1. Which information should be included in the education for a patient taking an antilipidemic?
1. Other drugs should be taken 1 hour before or 4 hours after the bile-acid sequestrant.
2. Lovastatin should be taken first thing in the morning.
3. Bile-acid sequestrants should be taken after meals.
4. A high-fiber diet may reduce the chance for muscle pain associated with reductase inhibitors.
Rationales [Page reference: 326]
Option 1: If other drugs are to be taken, administer them 1 hour before or 4 hours after the bile-acid sequestrant.
Option 2: Lovastatin is the only reductase inhibitor that should be taken with the evening meal to improve its
absorption. Reductase inhibitors are traditionally taken in the evening because of their action on cholesterol
synthesis; however, this is not clinically significant except for lovastatin.
Option 3: Bile-acid sequestrants are taken before meals and are mixed and vigorously shaken with 4 to 6 oz of
water, milk, fruit juice, or a noncarbonated beverage. Rinsing the glass with a small amount of additional liquid
ensures that the entire dose is taken.
Option 4: For all reductase inhibitors, muscle tenderness or pain may indicate a serious problem that may require
discontinuance of the drug.
2. Which condition has shown limited to no benefit with the initiation of HMG-CoA reductase inhibitors
(statins)?
1. Advanced heart failure
2. Type II diabetes
3. Low-density lipoprotein (LDL) cholesterol levels above 150 mg/dL
4. Moderate atherosclerosis
Rationales [Page reference: 320]
Option 1: In the guidelines, there is a recommendation not to use statins in advanced heart failure patients. It is
recognized that this disease state is a frequent comorbidity with lipid disorders; however, there is no evidence that
statins affect mortality in this population. Any benefit is in early disease, when lipid reduction might be helpful.
Once heart failure is advanced, these drugs have limited to no benefit.
Option 2: Diabetes is associated as a risk for atherosclerotic events and has been noted to benefit from this class
of drugs.
Option 3: Persons with baseline LDL cholesterol at or above 130 mg/dL generally will require LDL-lowering
drugs to achieve LDL cholesterol levels below 100 mg/dL, so drug therapy (usually with a statin) is initiated
simultaneously with therapeutic lifestyle changes (TLC).
Option 4: Known moderate atherosclerosis is an indication for stating therapy.
3. The APN should avoid prescribing which medication for a patient diagnosed with gestational diabetes?
1. Metformin
2. Insulin
3. Glyburide
4. Canagliflozin
Rationales [Page reference: 540]
Option 1: Most oral hypoglycemic agents are contraindicated in pregnancy; the exceptions are metformin and
glyburide.
Option 2: Insulin is the drug of choice in pregnancy.
Option 3: Most oral hypoglycemic agents are contraindicated in pregnancy; the exceptions are metformin and
glyburide.
Option 4: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors, such as canagliflozin, may affect renal
development and maturation in utero. These medications should be used during pregnancy only if the potential
benefit justifies the potential risk to the fetus.
,4. The lowest dose possible of levothyroxine (Synthroid) should be given to the patient with which condition?
1. Pregnancy
2. Diabetes
3. Osteoporosis
4. Simple nontoxic goiter
Rationales [Page reference: 583]
Option 1: Metabolic requirements are increased during pregnancy. Increasing hormone replacement by 25%
results in adequate coverage during pregnancy.
Option 2: There are not any dose changes needed of thyroid replacement for the patient with diabetes.
Option 3: Long-term levothyroxine therapy has been associated with decreased bone density in the hip and spine
in both pre- and postmenopausal women. Use the lowest dose possible for the osteoporosis patient.
Option 4: Simple nontoxic goiter is treated with liothyronine (Cytomel), not a low dose of levothyroxine.
5. A patient with left ventricular dysfunction is taking a calcium channel blocker (CCB) and a beta blocker
(BB). This combination may induce which condition?
