NR566 Midterm questions and verified answers
(detailed & elaborated) ACTUAL EXAM 2025 TESTS!!
Bioavailability of bisphosphonate drugs and appropriate patient education
Ans: Histamine2 blocking agents double alendronate bioavailability, but the impact is unknown. Aspirin
may decrease the bioavailability of tiludronate by up to 50% when taken 2 hours after the tiludronate.
Although indomethacin increases the bioavailability of tiludronate by 2- to 4-fold, the bioavailability is
not significantly altered by diclofenac; therefore, each NSAID must be considered individually.
Quiz Adverse effects associated with long-term use of bisphonates
Ans: Etidronate has also been associated with fractures in patients with Paget's disease when they are
given high doses or when therapy lasted longer than 6 months. These patients must be carefully
monitored with x-rays and laboratory work to assess for these lesions. The development of a rare form
of subtrochanteric femur fracture in non-Paget's patients using bisphosphonates is under close scrutiny
and has contributed to movement away from osteopenia prevention care to only osteoporosis therapy
(FDA, 2010a).
Quiz Specifics about administration and education regarding pancreatic enzymes
Ans: All doses are taken immediately before or with meals or snacks with a fatty component. Fruit, hard
candy, fruit juice like drinks, tea or coffee, or popsicles do not require enzymes (CFF, 2009). Capsules
may be opened and sprinkled on food. Capsules with enteric-coated beads should not be chewed. They
may be sprinkled on soft acidic food that is not hot and that can be swallowed without chewing, such as
applesauce or gelatin. Swallow immediately because the proteolytic enzymes may irritate the mucosa.
Following with a glass of water or juice or eating immediately after taking the drug helps to ensure that
the medication is swallowed and does not remain in contact with the mouth and esophagus for long
periods. Pancrelipase is destroyed by acid. Proton pump inhibitors, sodium bicarbonate, or aluminum-
based antacids may be used with preparations without enteric coating to neutralize gastric pH. Calcium-
,and magnesium-based antacids should not be used for this purpose because they interfere with drug
action. Enteric-coated beads are designed to withstand the acid pH of the stomach. Enteric-coated
formulations should not be mixed with alkaline food or the coating will be destroyed.
Quiz Common adverse effects with aromatase inhibitors
Ans: Adverse effects for the drug class include various pain syndromes, vertigo, insomnia resulting in
daytime sleepiness and confusion, increased risk of blood clots, and hair loss. A key concern is the loss of
bone mass. Bone loss can be significant when considering the concurrent osteoporotic risks of
postmenopause. Closer monitoring is required. All patients should be on calcium and vitamin D
supplementation. A relative leukopenia can occur, but the incidence of viral and bacteria infections is
not considered greater than matched groups (about 10%). Hypertension occurs in 10% of patients. A
life-threatening increase in blood clotting can result in MI, stroke, or pulmonary embolus. Hot flashes
can be intense.
Quiz Drugs associated risk for bone loss which should be monitored
Ans: Aromatase inhibitors
Thyroid hormones
Glucocorticoids
PPIs
SSRIs
Quiz Clinical signs and symptoms DM
Ans: Increased thirst
Frequent urination
Extreme hunger
Unexplained weight loss
,Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that
happens when there's not enough available insulin)
Fatigue
Irritability
Blurred vision
Slow-healing sores
Frequent infections, such as gums or skin infections and vaginal infections
Quiz Risk factors & associated complications of DM
Ans: Complications: stroke, heart attack, peripheral artery disease, diabetic retinopathy, cataracts,
glaucoma, diabetic nephropathy, peripheral neuropathy, diabetic foot.
Risk factors: >45 years old, physical inactivity, 1st degree relative relative with DM, high risk ethic group
(african american, hispanic, native american, asian american, and pacific islander), hx of gest DM, htn,
HDL < 35, triglycerides >250, polycystic ovarian syndrome, acanthosis nigricans, hx of cardiovascular
disease.
