NR 661 Family Nurse Practitioner Quiz For Endocrine

ADA Diagnostic Criteria for T2DM ADA Diagnostic Criteria for IFG (pre-diabetics) Intial Management What is a reasonable A1C goal for a newly diagnosed patient with diabetes? Treatment Goals ADA treatment for IFG or A1C 5.7-6.4% When to consider Metformin ADA first line treatment Evidence Level A: What is a contraindication for initiating metformin in a newly diagnosed patient with diabetes A person who binges on metformin? Metformin is often chose for How much metformin expected to decrease A1C% in a patient who take moderate dose daily? Exercise decreases A1C to Metformin plus what other meds: Sulfonylurea DPP4 agents TZDs GLP-1 Agonists (injectable) Jones is a active 60 y/o retired patient who was diagnosed with type 2 diabetes 6 months ago. what is the appropriate action today according to ADA? What meds are safe when combined? *Usually discontinue sulfonylureas, glitazones after initiating insulin A1C 5.9%, newly diagnosed with IFG 55 y/o female, intolerant of metformin, 79 y/o male, A1C 8.9%, newly 62 y/o female taking metformin, A1C 27 y/o male, A1C 6.9%, newly 62 y/o female who takes metformin, 55 y/o female, takes metformin plus Cashopenic When should you consider insulin? Insulin Type: Immediate Regular Mixed (rapid plus NPH Long Acting Basal Insulin Formulations Initiating Basal Insulin Once you need better control… Thyroid Stimulating Hormone Common Signs and Symptoms:Hypothyroidism Hyperthyroidism Hypothyroidism What lab abnormalities are associated with hypothyroidism? Select all that apply Hyperthyroidism A 27 year old male has suspected hyperthyroidism. How should he … screened? Thyroid Values – TSH is thyrotropin Elevated TSH Decreased TSH Serum TSH normal: no further testing Primary Hypothyroidism Subclinical Hypothyroidism Hyperthyroidism Once HYPOTHYROIDISM is DIAGNOSED and treatment is started Primary Hypothyroidism: How do we replace? How do we replace? A 27 year old female has been diagnosed with primary hypothyroidism. She asks, “How long before I feel better?” A correct reply is: Replacement in Middle/Older Adults Presence of cardiac disease or comorbids: A patient has been diagnosed with hypothyroidism today. What should … evaluated in order to determine how much levothyroxine to prescribe? Select all that apply A 75 year old female has the following lab values. She complains of fatigue. Subclinical Hypothyroidism – Treatment is controversial A 45 year old patient who has subclinical hypothyroidism requests levothyroxine for her symptoms. What are the risks of prescribing levothyroxine? A 51 year old patient has been diagnosed with hypothyroidism. How should her levothyroxine dose be managed today? Taking levothyroxine with food … 2 pills daily instead of one Taking levothyroxine with vitamins Switching to a generic form of levothyroxine Follow Up A 27 year old male reports a recent 12 pound weight loss, extreme fatigue, and feeling “edgy”. What is the most appropriate action for the NP? Select all that apply. TSH0.1 mU/L, B/p 150/90, HR120, t: 99.5 A 35 year old female was diagnosed with hypothyroidism 6 weeks ago and is being replaced with 88 mcg of levothyroxine daily. Based on today’s labs, what action is appropriate? TSH 2.4 mU/L A 60 year old patient has 7.8% A1C on 1000 mg metformin BID. What drug class could … considered to achieve better glucose control if cost is major determinant of drug choice? A 49 year old male takes maximum doses of metformin daily. His A1C has risen to 10.2%. What insulin could … used initially to attain better glucose control? Select all that apply. A 30 year old female with normal BMI has symptoms of hypothyroidism. Her – TSH is: 35.6 mU/L. What must The NP is initiating levothyroxine for primary hypothyroidism in a 75 year old female. Her projected levothyroxine needs are 88 mcg per day. What dose would … the most appropriate for initial therapy in this client?