1. Heart failure or bradycardia
2. Tachycardia and hypotension
3. Angina and tachycardia
4. Hypoglycemia
Rationales [Page reference: 290]
Option 1: Combinations of BBs and CCBs have been shown to be more effective than the individual drugs used
alone. However, these combinations are questionable for patients with left ventricular dysfunction because
together they may induce heart failure or bradycardia. Verapamil and diltiazem also should be avoided in these
combinations.
Option 2: Combinations of long-acting nitrates and CCBs are rarely used because of the high risk for hypotension
and because their adverse reaction profiles are additive. This combination is usually reserved for refractory cases
of vasospastic angina. The use of a CCB and a BB is not associated with tachycardia.
Option 3: The combination of a CCB and a BB in the presence of left ventricular dysfunction may induce heart
failure or bradycardia. The combination of both drugs will not induce angina and tachycardia.
Option 4: The combination of a CCB and a BB in the presence of left ventricular dysfunction may induce heart
failure or bradycardia. The combination of both drugs will not induce hypoglycemia.
6. Sudden withdrawal of calcium channel blockers (CCBs) can precipitate which condition?
1. Liver failure
2. Myocardial ischemia
3. Edema
4. Decreased heart rate
Rationales [Page reference: 291]
Option 1: Liver failure with sudden withdrawal of CCBs is not noted. Liver function should be evaluated prior to
initiating therapy. Dosage reductions for most CCBs are recommended with severe hepatic impairment because of
the extensive metabolism of these drugs by the liver.
Option 2: It is important to induce a gradual withdrawal of CCBs because sudden withdrawal may precipitate
myocardial ischemia.
Option 3: Edema can be noted as an adverse reaction associated with CCBs; sudden withdrawal is not noted to
precipitate edema.
Option 4: Withdrawal from CCBs is not noted to induce a decreased heart rate independent of other factors.
,7. Which diagnostic test used to evaluate the treatment of growth hormones is most cost-effective?
1. Magnetic resonance imaging (MRI)
2. X-ray
3. Computed tomography (CT) scan
4. Positron emission tomography (PET) scan
Rationales [Page reference: 575]
Option 1: MRI is a diagnostic tool used to create detailed images of the organs and tissues within the body.
Although an MRI may be used within the treatment plan, it is not the most cost-effective.
Option 2: X-ray is the most cost-effective method. Monitoring of bone age by x-ray is done to evaluate growth
and determine epiphyseal closure.
Option 3: CT scan combines data from several x-rays to provide a detailed image of structures inside the body.
Although a CT scan may be used within the treatment plan, it is not the most cost-effective.
Option 4: PET scans are used to image areas of the body to find areas of disease. It is generally not used to
monitor the effectiveness of growth hormones.
8. Which of these is a microvascular complication of uncontrolled diabetes?
1. Proliferative retinopathy
2. Cardiovascular disease
3. Stroke
4. Peripheral vascular disease
Rationales [Page reference: 1022]
Option 1: Uncontrolled diabetes can result in microvascular and macrovascular complications. Microvascular
involvement affects the eyes, heart, kidney, and nervous system.
Option 2: Uncontrolled diabetes can result in microvascular and macrovascular complications. Macrovascular
involvement includes cardiovascular, peripheral vascular, and cerebrovascular systems.
Option 3: Uncontrolled diabetes can result in microvascular and macrovascular complications. Macrovascular
involvement includes cardiovascular, peripheral vascular, and cerebrovascular systems.
Option 4: Uncontrolled diabetes can result in microvascular and macrovascular complications. Macrovascular
involvement includes cardiovascular, peripheral vascular, and cerebrovascular systems.
9. A 17-year-old patient diagnosed with type 2 diabetes mellitus (DM) should be started on which oral
medication?
1. Repaglinide (Prandin)
2. Metformin (Glucophage)
3. Insulin glargine (Lantus)
4. Sitagliptin (Januvia)
Rationales [Page reference: 1032]
Option 1: Repaglinide is a meglitinide and is not approved for use in children.
Option 2: Metformin is the only oral agent approved for use in children by the U.S. Food and Drug
Administration (FDA).
Option 3: A basal insulin may be used to control hyperglycemia in children; however, it would not be the initial
medication.