Quiz Diagnostic criteria of DM
Ans: Acute symptoms of diabetes plus casual plasma glucose concentration ≥200 mg/dL.
*Casual is defined as any time of day without regard to time since last meal. The classic symptoms of
diabetes are polyuria, polydipsia, and unexplained weight loss.
Fasting plasma glucose ≥126 mg/dL. * Fasting is defined as no caloric intake for at least 8 h.
2-h postload plasma glucose in an oral glucose tolerance test ≥200 mg/dL. The test uses a glucose load
containing the equivalent of 75 g anhydrous glucose dissolved in water.
Hb A1c ≥6.5%.
PRE-DIABETES:
Fasting plasma glucose 100-125 mg/dL (IFG) or
, plasma glucose 140-199 mg/dL (IGT) 2 hr post-ingestion of standard glucose load (75 g) or
Hb A1c 5.7%-6.4%
Quiz Criteria for screening asymptomatic adults
Ans: Individuals ≥45 yr and who have a BMI ≥25 kg/m2 should be tested. If normal, the test should be
repeated at 3 yr intervals.
Individuals <45 yr and who have a BMI ≥25 kg/m2 and have additional risk factors should have more
frequent testing.
Additional risk factors are the following:
• Physically inactive
• First-degree relative with diabetes
• Members of high-risk ethnic group (African American, Hispanic, Native American, Asian American,
Pacific Islander)
• Delivered a baby weighing >9 lb or previously diagnosed with GDM
• Hypertensive (B/P ≥140/90 mm Hg)
• HDL cholesterol ≤35 mg/dL and/or triglyceride level ≥250 mg/dL
• Have polycystic ovary syndrome (PCOS)
• IGT or IFG on previous testing
• Have other clinical conditions associated with insulin resistance (PCOS or acanthosis nigricans)
• History of CVD
Quiz Rapid Acting Insulin
Ans: Humalog, Novolog, Apidra
Quiz Short Acting Insulin
(detailed & elaborated) ACTUAL EXAM 2025 TESTS!!
Bioavailability of bisphosphonate drugs and appropriate patient education
Ans: Histamine2 blocking agents double alendronate bioavailability, but the impact is unknown. Aspirin
may decrease the bioavailability of tiludronate by up to 50% when taken 2 hours after the tiludronate.
Although indomethacin increases the bioavailability of tiludronate by 2- to 4-fold, the bioavailability is
not significantly altered by diclofenac; therefore, each NSAID must be considered individually.
Quiz Adverse effects associated with long-term use of bisphonates
Ans: Etidronate has also been associated with fractures in patients with Paget's disease when they are
given high doses or when therapy lasted longer than 6 months. These patients must be carefully
monitored with x-rays and laboratory work to assess for these lesions. The development of a rare form
of subtrochanteric femur fracture in non-Paget's patients using bisphosphonates is under close scrutiny
and has contributed to movement away from osteopenia prevention care to only osteoporosis therapy
(FDA, 2010a).
Quiz Specifics about administration and education regarding pancreatic enzymes
Ans: All doses are taken immediately before or with meals or snacks with a fatty component. Fruit, hard
candy, fruit juice like drinks, tea or coffee, or popsicles do not require enzymes (CFF, 2009). Capsules
may be opened and sprinkled on food. Capsules with enteric-coated beads should not be chewed. They
may be sprinkled on soft acidic food that is not hot and that can be swallowed without chewing, such as
applesauce or gelatin. Swallow immediately because the proteolytic enzymes may irritate the mucosa.
Following with a glass of water or juice or eating immediately after taking the drug helps to ensure that
the medication is swallowed and does not remain in contact with the mouth and esophagus for long
periods. Pancrelipase is destroyed by acid. Proton pump inhibitors, sodium bicarbonate, or aluminum-
based antacids may be used with preparations without enteric coating to neutralize gastric pH. Calcium-
,and magnesium-based antacids should not be used for this purpose because they interfere with drug
action. Enteric-coated beads are designed to withstand the acid pH of the stomach. Enteric-coated
formulations should not be mixed with alkaline food or the coating will be destroyed.
