NR 565 Final Exam Study Guide Questions and answers 2024

NR 565 Final Exam Study Guide Questions and answers 2024 What labs are used to diagnose Thyroid? - CORRECT ANSWER TSH, total T4 and T3, free T4 and T3 Timeframe for re-check of labs after starting levothyroxine - CORRECT ANSWER 6-8 wks after starting therapy Signs and symptoms of hypothyroidism - CORRECT ANSWER Face: Pale, puffy, expressionless Skin: Cold and dry Hair: Brittle and hair loss Heart rate and temp are lowered Complaints by patient: lethargy, fatigue, intolerance to cold Mentation may be impaired Thyroid enlargement if ↓'d levels of T3 and T4 promoting excessive release of TSH Treatment of thyroid storm - CORRECT ANSWER High dose potassium iodide or strong iodine solution to suppress thyroid hormone release, methimazole to suppress thyroid hormone synthesis, beta blocker to reduce heart rate, sedation cooling glucocorticoids and IV fluids Result of not treating hypothyroidism during pregnancy - CORRECT ANSWER permanent neurological defects, ↓'d IQ, large protruding tongue, potbelly dwarfish stature, impaired development of nervous system bone teeth and muscles. Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and not the hyperthyroidism itself) - CORRECT ANSWER Metoprolol could be used to treat tachycardia experienced with hyperthyroidism, but it does not treat hyperthyroidism itself. Drug/Food/Supplement interactions with levothyroxine Absorption REDUCED by: - CORRECT ANSWER Histamine 2 receptor blockers (Cimetidine [Tagamet]) Proton pump inhibitors (Lansoprazole) Sucralfate (Carafate) Cholestyramine (Questran) Colestipol (Colestid) Aluminum containing antacids (maalox, mylanta) Calcium supplements (tums, os-cal) Iron supplements Magnesium salts Orlistat (Xenical) * 4 hours between levothyroxine and the above meds is recommended and food reduces absorption as well How to confirm a diagnosis of DM prior to beginning treatment - CORRECT ANSWER Hemoglobin A1C 6.5%, Fasting plasma glucose ≧ 126 mg/dL, Random plasma glucose ≧200 mg/dL plus symptoms of diabetes, Oral glucose tolerance test (OGTT): 2-h plasma glucose ≧200 mg/dL A1C General goals - CORRECT ANSWER less than 7%, less than 8% in patients with severe hypoglycemia, limited life expectancy, or advanced microvascular or macrovascular complications A1c - Older Adult goal - CORRECT ANSWER When should insulin be considered? - CORRECT ANSWER Type 1 Diabetics All are on insulin Type 2 Diabetics Step 3 - Three drug combination (inclusive of metformin