,GCU NSG 318 Exam 4 | Introduction to Pharmacology | Grand
Canyon University | Q & A | 2026 Edition (PDF)
1. A patient with type 2 diabetes is prescribed metformin. Which statement by the patient indicates a
need for further teaching?
A) "I will take this medication with meals to reduce stomach upset."
B) "I should report any muscle pain or weakness to my provider."
C) "I can stop taking this medication once my blood sugar is normal."
D) "I will avoid drinking excessive alcohol while on this medication."
Correct Answer: "I can stop taking this medication once my blood sugar is normal."
Rationale: Metformin is a maintenance medication for type 2 diabetes that must be taken consistently,
not discontinued when blood glucose levels normalize. Metformin should be taken with meals to reduce
GI distress, alcohol should be limited due to lactic acidosis risk, and muscle pain may indicate a serious
adverse effect.
2. Which of the following best describes the mechanism of action of sulfonylureas?
A) Inhibition of glucose absorption in the intestine
B) Stimulation of insulin release from pancreatic beta cells
C) Decrease in hepatic glucose production
D) Increase in peripheral glucose uptake
Correct Answer: Stimulation of insulin release from pancreatic beta cells
Rationale: Sulfonylureas (e.g., glipizide, glyburide) stimulate insulin secretion from pancreatic beta cells
by closing ATP-sensitive potassium channels. This increases endogenous insulin levels. Metformin
decreases hepatic glucose production, and thiazolidinediones increase peripheral glucose uptake.
3. A patient with type 2 diabetes is prescribed pioglitazone. Which adverse effect should the nurse
monitor for closely?
A) Hypoglycemia
,B) Fluid retention and heart failure
C) Lactic acidosis
D) Weight loss
Correct Answer: Fluid retention and heart failure
Rationale: Thiazolidinediones (pioglitazone, rosiglitazone) cause fluid retention, which can exacerbate or
precipitate heart failure. Patients should be monitored for weight gain, edema, and shortness of breath.
Hypoglycemia is less common with this class, and lactic acidosis is associated with metformin.
4. A patient with diabetes is prescribed insulin lispro. Which instruction regarding administration timing
is correct?
A) "Inject this insulin 30-60 minutes before meals."
B) "Inject this insulin immediately before or within 15 minutes of starting a meal."
C) "Inject this insulin at bedtime regardless of meals."
D) "Inject this insulin only when blood glucose is above 200 mg/dL."
Correct Answer: "Inject this insulin immediately before or within 15 minutes of starting a meal."
Rationale: Insulin lispro is a rapid-acting insulin analog with an onset of 15-30 minutes. It should be given
immediately before or within 15 minutes of starting a meal to match the postprandial glucose rise.
Regular insulin is given 30-60 minutes before meals.
5. Which insulin has the longest duration of action?
A) Insulin aspart
B) Insulin glargine
C) Regular insulin
D) NPH insulin
Correct Answer: Insulin glargine
, Rationale: Insulin glargine is a long-acting basal insulin with a duration of approximately 24 hours. Insulin
aspart is rapid-acting (3-5 hours), regular insulin is short-acting (5-8 hours), and NPH insulin is
intermediate-acting (12-18 hours).
6. A patient receiving insulin glargine reports hypoglycemia at the same time each day. What is the most
likely cause?
A) The patient is not rotating injection sites
B) The patient is mixing glargine with other insulins
C) The patient is injecting into a muscle instead of subcutaneous tissue
D) The patient is taking too high a dose
Correct Answer: The patient is mixing glargine with other insulins
Rationale: Insulin glargine should not be mixed with any other insulin because the acidic pH of the
formulation causes precipitation when mixed. This can alter its absorption profile and lead to
unpredictable hypoglycemia. Site rotation and injection technique can affect absorption but are less
likely to cause predictable daily hypoglycemia.
7. Which of the following is a sign of hyperglycemia?
A) Diaphoresis and tachycardia
B) Polyuria and polydipsia
C) Tremors and anxiety
D) Confusion and lethargy
Correct Answer: Polyuria and polydipsia
Rationale: Polyuria (frequent urination) and polydipsia (excessive thirst) are classic signs of
hyperglycemia due to osmotic diuresis from elevated blood glucose. Diaphoresis, tachycardia, tremors,
anxiety, confusion, and lethargy are signs of hypoglycemia.
