NU 578 Unit 4 Exam (PDF) | Updated Exam
Questions | University of South Alabama
Question 1
A 58-year-old patient with type 2 diabetes and an eGFR
of 35 mL/min is prescribed metformin. What is the most
appropriate action?
A) Start metformin at a low dose
B) Prescribe metformin with a sulfonylurea
C) Avoid metformin and consider an alternative
D) Increase metformin dose for efficacy
Correct Answer: C
Rationale: Metformin is contraindicated in patients with an
eGFR <45 mL/min due to the risk of lactic acidosis. An
alternative agent (e.g., a SGLT2 inhibitor or insulin) should
be considered.
Question 2
Which insulin has the fastest onset of action?
1
,A) NPH insulin
B) Insulin glargine
C) Insulin aspart
D) Regular insulin
Correct Answer: C
Rationale: Insulin aspart is a rapid-acting analog with an
onset of 5–15 minutes. NPH is intermediate-acting,
glargine is long-acting, and regular insulin is short-acting
with a slower onset.
Question 3
A patient on metformin reports significant gastrointestinal
upset. What is the best next step?
A) Discontinue metformin immediately
B) Switch to immediate-release metformin
C) Start with a lower dose and titrate slowly
D) Add an antidiarrheal agent
2
,Correct Answer: C
Rationale: GI side effects from metformin are common but
often resolve with dose titration. Starting with a low dose
(500 mg once daily) and increasing slowly over weeks
improves tolerability. Extended-release formulations may
also help.
Question 4
Which SGLT2 inhibitor has been shown to reduce
cardiovascular death and hospitalizations for heart
failure?
A) Canagliflozin
B) Dapagliflozin
C) Empagliflozin
D) Ertugliflozin
Correct Answer: C
Rationale: Empagliflozin demonstrated cardiovascular
benefit in the EMPA-REG OUTCOME trial, reducing CV
3
, death and HF hospitalizations. Dapagliflozin also has
benefits but empagliflozin has the strongest CV outcome
data.
Question 5
What is the primary mechanism of action of GLP-1
receptor agonists?
A) Increase insulin secretion and decrease glucagon
secretion
B) Inhibit DPP-4 enzyme
C) Increase urinary glucose excretion
D) Decrease hepatic glucose production
Correct Answer: A
Rationale: GLP-1 agonists enhance glucose-dependent
insulin secretion, suppress glucagon release, slow gastric
emptying, and promote satiety. DPP-4 inhibitors (not GLP-
1 agonists) inhibit the DPP-4 enzyme.
4
Questions | University of South Alabama
Question 1
A 58-year-old patient with type 2 diabetes and an eGFR
of 35 mL/min is prescribed metformin. What is the most
appropriate action?
A) Start metformin at a low dose
B) Prescribe metformin with a sulfonylurea
C) Avoid metformin and consider an alternative
D) Increase metformin dose for efficacy
Correct Answer: C
Rationale: Metformin is contraindicated in patients with an
eGFR <45 mL/min due to the risk of lactic acidosis. An
alternative agent (e.g., a SGLT2 inhibitor or insulin) should
be considered.
Question 2
Which insulin has the fastest onset of action?
1
,A) NPH insulin
B) Insulin glargine
C) Insulin aspart
D) Regular insulin
Correct Answer: C
Rationale: Insulin aspart is a rapid-acting analog with an
onset of 5–15 minutes. NPH is intermediate-acting,
glargine is long-acting, and regular insulin is short-acting
with a slower onset.
Question 3
A patient on metformin reports significant gastrointestinal
upset. What is the best next step?
A) Discontinue metformin immediately
B) Switch to immediate-release metformin
C) Start with a lower dose and titrate slowly
D) Add an antidiarrheal agent
2
,Correct Answer: C
Rationale: GI side effects from metformin are common but
often resolve with dose titration. Starting with a low dose
(500 mg once daily) and increasing slowly over weeks
improves tolerability. Extended-release formulations may
also help.
Question 4
Which SGLT2 inhibitor has been shown to reduce
cardiovascular death and hospitalizations for heart
failure?
A) Canagliflozin
B) Dapagliflozin
C) Empagliflozin
D) Ertugliflozin
Correct Answer: C
Rationale: Empagliflozin demonstrated cardiovascular
benefit in the EMPA-REG OUTCOME trial, reducing CV
3
, death and HF hospitalizations. Dapagliflozin also has
benefits but empagliflozin has the strongest CV outcome
data.
Question 5
What is the primary mechanism of action of GLP-1
receptor agonists?
A) Increase insulin secretion and decrease glucagon
secretion
B) Inhibit DPP-4 enzyme
C) Increase urinary glucose excretion
D) Decrease hepatic glucose production
Correct Answer: A
Rationale: GLP-1 agonists enhance glucose-dependent
insulin secretion, suppress glucagon release, slow gastric
emptying, and promote satiety. DPP-4 inhibitors (not GLP-
1 agonists) inhibit the DPP-4 enzyme.
4
