NSG 533 Advanced Pharmacology Test 1 Ques ons With
All Correct Answers 2025/2026 With complete solu on
New!! RATED A+
EP is a 38-year-old female pa ent that comes in for diabetes educa on and management. She
was diagnosed 12 years ago and states lately she is not able to control her diet although she
con nues a 1600 calorie diet with appropriate daily carbohydrate intake (per die an
prescrip on) and walks 40 minutes every day of the week. She states compliance with all
medica ons. She denies any history of hypoglycemia despite being able to iden fy 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
Medica ons: Me3ormin 850 mg d, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline 100 mg
daily, mul vitamin 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 - Ans Exena de -
Exena de (Bydureon) once weekly has been able to demonstrate weight loss and decrease
A1C% by 0.7% to 1.2% in clinical trials; however it is contraindicated for EP due to the self-
reported history of thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this pa ent due to hyperkalemia
which could be made worse by this drug. The package insert does not indicate a specific
potassium concentra on cut off to no longer use this medica on; however, there are beEer
choices in this pa ent.
Sitaglip n - Sitaglip n (Januvia) is able to obtain an A1C goal of less than 7% based on clinical
trials and currently the pa ent does not have any cau onary objec ve measures to not use this
medica on. DPP-IV inhibitors are weight neutral. DPP-IV inhibitors can be used in pa ents
taking sulfonylureas; however, it may be recommended to reduce or stop the sulfonylurea dose.
Acarbose - Acarbose (Precose) is not recommended for ini al management and is associated
with significant GI side effects. More informa on would be needed regarding fas ng and post-
,prandial numbers. In addi on, 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/hepa c func on
were noted with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed 2 y ago)
Pancrea s (idiopathic) (acute hospitaliza on 3 y ago)
Family history: Type 2 diabetes
Medica on: HCTZ 25 mg daily, simvasta n 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 - Ans Me3ormin is the drug of choice recommended for most
pa ents with diabetes in addi on to lifestyle modifica ons assuming no contraindica ons or
intolerabili es are present upon evalua on. Me3ormin has also shown to provide posi ve
weight neutral/loss effects in obese pa ents. It is crucial to know the renal status of pa ents
commencing me3ormin therapy to limit the risk of lac c acidosis (JR is without
contraindica on).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several poten al choices. The
second step can be a dipep dyl pep dase-4 inhibitor, it can be a glucagon-like pep de-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 rela vely benign side effect profile. Sitaglip n has been
associated with case reports of pancrea s, so this specific agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduc on necessary to gain glycemic control and
may assist with weight loss goals for this pa ent. New informa on suggests these agents may
, provide benefits in those with ASCVD. JR has a past history of pancrea s and GLP-1 analogs are
not recommended due to this contraindica on
TZDs have data to support an A1C reduc on necessary to gain glycemic control, but are
associated with weight gain, nega ve effects on lipids and increased risk of fracture. Un l
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 poten al to cause hypoglycemia, so pa ent educa on is crucial. Because of his
allergies to "sulfa", use would be contr
A pa ent with type 1 diabetes reports taking propranolol for hypertension. What concern does
this informa on present for the provider? - Ans A pa ent 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 pa ent who has been diagnosed with hypothyroidism about a new
prescrip on for levothyroxine. Which statement by the pa ent indicates a need for further
teaching?
a. "I should not take heartburn medica on without consul ng my provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
c. "If I take a mul vitamin with iron, I should take it 4 hours aTer the levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of levothyroxine." - Ans D.
Calcium may reduce levothyroxine absorp on. Further educa on is needed if the pa ent feels
she can take half of a prescribed medica on.
MC has undiagnosed mul ple gastric ulcers. Shortly aTer consuming a large meal and alcohol
he experiences significant GI distress. He takes an OTC heartburn remedy. Within a minute or
two he develops what he will later describe as "belching, nausea and a bad bloated feeling".
Several of the ulcers began to bleed and he becomes profoundly hypotensive from the blood
loss and is taken to the ED. Endoscopy confirms mul ple bleeds; the endoscopist remarks that it
appears as if the lesions had been literally stretched apart causing addi onal ssue damage.
