NSG 533 Advanced Pharmacology Test 1 |
Questions and Correct Answers plus Rationale
(Already Graded A+) | New Update 2026-2027 |
Wilkes University
Question 1
EP is a 38-year-old female patient that comes in for diabetes education and
management. She was diagnosed 12 years ago and states lately she is not able
to control her diet although she continues a 1600 calorie diet with appropriate
daily carbohydrate intake (per dietitian prescription) and walks 40 minutes every
day of the week. She states compliance with all medications. She denies any
history of hypoglycemia despite being able to identify signs and symptoms and
describe appropriate treatment strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily,
sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mmHg; P 72 beats/min; BMI 31 m/kg²
Which of the following agents is most appropriate to add to EP's regimen for
glycemic control?
A. Exenatide
B. Dapagliflozin
C. Sitagliptin
D. Acarbose
Correct Answer: C. Sitagliptin
Rationale: Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based
on clinical trials and currently the patient does not have any cautionary objective
,measures to not use this medication. DPP-IV inhibitors are weight neutral. DPP-IV
inhibitors can be used in patients taking sulfonylureas; however, it may be
recommended to reduce or stop the sulfonylurea dose. Exenatide (A) is
contraindicated for EP due to the self-reported history of thyroid cancer.
Dapagliflozin (B) is contraindicated due to hyperkalemia which could be made
worse by this drug. Acarbose (D) is not recommended for initial management and
is associated with significant GI side effects.
Question 2
JR is a 68-year-old African American man with a new diagnosis of T2DM. He was
classified as having prediabetes (at risk for developing diabetes) 5 years before
the diagnosis and has a strong family history of type 2 diabetes. JR's blood
pressure was 150/92 mmHg. His laboratory results revealed an A1C of 8.1%,
normal cholesterol panel, and normal renal/hepatic function were noted with
today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago), Hyperlipidemia
(diagnosed 2 y ago), Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mmHg; P: 78 beats/min; RR: 12 rpm; Waist Circumference: 46
in; Weight: 267 lb; Height: 5'6"; BMI: 43.1 kg/m²
Despite improvements in the past six weeks due to lifestyle changes and
exercise, drug therapy is to be started for JR's diabetes. Which of the following is
the most appropriate initial therapy?
A. Metformin monotherapy
B. Metformin + DPP-4 inhibitor
C. Metformin + GLP-1 agonist
D. Metformin + sulfonylurea
Correct Answer: B. Metformin + DPP-4 inhibitor
, Rationale: Since his entry A1C is >7.5%, dual therapy is indicated. Metformin is the
drug of choice recommended for most patients with diabetes in addition to
lifestyle modifications assuming no contraindications or intolerabilities are present
upon evaluation. DPP4 inhibitors are weight neutral with a relatively benign side
effect profile. Sitagliptin has been associated with case reports of pancreatitis, so
this specific agent should be avoided. GLP-1 analogs (C) are not recommended
due to his past history of pancreatitis. Sulfonylureas (D) are associated with weight
gain and potential hypoglycemia. TZDs are associated with weight gain, negative
effects on lipids and increased risk of fracture.
Question 3
A patient with type 1 diabetes reports taking propranolol for hypertension.
What concern does this information present for the provider?
A. Propranolol may increase blood glucose levels
B. Propranolol may mask symptoms of hypoglycemia
C. Propranolol may cause hyperkalemia
D. Propranolol may decrease insulin absorption
Correct Answer: B. Propranolol may mask symptoms of hypoglycemia
Rationale: A patient with Type 1 DM is insulin dependent for glucose control and
at high risk for hypoglycemic episodes. Propranolol (a non-selective beta-blocker)
can mask the adrenergic symptoms of hypoglycemia (tachycardia, palpitations,
tremor) and also prolong hypoglycemic episodes. Needs to switch to ACE or ARB.
Propranolol does not typically increase blood glucose (A), cause hyperkalemia (C),
or decrease insulin absorption (D).
Question 4
A provider teaches a patient who has been diagnosed with hypothyroidism
about a new prescription for levothyroxine. Which statement by the patient
indicates a need for further teaching?
