1. Question: Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include:
2. Question: Nonselective beta blockers and alcohol create serious drug interactions with insulin because they:  
3. Question: Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true?
4. Question: The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done:
5. Question: When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research?
6. Question: Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it:
7. Question: Prior to prescribing metformin, the provider should:
8. Question: The action of “gliptins” is different from other antidiabetic agents because they:
9. Question: Sitagliptin has been approved for:
10. Question: GLP-1 agonists:
11. Question: Avoid concurrent administration of exenatide with which of the following drugs?
12. Question: Administration of exenatide is by subcutaneous injection:
13. Question: Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report:
14. Question: Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for:
15. Question: Which of the following is not an indication that growth hormone supplements should be discontinued?
16. Question: Besides osteoporosis, IV bisphosphonates are also indicated for:
17. Question: What is the role of calcium supplements when patients take bisphosphonates?
18. Question: Which of the following statements about pancreatic enzymes is true?
19. Question: Both men and women experience bone loss with aging. The bones most likely to demonstrate significant loss are:
20. Question: Bisphosphonates treat or prevent osteoporosis by:
21. Question: Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs?
22. Question: Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic secretions. Each replacement drug has lipase, protease, and amylase components, but the drug is prescribed in units of:
23. Question: Brands of pancreatic enzyme replacement drugs are:
24. Question: When given subcutaneously, how long until neutral protamine Hagedorn insulin begins to take effect (onset of action) after administration?
25. Question: Besides cystic fibrosis, which other medical state may trigger the need for pancreatic enzymes?

Chapter 33. Diabetes Mellitus

1. Question:  Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90% of type 1 diabetics have:
2. Question: Type 2 diabetes is a complex disorder involving:
3. Question: Diagnostic criteria for diabetes include:
4. Question: Routine screening of asymptomatic adults for diabetes is appropriate for:
5. Question: Screening for children who meet the following criteria should begin at age 10 and occur every 3 years thereafter:
6. Question: Insulin is used to treat both types of diabetes. It acts by:
7. Question: Adam has type 1 diabetes and plays tennis for his university. He exhibits a knowledge deficit about his insulin and his diagnosis. He should be taught that:
8. Question: Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset and duration of action?
9. Question: The drug of choice for type 2 diabetics is metformin. Metformin:
10. Question: Before prescribing metformin, the provider should:
11. Question: Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they:
12. Question: Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include:
13. Question: Control targets for patients with diabetes include:
14. Question: Establishing glycemic targets is the first step in treatment of both types of diabetes. For type 1 diabetes:
15. Question: Treatment with insulin for type 1 diabetics:
16. Question: When the total daily insulin dose is split and given twice daily, which of the following rules may be followed?
17. Question: Studies have shown that control targets that reduce the HbA1C to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include:
18. Question: Prevention of conversion from prediabetes to diabetes in young children must take highest priority and should focus on:
19. Question: The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are:
20. Question: Unlike most type 2 diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in older adults is:
21. Question: The drugs recommended for older adults with type 2 diabetes include:
22. Question: Ethnic groups differ in their risk for and presentation of diabetes. Hispanics:
23. Question: The American Heart Association states that people with diabetes have a 2- to 4-fold increase in the risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include:
24. Question: All diabetic patients with known cardiovascular disease should be treated with:
25. Question: All diabetic patients with hyperlipidemia should be treated with:
26. Question: Both angiotensin converting enzyme inhibitors and some angiotensin II receptor blockers have been approved in treating:
27. Question: Protein restriction helps slow the progression of albuminuria, glomerular filtration rate, decline, and end stage renal disease in some patients with diabetes. It is useful for patients who:
28. Question: Diabetic autonomic neuropathy (DAN) is the earliest and most common complication of diabetes. Symptoms associated with DAN include:
29. Question: Drugs used to treat diabetic peripheral neuropathy include:
30. Question: The American Diabetic Association has recommended which of the following tests for ongoing management of diabetes?
31. Question: Allison is an 18-year-old college student with type 1 diabetes. She is on NPH twice daily and Novolog before meals. She usually walks for 40 minutes each evening as part of her exercise regimen. She is beginning a 30-minute swimming class three times a week at 1 p.m. What is important for her to do with this change in routine?
32. Question: Allison is an 18-year-old college student with type 1 diabetes. Allison’s pre-meal BG at 11:30 a.m. is 130. She eats an apple and has a sugar-free soft drink. At 1 p.m. before swimming her BG is 80. What should she do
33. Question: Bart is a patient is a 67-year-old male with T2 DM. He is on glipizide and metformin. He presents to the clinic with confusion, sluggishness, and extreme thirst. His wife tells you Bart does not follow his meal plan or exercise regularly, and hasn’t checked his BG for 1 week. A random glucose is drawn and it is 500. What is a likely diagnosis based on preliminary assessment?
34. Question: What would one expected assessment finding be for hyperglycemic hyperosmolar syndrome?
35. Question: A patient on metformin and glipizide arrives at her 11:30 a.m. clinic appointment diaphoretic and dizzy. She reports taking her medication this morning and ate a bagel and coffee for breakfast. BP is 110/70 and random finger-stick glucose is 64. How should this patient be treated?
36. Question: When methimazole is started for hyperthyroidism it may take________ to see a total reversal of hyperthyroid symptoms.
37. Question: In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for:
38. Question: After starting a patient with Grave’s disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every:
39. Question: A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with:
40. Question: Goals when treating hypothyroidism with thyroid replacement include:
41. Question: When starting a patient on levothyroxine for hypothyroidism the patient will need follow- up measurement of thyroid function in:
42. Question: Question: Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored with TSH and free T4 levels every:
43. Question: Treatment of a patient with hypothyroidism and cardiovascular disease consists of:
44. Question: Infants with congenital hypothyroidism are treated with:
45. Question: When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include:
46. Question: In hyperthyroid states, what organ system other than CV must be evaluated to establish potential adverse issues?
47. Question: Why are “natural” thyroid products not readily prescribed for most patients?
48. Question: What is the desired mixed of T3 to T4 drug levels in newly diagnosed endocrine patients?
49. Question: Laboratory values are actually different for TSH when screening for thyroid issues and when used for medication management. Which of the follow holds true?
50. Question: What happens to the typical hormone replacement dose when a woman becomes pregnant?
51. Question: All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black Box Warning regarding:
52. Question: Jamie has fractured his ankle and has received a prescription for acetaminophen and hydrocodone (Vicodin). Education when prescribing Vicodin includes:
53. Question: When prescribing NSAIDS, a complete drug history should be conducted as NSAIDs interact with these drugs:
54. Question: Josefina is a 2-year-old child with acute otitis media and an upper respiratory infection. Along with an antibiotic she receives a recommendation to treat the ear pain with ibuprofen. What education would her parent need regarding ibuprofen?
55. Question: Henry is 82 years old and takes two aspirin every morning to treat the

arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry?

56. Question: Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for:
57. Question: Daniel has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation. It is time to discontinue the prednisone. How is prednisone discontinued?
58. Question: Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects?
59. Question: Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of:
60. Question: Patients who are on chronic long-term corticosteroid therapy need education regarding:
61. Question: Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry?
62. Question: Patient education when prescribing colchicine includes:
63. Question: Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes:
64. Question: Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes:
65. Question: Sallie has been taking 10 mg per day of prednisone for the past 6 months.

She should be assessed for:

66. Question: The trial period to determine effective anti-inflammatory activity aspirin for rheumatoid arthritis is:
67. Question: Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is:
68. Question: Monitoring a patient on a high-dose aspirin level includes:
69. Question: Patients who are on long-term aspirin therapy should have___ annually.
70. Question: Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be:
71. Question: Larry has heart failure, which is being treated with digoxin because it exhibits:
72. Question: Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for this combination includes:
73. Question: Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct.
74. Question: Serum digoxin levels are monitored for potential toxicity. Monitoring should occur:
75. Question: Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for dyspnea, jugular venous distention, and peripheral edema because they may indicate:
76. Question: Which of the following is true about procainamide and its dosing schedule?
77. Question: Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following EXCEPT:
78. Question: The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not have thyroid disease and wants to know why the test is ordered. Which is a correct response?
79. Question: Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because:
80. Question: Ray has been diagnosed with hypertension and an angiotensin-converting enzyme inhibitor is determined to be needed. Prior to prescribing this drug, the NP should assess for:
81. Question: Angiotensin-converting enzyme inhibitors are the drug of choice in treating hypertension in diabetic patients because they:
82. Question: A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which of the following statements is true about this adverse response?
83. Question: Angiotensin-converting enzyme inhibitors are useful in a variety of disorders. Which of the following statements are true about both its usefulness in the disorder and the reason for its use?
84. Question: Despite good blood pressure control, an NP might change a patient’s drug from an angiotensin-converting enzyme (ACE) inhibitor to an angiotensin II receptor blocker (ARB) because the ARB:
85. Question: While taking an angiotensin II receptor blocker (ARB), patients need to avoid certain over-the-counter drugs without first consulting the provider because:
86. Question: Laboratory monitoring for patients on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers should include:
87. Question: Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it:
88. Question: Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker?
89. Question: Patient teaching related to amlodipine includes:
90. Question: Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be:
91. Question: In teaching about the use of sublingual nitroglycerine, the patient should be instructed:
92. Question: Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to:
93. Question: Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor?
94. Question: Because of the pattern of cholesterol synthesis, reductase inhibitors are given:
95. Question: Janice has elevated LDL, VLDL, and triglyceride levels. Niaspan, an extended-release form of niacin, is chosen to treat her hyperlipidemia. Due to its metabolism and excretion, which of the following laboratory results should be monitored?
96. Question: Niaspan is less likely to cause which side effect that is common to niacin?
97. Question: Dulcea has type 2 diabetes and a high triglyceride level. She has gemfibrozil prescribed to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug?
98. Question: Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct.
99. Question: Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other anti-lipidemics, this drug:
100. Question: Because of their site of action, bile acid sequestering resins:
101. Question: Colestipol comes in a powdered form. The patient is taught to:
102. Question: The choice of diuretic to use in treating hypertension is based on:
103. Question: Direct renin inhibitors have the following properties. They:
104. Question: When comparing angiotensin-converting enzyme (ACE) and angiotensin II receptor blocker (ARB) medications, which of the following holds true?
105. Question: What does the provider understand about the issue of “Diabetic Renal Protection” with angiotensin-converting enzyme (ACE) medications? Diabetes mellitus patients:
106. Question: What dermatological issue is linked to Amiodarone use?
107. Question: Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why?
108. Question: Angina is produced by an imbalance between myocardial oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS?
109. Question: Not all chest pain is caused by myocardial ischemia. Noncardiac causes of chest pain include:
110. Question: The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is class:
111. Question: Patients at high risk for developing significant coronary heart disease are those with:
112. Question: To reduce mortality, all patients with angina, regardless of class, should be on:
113. Question: Patients who have angina, regardless of class, who are also diabetic, should be on:
114. Question: Management of all types and grades of angina includes the use of lifestyle modification to reduce risk factors. Which of these modifications are appropriate for which reason? Both the modification and the reason for it must be true for the answer to be correct.
115. Question: Nitrates are especially helpful for patients with angina who also have:
116. Question: Beta blockers are especially helpful for patients with exertional angina who also have:
117. Question: Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use?
118. Question: Isosorbide dinitrate is a long-acting nitrate given twice daily. The schedule for administration is 7

a.m. and 2 p.m. because:

119. Question: Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because:
120. Question: Drug choices to treat angina in older adults differ from those of younger adults only in:
121. Question: Which of the following drugs has been associated with increased risk for myocardial infarction in women?
122. Question: Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT:
123. Question: Situations that suggest referral to a specialist is appropriate include:
124. Question: The rationale for prescribing calcium blockers for angina can be based on the need for:
125. Question: Medications are typically started for angina patients when:
126. Question: The most common cause of angina is:
127. Question: Ranolazine is used in angina patients to:
128. Question: When is aspirin (ASA) used in angina patients?
129. Question: Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the treatment of heart failure because they have more than one action to address the pathological changes in this disorder. Which of the following pathological changes in heart failure is NOT addressed by ACE inhibitors?
130. Question: One of the three types of heart failure involves systolic dysfunction. Potential causes of this most common form of heart failure include:
131. Question: The American Heart Association and the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment. Patients with symptoms and underlying disease are classified as stage:
132. Question: Diagnosis of heart failure cannot be made by symptoms alone because many disorders share the same symptoms. The most specific and sensitive diagnostic test for heart failure is:
133. Question: Treatments for heart failure, including drug therapy, are based on the stages developed by the ACC/AHA. Stage A patients are treated with:
134. Question: Class I recommendations for stage A heart failure include:
135. Question: Stage B patients should have beta blockers added to their heart failure treatment regimen when:
136. Question: Increased life expectancy for patients with heart failure has been associated with the use of:
137. Question: Stage C patients usually require a combination of three to four drugs to manage their heart failure.

In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true?