Option 4: Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor and is not approved for use in children.
, 10. How long is insulin stable at room temperature once opened?
1. 3 months
2. 7 days
3. 30 days
4. 14 days
Rationales [Page reference: 526]
Option 1: Most insulins are stable at room temperature for fewer than 3 months.
Option 2: Most insulins are stable at room temperature for more than 7 days.
Option 3: Most insulins are stable at room temperature for 1 month.
Option 4: Most insulins are stable at room temperature for more than 2 weeks.
11. An 8-year-old male patient has been started on growth hormones for treatment of short stature. The APN
instructs the mother that growth hormones work by which mechanism?
1. Stimulating synthesis of somatomedins
2. Decreasing protein synthesis
3. Augmenting fat stores
4. Increasing cholesterol levels
Rationales [Page reference: 575]
Option 1: Growth hormones stimulate synthesis of somatomedins in the growth plate and the liver, resulting in
increased linear organ and skeletal growth, and increased cellular protein synthesis.
Option 2: Growth hormones stimulate synthesis of somatomedins in the growth plate and the liver, resulting in
increased linear organ and skeletal growth, and increased cellular protein synthesis.
Option 3: Growth hormones can cause a reduction in fat stores.
Option 4: Growth hormones can cause a decrease in cholesterol levels.
12. According to the American Diabetic Association (ADA) standards of medical care in diabetes, which of
these is a diagnostic criterion for diabetes?
1. HbA1c 6.5%
2. Random glucose less than 200 mg/dL
3. Fasting glucose of 100 mg/dL
4. Fasting glucose less than 92 mg /dL
Rationales [Page reference: 1023]
Option 1: According to ADA guidelines, the diagnostic criteria for diabetes includes HbA1c 6.5%.
Option 2: Random glucose less than 200 mg/dL is not one of the diagnostic criteria for diabetes.
Option 3: Fasting glucose of 100 mg/dL is not one of the diagnostic criteria for diabetes.
Option 4: Fasting glucose less than 92 mg/dL is not one of the diagnostic criteria for diabetes.
1. Other drugs should be taken 1 hour before or 4 hours after the bile-acid sequestrant.
2. Lovastatin should be taken first thing in the morning.
3. Bile-acid sequestrants should be taken after meals.
4. A high-fiber diet may reduce the chance for muscle pain associated with reductase inhibitors.
Rationales [Page reference: 326]
Option 1: If other drugs are to be taken, administer them 1 hour before or 4 hours after the bile-acid sequestrant.
Option 2: Lovastatin is the only reductase inhibitor that should be taken with the evening meal to improve its
absorption. Reductase inhibitors are traditionally taken in the evening because of their action on cholesterol
synthesis; however, this is not clinically significant except for lovastatin.
Option 3: Bile-acid sequestrants are taken before meals and are mixed and vigorously shaken with 4 to 6 oz of
water, milk, fruit juice, or a noncarbonated beverage. Rinsing the glass with a small amount of additional liquid
ensures that the entire dose is taken.
Option 4: For all reductase inhibitors, muscle tenderness or pain may indicate a serious problem that may require
discontinuance of the drug.
2. Which condition has shown limited to no benefit with the initiation of HMG-CoA reductase inhibitors
(statins)?
1. Advanced heart failure
2. Type II diabetes
3. Low-density lipoprotein (LDL) cholesterol levels above 150 mg/dL
4. Moderate atherosclerosis
Rationales [Page reference: 320]
Option 1: In the guidelines, there is a recommendation not to use statins in advanced heart failure patients. It is
recognized that this disease state is a frequent comorbidity with lipid disorders; however, there is no evidence that
statins affect mortality in this population. Any benefit is in early disease, when lipid reduction might be helpful.
Once heart failure is advanced, these drugs have limited to no benefit.
Option 2: Diabetes is associated as a risk for atherosclerotic events and has been noted to benefit from this class
of drugs.
