NSG 533 Advanced Pharmacology Exam
2025–2026 | Verified Questions, Answers,
and Complete Study Guide for Graduate
Nursing Students
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 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN
- ANSWER -Exenatide - Exenatide (Bydureon) once weekly has been
able to demonstrate weight loss and decrease A1C% by 0.7% to 1.2% in
pg. 1
,clinical trials; however it is contraindicated for EP due to the self-
reported history of thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient
due to hyperkalemia which could be made worse by this drug. The
package insert does not indicate a specific potassium concentration cut
off to no longer use this medication; however, there are better choices
in this patient.
Sitagliptin - 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.
Acarbose - Acarbose (Precose) is not recommended for initial
management and is associated with significant GI side effects. More
information would be needed regarding fasting and post-prandial
numbers. In addition, adding acarbose would only lower A1c by 0.8% at
best and therefore would not achieve the desired A1C goal of <7%
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 mm Hg. 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)
pg. 2
,Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist
Circumference: 46 in Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
Despite improvements in the past six weeks due to lifestyle changes and
exercise, drug therapy is to be started for JR's diabet - ANSWER -
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.
Metformin has also shown to provide positive weight neutral/loss
effects in obese patients. It is crucial to know the renal status of
patients commencing metformin therapy to limit the risk of lactic
acidosis (JR is without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several
potential choices. The second step can be a dipeptidyl peptidase-4
inhibitor, it can be a glucagon-like peptide-1 (GLP-1) receptor agonist, it
can be a TZD, it can be a sulfonylurea agent, it can be a SGLT2 inhibitor,
or it could be basal insulin. Anything next can be tried depending on
what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect
profile. Sitagliptin has been associated with case reports of pancreatitis,
so this specific agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduction necessary to
gain glycemic control and may assist with weight loss goals for this
pg. 3
, patient. New information suggests these agents may provide benefits in
those with ASCVD. JR has a past history of pancreatitis and GLP-1
analogs are not recommended due to this contraindication
TZDs have data to support an A1C reduction necessary to gain glycemic
control, but are associated with weight gain, negative effects on lipids
and increased risk of fracture. Until recently, TZDs have also been linked
to increased CV events and use has fallen out of favor
Sulfonylureas provide excellent A1C lowering, but are also associated
with weight gain. They also have the potential to cause hypoglycemia,
so patient education is crucial. Because of his allergies to "sulfa", use
would be contr
A patient with type 1 diabetes reports taking propranolol for
hypertension. What concern does this information present for the
provider? - ANSWER -A patient with Type 1 DM is insulin dependent for
glucose control and at high risk for hypoglycemic episodes. Propanolol
causes prolonged hypoglycemic episodes. Needs to switch to ACE or
ARB.
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?
a. "I should not take heartburn medication without consulting my
provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my
provider."
pg. 4
2025–2026 | Verified Questions, Answers,
and Complete Study Guide for Graduate
Nursing Students
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 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN
- ANSWER -Exenatide - Exenatide (Bydureon) once weekly has been
able to demonstrate weight loss and decrease A1C% by 0.7% to 1.2% in
pg. 1
,clinical trials; however it is contraindicated for EP due to the self-
reported history of thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient
due to hyperkalemia which could be made worse by this drug. The
package insert does not indicate a specific potassium concentration cut
off to no longer use this medication; however, there are better choices
in this patient.
Sitagliptin - 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.
Acarbose - Acarbose (Precose) is not recommended for initial
management and is associated with significant GI side effects. More
information would be needed regarding fasting and post-prandial
numbers. In addition, adding acarbose would only lower A1c by 0.8% at
best and therefore would not achieve the desired A1C goal of <7%
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 mm Hg. 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)
pg. 2
,Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist
Circumference: 46 in Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
Despite improvements in the past six weeks due to lifestyle changes and
exercise, drug therapy is to be started for JR's diabet - ANSWER -
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.
Metformin has also shown to provide positive weight neutral/loss
effects in obese patients. It is crucial to know the renal status of
patients commencing metformin therapy to limit the risk of lactic
acidosis (JR is without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several
potential choices. The second step can be a dipeptidyl peptidase-4
inhibitor, it can be a glucagon-like peptide-1 (GLP-1) receptor agonist, it
can be a TZD, it can be a sulfonylurea agent, it can be a SGLT2 inhibitor,
or it could be basal insulin. Anything next can be tried depending on
what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect
profile. Sitagliptin has been associated with case reports of pancreatitis,
so this specific agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduction necessary to
gain glycemic control and may assist with weight loss goals for this
pg. 3
, patient. New information suggests these agents may provide benefits in
those with ASCVD. JR has a past history of pancreatitis and GLP-1
analogs are not recommended due to this contraindication
TZDs have data to support an A1C reduction necessary to gain glycemic
control, but are associated with weight gain, negative effects on lipids
and increased risk of fracture. Until recently, TZDs have also been linked
to increased CV events and use has fallen out of favor
Sulfonylureas provide excellent A1C lowering, but are also associated
with weight gain. They also have the potential to cause hypoglycemia,
so patient education is crucial. Because of his allergies to "sulfa", use
would be contr
A patient with type 1 diabetes reports taking propranolol for
hypertension. What concern does this information present for the
provider? - ANSWER -A patient with Type 1 DM is insulin dependent for
glucose control and at high risk for hypoglycemic episodes. Propanolol
causes prolonged hypoglycemic episodes. Needs to switch to ACE or
ARB.
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?
a. "I should not take heartburn medication without consulting my
provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my
provider."
pg. 4