Canyon University | Q & A | 2026 Edition (PDF)
1. A patient with type 2 diabetes is prescribed metformin. Which statement by the patient indicates a
need for further teaching?
A) "I will take this medication with meals to reduce stomach upset."
B) "I should report any muscle pain or weakness to my provider."
C) "I can stop taking this medication once my blood sugar is normal."
D) "I will avoid drinking excessive alcohol while on this medication."
Correct Answer: "I can stop taking this medication once my blood sugar is normal."
Rationale: Metformin is a maintenance medication for type 2 diabetes that must be taken consistently,
not discontinued when blood glucose levels normalize. Metformin should be taken with meals to reduce
GI distress, alcohol should be limited due to lactic acidosis risk, and muscle pain may indicate a serious
adverse effect.
2. Which of the following best describes the mechanism of action of sulfonylureas?
A) Inhibition of glucose absorption in the intestine
B) Stimulation of insulin release from pancreatic beta cells
C) Decrease in hepatic glucose production
D) Increase in peripheral glucose uptake
Correct Answer: Stimulation of insulin release from pancreatic beta cells
Rationale: Sulfonylureas (e.g., glipizide, glyburide) stimulate insulin secretion from pancreatic beta cells
by closing ATP-sensitive potassium channels. This increases endogenous insulin levels. Metformin
decreases hepatic glucose production, and thiazolidinediones increase peripheral glucose uptake.
3. A patient with type 2 diabetes is prescribed pioglitazone. Which adverse effect should the nurse
monitor for closely?
A) Hypoglycemia
,B) Fluid retention and heart failure
C) Lactic acidosis
D) Weight loss
Correct Answer: Fluid retention and heart failure
Rationale: Thiazolidinediones (pioglitazone, rosiglitazone) cause fluid retention, which can exacerbate or
precipitate heart failure. Patients should be monitored for weight gain, edema, and shortness of breath.
Hypoglycemia is less common with this class, and lactic acidosis is associated with metformin.
4. A patient with diabetes is prescribed insulin lispro. Which instruction regarding administration timing
is correct?
A) "Inject this insulin 30-60 minutes before meals."
B) "Inject this insulin immediately before or within 15 minutes of starting a meal."
C) "Inject this insulin at bedtime regardless of meals."
D) "Inject this insulin only when blood glucose is above 200 mg/dL."
Correct Answer: "Inject this insulin immediately before or within 15 minutes of starting a meal."
Rationale: Insulin lispro is a rapid-acting insulin analog with an onset of 15-30 minutes. It should be given
immediately before or within 15 minutes of starting a meal to match the postprandial glucose rise.
Regular insulin is given 30-60 minutes before meals.
5. Which insulin has the longest duration of action?
A) Insulin aspart
B) Insulin glargine
C) Regular insulin
D) NPH insulin
Correct Answer: Insulin glargine
, Rationale: Insulin glargine is a long-acting basal insulin with a duration of approximately 24 hours. Insulin
aspart is rapid-acting (3-5 hours), regular insulin is short-acting (5-8 hours), and NPH insulin is
intermediate-acting (12-18 hours).
6. A patient receiving insulin glargine reports hypoglycemia at the same time each day. What is the most
likely cause?
A) The patient is not rotating injection sites
B) The patient is mixing glargine with other insulins
C) The patient is injecting into a muscle instead of subcutaneous tissue
D) The patient is taking too high a dose
Correct Answer: The patient is mixing glargine with other insulins
Rationale: Insulin glargine should not be mixed with any other insulin because the acidic pH of the
formulation causes precipitation when mixed. This can alter its absorption profile and lead to
unpredictable hypoglycemia. Site rotation and injection technique can affect absorption but are less
likely to cause predictable daily hypoglycemia.
7. Which of the following is a sign of hyperglycemia?
A) Diaphoresis and tachycardia
B) Polyuria and polydipsia
C) Tremors and anxiety
D) Confusion and lethargy
Correct Answer: Polyuria and polydipsia
Rationale: Polyuria (frequent urination) and polydipsia (excessive thirst) are classic signs of
hyperglycemia due to osmotic diuresis from elevated blood glucose. Diaphoresis, tachycardia, tremors,
anxiety, confusion, and lethargy are signs of hypoglycemia.
