NR 565 Final Study Guide Questions with Verified Answers
(Correct Update)
Question 1: Thyroid o Diagnosis & Evaluation What labs are used to diagnose?
Answer: -TSH - used primarily for screening and diagnosing hypothyroid and for monitoring
replacement therapy in hypothyroid patients
-T4 - Used to monitor thyroid hormone replacement therapy and to screen for thyroid dysfunction
-T3 - Useful in the diagnosis of hyperthyroidism; can also be used to monitor hormone replacement
therapy
-TSH low
-T4 normal
-T3 is high = hyperthyroidism
Question 2: Thyroid o Diagnosis & Evaluation Timeframe for re-check of labs after starting
levothyroxine?
Answer: Recheck TSH 6-8 weeks after initiating therapy and after any dosage change; Check TSH at
least once a year after serum TSH is stabilized
Question 3: Thyroid o Diagnosis & Evaluation Signs and symptoms of hypothyroidism?
Answer: Hypothyroidism: Depend on severity. o Mild: subtle and may go unrecognized o Moderate to
severe:
-Face is pale, putty, and expressionless.
-Skin cold and dry.
-Hair is brittle and hair loss occurs.
-Slowed Heart rate.
-Patient may complain of lethargy, fatigue, and
-Temperature is lowered & intolerant to cold.
-Thyroid Enlargement may occur if reduced levels of T3 and T4 Mentation may be impaired.
Question 4: Thyroid o Diagnosis & Evaluation Signs and symptoms of hyperthyroidism?
Answer: o Elevated Heart rate and strong, and dysrhythmias and angina may develop o The CNS is
stimulated, resulting is nervousness, insomnia, rapid thought flow, and rapid speech, hyperreflexia,
tremors o Skeletal muscles may weaken and atrophy o Metabolic rate is raised, resulting in health and
skin that is warm and moist o Feeling Hot + Heat intolerance o Appetit is increased but fails to match
metabolic rate resulting in weight loss o All of these signs are referred to as thyrotoxicosis o Also
usually present with exophthalmos - bulging of the eyes
Page 1
,Question 5: Thyroid o Treatment Treatment of thyroid storm?
Answer: Characterized by profound hyperthermia (105 degrees F or higher), severe tachycardia,
restlessness, agitation, and tremor. Unconsciousness, coma, hypotension, and heart failure may ensure.
These symptoms are produced by excessive levels of thyroid hormone Thyroid crisis can be life
threatening and requires immediate treatment. o High doses of potassium iodide or strong iodine
solution are given to suppress thyroid hormone release. o Methimazole is given to suppress thyroid
hormone synthesis o A beta blocker is given to reduce heart rate o Additional measures include sedation,
cooling, and giving glucocorticoids and IVF
Question 6: Thyroid o Treatment Result of not treating hypothyroidism during pregnancy?
Answer: Can result in permanent neuropsychological deficits in the child - decrease child's IQ The ettect
of hypothyroidism is limited largely to the first trimester, a time during which the fetus is unable to
produce thyroid hormone of its own Some authorities currently recommend routine screening for
hypothyroidism as soon as pregnancy is confirmed Women already taking thyroid hormone replacement
will need to increase dose by 50% max between weeks 4-8 of gestation and the levels will level out by
week 16
Question 7: Thyroid o Treatment Medication to treat symptoms of hyperthyroidism (notice this
is treating symptoms and not the hyperthyroidism itself)
Answer: Methimazole - first line drug of choice (not given to women who are pregnant or breastfeeding)
o Methimazole blocks synthesis of thyroid hormone. 1) Prevents the oxidation of iodine, therefore
inhibiting incorporation of iodine into tyrosine. 2) prevents iodinated tyrosine from coupling
Propylthiouracil - preferred treatment for thyroid storm Beta blockers - help with tachycardia
experienced with hyperthyroidism
Question 8: Thyroid o Treatment Drug/Food/Supplement interactions with levothyroxine
Answer: Absorption of levothyroxine is reduced by food - it should be taken on an empty stomach in the
morning, at least 30-60 minutes before breakfast Drugs that reduce absorption include: H2 receptor
blockers, PPIs, Carafate, Questran, Colestid, Maalox/Mylanta, Tums, iron, Mag salts, Xenical Drugs
that accelerate levothyroxine: Phenytoin, Carbamazepine, rifampin, Sertraline, and phenobarbital
Patients taking the following drugs may need to increase their dose of levothyroxine: Warfarin and
catecholamines Levothyroxine can also increase requirements for insulin and digoxin
Question 9: Diabetes o How to confirm a diagnosis prior to beginning treatment
Answer: Fasting plasma glucose >/= 125mg/dl OR Random plasma glucose >/= 200mg/dl plus
symptoms of diabetes (polyuria, polydipsia, unexplained weight loss) OR Oral glucose tolerance test
(OGTT): 2-hour plasma glucose >/= 200mg/dl OR HgbA1C pf 6.5% or greater - (a test that provides an
estimate of glycemic control over the previous 2-3 months) is now considered a standard test as well
Page 2
, Question 10: Diabetes o A1C General goals
Answer: To keep A1C below 7% o <8% is less stringent for those with hx. Of severe hypoglycemia,
limited life expectancy, pr advanced microvascular or macrovascular complications
Question 11: Diabetes o A1C Older Adult goal
Answer: Recommended goal for A1C in the geriatric population is 7.5-8% in older patients with
moderate comorbidities and life expectancy less than 10 years o 8-8.5% for older patients with complex
medical issues
Question 12: Diabetes o A1C When should insulin be considered?
