NR565 Week 5: Endocrine System Case Study – Helen Smith, Alfonso Giuliani, John Jones (ALL CORRECT) 100 out of 100 points | GRADED A

NR565 Week 5: Endocrine System Case Study – Helen Smith, Alfonso Giuliani, John Jones Question 1 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. I do. 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 ~183 mg/dl 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? Don’t take the metformin the day of the procedure and for 48 hours afterward. 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. 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) Complete metabolic profile (CMP) Lipid Panel Urinalysis 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. He reports drinking “a few beers on the weekend during football season”. He drinks 3-4 cups of coffee per day. Use the John Jones case study to answer the following question. Metformin works by decreasing and . glucogenesis; incretin secretion incretin secretion; insulin production glucogenesis; insulin resistance insulin resistance; incretin secretion 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 Metformin Use the John Jones case study to answer the following question. Which of the following statements best describes John’s status? 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. Use the John Jones case study to answer the following question. John’s triglycerides are 260 mg/dl and his HDL is 35mg/dl. Referring to the ADA Standards of Medical Care in Diabetes-2020, what is the correct action to take at this time? Increase John’s atorvastatin to 20mg per day. Leave John’s atorvastatin as is and re-check lipids when A1C is re-checked. Increase John’s atorvastatin to 40 mg per day. Stop John’s atorvastatin since he is now being treated for diabetes. Use the John Jones case study to answer the following question. What is the recommended interval for monitoring John’s HgbA1C? 1-month 6-weeks 3-months 6-months Use the John Jones case study to answer the following question. Which of John’s behaviors should be addressed to encourage lifestyle changes and decrease A1C levels? Select all that apply. He drinks 3-4 cups of coffee per day. Sits at a desk several hours a day. Weight 235lbs His diet largely consists of fast-food meals. He drinks sweet tea with every meal. Family history is significant for diabetes. BP 130/90 Use the Alfonso Giuliani case study to answer the following question. Which lab test is necessary to evaluate before prescribing a sodium/glucose cotransporter-2 inhibitor (SGLT2i)? CBC LFTs HgbA1C CMP Use the Alfonso Giuliani case study to answer the following question. Alfonso should be started on statin therapy to address his high total cholesterol and low HDL. True False Identify SGLT2i agents in the list below. Select all that apply. linagliptin dapagliflozin alogliptin sitagliptin saxagliptin canagliflozin empagliflozin Question 15 31.2% 37.6% 46.5% 52.1% Use the Alfonso Giuliani case study to answer the following question. Which of the following benefits from GLP-1 therapy are helpful to Alfonso? Select all that apply. appetite suppression weight loss low risk for hypoglycemia blood pressure control Question 17 Atorvastatin 10-20 mg Rosuvastatin 20-40 mg Atorvastatin 40–80 mg Pravastatin 40-80 mg Use the Alfonso Giuliani case study to answer the following question. Which of the following lab values are important to monitor while taking GLP-1 agents? hemoglobin and hematocrit amylase and lipase aspartate transaminase & alkaline phosphatase magnesium and calcium Question 19 exenatide semaglutide dulaglutide lixisenatide liraglutide rosiglitazone pioglitazone albiglutide Use the Alfonso Giuliani case study to answer the following question. Which of the following complications may be caused by GLP-1 agents? diverticulitis cholecystitis pancreatitis cellulitis Use the Alfonso Giuliani case study to answer the following question. Considering Alfonso’s ASCVD risk score, which of the following diabetic drug classes should be considered in addition to metformin? TZD SGLT2i GLP-1 Sulfonylurea Question 22 0 / 2 pts Use the Alfonso Giuliani case study to answer the following question. Which of the following types of statin therapy should be started for Alonso? High-intensity statin therapy Low-intensity statin therapy Moderate-intensity statin therapy Use the Helen Smith case study to answer the following question. Helen’s has abnormal thyroid values: TSH 24 mU/L Free T4 0.2 ng/dl What condition do these tests indicate? Hashimoto’s thyroiditis Hypothyroidism Grave’s Disease Hyperthyroidism What are the Black Box Warnings associated with NSAIDs? Select all that apply. Increases risk for GI bleeding, ulceration, and perforation Increases risk for cardiovascular thrombotic event Increases all-cause mortality Increases risk for serious skin reactions Use the Helen Smith case study to answer the following question. Which of the following criteria support’s Helen’s diagnosis of DM? (Select all that apply) Glucose: 189 mg/dL T. Cholesterol 240 mg/dl Triglycerides 260 mg/dl HgbA1C: 9.2% nocturia Use the Helen Smith case study to answer the following question. If the standard starting dose of levothyroxine 1.6 mcg/kg/dose is prescribed for Helen, what is the correct dose? 200mcg 175mcg 300mcg 150mcg Use the Helen Smith case study to answer the following question. Because metformin is contraindicated with her age. Because only diabetic medication should be prescribed. Because heart failure can predispose patients to lactic acidosis. Because metformin interacts with her Irbesartan. Use the Helen Smith case study to answer the following question. Which of the following lab values require consideration for possible treatment? Hgb 15.3 g/dL Alkaline phosphatase: 50 U/L Triglycerides 260 mg/dl TSH 24 mU/L Total Cholesterol 240 mg/dl HDL 35 mg/dl LDL 120mg/dl AST (aspartate aminotransferase): 20 Hct 48% Free T4 0.2 ng/dl Use the Helen Smith case study to answer the following question. What is the daily maximum dose of levothyroxine? 