NURS 615 COMPREHENSIVE EXAMINATION
TEST 2026 QUESTIONS AND SOLUTIONS
GRADED A+
◉ What is the medication of choice for hypertensive crisis with
pheochromocytoma?.
Answer: Surgical resection of the tumor is the first treatment of
choice either my open laparotomy or laparoscopy either surgical
option requires prior treatment of nonspecific irreversible
adrenergic adraonoreceptor blocker phenoxybenzamine or a shorter
acting alpha antagonists, prazosin, terazosin, and doxazosin. Mainly
use phenozibenamine in practice. Doing so promotes the surgery to
proceed while minimizing the likelihood of severe intraoperative
hypertension which is likely when the tumor is manipulated.
◉ What is the onset of action, peak of action, and duration of action
of each insulin preparation?.
Answer: (Intermediate Acting) NPH
Onset-60-90 min after administration,
Peak 48 hrs
Duration 10-18 hrs.
(Short Acting) Regular Onset 30-60 min
,Peak 2-4 hrs
Duration 6-10 hrs
(Long Acting) Aspart, Lispro, Glulisine
Onset less than 15 min
Peak 1-2 hrs
Duration 3-6 hrs
(Long Acting) Glargine, Detemir
Onset 1-2 hrs
Peak NO PEAK
Duration 24 hrs
◉ Identify the symptoms of hypoglycemia, hyperglycemia, and
ketoacidosis..
Answer: Hypoglycemia- dizziness, confusion, diaphoresis,
tachycardia
Hyperglycemia- polyphagia, polydipsia, polyuria, blurred vision, and
fatigue
Ketoacidosis- hallmark symptoms include acetone breath like nail
polish remover or fruity breath. Also abdominal pain, nausea,
vomiting and sob.
,◉ When changing from NPH to glargine insulin, how will you adjust
the patient's dose?.
Answer: The initial dose of glargine is reduced by 20% to prevent
hypoglycemia.
◉ How does metformin work?.
Answer: Decreases hyperglycemia by decreasing hepatic glucose
production called hepatic gluconeogenesis. The average person with
type 2 diabetes has three times the rate of gluconeogenesis,
metformin treatment reduces this by over 1/3rd. The molecular
mechanism of metformin isn't completely understood. In addition to
suppressing hepatic glucose production, metformin increases
insulin sensitivity, enhances peripheral glucose uptake by inducing
the phosphorilization of glu4 enhancer factor, decreases insulin
induced suppression of fatty acid oxidation, and decreases
absorption of glucose from the GI tract. Also of note** Metformin
helps reduce LDL cholesterol and triglyceride levels and is not
associated with weight gain, in some people it helps promote weight
loss**
◉ What diagnostic testing is required before and throughout
therapy with metformin?.
Answer: Metformin is not metabolized, it is cleared from the body by
tubular secretion and is secreted unchanged in the urine. Metformin
is undetectable in blood plasma within 24 hrs of a single oral dose
the average elimination half-life in plasma is 6.2 hrs as it is secreted
in the urine you should check a serum crt to assess renal function.
, ◉ What is the action of gliptin?.
Answer: The mechanism of DDP-4 inhibitors is to increase incretin
levels incretin are GLP1 and GIP which inhibit glucagon release in
which in turn increases insulin secretion, decreases gastric
emptying, and decreases blood glucose levels
◉ How do GLP agonists work?.
Answer: They bind directly to a receptor in the pancreatic beta cell.
These agents work in the same pathway as the DPP-4 inhibitors as
mentioned above but are generally considered more potent.
◉ When should exenatide be administered?.
Answer: 60 minutes prior to the morning and evening meal
◉ How will you assess for granulocytopenia?.
Answer: Signs of a Cold or flu including fever and sore throat
◉ What are the adverse effects of propylthiouracil?.
Answer: Agranulocytosis, thrombocytopenia, and fulminant liver
failure as stated above, pt's on PTU when they develop fever or sore
throat, it would be important to check a CBC preferably with a smear
and a diff.
