NURS 251 Pharmacology Module 8 Exam Endocrine
Reproductive GI Pharmacology Actual Exam 2026/2027 –
Complete Questions and Answers with Detailed
Rationales – Pass Guaranteed – A+ Graded
Domain 1: Diabetes Mellitus Pharmacology (30% - 15 Questions)
Q1: A patient with type 2 diabetes is prescribed insulin glargine (Lantus) 20 units at
bedtime. Which statement by the patient indicates correct understanding of this
medication?
A. "I can mix this insulin with my regular insulin in the same syringe to save injections."
B. "I should take this insulin 15 minutes before meals to cover my carbohydrates."
C. "This insulin provides a steady, peakless basal coverage for about 24 hours."
D. "If I miss a dose, I should double the dose the next night."
Correct Answer: C
Rationale: C. [CORRECT] Insulin glargine is a long-acting basal insulin with a relatively
flat, peakless action profile lasting approximately 24 hours. It mimics basal insulin
secretion. A is incorrect; glargine should NEVER be mixed with other insulins due to its
acidic pH. B is incorrect; glargine is not mealtime insulin—it's basal coverage, not bolus.
D is incorrect; doubling doses can cause severe hypoglycemia; patients should take the
missed dose if remembered unless it's close to the next scheduled dose.
Q2: A patient is taking metformin (Glucophage) 1000mg twice daily for type 2 diabetes.
Which finding requires immediate discontinuation of the medication?
A. Fasting blood glucose of 180 mg/dL
,B. eGFR of 25 mL/min/1.73m²
C. Hemoglobin A1c of 8.2%
D. Weight gain of 5 pounds
Correct Answer: B
Rationale: B. [CORRECT] Metformin is contraindicated when eGFR falls below 30
mL/min/1.73m² due to increased risk of lactic acidosis. The FDA requires
discontinuation when eGFR <30 or before iodinated contrast studies. A is incorrect;
elevated glucose indicates need for additional therapy, not metformin discontinuation. C
is incorrect; A1c of 8.2% indicates suboptimal control but doesn't require stopping
metformin. D is incorrect; metformin is weight-neutral or causes modest weight loss;
weight gain is not a contraindication.
Q3: A nurse is preparing to mix NPH insulin and regular insulin in the same syringe.
Which technique is correct?
A. Inject air into the NPH vial first, then the regular vial, and draw up NPH before regular
B. Inject air into both vials, then draw up regular (clear) insulin before NPH (cloudy)
C. Draw up NPH first because it is cloudy and easier to see in the syringe
D. Roll the regular insulin vial to resuspend particles before drawing up
Correct Answer: B
Rationale: B. [CORRECT] The correct mnemonic is "clear before cloudy" or "regular
before NPH." Inject air into both vials first (prevents vacuum), then draw up regular
insulin to prevent contaminating the regular vial with NPH particles. A is incorrect;
drawing NPH first risks contaminating the regular insulin vial with intermediate-acting
particles. C is incorrect; NPH is cloudy because it contains protamine; it should be
drawn second. D is incorrect; regular insulin is clear and doesn't require rolling—NPH
requires gentle rolling to resuspend.
, Q4: A patient asks about the mechanism of action of sitagliptin (Januvia). Which
explanation by the nurse is most accurate?
A. "It inhibits the enzyme that breaks down incretin hormones, increasing insulin
secretion in response to meals."
B. "It stimulates insulin release from the pancreas regardless of blood glucose levels."
C. "It blocks glucose reabsorption in the kidneys, causing glucose to be excreted in
urine."
D. "It activates PPAR-gamma receptors to improve insulin sensitivity in muscle and fat."
Correct Answer: A
Rationale: A. [CORRECT] Sitagliptin is a DPP-4 inhibitor. It inhibits dipeptidyl peptidase-4,
the enzyme that degrades GLP-1 and GIP, thereby prolonging incretin activity, enhancing
glucose-dependent insulin secretion, and suppressing glucagon. B is incorrect; this
describes sulfonylureas, which cause hypoglycemia risk. C is incorrect; this describes
SGLT2 inhibitors (empagliflozin). D is incorrect; this describes thiazolidinediones
(pioglitazone).
Q5: A patient with type 2 diabetes is prescribed empagliflozin (Jardiance). Which
adverse effect should the nurse emphasize in discharge teaching?
A. Risk of hypoglycemia when used as monotherapy
B. Increased risk of urinary tract infections and genital mycotic infections
C. Acute pancreatitis requiring immediate medical attention
D. Severe constipation and gastric emptying delays
Correct Answer: B
Rationale: B. [CORRECT] SGLT2 inhibitors increase glucose in urine (glycosuria), creating
a favorable environment for bacterial and fungal growth. Patients should report dysuria,
frequency, or genital itching promptly. A is incorrect; SGLT2 inhibitors rarely cause
hypoglycemia when used alone (insulin-independent mechanism). C is incorrect;
pancreatitis risk is associated with GLP-1 agonists and DPP-4 inhibitors, not SGLT2
Reproductive GI Pharmacology Actual Exam 2026/2027 –
Complete Questions and Answers with Detailed
Rationales – Pass Guaranteed – A+ Graded
Domain 1: Diabetes Mellitus Pharmacology (30% - 15 Questions)
Q1: A patient with type 2 diabetes is prescribed insulin glargine (Lantus) 20 units at
bedtime. Which statement by the patient indicates correct understanding of this
medication?