What did the pa ent most likely take (i.e. what was the OTC remedy)? - Ans I would accept Alka-
Selzer. I contains NaHCO3 (as well as ASA). In the presence of HCL it Liberates CO2, that can
All Correct Answers 2025/2026 With complete solu on
New!! RATED A+
EP is a 38-year-old female pa ent that comes in for diabetes educa on and management. She
was diagnosed 12 years ago and states lately she is not able to control her diet although she
con nues a 1600 calorie diet with appropriate daily carbohydrate intake (per die an
prescrip on) and walks 40 minutes every day of the week. She states compliance with all
medica ons. She denies any history of hypoglycemia despite being able to iden fy 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
Medica ons: Me3ormin 850 mg d, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline 100 mg
daily, mul vitamin 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 - Ans Exena de -
Exena de (Bydureon) once weekly has been able to demonstrate weight loss and decrease
A1C% by 0.7% to 1.2% in clinical trials; however it is contraindicated for EP due to the self-
reported history of thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this pa ent due to hyperkalemia
which could be made worse by this drug. The package insert does not indicate a specific
potassium concentra on cut off to no longer use this medica on; however, there are beEer
choices in this pa ent.
Sitaglip n - Sitaglip n (Januvia) is able to obtain an A1C goal of less than 7% based on clinical
trials and currently the pa ent does not have any cau onary objec ve measures to not use this
medica on. DPP-IV inhibitors are weight neutral. DPP-IV inhibitors can be used in pa ents
taking sulfonylureas; however, it may be recommended to reduce or stop the sulfonylurea dose.
Acarbose - Acarbose (Precose) is not recommended for ini al management and is associated
with significant GI side effects. More informa on would be needed regarding fas ng and post-
,prandial numbers. In addi on, 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/hepa c func on
were noted with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed 2 y ago)
Pancrea s (idiopathic) (acute hospitaliza on 3 y ago)
Family history: Type 2 diabetes
Medica on: HCTZ 25 mg daily, simvasta n 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 - Ans Me3ormin is the drug of choice recommended for most
pa ents with diabetes in addi on to lifestyle modifica ons assuming no contraindica ons or
intolerabili es are present upon evalua on. Me3ormin has also shown to provide posi ve
weight neutral/loss effects in obese pa ents. It is crucial to know the renal status of pa ents
commencing me3ormin therapy to limit the risk of lac c acidosis (JR is without
contraindica on).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several poten al choices. The
second step can be a dipep dyl pep dase-4 inhibitor, it can be a glucagon-like pep de-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 rela vely benign side effect profile. Sitaglip n has been
associated with case reports of pancrea s, so this specific agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduc on necessary to gain glycemic control and
may assist with weight loss goals for this pa ent. New informa on suggests these agents may
, provide benefits in those with ASCVD. JR has a past history of pancrea s and GLP-1 analogs are
not recommended due to this contraindica on
TZDs have data to support an A1C reduc on necessary to gain glycemic control, but are
associated with weight gain, nega ve effects on lipids and increased risk of fracture. Un l
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 poten al to cause hypoglycemia, so pa ent educa on is crucial. Because of his
allergies to "sulfa", use would be contr
A pa ent with type 1 diabetes reports taking propranolol for hypertension. What concern does
this informa on present for the provider? - Ans A pa ent 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 pa ent who has been diagnosed with hypothyroidism about a new
prescrip on for levothyroxine. Which statement by the pa ent indicates a need for further
teaching?
a. "I should not take heartburn medica on without consul ng my provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
c. "If I take a mul vitamin with iron, I should take it 4 hours aTer the levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of levothyroxine." - Ans D.
Calcium may reduce levothyroxine absorp on. Further educa on is needed if the pa ent feels
she can take half of a prescribed medica on.
MC has undiagnosed mul ple gastric ulcers. Shortly aTer consuming a large meal and alcohol
he experiences significant GI distress. He takes an OTC heartburn remedy. Within a minute or
two he develops what he will later describe as "belching, nausea and a bad bloated feeling".
Several of the ulcers began to bleed and he becomes profoundly hypotensive from the blood
loss and is taken to the ED. Endoscopy confirms mul ple bleeds; the endoscopist remarks that it
appears as if the lesions had been literally stretched apart causing addi onal ssue damage.
What did the pa ent most likely take (i.e. what was the OTC remedy)? - Ans I would accept Alka-
Selzer. I contains NaHCO3 (as well as ASA). In the presence of HCL it Liberates CO2, that can
