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Biguanide – Metformin

Total questions: 50

Worksheet time: 25mins

Name
Class
Date
1.

Metformin’s main action is to:

a)

Increase pancreatic insulin secretion

b)

Decrease hepatic glucose production

c)

Increase carbohydrate absorption

d)

Replace insulin

2.

Metformin should be held for 48 hours before and after:

a)

Blood transfusion

b)

IV contrast dye

c)

Steroid administration

d)

Surgery

3.

Which adverse effect is most common with metformin?

a)

Gas and diarrhea

b)

Hypoglycemia

c)

Constipation

d)

Bradycardia

4.

A nurse suspects lactic acidosis in a metformin patient when the client reports:

a)

Sweating and tremors

b)

Muscle pain and rapid breathing

c)

Polyuria and thirst

d)

Confusion and fever

5.

Metformin is contraindicated in which condition?

a)

Hypertension

b)

Renal insufficiency

c)

Obesity

d)

Osteoporosis

6.

Which statement shows correct understanding of metformin teaching?

a)

I’ll take this before meals with juice.

b)

I’ll avoid alcohol while taking this.

7.

Sulfonylureas act by:

a)

Increasing insulin production from the pancreas

b)

Decreasing glucose absorption

c)

Improving insulin sensitivity

d)

Decreasing glucagon secretion

8.

The major risk of sulfonylureas is:

a)

Hyperkalemia

b)

Hypoglycemia

c)

Fluid retention

d)

Nausea

9.

Which teaching is most important for glipizide?

a)

Take it before meals.

b)

Skip it if you eat a large meal.

c)

Take it at bedtime.

d)

Avoid protein.

10.

Sulfonylureas should be avoided in patients allergic to:

a)

Penicillin

b)

Sulfa drugs

c)

Aspirin

d)

Insulin

11.

Mixing sulfonylureas with alcohol can cause:

a)

Lactic acidosis

b)

Flushing and nausea (Disulfiram reaction)

c)

Tachycardia

d)

Weight gain

12.

Which patient is most at risk for hypoglycemia from glyburide?

a)

45-year-old eating regular meals

b)

68-year-old skipping breakfast

c)

30-year-old who exercises after lunch

d)

55-year-old on metformin

13.

Meglitinides work by:

a)

Increasing insulin secretion from the pancreas

b)

Decreasing insulin resistance

c)

Blocking carbohydrate absorption

d)

Replacing insulin

14.

When should a patient take repaglinide?

a)

30 minutes before meals

b)

With the first bite of each meal

c)

At bedtime

d)

On an empty stomach

15.

A patient skipped lunch. What should they do about their repaglinide dose?

a)

Take it anyway

b)

Skip the dose

c)

Double the next dose

d)

Take it with dinner

16.

The primary side effect of meglitinides is:

a)

Weight gain and hypoglycemia

b)

Hair loss

c)

Bradycardia

d)

Diarrhea

17.

Pioglitazone (Actos) works by:

a)

Increasing insulin sensitivity

b)

Stimulating insulin release

c)

Blocking carbohydrate absorption

d)

Replacing insulin

18.

Which adverse effect requires immediate intervention?

a)

Weight loss

b)

Shortness of breath and swelling (heart failure)

c)

Diarrhea

d)

Dry mouth

19.

TZDs are contraindicated in which condition?

a)

Hypotension

b)

Heart failure

c)

Hypothyroidism

d)

Asthma

20.

Long-term use of pioglitazone increases risk for:

a)

Bladder cancer

b)

Gastric ulcers

c)

Osteoporosis

d)

Hypocalcemia

21.

Teaching for a patient on pioglitazone should include:

a)

"Report swelling and weight gain."

b)

"Take with dairy for absorption."

c)

"Use with insulin only."

d)

"Avoid fluids."

22.

DPP-4 inhibitors lower blood sugar by:

a)

Blocking glucose absorption

b)

Increasing insulin and decreasing glucagon

c)

Stimulating glycogen breakdown

d)

Inhibiting insulin release

23.

A serious side effect of sitagliptin is:

a)

Pancreatitis

b)

Diarrhea

c)

Bradycardia

d)

Weight gain

24.

Which symptom should be reported immediately with sitagliptin?

a)

Sneezing and sore throat

b)

Abdominal pain radiating to the back

c)

Mild nausea

d)

Polyuria

25.