Answer: Recommendation: A GLP-1 should be considered before starting insulin Insulin is introduced
in Step 3 which includes a 3-drug combination which includes insulin. A1C of 9% of greater would start
at Step 2 with dual med therapy A1C of 10% or greater or fasting glucose of 300 or greater and is
symptomatic would start on combination injectable therapy immediately (Step 4)
Question 13: Diabetes o A1C At what time interval should it be re-checked?
Answer: Should be monitored every 3 months until value drops to 7% and at least every 6 months
thereafter
Question 14: Diabetes o Action of Insulin
Answer: Metabolic actions of insulin are primarily anabolic - Insulin promotes conservation of energy
and buildup of energy stores, such as glycogen and the hormone also promotes cell growth and division
Stimulates cellular transport (uptake) of glucose, amino acids, nucleotides, and potassium Insulin
promotes synthesis of complex organic molecules In all: Under the influence of insulin - glucose is
converted into glycogen, amino acids are assembled into proteins, and fatty acids are incorporated into
triglycerides
Question 15: Diabetes o Pioglitazone contraindications
Answer: Associated with heart failure secondary to renal retention of fluid. If heart failure is diagnosed,
pioglitazone should be discontinued or used in reduced dosage
Question 16: GLP-1: Glucagon-like Peptide-1 Receptor Agonists
Answer: Dulaglutide (Trulicity) Semaglutide (Ozempic) Liraglutide (Victoza)
Question 17: TZD: Thiazolidinediones
Answer: Rosiglitazone (Avandia) Pioglitazone (Actos)
Question 18: DPP4-I: Dipeptidylpeptidase-4 Inhibitors
Answer: Sitagliptin (Januvia) Saxagliptin (Onglyza) Linagliptin (Tradjenta) Alogliptin (Nesina)
Page 3
(Correct Update)
Question 1: Thyroid o Diagnosis & Evaluation What labs are used to diagnose?
Answer: -TSH - used primarily for screening and diagnosing hypothyroid and for monitoring
replacement therapy in hypothyroid patients
-T4 - Used to monitor thyroid hormone replacement therapy and to screen for thyroid dysfunction
-T3 - Useful in the diagnosis of hyperthyroidism; can also be used to monitor hormone replacement
therapy
-TSH low
-T4 normal
-T3 is high = hyperthyroidism
Question 2: Thyroid o Diagnosis & Evaluation Timeframe for re-check of labs after starting
levothyroxine?
Answer: Recheck TSH 6-8 weeks after initiating therapy and after any dosage change; Check TSH at
least once a year after serum TSH is stabilized
Question 3: Thyroid o Diagnosis & Evaluation Signs and symptoms of hypothyroidism?
Answer: Hypothyroidism: Depend on severity. o Mild: subtle and may go unrecognized o Moderate to
severe:
-Face is pale, putty, and expressionless.
-Skin cold and dry.
-Hair is brittle and hair loss occurs.
-Slowed Heart rate.
-Patient may complain of lethargy, fatigue, and
-Temperature is lowered & intolerant to cold.
-Thyroid Enlargement may occur if reduced levels of T3 and T4 Mentation may be impaired.
Question 4: Thyroid o Diagnosis & Evaluation Signs and symptoms of hyperthyroidism?
Answer: o Elevated Heart rate and strong, and dysrhythmias and angina may develop o The CNS is
stimulated, resulting is nervousness, insomnia, rapid thought flow, and rapid speech, hyperreflexia,
tremors o Skeletal muscles may weaken and atrophy o Metabolic rate is raised, resulting in health and
skin that is warm and moist o Feeling Hot + Heat intolerance o Appetit is increased but fails to match
metabolic rate resulting in weight loss o All of these signs are referred to as thyrotoxicosis o Also
usually present with exophthalmos - bulging of the eyes
Page 1
,Question 5: Thyroid o Treatment Treatment of thyroid storm?
Answer: Characterized by profound hyperthermia (105 degrees F or higher), severe tachycardia,
restlessness, agitation, and tremor. Unconsciousness, coma, hypotension, and heart failure may ensure.