Quiz Common adverse effects with aromatase inhibitors
Ans: Adverse effects for the drug class include various pain syndromes, vertigo, insomnia resulting in
daytime sleepiness and confusion, increased risk of blood clots, and hair loss. A key concern is the loss of
bone mass. Bone loss can be significant when considering the concurrent osteoporotic risks of
postmenopause. Closer monitoring is required. All patients should be on calcium and vitamin D
supplementation. A relative leukopenia can occur, but the incidence of viral and bacteria infections is
not considered greater than matched groups (about 10%). Hypertension occurs in 10% of patients. A
life-threatening increase in blood clotting can result in MI, stroke, or pulmonary embolus. Hot flashes
can be intense.
Quiz Drugs associated risk for bone loss which should be monitored
Ans: Aromatase inhibitors
Thyroid hormones
Glucocorticoids
PPIs
SSRIs
Quiz Clinical signs and symptoms DM
Ans: Increased thirst
Frequent urination
Extreme hunger
Unexplained weight loss
,Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that
happens when there's not enough available insulin)
Fatigue
Irritability
Blurred vision
Slow-healing sores
Frequent infections, such as gums or skin infections and vaginal infections
Quiz Risk factors & associated complications of DM
Ans: Complications: stroke, heart attack, peripheral artery disease, diabetic retinopathy, cataracts,
glaucoma, diabetic nephropathy, peripheral neuropathy, diabetic foot.
Risk factors: >45 years old, physical inactivity, 1st degree relative relative with DM, high risk ethic group
(african american, hispanic, native american, asian american, and pacific islander), hx of gest DM, htn,
HDL < 35, triglycerides >250, polycystic ovarian syndrome, acanthosis nigricans, hx of cardiovascular
disease.
Quiz Diagnostic criteria of DM
Ans: Acute symptoms of diabetes plus casual plasma glucose concentration ≥200 mg/dL.
*Casual is defined as any time of day without regard to time since last meal. The classic symptoms of
diabetes are polyuria, polydipsia, and unexplained weight loss.
Fasting plasma glucose ≥126 mg/dL. * Fasting is defined as no caloric intake for at least 8 h.
2-h postload plasma glucose in an oral glucose tolerance test ≥200 mg/dL. The test uses a glucose load
containing the equivalent of 75 g anhydrous glucose dissolved in water.
Hb A1c ≥6.5%.
PRE-DIABETES:
Fasting plasma glucose 100-125 mg/dL (IFG) or
, plasma glucose 140-199 mg/dL (IGT) 2 hr post-ingestion of standard glucose load (75 g) or
Hb A1c 5.7%-6.4%
Quiz Criteria for screening asymptomatic adults
Ans: Individuals ≥45 yr and who have a BMI ≥25 kg/m2 should be tested. If normal, the test should be
repeated at 3 yr intervals.
Individuals <45 yr and who have a BMI ≥25 kg/m2 and have additional risk factors should have more
frequent testing.
Additional risk factors are the following:
• Physically inactive
• First-degree relative with diabetes
• Members of high-risk ethnic group (African American, Hispanic, Native American, Asian American,
Pacific Islander)
• Delivered a baby weighing >9 lb or previously diagnosed with GDM
• Hypertensive (B/P ≥140/90 mm Hg)
• HDL cholesterol ≤35 mg/dL and/or triglyceride level ≥250 mg/dL
• Have polycystic ovary syndrome (PCOS)
• IGT or IFG on previous testing
• Have other clinical conditions associated with insulin resistance (PCOS or acanthosis nigricans)
• History of CVD
Quiz Rapid Acting Insulin
Ans: Humalog, Novolog, Apidra
Quiz Short Acting Insulin
