,NU 578 U4 Exam | Pharm for Adv Practice Nurses (2026/2027) Q&A | U South
Alabama
1. Which medication is the first-line pharmacologic therapy for a patient newly diagnosed
with type 2 diabetes and an A1c of 7.5%?
A) Metformin
B) Insulin glargine
C) Glipizide
D) Liraglutide
Correct Answer: Metformin
Rationale: Metformin is recommended as the first-line pharmacologic agent for type 2
diabetes due to its efficacy, favorable safety profile, and low risk of hypoglycemia. It works
primarily by reducing hepatic glucose production and improving peripheral insulin
sensitivity. Insulin is typically reserved for patients with significant hyperglycemia or when
oral agents fail. GLP-1 agonists and sulfonylureas are considered add-on therapies.
2. A patient taking metformin is scheduled for a CT scan with IV contrast. What is the most
important nursing action?
A) Continue metformin as usual
B) Hold metformin 48 hours before and after the procedure
C) Increase the metformin dose
D) Switch to insulin temporarily
Correct Answer: Hold metformin 48 hours before and after the procedure
Rationale: Metformin should be held 48 hours before and after administration of iodinated
IV contrast to prevent contrast-induced nephropathy and the subsequent risk of lactic
acidosis. Renal function should be assessed before restarting the medication. Continuing
metformin increases the risk of a rare but serious adverse effect. Dose increases are not
appropriate in this situation.
,3. A patient with type 2 diabetes on insulin is also prescribed liraglutide. What is the best
explanation for this combination?
A) Liraglutide prevents insulin resistance.
B) It reduces glucose absorption from the intestine.
C) It promotes endogenous insulin secretion in a glucose-dependent manner and slows
gastric emptying.
D) It directly stimulates glucose uptake by peripheral tissues.
Correct Answer: It promotes endogenous insulin secretion in a glucose-dependent
manner and slows gastric emptying.
Rationale: Liraglutide is a GLP-1 receptor agonist that enhances glucose-dependent insulin
secretion, suppresses glucagon release, and slows gastric emptying, which promotes satiety
and weight loss. It does not directly reverse insulin resistance or stimulate peripheral glucose
uptake. Its additive benefit with insulin is improved glycemic control with potential weight
loss.
4. A patient on empagliflozin reports increased thirst and frequent urination. Which
mechanism explains these symptoms?
A) Inhibition of DPP-4, increasing incretin levels
B) Reduced hepatic glucose production
C) Increased renal glucose excretion due to SGLT2 inhibition
D) Enhanced peripheral insulin sensitivity
Correct Answer: Increased renal glucose excretion due to SGLT2 inhibition
Rationale: Empagliflozin is an SGLT2 inhibitor that blocks glucose reabsorption in the
proximal renal tubule, leading to glycosuria. This osmotic diuresis causes increased urination
and subsequent thirst. DPP-4 inhibition and reduced hepatic glucose production are
mechanisms of other drug classes. Enhanced insulin sensitivity is the mechanism of
thiazolidinediones.
5. Which insulin has the most rapid onset of action?
, A) Insulin glargine
B) Insulin detemir
C) Insulin lispro
D) NPH insulin
Correct Answer: Insulin lispro
Rationale: Insulin lispro is a rapid-acting insulin analog with an onset of 15 minutes, peak
at 1 hour, and duration of 3-4 hours. It is ideal for mealtime coverage. Insulin glargine and
detemir are long-acting basal insulins. NPH is an intermediate-acting insulin.
6. A patient is prescribed levothyroxine. Which instruction should the nurse include?
A) Take it at bedtime with a snack.
B) Take it in the morning on an empty stomach.
C) Take it with calcium supplements.
D) Take it with grapefruit juice.
Correct Answer: Take it in the morning on an empty stomach.
Rationale: Levothyroxine should be taken on an empty stomach, 30-60 minutes before
breakfast, to ensure consistent absorption. Food, especially calcium and iron supplements,
can significantly decrease its absorption. Grapefruit juice does not have a major interaction
with levothyroxine but is not recommended for administration.
7. A patient with hyperthyroidism is prescribed methimazole. Which adverse effect requires
immediate reporting?