A. "I can mix this insulin with my regular insulin in the same syringe to save injections."
B. "I should take this insulin 15 minutes before meals to cover my carbohydrates."
C. "This insulin provides a steady, peakless basal coverage for about 24 hours."
D. "If I miss a dose, I should double the dose the next night."
Correct Answer: C
Rationale: C. [CORRECT] Insulin glargine is a long-acting basal insulin with a relatively
flat, peakless action profile lasting approximately 24 hours. It mimics basal insulin
secretion. A is incorrect; glargine should NEVER be mixed with other insulins due to its
acidic pH. B is incorrect; glargine is not mealtime insulin—it's basal coverage, not bolus.
D is incorrect; doubling doses can cause severe hypoglycemia; patients should take the
missed dose if remembered unless it's close to the next scheduled dose.
Q2: A patient is taking metformin (Glucophage) 1000mg twice daily for type 2 diabetes.
Which finding requires immediate discontinuation of the medication?
A. Fasting blood glucose of 180 mg/dL
,B. eGFR of 25 mL/min/1.73m²
C. Hemoglobin A1c of 8.2%
D. Weight gain of 5 pounds
Correct Answer: B
Rationale: B. [CORRECT] Metformin is contraindicated when eGFR falls below 30
mL/min/1.73m² due to increased risk of lactic acidosis. The FDA requires
discontinuation when eGFR <30 or before iodinated contrast studies. A is incorrect;
elevated glucose indicates need for additional therapy, not metformin discontinuation. C
is incorrect; A1c of 8.2% indicates suboptimal control but doesn't require stopping
metformin. D is incorrect; metformin is weight-neutral or causes modest weight loss;
weight gain is not a contraindication.
Q3: A nurse is preparing to mix NPH insulin and regular insulin in the same syringe.
Which technique is correct?
A. Inject air into the NPH vial first, then the regular vial, and draw up NPH before regular
B. Inject air into both vials, then draw up regular (clear) insulin before NPH (cloudy)
C. Draw up NPH first because it is cloudy and easier to see in the syringe
D. Roll the regular insulin vial to resuspend particles before drawing up
Correct Answer: B
Rationale: B. [CORRECT] The correct mnemonic is "clear before cloudy" or "regular
before NPH." Inject air into both vials first (prevents vacuum), then draw up regular
insulin to prevent contaminating the regular vial with NPH particles. A is incorrect;
drawing NPH first risks contaminating the regular insulin vial with intermediate-acting
particles. C is incorrect; NPH is cloudy because it contains protamine; it should be
drawn second. D is incorrect; regular insulin is clear and doesn't require rolling—NPH
requires gentle rolling to resuspend.
, Q4: A patient asks about the mechanism of action of sitagliptin (Januvia). Which
explanation by the nurse is most accurate?
A. "It inhibits the enzyme that breaks down incretin hormones, increasing insulin
secretion in response to meals."
B. "It stimulates insulin release from the pancreas regardless of blood glucose levels."
C. "It blocks glucose reabsorption in the kidneys, causing glucose to be excreted in
urine."
D. "It activates PPAR-gamma receptors to improve insulin sensitivity in muscle and fat."
Correct Answer: A
Rationale: A. [CORRECT] Sitagliptin is a DPP-4 inhibitor. It inhibits dipeptidyl peptidase-4,
the enzyme that degrades GLP-1 and GIP, thereby prolonging incretin activity, enhancing
glucose-dependent insulin secretion, and suppressing glucagon. B is incorrect; this
describes sulfonylureas, which cause hypoglycemia risk. C is incorrect; this describes
SGLT2 inhibitors (empagliflozin). D is incorrect; this describes thiazolidinediones
(pioglitazone).
Q5: A patient with type 2 diabetes is prescribed empagliflozin (Jardiance). Which
adverse effect should the nurse emphasize in discharge teaching?
A. Risk of hypoglycemia when used as monotherapy
B. Increased risk of urinary tract infections and genital mycotic infections
C. Acute pancreatitis requiring immediate medical attention
D. Severe constipation and gastric emptying delays
Correct Answer: B
Rationale: B. [CORRECT] SGLT2 inhibitors increase glucose in urine (glycosuria), creating
a favorable environment for bacterial and fungal growth. Patients should report dysuria,
frequency, or genital itching promptly. A is incorrect; SGLT2 inhibitors rarely cause
hypoglycemia when used alone (insulin-independent mechanism). C is incorrect;
pancreatitis risk is associated with GLP-1 agonists and DPP-4 inhibitors, not SGLT2
