Oral Antidiabetics NCLEX Quiz: Metformin & Diabetes Meds

1. Which oral antidiabetic is contraindicated in patients with heart failure?

Metformin

Pioglitazone

Sitagliptin

Acarbose

2. Which oral antidiabetic class has been shown to reduce cardiovascular events and mortality in patients with established heart disease?

Alpha-glucosidase inhibitors

SGLT2 inhibitors

Meglitinides

Acarbose

3. A patient on an oral antidiabetic develops persistent nausea, vomiting, and abdominal pain. Lab work shows pH 7.25 and elevated lactate. What is the likely diagnosis?

Metformin-associated lactic acidosis

Acute pancreatitis from DPP-4 inhibitor

Sulfonylurea-induced hepatotoxicity

SGLT2 inhibitor euglycemic DKA

4. Alpha-glucosidase inhibitors like miglitol are taken with the first bite of a meal. What is the rationale?

To maximize drug absorption

To delay carbohydrate digestion and reduce postprandial glucose spikes

To prevent hypoglycemia

To increase insulin secretion

5. Nateglinide and repaglinide are rapid-acting insulin secretagogues. They are best suited for patients with which pattern of hyperglycemia?

Fasting hyperglycemia only

Postprandial (after-meal) hyperglycemia

Dawn phenomenon

Nocturnal hypoglycemia

6. Which oral antidiabetic has the lowest risk of hypoglycemia when used as monotherapy?

Glyburide

Glibenclamide

Metformin

Glipizide

7. A patient reports yellow discoloration of skin and sclera after starting a thiazolidinedione. What should be checked?

Liver function tests

Pancreatic enzymes

Renal function

Thyroid function

8. Combination oral antidiabetic therapy may be used to target multiple pathways. Which combination is safe and effective?

Metformin and pioglitazone

Two sulfonylureas together

Acarbose and SGLT2 inhibitor

Two DPP-4 inhibitors together

9. A patient taking metformin requires a CT scan with contrast. What nursing action is most appropriate?

Continue metformin as scheduled

Hold metformin 48 hours after contrast and monitor renal function

Increase metformin dose to compensate

Switch to insulin immediately

10. GLP-1 receptor agonists mimic incretin hormones. Which two gut hormones are incretin hormones?

Gastrin and secretin

GLP-1 and GIP

Cholecystokinin and motilin

Peptide YY and pancreatic polypeptide

11. Metformin works primarily by decreasing hepatic glucose production and improving insulin sensitivity. Which patient condition contraindicates metformin use?

Type 2 diabetes with BMI 28

Severe renal impairment (eGFR

Hypertension controlled with lisinopril

Mild hyperlipidemia

12. Sulfonylureas like glyburide carry a higher risk of hypoglycemia compared to other agents. Why?

They directly stimulate insulin secretion regardless of glucose levels

They increase glucagon production

They inhibit hepatic glucose production

They increase renal glucose excretion

13. A patient on acarbose reports bloating and diarrhea. This occurs because acarbose delays breakdown and absorption of what?

Proteins

Carbohydrates

Lipids

Vitamins

14. Meglitinides stimulate pancreatic beta cells to release insulin. When should they be taken?

Once daily at bedtime

Before each meal

With the largest meal

Every 12 hours

15. SGLT2 inhibitors like empagliflozin lower blood glucose by promoting glucose excretion in urine. Which complication requires monitoring?

Genital mycotic infections

Severe hypoglycemia

Lactic acidosis

Hepatotoxicity

16. A patient develops edema and weight gain after starting pioglitazone. What is the mechanism?

Increased sodium reabsorption in the proximal tubule

Fluid retention from PPAR-γ activation

Acute kidney injury

Congestive heart failure

17. DPP-4 inhibitors like sitagliptin work by prolonging the action of which hormone?

Glucagon

Incretins (GLP-1 and GIP)

Cortisol

Epinephrine

18. Which oral antidiabetic is most likely to cause lactic acidosis?

Metformin

Glipizide

Pioglitazone

Sitagliptin

19. Thiazolidinediones improve insulin sensitivity by activating which nuclear receptor?

Peroxisome proliferator-activated receptor gamma (PPAR-γ)

Glucocorticoid receptor

Thyroid hormone receptor

Estrogen receptor

20. A patient on sulfonylureas reports sweating, tremors, and confusion. What is the most likely cause?

Hyperglycemia

Hypoglycemia

Diabetic ketoacidosis

Hyperosmolar hyperglycemic state

Oral Diabetes Quiz: Do You Know Metformin and Beyond?

1. Which oral antidiabetic is contraindicated in patients with heart failure?

2.

What first name or nickname would you like us to use?

2. Which oral antidiabetic class has been shown to reduce cardiovascular events and mortality in patients with established heart disease?

3. A patient on an oral antidiabetic develops persistent nausea, vomiting, and abdominal pain. Lab work shows pH 7.25 and elevated lactate. What is the likely diagnosis?

4. Alpha-glucosidase inhibitors like miglitol are taken with the first bite of a meal. What is the rationale?

5. Nateglinide and repaglinide are rapid-acting insulin secretagogues. They are best suited for patients with which pattern of hyperglycemia?

6. Which oral antidiabetic has the lowest risk of hypoglycemia when used as monotherapy?

7. A patient reports yellow discoloration of skin and sclera after starting a thiazolidinedione. What should be checked?

8. Combination oral antidiabetic therapy may be used to target multiple pathways. Which combination is safe and effective?

9. A patient taking metformin requires a CT scan with contrast. What nursing action is most appropriate?

10. GLP-1 receptor agonists mimic incretin hormones. Which two gut hormones are incretin hormones?

11. Metformin works primarily by decreasing hepatic glucose production and improving insulin sensitivity. Which patient condition contraindicates metformin use?

12. Sulfonylureas like glyburide carry a higher risk of hypoglycemia compared to other agents. Why?

13. A patient on acarbose reports bloating and diarrhea. This occurs because acarbose delays breakdown and absorption of what?

14. Meglitinides stimulate pancreatic beta cells to release insulin. When should they be taken?

15. SGLT2 inhibitors like empagliflozin lower blood glucose by promoting glucose excretion in urine. Which complication requires monitoring?

16. A patient develops edema and weight gain after starting pioglitazone. What is the mechanism?

17. DPP-4 inhibitors like sitagliptin work by prolonging the action of which hormone?

18. Which oral antidiabetic is most likely to cause lactic acidosis?

19. Thiazolidinediones improve insulin sensitivity by activating which nuclear receptor?

20. A patient on sulfonylureas reports sweating, tremors, and confusion. What is the most likely cause?