NSG533 / NSG 533 Exam 2: Advanced Pharmacology
– Wilkes University Actual Exam Complete Questions
& Rationales | Advanced Therapeutics | Pass
Guaranteed - A+ Graded
Endocrine Pharmacology (Diabetes, Thyroid, Adrenal)
Q1: A 55-year-old patient with type 2 diabetes is started on insulin glulisine before
meals. The NP counsels the patient that this rapid-acting insulin should be administered
how long before eating?
A. 30–45 minutes before the meal
B. 15–20 minutes before the meal or at mealtime [CORRECT]
C. 1–2 hours before the meal
D. At bedtime only
Correct Answer: B
Rationale: The best answer is B. Rapid-acting insulins like glulisine, lispro, and aspart
have an onset of about 15 minutes, so you give them right before eating or up to 15
minutes prior. If you give them too early, the patient risks hypoglycemia before the food
hits.
Q2: A 62-year-old patient with type 2 diabetes, eGFR 45 mL/min/1.73m², and
established atherosclerotic cardiovascular disease is not at glycemic goal on metformin
alone. Which add-on agent provides both cardiovascular risk reduction and renal
protection?
A. Glipizide
B. Pioglitazone
C. Empagliflozin [CORRECT]
D. Nateglinide
Correct Answer: C
Rationale: The best answer is C. Empagliflozin is an SGLT2 inhibitor with robust
evidence from EMPA-REG and other trials showing it reduces heart failure
,hospitalizations, slows CKD progression, and lowers CV events in patients with T2DM
and ASCVD. In clinical practice, we choose this because it addresses both the glucose
and the organ protection.
Q3: A patient on metformin is scheduled for a CT scan with iodinated contrast. The
patient's eGFR is 38 mL/min/1.73m². What is the most appropriate action regarding
metformin?
A. Continue metformin through the procedure without interruption
B. Hold metformin only on the day of the scan
C. Hold metformin 48 hours before and restart 48 hours after the scan once renal
function is stable [CORRECT]
D. Switch to insulin permanently before the scan
Correct Answer: C
Rationale: The best answer is C. With an eGFR below 60 and especially in the 30–60
range, iodinated contrast can worsen renal function and increase the risk of
metformin-associated lactic acidosis. Current guidelines say to hold it 48 hours prior
and make sure renal function is stable before restarting 48 hours after.
Q4: A patient taking glyburide presents to the clinic with tremors, diaphoresis, and
confusion. Blood glucose is 48 mg/dL. Which characteristic of sulfonylureas makes this
adverse effect particularly dangerous?
A. They cause weight loss that masks hypoglycemia
B. They only work in the presence of food
C. They stimulate insulin release independent of blood glucose and have a long duration
[CORRECT]
D. They inhibit glucagon secretion reversibly
Correct Answer: C
Rationale: The best answer is C. Sulfonylureas bind to the ATP-sensitive potassium
channels on beta cells and push out insulin whether the glucose is low or not, and
agents like glyburide hang around a long time. That means hypoglycemia can be
prolonged and severe, often requiring hospitalization and IV dextrose.
Q5: A patient started on canagliflozin returns with complaints of genital itching and
dysuria. Urinalysis is negative for bacteria but positive for glucose. Which adverse effect
is most likely responsible?
, A. Hypoglycemia from excessive insulin secretion
B. Euglycemic diabetic ketoacidosis
C. Genital mycotic infection from glucosuria [CORRECT]
D. Acute interstitial nephritis
Correct Answer: C
Rationale: The best answer is C. SGLT2 inhibitors dump glucose into the urine by
blocking reabsorption in the proximal tubule — that sugary environment in the genital
area is a perfect setup for yeast and fungal overgrowth. It's one of the most common
side effects and usually responds to antifungal treatment.
Q6: A patient with type 2 diabetes and BMI 34 is started on semaglutide. Which
counseling point is most important regarding gastrointestinal effects?
A. GI side effects are rare and usually mild
B. Nausea and vomiting are common initially and typically improve with slow dose
titration [CORRECT]
C. Diarrhea indicates an allergy and the drug should be stopped immediately
D. Take with a high-fat meal to improve absorption
Correct Answer: B
Rationale: The best answer is B. GLP-1 receptor agonists like semaglutide slow gastric
emptying and affect satiety centers, so nausea, vomiting, and diarrhea are very common
at initiation. We always start low and go slow — titrating the dose every 4 weeks helps
the GI tract adapt and improves adherence.
Q7: A patient with type 2 diabetes and NYHA Class III heart failure is considering
pioglitazone for glycemic control. What is the NP's primary concern?
A. Hypoglycemia risk when used as monotherapy
B. Rapid weight loss causing malnutrition
C. Fluid retention and worsening heart failure [CORRECT]
D. Increased risk of pancreatitis
Correct Answer: C
Rationale: The best answer is C. Pioglitazone is a TZD that causes sodium and water
retention through PPAR-gamma activation in the renal collecting ducts. In a patient with
Class III heart failure, that fluid overload can tip them into acute decompensation, so
TZDs are essentially contraindicated in symptomatic HF.