A) Weight gain
B) Sore throat and fever
C) Cold intolerance
D) Constipation
Correct Answer: Sore throat and fever
Alabama
1. Which medication is the first-line pharmacologic therapy for a patient newly diagnosed
with type 2 diabetes and an A1c of 7.5%?
A) Metformin
B) Insulin glargine
C) Glipizide
D) Liraglutide
Correct Answer: Metformin
Rationale: Metformin is recommended as the first-line pharmacologic agent for type 2
diabetes due to its efficacy, favorable safety profile, and low risk of hypoglycemia. It works
primarily by reducing hepatic glucose production and improving peripheral insulin
sensitivity. Insulin is typically reserved for patients with significant hyperglycemia or when
oral agents fail. GLP-1 agonists and sulfonylureas are considered add-on therapies.
2. A patient taking metformin is scheduled for a CT scan with IV contrast. What is the most
important nursing action?
A) Continue metformin as usual
B) Hold metformin 48 hours before and after the procedure
C) Increase the metformin dose
D) Switch to insulin temporarily
Correct Answer: Hold metformin 48 hours before and after the procedure
Rationale: Metformin should be held 48 hours before and after administration of iodinated
IV contrast to prevent contrast-induced nephropathy and the subsequent risk of lactic
acidosis. Renal function should be assessed before restarting the medication. Continuing
metformin increases the risk of a rare but serious adverse effect. Dose increases are not
appropriate in this situation.
,3. A patient with type 2 diabetes on insulin is also prescribed liraglutide. What is the best
explanation for this combination?
A) Liraglutide prevents insulin resistance.
B) It reduces glucose absorption from the intestine.
C) It promotes endogenous insulin secretion in a glucose-dependent manner and slows
gastric emptying.
D) It directly stimulates glucose uptake by peripheral tissues.
Correct Answer: It promotes endogenous insulin secretion in a glucose-dependent
manner and slows gastric emptying.
Rationale: Liraglutide is a GLP-1 receptor agonist that enhances glucose-dependent insulin
secretion, suppresses glucagon release, and slows gastric emptying, which promotes satiety
and weight loss. It does not directly reverse insulin resistance or stimulate peripheral glucose
uptake. Its additive benefit with insulin is improved glycemic control with potential weight
loss.
4. A patient on empagliflozin reports increased thirst and frequent urination. Which
mechanism explains these symptoms?
A) Inhibition of DPP-4, increasing incretin levels
B) Reduced hepatic glucose production
C) Increased renal glucose excretion due to SGLT2 inhibition
D) Enhanced peripheral insulin sensitivity
Correct Answer: Increased renal glucose excretion due to SGLT2 inhibition
Rationale: Empagliflozin is an SGLT2 inhibitor that blocks glucose reabsorption in the
proximal renal tubule, leading to glycosuria. This osmotic diuresis causes increased urination
and subsequent thirst. DPP-4 inhibition and reduced hepatic glucose production are
mechanisms of other drug classes. Enhanced insulin sensitivity is the mechanism of
thiazolidinediones.
5. Which insulin has the most rapid onset of action?
, A) Insulin glargine
B) Insulin detemir
C) Insulin lispro
D) NPH insulin
Correct Answer: Insulin lispro
Rationale: Insulin lispro is a rapid-acting insulin analog with an onset of 15 minutes, peak
at 1 hour, and duration of 3-4 hours. It is ideal for mealtime coverage. Insulin glargine and
detemir are long-acting basal insulins. NPH is an intermediate-acting insulin.
6. A patient is prescribed levothyroxine. Which instruction should the nurse include?
A) Take it at bedtime with a snack.
B) Take it in the morning on an empty stomach.
C) Take it with calcium supplements.
D) Take it with grapefruit juice.
Correct Answer: Take it in the morning on an empty stomach.
Rationale: Levothyroxine should be taken on an empty stomach, 30-60 minutes before
breakfast, to ensure consistent absorption. Food, especially calcium and iron supplements,
can significantly decrease its absorption. Grapefruit juice does not have a major interaction
with levothyroxine but is not recommended for administration.
7. A patient with hyperthyroidism is prescribed methimazole. Which adverse effect requires
immediate reporting?
A) Weight gain
B) Sore throat and fever
C) Cold intolerance
D) Constipation
Correct Answer: Sore throat and fever