TEST 2026 QUESTIONS AND SOLUTIONS
GRADED A+
◉ What is the medication of choice for hypertensive crisis with
pheochromocytoma?.
Answer: Surgical resection of the tumor is the first treatment of
choice either my open laparotomy or laparoscopy either surgical
option requires prior treatment of nonspecific irreversible
adrenergic adraonoreceptor blocker phenoxybenzamine or a shorter
acting alpha antagonists, prazosin, terazosin, and doxazosin. Mainly
use phenozibenamine in practice. Doing so promotes the surgery to
proceed while minimizing the likelihood of severe intraoperative
hypertension which is likely when the tumor is manipulated.
◉ What is the onset of action, peak of action, and duration of action
of each insulin preparation?.
Answer: (Intermediate Acting) NPH
Onset-60-90 min after administration,
Peak 48 hrs
Duration 10-18 hrs.
(Short Acting) Regular Onset 30-60 min
,Peak 2-4 hrs
Duration 6-10 hrs
(Long Acting) Aspart, Lispro, Glulisine
Onset less than 15 min
Peak 1-2 hrs
Duration 3-6 hrs
(Long Acting) Glargine, Detemir
Onset 1-2 hrs
Peak NO PEAK
Duration 24 hrs
◉ Identify the symptoms of hypoglycemia, hyperglycemia, and
ketoacidosis..
Answer: Hypoglycemia- dizziness, confusion, diaphoresis,
tachycardia
Hyperglycemia- polyphagia, polydipsia, polyuria, blurred vision, and
fatigue
Ketoacidosis- hallmark symptoms include acetone breath like nail
polish remover or fruity breath. Also abdominal pain, nausea,
vomiting and sob.
,◉ When changing from NPH to glargine insulin, how will you adjust
the patient's dose?.
Answer: The initial dose of glargine is reduced by 20% to prevent
hypoglycemia.
◉ How does metformin work?.
Answer: Decreases hyperglycemia by decreasing hepatic glucose
production called hepatic gluconeogenesis. The average person with
type 2 diabetes has three times the rate of gluconeogenesis,
metformin treatment reduces this by over 1/3rd. The molecular
mechanism of metformin isn't completely understood. In addition to
suppressing hepatic glucose production, metformin increases
insulin sensitivity, enhances peripheral glucose uptake by inducing
the phosphorilization of glu4 enhancer factor, decreases insulin
induced suppression of fatty acid oxidation, and decreases
absorption of glucose from the GI tract. Also of note** Metformin
helps reduce LDL cholesterol and triglyceride levels and is not
associated with weight gain, in some people it helps promote weight
loss**
◉ What diagnostic testing is required before and throughout
therapy with metformin?.
Answer: Metformin is not metabolized, it is cleared from the body by
tubular secretion and is secreted unchanged in the urine. Metformin
is undetectable in blood plasma within 24 hrs of a single oral dose
the average elimination half-life in plasma is 6.2 hrs as it is secreted
in the urine you should check a serum crt to assess renal function.
, ◉ What is the action of gliptin?.
Answer: The mechanism of DDP-4 inhibitors is to increase incretin
levels incretin are GLP1 and GIP which inhibit glucagon release in
which in turn increases insulin secretion, decreases gastric
emptying, and decreases blood glucose levels
◉ How do GLP agonists work?.
Answer: They bind directly to a receptor in the pancreatic beta cell.
These agents work in the same pathway as the DPP-4 inhibitors as
mentioned above but are generally considered more potent.
◉ When should exenatide be administered?.
Answer: 60 minutes prior to the morning and evening meal
◉ How will you assess for granulocytopenia?.
Answer: Signs of a Cold or flu including fever and sore throat
◉ What are the adverse effects of propylthiouracil?.
Answer: Agranulocytosis, thrombocytopenia, and fulminant liver
failure as stated above, pt's on PTU when they develop fever or sore
throat, it would be important to check a CBC preferably with a smear
and a diff.
