NR 566 / NR566 Advanced Pharmacology
Care of the Family Midterm Review Quiz
bank | LATEST |Q & A| Chamberlain
College
1. Hypoglycemia can result
... [Show More] from the action of either insulin or an oral hypoglycemic. Signs
and symptoms of hypoglycemia include:
A. “Fruity” breath odor and rapid respiration
B. Diarrhea, abdominal pain, weight loss, and hypertension
C. Dizziness, confusion, diaphoresis, and tachycardia
D. Easy bruising, palpitations, cardiac dysrhythmias, and coma
2. Nonselective beta blockers and alcohol create serious drug interactions with insulin
because they:
A. Increase blood glucose levels
B. Produce unexplained diaphoresis
C. Interfere with the ability of the body to metabolize glucose
D. Mask the signs and symptoms of altered glucose levels
3. Lispro is an insulin analogue produced by recombinant DNA technology. Which of the
following statements about this form of insulin is NOT true?
A. Optimal time of preprandial injection is 15 minutes.
B. Duration of action is increased when the dose is increased.
C. It is compatible with neutral protamine Hagedorn insulin.
D. It has no pronounced peak.
4. The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH)
insulin to insulin glargine to improve glycemia control throughout the day. If this is done:
A. The initial dose of glargine is reduced by 20% to avoid hypoglycemia.
B. The initial dose of glargine is 2 to 10 units per day.
C. Patients who have been on high doses of NPH will need tests for insulin antibodies.
D. Obese patients may require more than 100 units per day.
5. When blood glucose levels are difficult to control in type 2 diabetes some form of insulin
may be added to the treatment regimen to control blood glucose and limit complication
risks. Which of the following statements is accurate based on research?A. Premixed insulin analogues are better at lowering HbA1C and have less risk for
hypoglycemia.
B. Premixed insulin analogues and the newer premixed insulins are associated with more
weight gain than the oral antidiabetic agents.
C. Newer premixed insulins are better at lowering HbA1C and postprandial glucose
levels than long-acting insulins.
D. Patients who are not controlled on oral agents and have postprandial hyperglycemia can
have neutral protamine Hagedorn insulin added at bedtime.
6. Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because
it:
A. Substitutes for insulin usually secreted by the pancreas
B. Decreases glycogenolysis by the liver
C. Increases the release of insulin from beta cells
D. Decreases peripheral glucose utilization
7. Prior to prescribing metformin, the provider should:
A. Draw a serum creatinine to assess renal function
B. Try the patient on insulin
C. Tell the patient to increase iodine intake
D. Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions
8. The action of “gliptins” is different from other antidiabetic agents because they:
A. Have a low risk for hypoglycemia
B. Are not associated with weight gain
C. Close ATP-dependent potassium channels in the beta cell
D. Act on the incretin system to indirectly increase insulin production
9. Sitagliptin has been approved for:
A. Monotherapy in once-daily doses
B. Combination therapy with metformin
C. Both 1 and 2
D. Neither 1 nor 2
10. GLP-1 agonists:
A. Directly bind to a receptor in the pancreatic beta cell
B. Have been approved for monotherapy
C. Speed gastric emptying to decrease appetite
D. Can be given orally once daily
11. Avoid concurrent administration of exenatide with which of the following drugs?
A. Digoxin
B. WarfarinC. Lovastatin
D. All of the above
12. Administration of exenatide is by subcutaneous injection:
A. 30 minutes prior to the morning meal
B. 60 minutes prior to the morning and evening meal
C. 15 minutes after the evening meal
D. 60 minutes before each meal daily
13. Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism
with propylthiouracil. Patients should be taught to report:
A. Tinnitus and decreased salivation
B. Fever and sore throat
C. Hypocalcemia and osteoporosis
D. Laryngeal edema and difficulty swallowing
14. Elderly patients who are started on levothyroxine for thyroid replacement should be
monitored for:
A. Excessive sedation
B. Tachycardia and angina
C. Weight gain
D. Cold intolerance
15. Which of the following is not an indication that growth hormone supplements should be
discontinued?
