NSG533 COMPREHENSIVE EXAMINATION
2026 COMPLETE QUESTIONS AND
CORRECT ANSWERS GRADED A+
◉ JR is a 68-year-old African American man with a new diagnosis of
T2DM. He was classified as having prediabetes (at risk for
developing diabetes) 5 years before the diagnosis and has a strong
family history of type 2 diabetes. JR's blood pressure was 150/92
mm Hg. His laboratory results revealed an A1C of 8.1%, normal
cholesterol panel, and normal renal/hepatic function were noted
with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago)
Hyperlipidemia (diagnosed 2 y ago) Pancreatitis (idiopathic) (acute
hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist
Circumference: 46 in Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
,Despite improvements in the past six weeks due to lifestyle changes
and exercise, drug therapy is to be started for JR's diabet.
Answer: Metformin is the drug of choice recommended for most
patients with diabetes in addition to lifestyle modifications
assuming no contraindications or intolerabilities are present upon
evaluation. Metformin has also shown to provide positive weight
neutral/loss effects in obese patients. It is crucial to know the renal
status of patients commencing metformin therapy to limit the risk of
lactic acidosis (JR is without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are
several potential choices. The second step can be a dipeptidyl
peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-1)
receptor agonist, it can be a TZD, it can be a sulfonylurea agent, it
can be a SGLT2 inhibitor, or it could be basal insulin. Anything next
can be tried depending on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect
profile. Sitagliptin has been associated with case reports of
pancreatitis, so this specific agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduction necessary to
gain glycemic control and may assist with weight loss goals for this
patient. New information suggests these agents may provide
benefits in those with ASCVD. JR has a past history of pancreatitis
and GLP-1 analogs are not recommended due to this
contraindication
TZDs have data to support an A1C reduction necessary to gain
glycemic control, but are associated with weight gain, negative
effects on lipids and increased risk of fracture. Until recently, TZDs
,have also been linked to increased CV events and use has fallen out
of favor
Sulfonylureas provide excellent A1C lowering, but are also
associated with weight gain. They also have the potential to cause
hypoglycemia, so patient education is crucial. Because of his
allergies to "sulfa", use would be contr
◉ A patient with type 1 diabetes reports taking propranolol for
hypertension. What concern does this information present for the
provider?.
Answer: A patient with Type 1 DM is insulin dependent for glucose
control and at high risk for hypoglycemic episodes. Propanolol
causes prolonged hypoglycemic episodes. Needs to switch to ACE or
ARB.
◉ A provider teaches a patient who has been diagnosed with
hypothyroidism about a new prescription for levothyroxine. Which
statement by the patient indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my
provider first."
b. "I should report insomnia, tremors, and an increased heart rate to
my provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the
levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of
levothyroxine.".
, Answer: D. Calcium may reduce levothyroxine absorption. Further
education is needed if the patient feels she can take half of a
prescribed medication.
◉ MC has undiagnosed multiple gastric ulcers. Shortly after
consuming a large meal and alcohol he experiences significant GI
distress. He takes an OTC heartburn remedy. Within a minute or two
he develops what he will later describe as "belching, nausea and a
bad bloated feeling". Several of the ulcers began to bleed and he
becomes profoundly hypotensive from the blood loss and is taken to
the ED. Endoscopy confirms multiple bleeds; the endoscopist
remarks that it appears as if the lesions had been literally stretched
apart causing additional tissue damage. What did the patient most
likely take (i.e. what was the OTC remedy)?.
Answer: I would accept Alka-Selzer. I contains NaHCO3 (as well as
ASA). In the presence of HCL it Liberates CO2, that can cause gastric
distention, belching and nausea. The reaction is fairly swift allowing
little time for dissipation. Tums, its primary ingredient calcium
carbonate which when taken cause a reaction with the stomach acid
such as production of carbon dioxide gas which can cause bloating
and the stomach to stretch to tear the ulcers open.
◉ On your way to this examination, you experience the vulnerable
feeling that an attack of acute diarrhea is imminent! If you stop at a
drug store, which anti-diarrheal drugs could you buy without a
prescription even though it is chemically related to the strong opioid
analgesic meperidine (but acts only on the peripheral opioid
receptor)?.