Sitagliptin may also cause:

a)

Flu-like or upper respiratory symptoms

b)

Hearing loss

c)

Constipation

d)

Hypertension

26.

DPP-4 inhibitors are best taken:

a)

Once daily, with or without food

b)

On an empty stomach

c)

At bedtime

d)

Only when glucose >150

27.

GLP-1 agonists work by:

a)

Increasing insulin and reducing glucagon

b)

Blocking insulin receptors

28.

A patient taking liraglutide reports severe abdominal pain. What should the nurse do?

a)

Reassure that it’s normal

b)

Notify provider – possible pancreatitis

c)

Encourage fluids

d)

Give antacid

29.

GLP-1 agonists also help by:

a)

Promoting weight loss and fullness

b)

Increasing appetite

c)

Causing fluid retention

d)

Raising cholesterol

30.

What is a serious risk associated with GLP-1 drugs?

a)

Thyroid cancer

b)

Hypocalcemia

c)

Bradycardia

d)

Hyperkalemia

31.

How should oral semaglutide (Rybelsus) be taken?

a)

On an empty stomach before breakfast

b)

After eating

c)

With juice

d)

With milk

32.

The mechanism of SGLT2 inhibitors is:

a)

Increasing urinary glucose excretion

b)

Increasing insulin secretion

c)

Slowing gastric emptying

d)

Replacing insulin

33.

A common side effect of SGLT2 inhibitors is:

a)

Genital yeast infections

b)

Hair loss

c)

Constipation

d)

Numbness

34.

The nurse should teach a patient on canagliflozin to report:

a)

Burning during urination

b)

Mild thirst

c)

Appetite loss

d)

Itching

35.

SGLT2 inhibitors are contraindicated in:

a)

Liver failure

b)

Renal disease

c)

Hypothyroidism

d)

COPD

36.

SGLT2 inhibitors can cause which dangerous effect in rare cases?

a)

Ketoacidosis

b)

Hypercalcemia

c)

Bradycardia

d)

Rash

37.

Alpha-glucosidase inhibitors act by:

a)

Delaying carbohydrate absorption in the gut

b)

Increasing insulin secretion

c)

Promoting glucagon release

d)

Decreasing appetite

38.

These drugs should be taken:

a)

With the first bite of food

b)

On an empty stomach

c)

After eating

d)

Before bedtime

39.

Common side effects of acarbose include:

a)

Gas and bloating

b)

Constipation

c)

Bradycardia

d)

Tremors

40.

Hypoglycemia from acarbose must be treated with:

a)

Orange juice

b)

Glucose tablets (not sucrose)

c)

Milk

d)

Bread

41.

Pramlintide should be taken:

a)

Before meals

b)

After meals

c)

At bedtime

d)

On an empty stomach

42.

Major side effect of pramlintide:

a)

Hypoglycemia (especially with insulin)

b)

Constipation

c)

Rash

d)

Tachycardia

43.

The nurse knows pramlintide is used in:

a)

Type 2 diabetes only

b)

Type 1 and 2 with mealtime insulin

44.

Which two oral drug classes cause weight gain?

a)

Sulfonylureas and TZDs

b)

DPP-4 and GLP-1

c)

Biguanides and SGLT2

d)

Alpha-glucosidase and GLP-1

45.

Which two classes cause weight loss?

a)

GLP-1 and SGLT2

b)

TZD and sulfonylureas

c)

Biguanide and alpha-glucosidase

d)

DPP-4 and meglitinides

46.

Which drug classes can cause pancreatitis?

a)

DPP-4 and GLP-1

b)

Biguanides and TZDs

c)

Sulfonylureas and SGLT2

d)

Alpha-glucosidase and Amylin

47.

Which oral med is safest for older adults?

a)

Metformin

b)

Glyburide

c)

Repaglinide

d)

Pioglitazone

48.

Which med should be avoided in heart failure?

a)

Pioglitazone

b)

Metformin

c)

Sitagliptin

d)

Acarbose

49.

Which med can cause dehydration and hypotension?

a)

Canagliflozin

b)

Glipizide

c)

Pioglitazone

d)

Sitagliptin

50.

Which combination increases risk for hypoglycemia?

a)

Insulin + Pramlintide

b)

Metformin + TZD

c)

SGLT2 + DPP-4

d)

GLP-1 + Biguanide

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