A. Imaging indication of epiphyseal closure
B. Growth curve increases have plateaued
C. Complaints of mild bone pain
D. Achievement of anticipated height goals
16. Besides osteoporosis, IV bisphosphonates are also indicated for:
A. Paget’s Disease
B. Early osteopenia
C. Renal cancer
D. Early closure of cranial sutures
17. What is the role of calcium supplements when patients take bisphosphonates?
A. They must be restricted to allow the medication to work.
B. They must be taken in sufficient amounts to provide foundational elements for bone
growth.
C. They must be taken at the same time as the bisphosphonates.
D. They only work with bisphosphonates if daily intake is restricted.18. Which of the following statements about pancreatic enzymes is true?
A. Dosing may be titrated according to the decrease of steatorrhea.
B. The amount of carbohydrates in the meal drives the amount of enzyme used.
C. The amount of medication used is increased with a cystic fibrosis pulmonary flare.
D. The FDA and Internet-available formulations are bioequivalent.
19. Both men and women experience bone loss with aging. The bones most likely to
demonstrate significant loss are:
A. Cortical bones
B. Femoral neck bones
C. Cervical vertebrae
D. Pelvic bones
20. Bisphosphonates treat or prevent osteoporosis by:
A. Inhibiting osteoclastic activity
B. Fostering bone resorption
C. Enhancing calcium uptake in the bone
D. Strengthening the osteoclastic proton pump
21. Prophylactic use of bisphosphonates is recommended for patients with early osteopenia
related to long-term use of which of the following drugs?
A. Selective estrogen receptor modulators
B. Aspirin
C. Glucocorticoids
D. Calcium supplements
22. Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic
secretions. Each replacement drug has lipase, protease, and amylase components, but the
drug is prescribed in units of:
A. Lipase
B. Protease
C. Amylase
D. Pancreatin
23. Brands of pancreatic enzyme replacement drugs are:
A. Bioequivalent
B. About the same in cost per unit of lipase across brands
C. Able to be interchanged between generic and brand-name products to reduce cost
D. None of the above
24. When given subcutaneously, how long until neutral protamine Hagedorn insulin begins to
take effect (onset of action) after administration?
A. 15 to 30 minutesB. 60 to 90 minutes
C. 3 to 4 hours
D. 6 to 8 hours
25. Besides cystic fibrosis, which other medical state may trigger the need for pancreatic
enzymes?
A. Paget’s disease
B. Pulmonary cancers
C. Gallbladder surgery
D. Some bariatric surgeries
Chapter 33. Diabetes Mellitus
1. Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to
90% of type 1 diabetics have:
A. Autoantibodies to two tyrosine phosphatases
B. Mutation of the hepatic transcription factor on chromosome 12
C. A defective glucokinase molecule due to a defective gene on chromosome 7p
D. Mutation of the insulin promoter factor
2. Type 2 diabetes is a complex disorder involving:
A. Absence of insulin production by the beta cells
B. A suboptimal response of insulin-sensitive tissues in the liver
C. Increased levels of glucagon-like peptide in the postprandial period
D. Too much fat uptake in the intestine
3. Diagnostic criteria for diabetes include:
A. Fasting blood glucose greater than 140 mg/dl on two occasions
B. Postprandial blood glucose greater than 140 mg/dl
C. Fasting blood glucose 100 to 125 mg/dl on two occasions
D. Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl
4. Routine screening of asymptomatic adults for diabetes is appropriate for:
A. Individuals who are older than 45 and have a BMI of less than 25 kg/m2
B. Native Americans, African Americans, and Hispanics
C. Persons with HDL cholesterol greater than 100 mg/dl
D. Persons with prediabetes confirmed on at least two occasions
5. Screening for children who meet the following criteria should begin at age 10 and
occur every 3 years thereafter:
A. BMI above the 85th percentile for age and sexB. Family history of diabetes in first- or second-degree relative
C. Hypertension based on criteria for children
D. Any of the above
6. Insulin is used to treat both types of diabetes. It acts by:
A. Increasing beta cell response to low blood-glucose levels
B. Stimulating hepatic glucose production
C. Increasing peripheral glucose uptake by skeletal muscle and fat
D. Improving the circulation of free fatty acids
7. Adam has type 1 diabetes and plays tennis for his university. He exhibits a knowledge
deficit about his insulin and his diagnosis. He should be taught that:
A. He should increase his carbohydrate intake during times of exercise.
B. Each brand of insulin is equal in bioavailability, so buy the least expensive.
C. Alcohol produces hypoglycemia and can help control his diabetes when taken in small
amounts.
D. If he does not want to learn to give himself injections, he may substitute an oral
hypoglycemic to control his diabetes.
8. Insulin preparations are divided into categories based on onset, duration, and intensity
of action following subcutaneous injection. Which of the following insulin
preparations has the shortest onset and duration of action?
A. Lispro
B. Glulisine
C. Glargine
D. Detemir
9. The drug of choice for type 2 diabetics is metformin. Metformin:
A. Decreases glycogenolysis by the liver
B. Increases the release of insulin from beta cells
C. Increases intestinal uptake of glucose
D. Prevents weight gain associated with hyperglycemia
10. Before prescribing metformin, the provider should:
A. Draw a serum creatinine level to assess renal function.
B. Try the patient on insulin.
C. Prescribe a thyroid preparation if the patient needs to lose weight.
D. All of the above
11. Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle
modifications and metformin are insufficient to achieve target glucose levels.
Sulfonylureas have been moved to Step 2 therapy because they:
A. Increase endogenous insulin secretion
B. Have a significant risk for hypoglycemiaC. Address the insulin resistance found in type 2 diabetics
D. Improve insulin binding to receptors
12. Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve
glycemic control. Advantages of these drugs include:
A. Better reduction in glucose levels than other classes
B. Less weight gain than sulfonylureas
C. Low risk for hypoglycemia
D. Can be given twice daily
13. Control targets for patients with diabetes include:
A. HbA1C between 7 and 8
B. Fasting blood glucose levels between 100 and 120 mg/dl
C. Blood pressure less than 130/80 mm Hg
D. LDL lipids less than 130 mg/dl
14. Establishing glycemic targets is the first step in treatment of both types of diabetes.
For type 1 diabetes:
A. Tight control/intensive therapy can be given to adults who are willing to test their blood
glucose at least twice daily.
B. Tight control is acceptable for older adults if they are without complications.
C. Plasma glucose levels are the same for children as adults.
D. Conventional therapy has a fasting plasma glucose target between 120 and 150
mg/dl.
15. Treatment with insulin for type 1 diabetics:
A. Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight
B. Divides the total doses into three injections based on meal size
C. Uses a total daily dose of insulin glargine given once daily with no other insulin required
D. Is based on the level of blood glucose
16. When the total daily insulin dose is split and given twice daily, which of the
following rules may be followed?
A. Give two-thirds of the total dose in the morning and one-third in the evening.
B. Give 0.3 units per kg of premixed 70/30 insulin with one-third in the morning and twothirds in the evening.
C. Give 50% of an insulin glargine dose in the morning and 50% in the evening.
D. Give long-acting insulin in the morning and short-acting insulin at bedtime.
17. Studies have shown that control targets that reduce the HbA1C to less than 7% are
associated with fewer long-term complications of diabetes. Patients who should have
such a target include:
A. Those with long-standing diabetesB. Older adults
C. Those with no significant cardiovascular disease
D. Young children who are early in their disease
18. Prevention of conversion from prediabetes to diabetes in young children must take
highest priority and should focus on:
A. Aggressive dietary manipulation to prevent obesity
B. Fostering LDL levels less than 100 mg/dl and total cholesterol less than 170 mg/dl to
prevent cardiovascular disease
C. Maintaining a blood pressure that is less than 80% based on weight and height to prevent
hypertension
D. All of the above [Show Less]