Option 3: Persons with baseline LDL cholesterol at or above 130 mg/dL generally will require LDL-lowering
drugs to achieve LDL cholesterol levels below 100 mg/dL, so drug therapy (usually with a statin) is initiated
simultaneously with therapeutic lifestyle changes (TLC).
Option 4: Known moderate atherosclerosis is an indication for stating therapy.
3. The APN should avoid prescribing which medication for a patient diagnosed with gestational diabetes?
1. Metformin
2. Insulin
3. Glyburide
4. Canagliflozin
Rationales [Page reference: 540]
Option 1: Most oral hypoglycemic agents are contraindicated in pregnancy; the exceptions are metformin and
glyburide.
Option 2: Insulin is the drug of choice in pregnancy.
Option 3: Most oral hypoglycemic agents are contraindicated in pregnancy; the exceptions are metformin and
glyburide.
Option 4: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors, such as canagliflozin, may affect renal
development and maturation in utero. These medications should be used during pregnancy only if the potential
benefit justifies the potential risk to the fetus.
,4. The lowest dose possible of levothyroxine (Synthroid) should be given to the patient with which condition?
1. Pregnancy
2. Diabetes
3. Osteoporosis
4. Simple nontoxic goiter
Rationales [Page reference: 583]
Option 1: Metabolic requirements are increased during pregnancy. Increasing hormone replacement by 25%
results in adequate coverage during pregnancy.
Option 2: There are not any dose changes needed of thyroid replacement for the patient with diabetes.
Option 3: Long-term levothyroxine therapy has been associated with decreased bone density in the hip and spine
in both pre- and postmenopausal women. Use the lowest dose possible for the osteoporosis patient.
Option 4: Simple nontoxic goiter is treated with liothyronine (Cytomel), not a low dose of levothyroxine.
5. A patient with left ventricular dysfunction is taking a calcium channel blocker (CCB) and a beta blocker
(BB). This combination may induce which condition?
1. Heart failure or bradycardia
2. Tachycardia and hypotension
3. Angina and tachycardia
4. Hypoglycemia
Rationales [Page reference: 290]
Option 1: Combinations of BBs and CCBs have been shown to be more effective than the individual drugs used
alone. However, these combinations are questionable for patients with left ventricular dysfunction because
together they may induce heart failure or bradycardia. Verapamil and diltiazem also should be avoided in these
combinations.
Option 2: Combinations of long-acting nitrates and CCBs are rarely used because of the high risk for hypotension
and because their adverse reaction profiles are additive. This combination is usually reserved for refractory cases
of vasospastic angina. The use of a CCB and a BB is not associated with tachycardia.
Option 3: The combination of a CCB and a BB in the presence of left ventricular dysfunction may induce heart
failure or bradycardia. The combination of both drugs will not induce angina and tachycardia.
Option 4: The combination of a CCB and a BB in the presence of left ventricular dysfunction may induce heart
failure or bradycardia. The combination of both drugs will not induce hypoglycemia.
6. Sudden withdrawal of calcium channel blockers (CCBs) can precipitate which condition?
1. Liver failure
2. Myocardial ischemia
3. Edema
4. Decreased heart rate
Rationales [Page reference: 291]
Option 1: Liver failure with sudden withdrawal of CCBs is not noted. Liver function should be evaluated prior to
initiating therapy. Dosage reductions for most CCBs are recommended with severe hepatic impairment because of
the extensive metabolism of these drugs by the liver.
Option 2: It is important to induce a gradual withdrawal of CCBs because sudden withdrawal may precipitate
myocardial ischemia.
Option 3: Edema can be noted as an adverse reaction associated with CCBs; sudden withdrawal is not noted to
precipitate edema.
Option 4: Withdrawal from CCBs is not noted to induce a decreased heart rate independent of other factors.
,7. Which diagnostic test used to evaluate the treatment of growth hormones is most cost-effective?
1. Magnetic resonance imaging (MRI)
2. X-ray
3. Computed tomography (CT) scan
4. Positron emission tomography (PET) scan
Rationales [Page reference: 575]
Option 1: MRI is a diagnostic tool used to create detailed images of the organs and tissues within the body.
