1. Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signsand symptoms of hypoglycemia include: A. “Fruity” breath odor and rapid respiration B. Diarrhea, abdominal pain, weight loss, and hypertension C. Dizziness, confusion, diaphoresis, and tachycardia D. Easy bruising, palpitations, cardiac dysrhythmias, and coma 2. Nonselective beta blockers and alcohol create serious drug interactions with insulin because they: A. Increase blood glucose levels B. Produce unexplained diaphoresis C. Interfere with the ability of the body to metabolize glucose D. Mask the signs and symptoms of altered glucose levels 3. Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true? A. Optimal time of preprandial injection is 15 minutes. B. Duration of action is increased when the dose is increased. C. It is compatible with neutral protamine Hagedorn insulin. D. It has no pronounced peak. 4. 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: A. The initial dose of glargine is reduced by 20% to avoid hypoglycemia. B. The initial dose of glargine is 2 to 10 units per day. C. Patients who have been on high doses of NPH will need tests for insulin antibodies. D. Obese patients may require more than 100 units per day. 5. 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? A. Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia. B. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents. C. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins. D. Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime. 6. Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it: A. Substitutes for insulin usually secreted by the pancreas B. Decreases glycogenolysis by the liver C. Increases the release of insulin from beta cells D. Decreases peripheral glucose utilization 7. Prior to prescribing metformin, the provider should: A. Draw a serum creatinine to assess renal function B. Try the patient on insulin C. Tell the patient to increase iodine intake D. Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions 8. The action of “gliptins” is different from other antidiabetic agents because they: A. Have a low risk for hypoglycemia B. Are not associated with weight gain C. Close ATP-dependent potassium channels in the beta cell D. Act on the incretin system to indirectly increase insulin production 9. Sitagliptin has been approved for: A. Monotherapy in once-daily doses B. Combination therapy with metformin C. Both 1 and 2 D. Neither 1 nor 2 10. GLP-1 agonists: A. Directly bind to a receptor in the pancreatic beta cell B. Have been approved for monotherapy C. Speed gastric emptying to decrease appetite D. Can be given orally once daily 11. Avoid concurrent administration of exenatide with which of the following drugs? A. Digoxin B. Warfarin C. Lovastatin D. All of the above 12. Administration of exenatide is by subcutaneous injection: A. 30 minutes prior to the morning meal B. 60 minutes prior to the morning and evening meal C. 15 minutes after the evening meal D. 60 minutes before each meal daily 13. Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report: A. Tinnitus and decreased salivation B. Fever and sore throat C. Hypocalcemia and osteoporosis D. Laryngeal edema and difficulty swallowing 14. Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for: A. Excessive sedation B. Tachycardia and angina C. Weight gain D. Cold intolerance 15. Which of the following is not an indication that growth hormone supplements should be discontinued? A. Imaging indication of epiphyseal closure B. Growth curve increases have plateaued C. Complaints of mild bone pain D. Achievement of anticipated height goals 16. Besides osteoporosis, IV bisphosphonates are also indicated for: A. Paget’s Disease B. Early osteopenia C. Renal cancer D. Early closure of cranial sutures 17. What is the role of calcium supplements when patients take bisphosphonates? A. They must be restricted to allow the medication to work. B. They must be taken in sufficient amounts to provide foundational elements for bone growth. C. They must be taken at the same time as the bisphosphonates. D. They only work with bisphosphonates if daily intake is restricted