamine receptors
,Correct Answer:
B. Reduces hepatic glucose production and improves insulin sensitivity
Rationale:
Metformin primarily decreases hepatic gluconeogenesis and improves peripheral insulin
sensitivity.
5. A patient has eGFR 25 mL/min. Which diabetes medication should be avoided?
A. Metformin
B. Semaglutide
C. Insulin glargine
D. Empagliflozin
Correct Answer:
A. Metformin
Rationale:
Metformin is avoided in severe renal impairment because reduced clearance increases
the risk of lactic acidosis.
6. A patient with T2DM and HF needs add-on therapy with cardio/renal benefit.
Best option?
A. SGLT2 inhibitor (empagliflozin)
B. Sulfonylurea only
C. Pioglitazone
D. Acarbose
Correct Answer:
A. SGLT2 inhibitor (empagliflozin)
Rationale:
SGLT2 inhibitors reduce heart failure hospitalization and slow kidney disease
progression in appropriate patients with T2DM.
7. A patient on an SGLT2 inhibitor has nausea, abdominal pain, anion gap
metabolic acidosis, glucose 165. Most concerning diagnosis?
A. Euglycemic DKA
B. Hypothyroidism
C. GERD
D. BPH
Correct Answer:
A. Euglycemic DKA
Rationale:
SGLT2 inhibitors can cause diabetic ketoacidosis with only mildly elevated or near-
normal glucose levels.
, 8. A patient starting an SGLT2 inhibitor should be counseled about which
common adverse effect?
A. Genitourinary infections
B. Severe bradycardia
C. Hearing loss
D. Prostate shrinkage
Correct Answer:
A. Genitourinary infections
Rationale:
SGLT2 inhibitors increase urinary glucose excretion, which raises risk for genital
mycotic infections and some urinary infections.
9. A patient wants diabetes medication that supports weight loss and CV benefit.
Best class?
A. GLP-1 receptor agonist (semaglutide)
B. Thiazolidinedione
C. Sulfonylurea
D. Alpha-blocker
Correct Answer:
A. GLP-1 receptor agonist (semaglutide)
Rationale:
GLP-1 receptor agonists improve glycemic control, promote weight loss, and some
agents have cardiovascular benefit.
10. A patient with edema and HF symptoms worsens after starting pioglitazone.
Why?
A. TZDs can cause fluid retention and worsen HF
B. TZDs always cause dehydration
C. TZDs shrink the prostate
D. TZDs treat acute DKA
Correct Answer:
A. TZDs can cause fluid retention and worsen HF
Rationale:
Thiazolidinediones can cause sodium and fluid retention, which may exacerbate heart
failure.
11. A patient’s A1C goal should be relaxed due to age/comorbidities. Which target
is most appropriate?
A. < 5%
B. < 6%
C. < 8%
D. > 12%
FINAL EXAM
Verified Questions & Answers With Rationales
(Primary Care of the Maturing and
Aged Family Practicum)
Chamberlain
CONSISTS OF 150 QUESTIONS
WEEKS 5 – 8 COVERED
,1. A 58-year-old reports polyuria and blurred vision. Fasting glucose is 131 mg/dL
today and 128 mg/dL last week. Best next step?
A. Repeat fasting glucose in 1 year
B. Diagnose type 2 diabetes mellitus and begin management
C. Diagnose impaired fasting glucose only
D. Order no further testing
Correct Answer:
B. Diagnose type 2 diabetes mellitus and begin management
Rationale:
Two fasting plasma glucose values ≥126 mg/dL confirm diabetes. Polyuria and blurred
vision are classic hyperglycemia symptoms, so management should begin.
2. A 60-year-old has random glucose 225 mg/dL and classic symptoms (polyuria,
polydipsia). What is most accurate?
A. Diabetes can be diagnosed now
B. Diabetes cannot be diagnosed without A1C
C. This represents normal aging
D. Repeat testing is required for 6 months
Correct Answer:
A. Diabetes can be diagnosed now
Rationale:
Random plasma glucose ≥200 mg/dL with classic symptoms is diagnostic of diabetes.
3. A newly diagnosed T2DM patient asks for first-line medication. Most
appropriate?
A. Metformin
B. Methimazole
C. Donepezil
D. Tamsulosin
Correct Answer:
A. Metformin
Rationale:
Metformin is commonly used as initial therapy for type 2 diabetes unless
contraindicated, especially when no cardiorenal indication requires another first-line
agent.
4. A patient asks how metformin works. Best explanation?
A. Increases hepatic glucose output
B. Reduces hepatic glucose production and improves insulin sensitivity
C. Stimulates thyroid hormone production
D. Blocks dopamine receptors
,Correct Answer:
B. Reduces hepatic glucose production and improves insulin sensitivity
Rationale:
Metformin primarily decreases hepatic gluconeogenesis and improves peripheral insulin
sensitivity.
5. A patient has eGFR 25 mL/min. Which diabetes medication should be avoided?
A. Metformin
B. Semaglutide
C. Insulin glargine
D. Empagliflozin
Correct Answer:
A. Metformin
Rationale:
Metformin is avoided in severe renal impairment because reduced clearance increases
the risk of lactic acidosis.
6. A patient with T2DM and HF needs add-on therapy with cardio/renal benefit.
Best option?
A. SGLT2 inhibitor (empagliflozin)
B. Sulfonylurea only
C. Pioglitazone
D. Acarbose
Correct Answer:
A. SGLT2 inhibitor (empagliflozin)
Rationale:
SGLT2 inhibitors reduce heart failure hospitalization and slow kidney disease
progression in appropriate patients with T2DM.
7. A patient on an SGLT2 inhibitor has nausea, abdominal pain, anion gap
metabolic acidosis, glucose 165. Most concerning diagnosis?
A. Euglycemic DKA
B. Hypothyroidism
C. GERD
D. BPH
Correct Answer:
A. Euglycemic DKA
Rationale:
SGLT2 inhibitors can cause diabetic ketoacidosis with only mildly elevated or near-
normal glucose levels.
, 8. A patient starting an SGLT2 inhibitor should be counseled about which
common adverse effect?
A. Genitourinary infections
B. Severe bradycardia
C. Hearing loss
D. Prostate shrinkage
Correct Answer:
A. Genitourinary infections
Rationale:
SGLT2 inhibitors increase urinary glucose excretion, which raises risk for genital
mycotic infections and some urinary infections.
9. A patient wants diabetes medication that supports weight loss and CV benefit.
Best class?
A. GLP-1 receptor agonist (semaglutide)
B. Thiazolidinedione
C. Sulfonylurea
D. Alpha-blocker
Correct Answer:
A. GLP-1 receptor agonist (semaglutide)
Rationale:
GLP-1 receptor agonists improve glycemic control, promote weight loss, and some
agents have cardiovascular benefit.
10. A patient with edema and HF symptoms worsens after starting pioglitazone.
Why?
A. TZDs can cause fluid retention and worsen HF
B. TZDs always cause dehydration
C. TZDs shrink the prostate
D. TZDs treat acute DKA
Correct Answer:
A. TZDs can cause fluid retention and worsen HF
Rationale:
Thiazolidinediones can cause sodium and fluid retention, which may exacerbate heart
failure.
11. A patient’s A1C goal should be relaxed due to age/comorbidities. Which target
is most appropriate?
A. < 5%
B. < 6%
C. < 8%
D. > 12%