Although an MRI may be used within the treatment plan, it is not the most cost-effective.
Option 2: X-ray is the most cost-effective method. Monitoring of bone age by x-ray is done to evaluate growth
and determine epiphyseal closure.
Option 3: CT scan combines data from several x-rays to provide a detailed image of structures inside the body.
Although a CT scan may be used within the treatment plan, it is not the most cost-effective.
Option 4: PET scans are used to image areas of the body to find areas of disease. It is generally not used to
monitor the effectiveness of growth hormones.
8. Which of these is a microvascular complication of uncontrolled diabetes?
1. Proliferative retinopathy
2. Cardiovascular disease
3. Stroke
4. Peripheral vascular disease
Rationales [Page reference: 1022]
Option 1: Uncontrolled diabetes can result in microvascular and macrovascular complications. Microvascular
involvement affects the eyes, heart, kidney, and nervous system.
Option 2: Uncontrolled diabetes can result in microvascular and macrovascular complications. Macrovascular
involvement includes cardiovascular, peripheral vascular, and cerebrovascular systems.
Option 3: Uncontrolled diabetes can result in microvascular and macrovascular complications. Macrovascular
involvement includes cardiovascular, peripheral vascular, and cerebrovascular systems.
Option 4: Uncontrolled diabetes can result in microvascular and macrovascular complications. Macrovascular
involvement includes cardiovascular, peripheral vascular, and cerebrovascular systems.
9. A 17-year-old patient diagnosed with type 2 diabetes mellitus (DM) should be started on which oral
medication?
1. Repaglinide (Prandin)
2. Metformin (Glucophage)
3. Insulin glargine (Lantus)
4. Sitagliptin (Januvia)
Rationales [Page reference: 1032]
Option 1: Repaglinide is a meglitinide and is not approved for use in children.
Option 2: Metformin is the only oral agent approved for use in children by the U.S. Food and Drug
Administration (FDA).
Option 3: A basal insulin may be used to control hyperglycemia in children; however, it would not be the initial
medication.
Option 4: Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor and is not approved for use in children.
, 10. How long is insulin stable at room temperature once opened?
1. 3 months
2. 7 days
3. 30 days
4. 14 days
Rationales [Page reference: 526]
Option 1: Most insulins are stable at room temperature for fewer than 3 months.
Option 2: Most insulins are stable at room temperature for more than 7 days.
Option 3: Most insulins are stable at room temperature for 1 month.
Option 4: Most insulins are stable at room temperature for more than 2 weeks.
11. An 8-year-old male patient has been started on growth hormones for treatment of short stature. The APN
instructs the mother that growth hormones work by which mechanism?
1. Stimulating synthesis of somatomedins
2. Decreasing protein synthesis
3. Augmenting fat stores
4. Increasing cholesterol levels
Rationales [Page reference: 575]
Option 1: Growth hormones stimulate synthesis of somatomedins in the growth plate and the liver, resulting in
increased linear organ and skeletal growth, and increased cellular protein synthesis.
Option 2: Growth hormones stimulate synthesis of somatomedins in the growth plate and the liver, resulting in
increased linear organ and skeletal growth, and increased cellular protein synthesis.
Option 3: Growth hormones can cause a reduction in fat stores.
Option 4: Growth hormones can cause a decrease in cholesterol levels.
12. According to the American Diabetic Association (ADA) standards of medical care in diabetes, which of
these is a diagnostic criterion for diabetes?
1. HbA1c 6.5%
2. Random glucose less than 200 mg/dL
3. Fasting glucose of 100 mg/dL
4. Fasting glucose less than 92 mg /dL
Rationales [Page reference: 1023]
Option 1: According to ADA guidelines, the diagnostic criteria for diabetes includes HbA1c 6.5%.
Option 2: Random glucose less than 200 mg/dL is not one of the diagnostic criteria for diabetes.
Option 3: Fasting glucose of 100 mg/dL is not one of the diagnostic criteria for diabetes.
Option 4: Fasting glucose less than 92 mg/dL is not one of the diagnostic criteria for diabetes.