These symptoms are produced by excessive levels of thyroid hormone Thyroid crisis can be life
threatening and requires immediate treatment. o High doses of potassium iodide or strong iodine
solution are given to suppress thyroid hormone release. o Methimazole is given to suppress thyroid
hormone synthesis o A beta blocker is given to reduce heart rate o Additional measures include sedation,
cooling, and giving glucocorticoids and IVF
Question 6: Thyroid o Treatment Result of not treating hypothyroidism during pregnancy?
Answer: Can result in permanent neuropsychological deficits in the child - decrease child's IQ The ettect
of hypothyroidism is limited largely to the first trimester, a time during which the fetus is unable to
produce thyroid hormone of its own Some authorities currently recommend routine screening for
hypothyroidism as soon as pregnancy is confirmed Women already taking thyroid hormone replacement
will need to increase dose by 50% max between weeks 4-8 of gestation and the levels will level out by
week 16
Question 7: Thyroid o Treatment Medication to treat symptoms of hyperthyroidism (notice this
is treating symptoms and not the hyperthyroidism itself)
Answer: Methimazole - first line drug of choice (not given to women who are pregnant or breastfeeding)
o Methimazole blocks synthesis of thyroid hormone. 1) Prevents the oxidation of iodine, therefore
inhibiting incorporation of iodine into tyrosine. 2) prevents iodinated tyrosine from coupling
Propylthiouracil - preferred treatment for thyroid storm Beta blockers - help with tachycardia
experienced with hyperthyroidism
Question 8: Thyroid o Treatment Drug/Food/Supplement interactions with levothyroxine
Answer: Absorption of levothyroxine is reduced by food - it should be taken on an empty stomach in the
morning, at least 30-60 minutes before breakfast Drugs that reduce absorption include: H2 receptor
blockers, PPIs, Carafate, Questran, Colestid, Maalox/Mylanta, Tums, iron, Mag salts, Xenical Drugs
that accelerate levothyroxine: Phenytoin, Carbamazepine, rifampin, Sertraline, and phenobarbital
Patients taking the following drugs may need to increase their dose of levothyroxine: Warfarin and
catecholamines Levothyroxine can also increase requirements for insulin and digoxin
Question 9: Diabetes o How to confirm a diagnosis prior to beginning treatment
Answer: Fasting plasma glucose >/= 125mg/dl OR Random plasma glucose >/= 200mg/dl plus
symptoms of diabetes (polyuria, polydipsia, unexplained weight loss) OR Oral glucose tolerance test
(OGTT): 2-hour plasma glucose >/= 200mg/dl OR HgbA1C pf 6.5% or greater - (a test that provides an
estimate of glycemic control over the previous 2-3 months) is now considered a standard test as well
Page 2
, Question 10: Diabetes o A1C General goals
Answer: To keep A1C below 7% o <8% is less stringent for those with hx. Of severe hypoglycemia,
limited life expectancy, pr advanced microvascular or macrovascular complications
Question 11: Diabetes o A1C Older Adult goal
Answer: Recommended goal for A1C in the geriatric population is 7.5-8% in older patients with
moderate comorbidities and life expectancy less than 10 years o 8-8.5% for older patients with complex
medical issues
Question 12: Diabetes o A1C When should insulin be considered?
Answer: Recommendation: A GLP-1 should be considered before starting insulin Insulin is introduced
in Step 3 which includes a 3-drug combination which includes insulin. A1C of 9% of greater would start
at Step 2 with dual med therapy A1C of 10% or greater or fasting glucose of 300 or greater and is
symptomatic would start on combination injectable therapy immediately (Step 4)
Question 13: Diabetes o A1C At what time interval should it be re-checked?
Answer: Should be monitored every 3 months until value drops to 7% and at least every 6 months
thereafter
Question 14: Diabetes o Action of Insulin
Answer: Metabolic actions of insulin are primarily anabolic - Insulin promotes conservation of energy
and buildup of energy stores, such as glycogen and the hormone also promotes cell growth and division
Stimulates cellular transport (uptake) of glucose, amino acids, nucleotides, and potassium Insulin
promotes synthesis of complex organic molecules In all: Under the influence of insulin - glucose is
converted into glycogen, amino acids are assembled into proteins, and fatty acids are incorporated into
triglycerides
Question 15: Diabetes o Pioglitazone contraindications
Answer: Associated with heart failure secondary to renal retention of fluid. If heart failure is diagnosed,
pioglitazone should be discontinued or used in reduced dosage
Question 16: GLP-1: Glucagon-like Peptide-1 Receptor Agonists
Answer: Dulaglutide (Trulicity) Semaglutide (Ozempic) Liraglutide (Victoza)
Question 17: TZD: Thiazolidinediones
Answer: Rosiglitazone (Avandia) Pioglitazone (Actos)
Question 18: DPP4-I: Dipeptidylpeptidase-4 Inhibitors
Answer: Sitagliptin (Januvia) Saxagliptin (Onglyza) Linagliptin (Tradjenta) Alogliptin (Nesina)
Page 3
