NR 565 Advanced Pharmacology Final Exam|
COMPREHENSIVE EXAM BANK WITH ACTUAL
QUESTIONS AND CORRECT VERIFIED
ANSWERS AND WELL ELLABORATED
RATIONALES.
1. A 58-year-old patient with type 2 diabetes has a pre-meal
blood glucose of 145 mg/dL and a post-meal glucose of 210
mg/dL. According to the ADA glycemic goals, which of the
following best describes this patient's current glycemic
status?
A) Within target for pre-meal but above target for post-meal
B) Above target for both pre-meal and post-meal
C) Within target for both pre-meal and post-meal
D) Below target for pre-meal but within target for post-meal
Correct Answer: B
Rationale: The ADA glycemic goals for type 2 diabetes are
pre-meal blood glucose of 80-130 mg/dL and post-meal (1-2
hours) glucose of less than 180 mg/dL. This patient's pre-
meal value of 145 mg/dL exceeds the upper limit of 130
mg/dL, and the post-meal value of 210 mg/dL exceeds the
180 mg/dL target. Both values are above target.
2. A 62-year-old patient with type 2 diabetes and
hypertension is prescribed an ACE inhibitor. What is the
primary rationale for using an ACE inhibitor in this patient?
,A) To lower blood glucose levels
B) To prevent diabetic nephropathy
C) To increase insulin sensitivity
D) To promote weight loss
Correct Answer: B
Rationale: ACE inhibitors and ARBs are recommended for
patients with diabetes to prevent or slow the progression of
diabetic nephropathy. They provide renal protection by
reducing intraglomerular pressure and decreasing
proteinuria.
3. According to the ADA stepped care approach for type 2
diabetes, which of the following represents the correct
sequence of treatment intensification?
A) Lifestyle plus metformin to Lifestyle plus metformin plus
GLP-1 to Lifestyle plus metformin plus GLP-1 plus SGLT2
inhibitor
B) Lifestyle plus sulfonylurea to Lifestyle plus sulfonylurea
plus metformin to Lifestyle plus sulfonylurea plus metformin
plus insulin
C) Metformin alone to Metformin plus insulin to Metformin
plus insulin plus GLP-1
D) Lifestyle changes alone to Lifestyle plus sulfonylurea to
Lifestyle plus sulfonylurea plus SGLT2 inhibitor
Correct Answer: A
Rationale: The ADA stepped care approach begins with
lifestyle modifications plus metformin as first-line therapy.
,Step 2 adds a second agent, preferably a GLP-1 receptor
agonist. Step 3 adds additional agents based on patient
characteristics, such as an SGLT2 inhibitor for those with
cardiovascular or renal disease.
4. A 55-year-old female with type 2 diabetes is started on
metformin. Which statement about metformin is correct?
A) It should be taken on an empty stomach to maximize
absorption
B) It has a high risk of hypoglycemia and weight gain
C) It is contraindicated in pregnancy
D) It is excreted by the kidneys and carries a risk of lactic
acidosis in renal impairment
Correct Answer: D
Rationale: Metformin is excreted renally; accumulation in
patients with renal impairment can lead to lactic acidosis. It
should be taken with meals to reduce GI side effects, has a
low risk of hypoglycemia, and is considered safe in
pregnancy.
5. A patient with type 2 diabetes is prescribed glipizide.
Which of the following statements regarding glipizide is
accurate?
A) It is a first-generation sulfonylurea with a long duration of
action
B) It blocks calcium channels in pancreatic beta cells to
stimulate insulin release
, C) It should be avoided in patients who consume alcohol due
to risk of a disulfiram-like reaction
D) It increases peripheral insulin sensitivity and promotes
weight loss
Correct Answer: C
Rationale: Sulfonylureas such as glipizide can cause a
disulfiram-like reaction when taken with alcohol. Glipizide is
a second-generation sulfonylurea with a shorter duration
and higher potency. It promotes insulin release by blocking
potassium channels and is associated with hypoglycemia
and weight gain.
6. A 70-year-old patient with type 2 diabetes and hepatic
impairment is started on repaglinide. What is the most
important precaution to communicate to this patient?
A) Take the medication 1 hour before each meal
B) Monitor for symptoms of hypoglycemia due to slower
drug metabolism
C) Expect rapid weight loss during the first month of therapy
D) Discontinue the medication if gastrointestinal upset
occurs
Correct Answer: B
Rationale: Meglitinides like repaglinide are metabolized in
the liver. In patients with hepatic impairment, drug
metabolism is slowed, leading to increased drug levels and
a higher risk of hypoglycemia. Patients should be counseled
to eat within 30 minutes of taking the medication.