Questions and Correct Answers plus Rationale
(Already Graded A+) | New Update 2026-2027 |
Wilkes University
Question 1
EP is a 38-year-old female patient that comes in for diabetes education and
management. She was diagnosed 12 years ago and states lately she is not able
to control her diet although she continues a 1600 calorie diet with appropriate
daily carbohydrate intake (per dietitian prescription) and walks 40 minutes every
day of the week. She states compliance with all medications. She denies any
history of hypoglycemia despite being able to identify signs and symptoms and
describe appropriate treatment strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily,
sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mmHg; P 72 beats/min; BMI 31 m/kg²
Which of the following agents is most appropriate to add to EP's regimen for
glycemic control?
A. Exenatide
B. Dapagliflozin
C. Sitagliptin
D. Acarbose
Correct Answer: C. Sitagliptin
Rationale: Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based
on clinical trials and currently the patient does not have any cautionary objective
,measures to not use this medication. DPP-IV inhibitors are weight neutral. DPP-IV
inhibitors can be used in patients taking sulfonylureas; however, it may be
recommended to reduce or stop the sulfonylurea dose. Exenatide (A) is
contraindicated for EP due to the self-reported history of thyroid cancer.
Dapagliflozin (B) is contraindicated due to hyperkalemia which could be made
worse by this drug. Acarbose (D) is not recommended for initial management and
is associated with significant GI side effects.
Question 2
JR is a 68-year-old African American man with a new diagnosis of T2DM. He was
classified as having prediabetes (at risk for developing diabetes) 5 years before
the diagnosis and has a strong family history of type 2 diabetes. JR's blood
pressure was 150/92 mmHg. His laboratory results revealed an A1C of 8.1%,
normal cholesterol panel, and normal renal/hepatic function were noted with
today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago), Hyperlipidemia
(diagnosed 2 y ago), Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mmHg; P: 78 beats/min; RR: 12 rpm; Waist Circumference: 46
in; Weight: 267 lb; Height: 5'6"; BMI: 43.1 kg/m²
Despite improvements in the past six weeks due to lifestyle changes and
exercise, drug therapy is to be started for JR's diabetes. Which of the following is
the most appropriate initial therapy?
A. Metformin monotherapy
B. Metformin + DPP-4 inhibitor
C. Metformin + GLP-1 agonist
D. Metformin + sulfonylurea
Correct Answer: B. Metformin + DPP-4 inhibitor
, Rationale: Since his entry A1C is >7.5%, dual therapy is indicated. Metformin is the
drug of choice recommended for most patients with diabetes in addition to
lifestyle modifications assuming no contraindications or intolerabilities are present
upon evaluation. DPP4 inhibitors are weight neutral with a relatively benign side
effect profile. Sitagliptin has been associated with case reports of pancreatitis, so
this specific agent should be avoided. GLP-1 analogs (C) are not recommended
due to his past history of pancreatitis. Sulfonylureas (D) are associated with weight
gain and potential hypoglycemia. TZDs are associated with weight gain, negative
effects on lipids and increased risk of fracture.
Question 3
A patient with type 1 diabetes reports taking propranolol for hypertension.
What concern does this information present for the provider?
A. Propranolol may increase blood glucose levels
B. Propranolol may mask symptoms of hypoglycemia
C. Propranolol may cause hyperkalemia
D. Propranolol may decrease insulin absorption
Correct Answer: B. Propranolol may mask symptoms of hypoglycemia
Rationale: A patient with Type 1 DM is insulin dependent for glucose control and
at high risk for hypoglycemic episodes. Propranolol (a non-selective beta-blocker)
can mask the adrenergic symptoms of hypoglycemia (tachycardia, palpitations,
tremor) and also prolong hypoglycemic episodes. Needs to switch to ACE or ARB.
Propranolol does not typically increase blood glucose (A), cause hyperkalemia (C),
or decrease insulin absorption (D).
Question 4
A provider teaches a patient who has been diagnosed with hypothyroidism
about a new prescription for levothyroxine. Which statement by the patient
indicates a need for further teaching?