700mcg/day 500mcg/day 300mcg/day 1000mcg/day Use the Helen Smith case study to answer the following question. Which of the following medical conditions will determine Helen’s diabetes treatment regimen? Obesity Osteoarthritis Dyslipidemia Heart Failure Use the Helen Smith case study to answer the following question. Which DM drug class is contraindicated in patients with heart failure? Sulfonylurea Biguanide GLP-1 TZD Use the Helen Smith case study to answer the following question. There is still one important issue to address with Helen today. Which of the following concerns requires addressing? Heart failure Fatigue Weight Cholesterol Use the Helen Smith case study to answer the following question. Which medication should be prescribed for Helen to address her thyroid levels? Triiodothyronine Methimazole Levothyroxine Propylthiouracil Use the Helen Smith case study to answer the following question. Medication lists should always be reviewed for evidence-based prescribing practices. Helen is taking Naproxen 500 mg PO every 12 hours. What is the maximum dose of Naproxen per day (for 6 months)? 2000mg per day 1000mg per day 2500mg per day 1500mg per day Use the Helen Smith case study to answer the following question. Which of the following agents should be prescribed for Helen? (Independent searching may be required to find the answer to this question) Glipizide Dapagliflozin Glimepiride Pioglitazone Use the Helen Smith case study to answer the following question. Which of the following drug classes should be prescribed for Helen? GLP-1 Biguanide SGLTi DPP-4i Use the Helen Smith case study to answer the following question. Which of the following is the recommended initial dose of levothyroxine for the general population? 1.2mcg/kg/dose daily 1.8 mcg/kg/dose daily 2.0 mcg/kg/dose daily 1.6 mcg/kg/dose daily In youth who are overweight or obese and have a new onset of diabetes with an A1C>8.5%, how much basal insulin is recommended? 0.1 units/kg/da 0.8 units/kg/day 0.5 units/kg/day 1 unit/kg/day When considering older adults in the treatment and management of diabetes, what special considerations apply? Select all that apply. Screening for geriatric syndromes Current quality of life Self-management abilities A diabetic construction worker is seen for follow-up care. He has been taking metformin 1000mg PO twice daily for the last 3 months and his A1C is 8.7. Which section of the Standards of Medical Care in Diabetes—2020 best describes his treatment plan? Cost is a major issue Compelling need to minimize weight gain or promote weight loss Compelling need to minimize hypoglycemia ASCVD Predominates Which of the following diabetic drug classes should be prescribed with metformin for a patient with a BMI of 52? Select all that apply. Insulin TZD SGLT2i GLP-1 Which of the following agents are recommended when hypoglycemia is a concern? Select all that apply, Insulin SGLT2i DPP-4i GLP-1 TZD Sulfonylurea Which of the following hypertension drug classes are NOT recommended for the primary prevention of chronic kidney disease in patients who have diabetes with normal blood pressure and GFR? (Select all that apply) Angiotensin converting enzyme inhibitors Calcium channel blockers Angiotensin II receptor blockers Thiazide diuretics According to the ADA Standards of Medical Care in Diabetes-2020, what are the goals of care for diabetes? Select all that apply. Empower patients to manage their own disease process Maintain constant control of blood sugar Optimize quality of life Exercise is recommended for all youth with type 1 diabetes with the goal of min of moderate-to-vigorous intensity aerobic activity daily, with vigorous muscle-strengthening and bone-strengthening activities at least days per week. 60;3 30;3 50;5 45;5 Which of the following is the preferred medication for treating hyperglycemia in gestational diabetes? Insulin DPP-4i GLP-1 Metformin TZD Glyburide SGLT2i Which classes of oral diabetic drugs carry a higher risk for hypoglycemia? (Select all that apply) SGLT-2 inhibitors Sulfonylureas Biguanides α-glucosidase inhibitors Glinides Which of the following DM drug class has a warning that it can cause severe and disabling joint pain at any point in time during treatment? Metformin SGLT2i DPP-4i Insulin Glyburide TZD GLP-1 Which of the following exams is important for diabetics and requires a referral? Eye exam Foot exam Gait evaluation A single mom who makes minimum wage and struggles financially needs an additional diabetic medication after experiencing minimal A1C improvement with metformin. Which of the following DM drugs is appropriate? Select all that apply. Dulaglutide Sitagliptin Canagliflozin Glyburide Pioglitazone Glucophage NPH Match the A1C testing recommendations to the correct patient. Perform the A1C test at least two times a year Perform the A1C test quarterly A1C Testing Recommendations 6.1 Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). E 6.2 Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. E 6.3 Point-of-care testing for A1C provides the opportunity for more timely treatment changes. E American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers. 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