,NU636/NU 636 Advanced Pharmacology
Quiz 5 Bundle | Herzing | 26/27
1. A patient with type 2 diabetes mellitus and a history of heart failure is being evaluated for
pharmacotherapy. Which oral antidiabetic agent is contraindicated in this population due to an
increased risk of lactic acidosis?
A) Sitagliptin
B) Metformin
C) Empagliflozin
D) Linagliptin
Correct Answer: Metformin
Rationale: Metformin is contraindicated in patients with heart failure because of the increased risk of
lactic acidosis, particularly when tissue hypoperfusion is present. Sitagliptin and linagliptin are DPP-4
inhibitors that do not carry this contraindication. Empagliflozin has demonstrated benefit in heart
failure. The nurse must recognize this absolute contraindication when reviewing medication regimens
for patients with compromised cardiac function.
2. A 67-year-old male with type 2 diabetes has an HbA1c of 6.7% while taking metformin 1000 mg
twice daily. Which intervention does the advanced practice nurse anticipate?
A) Adding a sulfonylurea to the regimen
B) Making no change in the metformin dose
C) Decreasing metformin to 500 mg twice daily
,D) Initiating basal insulin therapy
Correct Answer: Making no change in the metformin dose
Rationale: An HbA1c of 6.7% is at or below the target of less than 7.0% for most patients with type 2
diabetes. The current regimen is effective and should be continued. Adding a sulfonylurea or initiating
insulin is not indicated when the target is met without adverse effects. Decreasing the metformin
dose would risk loss of glycemic control. The nurse should reinforce that the current therapeutic plan
is appropriate.
3. A patient receiving furosemide for heart failure develops muscle weakness and palpitations. Which
electrolyte imbalance is most likely responsible for these symptoms?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
Correct Answer: Hypokalemia
Rationale: Furosemide is a loop diuretic that increases urinary excretion of potassium, predisposing to
hypokalemia. Manifestations of hypokalemia include muscle weakness, fatigue, and cardiac
dysrhythmias such as palpitations. It does not typically cause hyperkalemia, hypernatremia, or
hypercalcemia. Potassium supplementation or concurrent potassium-sparing diuretic therapy may be
required. The nurse should monitor serum potassium levels closely.
4. Which medication is a potassium-sparing diuretic that also acts as an aldosterone antagonist?
, A) Hydrochlorothiazide
B) Furosemide
C) Spironolactone
D) Mannitol
Correct Answer: Spironolactone
Rationale: Spironolactone competitively antagonizes aldosterone receptors in the distal nephron,
promoting sodium and water excretion while retaining potassium. Hydrochlorothiazide and
furosemide are not potassium-sparing. Mannitol is an osmotic diuretic. Understanding this
mechanism is essential for monitoring potassium levels and recognizing the risk of hyperkalemia.
5. Which of the following is a cytochrome P450 3A4 inhibitor that can increase plasma concentrations
of certain drugs?
A) Rifampin
B) St. John's Wort
C) Ketoconazole
D) Phenobarbital
Correct Answer: Ketoconazole
Rationale: Ketoconazole is a known inhibitor of CYP3A4, which can decrease metabolism and increase
tissue concentrations of drugs metabolized by this enzyme. Rifampin, St. John's Wort, and
Quiz 5 Bundle | Herzing | 26/27
1. A patient with type 2 diabetes mellitus and a history of heart failure is being evaluated for
pharmacotherapy. Which oral antidiabetic agent is contraindicated in this population due to an
increased risk of lactic acidosis?
A) Sitagliptin
B) Metformin
C) Empagliflozin
D) Linagliptin
Correct Answer: Metformin
Rationale: Metformin is contraindicated in patients with heart failure because of the increased risk of
lactic acidosis, particularly when tissue hypoperfusion is present. Sitagliptin and linagliptin are DPP-4
inhibitors that do not carry this contraindication. Empagliflozin has demonstrated benefit in heart
failure. The nurse must recognize this absolute contraindication when reviewing medication regimens
for patients with compromised cardiac function.
2. A 67-year-old male with type 2 diabetes has an HbA1c of 6.7% while taking metformin 1000 mg
twice daily. Which intervention does the advanced practice nurse anticipate?
A) Adding a sulfonylurea to the regimen
B) Making no change in the metformin dose
C) Decreasing metformin to 500 mg twice daily
,D) Initiating basal insulin therapy
Correct Answer: Making no change in the metformin dose
Rationale: An HbA1c of 6.7% is at or below the target of less than 7.0% for most patients with type 2
diabetes. The current regimen is effective and should be continued. Adding a sulfonylurea or initiating
insulin is not indicated when the target is met without adverse effects. Decreasing the metformin
dose would risk loss of glycemic control. The nurse should reinforce that the current therapeutic plan
is appropriate.
3. A patient receiving furosemide for heart failure develops muscle weakness and palpitations. Which
electrolyte imbalance is most likely responsible for these symptoms?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
Correct Answer: Hypokalemia
Rationale: Furosemide is a loop diuretic that increases urinary excretion of potassium, predisposing to
hypokalemia. Manifestations of hypokalemia include muscle weakness, fatigue, and cardiac
dysrhythmias such as palpitations. It does not typically cause hyperkalemia, hypernatremia, or
hypercalcemia. Potassium supplementation or concurrent potassium-sparing diuretic therapy may be
required. The nurse should monitor serum potassium levels closely.
4. Which medication is a potassium-sparing diuretic that also acts as an aldosterone antagonist?
, A) Hydrochlorothiazide
B) Furosemide
C) Spironolactone
D) Mannitol
Correct Answer: Spironolactone
Rationale: Spironolactone competitively antagonizes aldosterone receptors in the distal nephron,
promoting sodium and water excretion while retaining potassium. Hydrochlorothiazide and
furosemide are not potassium-sparing. Mannitol is an osmotic diuretic. Understanding this
mechanism is essential for monitoring potassium levels and recognizing the risk of hyperkalemia.
5. Which of the following is a cytochrome P450 3A4 inhibitor that can increase plasma concentrations
of certain drugs?
A) Rifampin
B) St. John's Wort
C) Ketoconazole
D) Phenobarbital
Correct Answer: Ketoconazole
Rationale: Ketoconazole is a known inhibitor of CYP3A4, which can decrease metabolism and increase
tissue concentrations of drugs metabolized by this enzyme. Rifampin, St. John's Wort, and
