NR 565 Final Study Set – Complete With Solutions
Thyroid
o Diagnosis & Evaluation
What labs are used to diagnose? Correct Ans - -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
Thyroid
o Diagnosis & Evaluation
Timeframe for re-check of labs after starting levothyroxine? Correct Ans
- 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
Thyroid
o Diagnosis & Evaluation
Signs and symptoms of hypothyroidism? Correct Ans - Hypothyroidism:
Depend on severity.
o Mild: subtle and may go unrecognized
o Moderate to severe:
-Face is pale, puffy, 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.
Thyroid
o Diagnosis & Evaluation
Signs and symptoms of hyperthyroidism? Correct Ans - 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
Thyroid
o Treatment
Treatment of thyroid storm? Correct Ans - 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
Thyroid
o Treatment
,Result of not treating hypothyroidism during pregnancy? Correct Ans -
Can result in permanent neuropsychological deficits in the child - decrease
child's IQ
The effect 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
Thyroid
o Treatment
Medication to treat symptoms of hyperthyroidism (notice this is treating
symptoms and not the hyperthyroidism itself) Correct Ans -
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
Thyroid
o Treatment
Drug/Food/Supplement interactions with levothyroxine Correct Ans -
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
, Diabetes
o How to confirm a diagnosis prior to beginning treatment Correct Ans -
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
Diabetes
o A1C
General goals Correct Ans - 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
Diabetes
o A1C
Older Adult goal Correct Ans - 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
Diabetes
o A1C
When should insulin be considered? Correct Ans - 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)
Diabetes
o A1C
Thyroid
o Diagnosis & Evaluation
What labs are used to diagnose? Correct Ans - -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
Thyroid
o Diagnosis & Evaluation
Timeframe for re-check of labs after starting levothyroxine? Correct Ans
- 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
Thyroid
o Diagnosis & Evaluation
Signs and symptoms of hypothyroidism? Correct Ans - Hypothyroidism:
Depend on severity.
o Mild: subtle and may go unrecognized
o Moderate to severe:
-Face is pale, puffy, 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.
Thyroid
o Diagnosis & Evaluation
Signs and symptoms of hyperthyroidism? Correct Ans - 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
Thyroid
o Treatment
Treatment of thyroid storm? Correct Ans - 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
Thyroid
o Treatment
,Result of not treating hypothyroidism during pregnancy? Correct Ans -
Can result in permanent neuropsychological deficits in the child - decrease
child's IQ
The effect 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
Thyroid
o Treatment
Medication to treat symptoms of hyperthyroidism (notice this is treating
symptoms and not the hyperthyroidism itself) Correct Ans -
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
Thyroid
o Treatment
Drug/Food/Supplement interactions with levothyroxine Correct Ans -
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
, Diabetes
o How to confirm a diagnosis prior to beginning treatment Correct Ans -
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
Diabetes
o A1C
General goals Correct Ans - 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
Diabetes
o A1C
Older Adult goal Correct Ans - 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
Diabetes
o A1C
When should insulin be considered? Correct Ans - 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)
Diabetes
o A1C