2026 COMPLETE QUESTIONS AND
CORRECT ANSWERS GRADED A+
◉ JR is a 68-year-old African American man with a new diagnosis of
T2DM. He was classified as having prediabetes (at risk for
developing diabetes) 5 years before the diagnosis and has a strong
family history of type 2 diabetes. JR's blood pressure was 150/92
mm Hg. His laboratory results revealed an A1C of 8.1%, normal
cholesterol panel, and normal renal/hepatic function were noted
with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago)
Hyperlipidemia (diagnosed 2 y ago) Pancreatitis (idiopathic) (acute
hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist
Circumference: 46 in Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
,Despite improvements in the past six weeks due to lifestyle changes
and exercise, drug therapy is to be started for JR's diabet.
Answer: Metformin is the drug of choice recommended for most
patients with diabetes in addition to lifestyle modifications
assuming no contraindications or intolerabilities are present upon
evaluation. Metformin has also shown to provide positive weight
neutral/loss effects in obese patients. It is crucial to know the renal
status of patients commencing metformin therapy to limit the risk of
lactic acidosis (JR is without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are
several potential choices. The second step can be a dipeptidyl
peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-1)
receptor agonist, it can be a TZD, it can be a sulfonylurea agent, it
can be a SGLT2 inhibitor, or it could be basal insulin. Anything next
can be tried depending on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect
profile. Sitagliptin has been associated with case reports of
pancreatitis, so this specific agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduction necessary to
gain glycemic control and may assist with weight loss goals for this
patient. New information suggests these agents may provide
benefits in those with ASCVD. JR has a past history of pancreatitis
and GLP-1 analogs are not recommended due to this
contraindication
TZDs have data to support an A1C reduction necessary to gain
glycemic control, but are associated with weight gain, negative
effects on lipids and increased risk of fracture. Until recently, TZDs
,have also been linked to increased CV events and use has fallen out
of favor
Sulfonylureas provide excellent A1C lowering, but are also
associated with weight gain. They also have the potential to cause
hypoglycemia, so patient education is crucial. Because of his
allergies to "sulfa", use would be contr
◉ A patient with type 1 diabetes reports taking propranolol for
hypertension. What concern does this information present for the
provider?.
Answer: A patient with Type 1 DM is insulin dependent for glucose
control and at high risk for hypoglycemic episodes. Propanolol
causes prolonged hypoglycemic episodes. Needs to switch to ACE or
ARB.
◉ A provider teaches a patient who has been diagnosed with
hypothyroidism about a new prescription for levothyroxine. Which
statement by the patient indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my
provider first."
b. "I should report insomnia, tremors, and an increased heart rate to
my provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the
levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of
levothyroxine.".
, Answer: D. Calcium may reduce levothyroxine absorption. Further
education is needed if the patient feels she can take half of a
prescribed medication.
◉ MC has undiagnosed multiple gastric ulcers. Shortly after
consuming a large meal and alcohol he experiences significant GI
distress. He takes an OTC heartburn remedy. Within a minute or two
he develops what he will later describe as "belching, nausea and a
bad bloated feeling". Several of the ulcers began to bleed and he
becomes profoundly hypotensive from the blood loss and is taken to
the ED. Endoscopy confirms multiple bleeds; the endoscopist
remarks that it appears as if the lesions had been literally stretched
apart causing additional tissue damage. What did the patient most
likely take (i.e. what was the OTC remedy)?.
Answer: I would accept Alka-Selzer. I contains NaHCO3 (as well as
ASA). In the presence of HCL it Liberates CO2, that can cause gastric
distention, belching and nausea. The reaction is fairly swift allowing
little time for dissipation. Tums, its primary ingredient calcium
carbonate which when taken cause a reaction with the stomach acid
such as production of carbon dioxide gas which can cause bloating
and the stomach to stretch to tear the ulcers open.
◉ On your way to this examination, you experience the vulnerable
feeling that an attack of acute diarrhea is imminent! If you stop at a
drug store, which anti-diarrheal drugs could you buy without a
prescription even though it is chemically related to the strong opioid
analgesic meperidine (but acts only on the peripheral opioid
receptor)?.
