NSG 533 ADVANCED PHARMACOLOGY
EXAM 3 STUDY GUIDE QUESTIONS AND
ANSWERS
1. Which of the following is the primary mechanism of action for Metformin in the
management of Type 2 Diabetes?
A. Stimulating insulin secretion from pancreatic beta cells
B. Slowing the breakdown of complex carbohydrates in the GI tract
C. Inhibiting the reabsorption of glucose in the proximal convoluted tubule
D. Decreasing hepatic glucose production and improving insulin sensitivity
Answer: D
Conceptual Explanation: Metformin works primarily by reducing hepatic gluconeogenesis
and increasing peripheral glucose uptake by improving insulin sensitivity. It does not
stimulate insulin secretion, which is why it has a low risk of hypoglycemia.
,2. A patient with a history of heart failure and a reduced ejection fraction (HFrEF) is started
on an ACE inhibitor. What is the primary physiological benefit of this drug class in this
population?
A. Increasing heart rate to improve cardiac output
B. Directly increasing myocardial contractility
C. Reducing preload and afterload through the inhibition of Angiotensin II
D. Promoting sodium reabsorption in the distal tubule
Answer: C
Conceptual Explanation: ACE inhibitors block the conversion of Angiotensin I to
Angiotensin II, leading to vasodilation (reduced afterload) and decreased aldosterone
secretion (reduced preload/sodium retention), which slows cardiac remodeling.
3. Which medication is contraindicated in a patient with a known history of Medullary
Thyroid Carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)?
A. Liraglutide (Victoza)
B. Empagliflozin (Jardiance)
C. Sitagliptin (Januvia)
D. Glipizide (Glucotrol)
Answer: A
, Conceptual Explanation: GLP-1 receptor agonists, such as Liraglutide, carry a boxed
warning regarding the risk of thyroid C-cell tumors and are contraindicated in patients
with a personal or family history of MTC or MEN 2.
4. An 80-year-old patient is prescribed Levothyroxine for hypothyroidism. What is the most
appropriate initial dosing strategy?
A. Start with a full replacement dose of 1.6 mcg/kg/day
B. Administer with a high-calcium meal to improve absorption
C. Load with 500 mcg to achieve euthyroid state quickly
D. Start at 12.5 to 25 mcg daily and titrate slowly
Answer: D
Conceptual Explanation: In elderly patients or those with underlying cardiovascular
disease, Levothyroxine should be started at low doses (12.5-25 mcg) to prevent
tachyarrhythmias or myocardial ischemia.
5. Which electrolyte abnormality is a common side effect of Spironolactone (Aldactone)
therapy?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
EXAM 3 STUDY GUIDE QUESTIONS AND
ANSWERS
1. Which of the following is the primary mechanism of action for Metformin in the
management of Type 2 Diabetes?
A. Stimulating insulin secretion from pancreatic beta cells
B. Slowing the breakdown of complex carbohydrates in the GI tract
C. Inhibiting the reabsorption of glucose in the proximal convoluted tubule
D. Decreasing hepatic glucose production and improving insulin sensitivity
Answer: D
Conceptual Explanation: Metformin works primarily by reducing hepatic gluconeogenesis
and increasing peripheral glucose uptake by improving insulin sensitivity. It does not
stimulate insulin secretion, which is why it has a low risk of hypoglycemia.
,2. A patient with a history of heart failure and a reduced ejection fraction (HFrEF) is started
on an ACE inhibitor. What is the primary physiological benefit of this drug class in this
population?
A. Increasing heart rate to improve cardiac output
B. Directly increasing myocardial contractility
C. Reducing preload and afterload through the inhibition of Angiotensin II
D. Promoting sodium reabsorption in the distal tubule
Answer: C
Conceptual Explanation: ACE inhibitors block the conversion of Angiotensin I to
Angiotensin II, leading to vasodilation (reduced afterload) and decreased aldosterone
secretion (reduced preload/sodium retention), which slows cardiac remodeling.
3. Which medication is contraindicated in a patient with a known history of Medullary
Thyroid Carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)?
A. Liraglutide (Victoza)
B. Empagliflozin (Jardiance)
C. Sitagliptin (Januvia)
D. Glipizide (Glucotrol)
Answer: A
, Conceptual Explanation: GLP-1 receptor agonists, such as Liraglutide, carry a boxed
warning regarding the risk of thyroid C-cell tumors and are contraindicated in patients
with a personal or family history of MTC or MEN 2.
4. An 80-year-old patient is prescribed Levothyroxine for hypothyroidism. What is the most
appropriate initial dosing strategy?
A. Start with a full replacement dose of 1.6 mcg/kg/day
B. Administer with a high-calcium meal to improve absorption
C. Load with 500 mcg to achieve euthyroid state quickly
D. Start at 12.5 to 25 mcg daily and titrate slowly
Answer: D
Conceptual Explanation: In elderly patients or those with underlying cardiovascular
disease, Levothyroxine should be started at low doses (12.5-25 mcg) to prevent
tachyarrhythmias or myocardial ischemia.
5. Which electrolyte abnormality is a common side effect of Spironolactone (Aldactone)
therapy?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
