Question 1

0 / 0 pts

I understand the value of doing my own work and learning this skill to support my future independent practice

as a nurse practitioner. I understand that while there may be opportunities beyond my faculty’s control to

collaborate or share answers with peers, that it would not benefit my own personal and professional growth to

do so. I agree to do my own work and take personal responsibility for my learning.

I do not.

Correct!

I do.

Question 2

2 / 2 pts

Use the John Jones case study to answer the following question.

Which glucose level equates with a Hgb A1C of 8.1%?

~204 mg/dl

~160 mg/dl

~175 mg/dl

Correct!

~183 mg/dl

The correct answer is ~183mg/ dl. See page 400, Table 48.4, Hemoglobin A1c levels and their corresponding

eAG levels for complete information.

Question 3

2 / 2 pts

Use the John Jones case study to answer the following question.

John calls the office and reports that he is scheduled for diagnostic testing that requires IV contrast for imaging.

He inquires if there are concerns with undergoing this procedure while taking his medications. What

instructions should be given to John regarding his metformin regimen?

Correct!

Don’t take the metformin the day of the procedure and for 48 hours afterward.

No special instructions are needed.

Take the metformin the morning of the procedure but don’t take it for 48 hours afterward.

Don’t take the metformin the day of the procedure but resume the following day.

Metformin must be withheld on the day of the procedure and for 48 hours afterward. Serum creatinine levels

should be normal before resuming metformin.

Question 4

2 / 2 pts

Use the John Jones case study to answer the following question.

Which of the following lab test should be evaluated before prescribing metformin?

Complete blood count (CBC)

Correct!

Complete metabolic profile (CMP)

Lipid Panel

Urinalysis

CMP provides a baseline evaluation for both hepatic and renal function which should be evaluated throughout

treatment with metformin.

Question 5

2 / 2 pts

Use the John Jones case study to answer the following question.

Which behavior in John’s social history poses a potential concern with initiating metformin?

His diet largely consists of fast-food meals. He drinks sweet tea with every meal.

Correct!

He reports drinking “a few beers on the weekend during football season”.

No answer text provided.

He drinks 3-4 cups of coffee per day.

Metformin is contraindicated in alcoholics. Although it does not sound as if John is an alcoholic, further

questioning is needed, and the discussion should be documented. Metformin taken by alcoholics increases the

risk of lactic acidosis so John should be educated on this risk along with signs and symptoms of lactic acidosis.

Question 6

0 / 2 pts

Use the John Jones case study to answer the following question.

Metformin works by decreasing ____________ and _____________.

You Answered

glucogenesis; incretin secretion

incretin secretion; insulin production

Correct Answer

glucogenesis; insulin resistance

insulin resistance; incretin secretion

Metformin decreases glucogenesis and insulin resistance.

Question 7

2 / 2 pts

Use the John Jones case study to answer the following question.

Using the ADA Standards of Medical Care in Diabetes-2020, which of the following medications should be

prescribed for John?

Canagliflozin

Glyburide

Dulaglutide

Correct!

Metformin

According to the ADA Standards of Medical Care in Diabetes-2020, Metformin is the first-line medication to

prescribe for patients with a HgbA1C >6.5%.

American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes—2020

Abridged for Primary Care Providers. https://clinical.diabetesjournals.org/content/38/1/10

Question 8

2 / 2 pts

Use the John Jones case study to answer the following question.

Which of the following statements best describes John’s status?

Correct!

He has diabetes and requires pharmacological intervention.

He does not have diabetes.

He has diabetes but does not require pharmacological intervention.

He has pre-diabetes.

DM Diagnostic Criteria on pg 398 reviews the four criteria to diagnose DM which is the precursor to

pharmacological intervention. These criteria include:

• Fasting plasma glucose ≥126 mg/dLa Or

• Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes Or

• Oral glucose tolerance test (OGTT)