COMPREHENSIVE EXAM BANK WITH ACTUAL
QUESTIONS AND CORRECT VERIFIED
ANSWERS AND WELL ELLABORATED
RATIONALES.
1. A 58-year-old patient with type 2 diabetes has a pre-meal
blood glucose of 145 mg/dL and a post-meal glucose of 210
mg/dL. According to the ADA glycemic goals, which of the
following best describes this patient's current glycemic
status?
A) Within target for pre-meal but above target for post-meal
B) Above target for both pre-meal and post-meal
C) Within target for both pre-meal and post-meal
D) Below target for pre-meal but within target for post-meal
Correct Answer: B
Rationale: The ADA glycemic goals for type 2 diabetes are
pre-meal blood glucose of 80-130 mg/dL and post-meal (1-2
hours) glucose of less than 180 mg/dL. This patient's pre-
meal value of 145 mg/dL exceeds the upper limit of 130
mg/dL, and the post-meal value of 210 mg/dL exceeds the
180 mg/dL target. Both values are above target.
2. A 62-year-old patient with type 2 diabetes and
hypertension is prescribed an ACE inhibitor. What is the
primary rationale for using an ACE inhibitor in this patient?
,A) To lower blood glucose levels
B) To prevent diabetic nephropathy
C) To increase insulin sensitivity
D) To promote weight loss
Correct Answer: B
Rationale: ACE inhibitors and ARBs are recommended for
patients with diabetes to prevent or slow the progression of
diabetic nephropathy. They provide renal protection by
reducing intraglomerular pressure and decreasing
proteinuria.
3. According to the ADA stepped care approach for type 2
diabetes, which of the following represents the correct
sequence of treatment intensification?
A) Lifestyle plus metformin to Lifestyle plus metformin plus
GLP-1 to Lifestyle plus metformin plus GLP-1 plus SGLT2
inhibitor
B) Lifestyle plus sulfonylurea to Lifestyle plus sulfonylurea
plus metformin to Lifestyle plus sulfonylurea plus metformin
plus insulin
C) Metformin alone to Metformin plus insulin to Metformin
plus insulin plus GLP-1
D) Lifestyle changes alone to Lifestyle plus sulfonylurea to
Lifestyle plus sulfonylurea plus SGLT2 inhibitor
Correct Answer: A
Rationale: The ADA stepped care approach begins with
lifestyle modifications plus metformin as first-line therapy.
,Step 2 adds a second agent, preferably a GLP-1 receptor
agonist. Step 3 adds additional agents based on patient
characteristics, such as an SGLT2 inhibitor for those with
cardiovascular or renal disease.
4. A 55-year-old female with type 2 diabetes is started on
metformin. Which statement about metformin is correct?
A) It should be taken on an empty stomach to maximize
absorption
B) It has a high risk of hypoglycemia and weight gain
C) It is contraindicated in pregnancy
D) It is excreted by the kidneys and carries a risk of lactic
acidosis in renal impairment
Correct Answer: D
Rationale: Metformin is excreted renally; accumulation in
patients with renal impairment can lead to lactic acidosis. It
should be taken with meals to reduce GI side effects, has a
low risk of hypoglycemia, and is considered safe in
pregnancy.
5. A patient with type 2 diabetes is prescribed glipizide.
Which of the following statements regarding glipizide is
accurate?
A) It is a first-generation sulfonylurea with a long duration of
action
B) It blocks calcium channels in pancreatic beta cells to
stimulate insulin release
, C) It should be avoided in patients who consume alcohol due
to risk of a disulfiram-like reaction
D) It increases peripheral insulin sensitivity and promotes
weight loss
Correct Answer: C
Rationale: Sulfonylureas such as glipizide can cause a
disulfiram-like reaction when taken with alcohol. Glipizide is
a second-generation sulfonylurea with a shorter duration
and higher potency. It promotes insulin release by blocking
potassium channels and is associated with hypoglycemia
and weight gain.
6. A 70-year-old patient with type 2 diabetes and hepatic
impairment is started on repaglinide. What is the most
important precaution to communicate to this patient?
A) Take the medication 1 hour before each meal
B) Monitor for symptoms of hypoglycemia due to slower
drug metabolism
C) Expect rapid weight loss during the first month of therapy
D) Discontinue the medication if gastrointestinal upset
occurs
Correct Answer: B
Rationale: Meglitinides like repaglinide are metabolized in
the liver. In patients with hepatic impairment, drug
metabolism is slowed, leading to increased drug levels and
a higher risk of hypoglycemia. Patients should be counseled
to eat within 30 minutes of taking the medication.