138. Question: Digoxin has a very limited role in treatment of heart failure. It is used mainly for patients with:
139. Question: Which of the following classes of drugs is contraindicated in heart failure?
140. Question: Heart failure is a leading cause of death and hospitalization in older adults (greater than 65 years old). The drug of choice for this population is:
141. Question: ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes is considered to be safe, at least in the later parts of pregnancy?
142. Question: Heart failure is a chronic condition that can be adequately managed in primary care. However, consultation with or referral to a cardiologist is appropriate when:
143. Question: ACE inhibitors are a foundational medication in HF. Which group of patients cannot take them safely?
144. Question: What assessment that can be done at home is the most reliable for making decisions to change HF medications?
145. Question: Evidence is strong that the timing of HF interventions are best initiated when:
146. Question: HF patients frequently take more than one drug. When are anticoagulants typically used?
147. Question: What can chest x-rays contribute to the diagnosis and management of HF?
148. Question: The overall goal of treating hyperlipidemia is:
149. Question: When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment?
150. Question: First-line therapy for hyperlipidemia is:
151. Question: James is a 45-year-old patient with an LDL level of 120 and normal triglycerides. Appropriate first-line therapy for James may include diet counseling, increased physical activity, and:
152. Question: Joanne is a 60-year-old patient with an LDL of 132 and a family history of coronary artery disease. She has already tried diet changes (increased fiber and plant sterols) to lower her LDL and after 6 months her LDL is slightly higher. The next step in her treatment would be:
153. Question: Sharlene is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterol margarine daily for the past 3 months. Her LDL is 135 mg/dL. An appropriate treatment for her would be:
154. Question: Phil is a 54-year-old male with multiple risk factors who has been on a high-dose statin for 3 months to treat his high LDL level. His LDL is 135 mg/dL and his triglycerides are elevated. A reasonable change in therapy would be to:
155. Question: Jamie is a 34-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels.

What is the appropriate treatment for a pregnant woman?

156. Question: Han is a 48-year-old diabetic with hyperlipidemia and high triglycerides. His LDL is 112 mg/dL and he has not tolerated statins. He warrants a trial of a:
157. Question: Jose is a 12-year-old overweight child with a total cholesterol of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include with a reevaluation in 6 months.
158. Question: Monitoring of a patient who is on a lipid-lowering drug includes:
159. Question: Before starting therapy with a statin, the following baseline laboratory values should be evaluated:
160. Question: When starting a patient on a statin, education would include:
161. Question: Omega 3 fatty acids are best used to help treat:
162. Question: When are statins traditionally ordered to be taken?
163. Question: Which the following persons should not have a statin medication ordered?
164. Question: Fiber supplements are great options for elderly patients who have the concurrent problem of:
165. Question: What is considered the order of statin strength from lowest effect to highest?
166. Question: Because primary hypertension has no identifiable cause, treatment is based on interfering with the physiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension because they:
167. Question: Because of its action on various body systems, the patient taking a thiazide or loop diuretic may also need to receive the following supplement:
168. Question: All patients with hypertension benefit from diuretic therapy, but those who benefit the most are:
169. Question: Beta blockers treat hypertension because they:
170. Question: Which of the following disease processes could be made worse by taking a nonselective beta blocker?
171. Question: Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include:
172. Question: Angiotensin-converting enzyme (ACE) inhibitors treat hypertension because they:
173. Question: Compelling indications for an ACE inhibitor as treatment for hypertension based on clinical trials includes:
174. Question: An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone?
175. Question: If not chosen as the first drug in hypertension treatment, which drug class should be added as a second step because it will enhance the effects of most other agents?
176. Question: Treatment costs are important for patients with hypertension. Which of the following statements about cost is NOT true?
177. Question: Caffeine, exercise, and smoking should be avoided for at least how many minutes before blood pressure measurement?
178. Question: Blood pressure checks in children:
179. Question: Lack of adherence to blood pressure management is very common. Reasons for this lack of adherence include:
180. Question: Lifestyle modifications for patients with prehypertension or hypertension include:
181. Question: Which diuretic agents typically do not need potassium supplementation?
182. Question: Aldactone family medications are frequently used when the hypertensive patient also has:
183. Question: Hypertensive African Americans are typically listed as not being as responsive to which drug groups?
184. Question: What educational points concerning fluid intake must be covered with diuretic prescriptions?
185. Question: What is a common side effect concern with hypertensive medications and all individuals, but especially the elderly?
186. Question: Montelukast (Singulair) may be prescribed for:
187. Question: The known drug interactions with the inhaled corticosteroid beclomethasone (QVAR) include:
188. Question: When educating patients who are starting on inhaled corticosteroids, the provider should tell them that:
189. Question: Patients with allergic rhinitis may benefit from a prescription of:
190. Question: Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for:
191. Question: First-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they are:
192. Question: When recommending dimenhydrinate (Dramamine) to treat motion sickness, patients should be instructed to:
193. Question: Decongestants such as pseudoephedrine (Sudafed):
194. Question: Cough and cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population:
195. Question: Martin is a 60-year-old patient with hypertension. The first-line decongestant to prescribe would be:
196. Ques