NR 565 Final Study Guide Questions With Complete
Solutions
"As long as the short-acting insulin is drawn up first I can mix
my insulin glargine with it". Correct Answers Nope- Only
NPH can be mixed with short acting
-Always draw regular (Clear) before NPH (Cloudy)
A female patient taking Canagliflozin comes in with a UTI and
6 months ago had a fungal infection. What are your next steps?
Correct Answers -Stop the med and start a new one
A newly pregnant patient shows understanding of
Hypothyroidism in pregnant women by stating? Correct
Answers 2. I know that if I do not take my medicine it can
cause permanent damage to my baby.
3. I will need to increase my dose of medicine for a short time.
(Increased by 50% from weeks 4-8, back to normal by wk 16)
A patient comes into the clinic complaining of sore throat and
fever. She has recently started Methimazole in the last 4 weeks.
What does this suggest? Correct Answers -Agranulocytosis
-Labs to check:
CBC
LFTs
,A patient comes into the clinic with c/o bloating and abdominal
pain for a few weeks. What are appropriate options for
treatment? Correct Answers Lifestyle mods and H2RA
A patient has a TSH of .28 (Low), a free T4 of 3 (High), and a
free T3 over 650 (Very High). What med should she be started
on? Correct Answers -Patient has Hyperthyroidism
-Treatment for a thyroid storm is (to suppress hormone release):
Potassium iodide
Strong iodine solution
Methimazole
A patient has just been prescribed levothyroxine, the NP puts in
a lab order to check TSH levels in? Correct Answers 6-8 weeks
A patient has tested positive for H.Pylori. What are appropriate
treatment options? Correct Answers Start antibiotics for 10-14
days
A patient receives his first lab results showing an A1C of 7.2%.
What is the diagnosis? Correct Answers -Cannot confirm
because you need a second A1C after 3 months (value is
borderline)
A patient states that she will take her insulin lispro 30-60
minutes before a meal? Correct Answers Nope- must be within
15-30 mins of meal
,A patient states, "My sugars have been around 65-68 at times
but I feel like the med is working". Correct Answers Nope-
Values are too low
-Hypoglycemia unawareness, need to educate
A patient taking Sitagliptin (Pioglitazone) reports abdominal
pain with vomiting. What are your next steps? Correct Answers
-Patient experiencing pancreatitis -> stop this med
A patient who has a history of bladder cancer and HF should
avoid what class of DM meds? Correct Answers Pioglitazones
-Can cause renal fluid retention associated with HF
A patient who takes NSAIDS almost daily for arthritic pain and
refuses to try another med is at risk for an NSAID-induced ulcer.
The provider states... Correct Answers I will start a PPI to
prevent an Ulcer
A person comes in with an A1C of 10% and a fasting blood
glucose of >300. What are the next steps for the provider?
Correct Answers -Start insulin
(when A1C is above >9% start at step 2= insulin combo therapy)
A person with diabetes has recurrent severe hypoglycemia
events. What should his A1C goal be? Correct Answers 8%
, A pregnant patient is taking NSAIDS for pain and a Misoprostol
for an ulcer. What action does the provider take? Correct
Answers Stop the medication and switch her to a PPI
Misoprostol can cause a miscarriage
A pregnant woman comes in asking for GERD meds, what can
you recommend? Correct Answers Sucralafate
A random glucose of _______ is considered diabetic. Correct
Answers 200 with signs and symptoms
A woman taking Pioglitazone states, "I'm glad that this med
promotes weight loss." Correct Answers Nope-
Promotes an increase in LDL levels
Increases cardiovascular risk
-Educate about exercise and weight loss
ADA's DM Treatment Algorithm Correct Answers Step 1: At
diagnosis, initiate lifestyle changes
plus metformin.
Step 2: Continue step 1 & add a 2nd drug (TZD, DPP-4, SGLT-
2, or GLP-1). A sulfonylurea or basal insulin should be
considered if patient doesn't achieve goal with these drugs.