– Wilkes University Actual Exam Complete Questions
& Rationales | Advanced Therapeutics | Pass
Guaranteed - A+ Graded
Endocrine Pharmacology (Diabetes, Thyroid, Adrenal)
Q1: A 55-year-old patient with type 2 diabetes is started on insulin glulisine before
meals. The NP counsels the patient that this rapid-acting insulin should be administered
how long before eating?
A. 30–45 minutes before the meal
B. 15–20 minutes before the meal or at mealtime [CORRECT]
C. 1–2 hours before the meal
D. At bedtime only
Correct Answer: B
Rationale: The best answer is B. Rapid-acting insulins like glulisine, lispro, and aspart
have an onset of about 15 minutes, so you give them right before eating or up to 15
minutes prior. If you give them too early, the patient risks hypoglycemia before the food
hits.
Q2: A 62-year-old patient with type 2 diabetes, eGFR 45 mL/min/1.73m², and
established atherosclerotic cardiovascular disease is not at glycemic goal on metformin
alone. Which add-on agent provides both cardiovascular risk reduction and renal
protection?
A. Glipizide
B. Pioglitazone
C. Empagliflozin [CORRECT]
D. Nateglinide
Correct Answer: C
Rationale: The best answer is C. Empagliflozin is an SGLT2 inhibitor with robust
evidence from EMPA-REG and other trials showing it reduces heart failure
,hospitalizations, slows CKD progression, and lowers CV events in patients with T2DM
and ASCVD. In clinical practice, we choose this because it addresses both the glucose
and the organ protection.
Q3: A patient on metformin is scheduled for a CT scan with iodinated contrast. The
patient's eGFR is 38 mL/min/1.73m². What is the most appropriate action regarding
metformin?
A. Continue metformin through the procedure without interruption
B. Hold metformin only on the day of the scan
C. Hold metformin 48 hours before and restart 48 hours after the scan once renal
function is stable [CORRECT]
D. Switch to insulin permanently before the scan
Correct Answer: C
Rationale: The best answer is C. With an eGFR below 60 and especially in the 30–60
range, iodinated contrast can worsen renal function and increase the risk of
metformin-associated lactic acidosis. Current guidelines say to hold it 48 hours prior
and make sure renal function is stable before restarting 48 hours after.
Q4: A patient taking glyburide presents to the clinic with tremors, diaphoresis, and
confusion. Blood glucose is 48 mg/dL. Which characteristic of sulfonylureas makes this
adverse effect particularly dangerous?
A. They cause weight loss that masks hypoglycemia
B. They only work in the presence of food
C. They stimulate insulin release independent of blood glucose and have a long duration
[CORRECT]
D. They inhibit glucagon secretion reversibly
Correct Answer: C
Rationale: The best answer is C. Sulfonylureas bind to the ATP-sensitive potassium
channels on beta cells and push out insulin whether the glucose is low or not, and
agents like glyburide hang around a long time. That means hypoglycemia can be
prolonged and severe, often requiring hospitalization and IV dextrose.
Q5: A patient started on canagliflozin returns with complaints of genital itching and
dysuria. Urinalysis is negative for bacteria but positive for glucose. Which adverse effect
is most likely responsible?
, A. Hypoglycemia from excessive insulin secretion
B. Euglycemic diabetic ketoacidosis
C. Genital mycotic infection from glucosuria [CORRECT]
D. Acute interstitial nephritis
Correct Answer: C
Rationale: The best answer is C. SGLT2 inhibitors dump glucose into the urine by
blocking reabsorption in the proximal tubule — that sugary environment in the genital
area is a perfect setup for yeast and fungal overgrowth. It's one of the most common
side effects and usually responds to antifungal treatment.
Q6: A patient with type 2 diabetes and BMI 34 is started on semaglutide. Which
counseling point is most important regarding gastrointestinal effects?
A. GI side effects are rare and usually mild
B. Nausea and vomiting are common initially and typically improve with slow dose
titration [CORRECT]
C. Diarrhea indicates an allergy and the drug should be stopped immediately
D. Take with a high-fat meal to improve absorption
Correct Answer: B
Rationale: The best answer is B. GLP-1 receptor agonists like semaglutide slow gastric
emptying and affect satiety centers, so nausea, vomiting, and diarrhea are very common
at initiation. We always start low and go slow — titrating the dose every 4 weeks helps
the GI tract adapt and improves adherence.
Q7: A patient with type 2 diabetes and NYHA Class III heart failure is considering
pioglitazone for glycemic control. What is the NP's primary concern?
A. Hypoglycemia risk when used as monotherapy
B. Rapid weight loss causing malnutrition
C. Fluid retention and worsening heart failure [CORRECT]
D. Increased risk of pancreatitis
Correct Answer: C
Rationale: The best answer is C. Pioglitazone is a TZD that causes sodium and water
retention through PPAR-gamma activation in the renal collecting ducts. In a patient with
Class III heart failure, that fluid overload can tip them into acute decompensation, so
TZDs are essentially contraindicated in symptomatic HF.