Step 3: 3-drug combo, including metformin.
Solutions
"As long as the short-acting insulin is drawn up first I can mix
my insulin glargine with it". Correct Answers Nope- Only
NPH can be mixed with short acting
-Always draw regular (Clear) before NPH (Cloudy)
A female patient taking Canagliflozin comes in with a UTI and
6 months ago had a fungal infection. What are your next steps?
Correct Answers -Stop the med and start a new one
A newly pregnant patient shows understanding of
Hypothyroidism in pregnant women by stating? Correct
Answers 2. I know that if I do not take my medicine it can
cause permanent damage to my baby.
3. I will need to increase my dose of medicine for a short time.
(Increased by 50% from weeks 4-8, back to normal by wk 16)
A patient comes into the clinic complaining of sore throat and
fever. She has recently started Methimazole in the last 4 weeks.
What does this suggest? Correct Answers -Agranulocytosis
-Labs to check:
CBC
LFTs
,A patient comes into the clinic with c/o bloating and abdominal
pain for a few weeks. What are appropriate options for
treatment? Correct Answers Lifestyle mods and H2RA
A patient has a TSH of .28 (Low), a free T4 of 3 (High), and a
free T3 over 650 (Very High). What med should she be started
on? Correct Answers -Patient has Hyperthyroidism
-Treatment for a thyroid storm is (to suppress hormone release):
Potassium iodide
Strong iodine solution
Methimazole
A patient has just been prescribed levothyroxine, the NP puts in
a lab order to check TSH levels in? Correct Answers 6-8 weeks
A patient has tested positive for H.Pylori. What are appropriate
treatment options? Correct Answers Start antibiotics for 10-14
days
A patient receives his first lab results showing an A1C of 7.2%.
What is the diagnosis? Correct Answers -Cannot confirm
because you need a second A1C after 3 months (value is
borderline)
A patient states that she will take her insulin lispro 30-60
minutes before a meal? Correct Answers Nope- must be within
15-30 mins of meal
,A patient states, "My sugars have been around 65-68 at times
but I feel like the med is working". Correct Answers Nope-
Values are too low
-Hypoglycemia unawareness, need to educate
A patient taking Sitagliptin (Pioglitazone) reports abdominal
pain with vomiting. What are your next steps? Correct Answers
-Patient experiencing pancreatitis -> stop this med
A patient who has a history of bladder cancer and HF should
avoid what class of DM meds? Correct Answers Pioglitazones
-Can cause renal fluid retention associated with HF
A patient who takes NSAIDS almost daily for arthritic pain and
refuses to try another med is at risk for an NSAID-induced ulcer.
The provider states... Correct Answers I will start a PPI to
prevent an Ulcer
A person comes in with an A1C of 10% and a fasting blood
glucose of >300. What are the next steps for the provider?
Correct Answers -Start insulin
(when A1C is above >9% start at step 2= insulin combo therapy)
A person with diabetes has recurrent severe hypoglycemia
events. What should his A1C goal be? Correct Answers 8%
, A pregnant patient is taking NSAIDS for pain and a Misoprostol
for an ulcer. What action does the provider take? Correct
Answers Stop the medication and switch her to a PPI
Misoprostol can cause a miscarriage
A pregnant woman comes in asking for GERD meds, what can
you recommend? Correct Answers Sucralafate
A random glucose of _______ is considered diabetic. Correct
Answers 200 with signs and symptoms
A woman taking Pioglitazone states, "I'm glad that this med
promotes weight loss." Correct Answers Nope-
Promotes an increase in LDL levels
Increases cardiovascular risk
-Educate about exercise and weight loss
ADA's DM Treatment Algorithm Correct Answers Step 1: At
diagnosis, initiate lifestyle changes
plus metformin.
Step 2: Continue step 1 & add a 2nd drug (TZD, DPP-4, SGLT-
2, or GLP-1). A sulfonylurea or basal insulin should be
considered if patient doesn't achieve goal with these drugs.
Step 3: 3-drug combo, including metformin.
