3P APEA EXAM QUESTIONS AND ANSWERS.

3P APEA EXAM QUESTIONS AND
ANSWERS

Difference between varicose vein and arteriosclerosis - Correct Answer - Is the affected vessel
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Arteriosclerosis affects arteries whereas varicose veins affects veins v v v v v v v




A patient has poorly controlled hypertension for more than 10 years. Indicate the most likely position of
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his point of maximal impulse (PMI) - Correct Answer - 5th ICS, left of MCL
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A 43 year old Hispanic male has an audible diastolic murmur best heard in the mitral listening point. There
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is no audible click. His status has been monitored for the past two years. This murmur is probably -
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Correct Answer - mitral stenosis
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A patient who has diabetes presents with pain in his lower legs when he walks and pain resolution with
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rest. When specifically asked about his pain in his lower leg, he likely will report pain - Correct Answer - in
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the calf muscle
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A patient with hypertension describes a previous allergic reaction to a sulfa antibiotic as "sloughing of
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skin" and hospitalization. Which medication is contraindicated in this patient? - Correct Answer -
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hydrochlorothiazide
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A 75 year old patient who has aortic stenosis wants to know what symptoms indicate worsening of his
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stenosis. the NP replies: - Correct Answer - shortness of breath and syncope
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A 74 year old patient has PAD. Which item listed below is an important nonmodifiable risk factor for PAD?
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- Correct Answer - diabetes
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Benazepril should be d/c immediately if - Correct Answer - pregnancy occurs
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aortic regurgitation characteristics - Correct Answer - long asymptomatic period follow by exercise
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intolerance, then dyspnea at rest
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DVT classic symptoms - Correct Answer - swelling, pain, and discoloration of lower extremity
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Characteristic of ACE-induced cough is that? - Correct Answer - usually begins two weeks of starting
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therapy
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Valve most commonly involved in chronic rheumatic heart disease - Correct Answer - mitral
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Medication that can exacerbate HF - Correct Answer - naproxen v v v v v v v v v




Patient taking ACE inhibitors should avoid? - Correct Answer - potassium supplements
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Grade 3 murmur indication for a referral - Correct Answer - a fixed split
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Group of meds used to treat HF - Correct Answer - fosinopril, HCTZ, verapamil
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,Mr. Smith is a 72-year-old patient who takes warfarin for chronic A-fib. INR today is 4.0. the NP should: -
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Correct Answer - stop the warfarin today and repeat INR tomorrow
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According to the NHLBI, which characteristic is a coronary heart disease risk equivalent, that is, which risk
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factor places the pt. as a CHD risk similar to a hx of CHD - Correct Answer - diabetes mellitus
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good drug to reduce morbidity and mortality in mild HF - Correct Answer - metoprolol
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A pt. taking atorvastatin newly diagnosed with dyslipidemia complaints of fatigue, weakness, and muscle
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aches in his lower back, arms, legs for the past 3 days. it is not improved with rest How should this be
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evaluated? - Correct Answer - Stop the atorvastatin immediately
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symptom not indicative of HF - Correct Answer - headache v v v v v v v v v




What class of meds is preferred to normalized lipid levels and reduce risk of cardiac events - Correct
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Answer - HMG CoA reductase inhibitors
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Highest sensitivity in diagnosing HF - Correct Answer - BNP
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The NP is caring for a 74-year-old who had an acute coronary syndrome 6 weeks ago. What medications
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should be part of his regimen unless contraindicated - Correct Answer - ACE, ASA, beta blockers, and
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statin
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patient with the highest systolic B/P - Correct Answer - 75-year-old male
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test that is most cost effective to screen for abdominal aortic aneurysm - Correct Answer - abdominal
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ultrasound
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a 74-year-old patient has had an increase in b/p since the last exam. his b/p has increased from 144/90 to
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reading in the upper 160's/upper 80's. If medication is to be started on this patient, what would be a good
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first choice? - Correct Answer - Calcium channel blocker
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Factor contributing to the development of AAA - Correct Answer - cigarette smoking
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A 40-year-old African-American pt. has a b/p of 175/100 and 170/102. What is a reasonable plan of care
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for this pt today? - Correct Answer - initiate amlodipine 5mg daily
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Usual course of treatment for mitral valve prolapse - Correct Answer - is benign
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A 50-year-old patient with hypertension has taken HCTZ 25mg daily for the past 4 weeks. Her b/p has
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decreased from 155/95 to 145/90. How should the NP proceed? - Correct Answer - add another drug
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from another class to the daily 25mg HCTZ
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A patient with mitral valve prolapse reports chest pain and frequent arrhythmias. In the absence of other
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cardiac anomalies, the drug of choice to treat her symptoms is: - Correct Answer - metoprolol
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which hypertensive pt. is most likely to have adverse b/p effects from excessive sodium consumption? -
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Correct Answer - a 70-year-old African American
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where would the murmur associated w/mitral regurgitation best be auscultated? - Correct Answer -
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mitral listening point
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,A pt. with a positive hx of a tick bite 2 weeks ago and erythema migrans has a positive ELISA for borrelia
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burgdorferi. The Western blot is positive. How should he be managed? - Correct Answer - he should
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receive Doxycycline for Lyme disease
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a pt. has/seborrheic dermatitis. Which vehicle would be most appropriate to use in the hairline area to
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treat this? - Correct Answer - foam
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A microscopic exam of the sample taken from a skin lesion indicates hyphae. What type of infection might
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this indicate? - Correct Answer - fungal
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A pt. has been dx w/MRSA. she is allergic to sulfa. Which medication could be used to treat her? - Correct
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Answer - doxycycline
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A 15-year-old male has worked this summer as a lifeguard at a local swimming pool. He complains of
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itching in the groin area. He is dx with tinea cruris. The NP is likely to identify - Correct Answer - well
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marginated half moon shape macules on the inner thigh
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A pt. exhibits petechiae on both lower legs w/o other complaints. How should the NP proceed? - Correct
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Answer - order a CBC
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A pt. has been dx w/scabies. What is the medication of choice to treat this? - Correct Answer - permethrin
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and good hand hygiene
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A pt. has been in the sun for the past few weeks and has developed darkened skin and numerous 3-6 mm
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light-colored, flat lesions on his trunk. What is the likely etiology? - Correct Answer - tinea vesicolor
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Which vehicle is least appropriate in a pt. w/atopic dermatitis? - Correct Answer - lotions
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a pt. presents w/small vesicles on the lateral edges of his fingers and intense itching. there are small
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vesicles on the palmar surface of the hand. What is this called? - Correct Answer - dyshidrotic dermatitis
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a low-potency topical hydrocortisone cream would be most appropriate in a pt. who has been dx with? -
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Correct Answer - atopic dermatitis
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most common form of skin cancer - Correct Answer - basal cell carcinoma
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greatest percutaneous absorption areas in the body - Correct Answer - genitalia
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most common place for basal cell carcinoma - Correct Answer - face
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A 74-year-old is dx w/shingles. The NP is deciding how to best manage her care. What should be
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prescribed? - Correct Answer - an oral antiviral agent
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the American Cancer Society uses an ABCDE Mneumonic to help pt.'s develop awareness of suspicious
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skin lesions what do they represent? - Correct Answer - A= asymetry
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B=border

C=color

D=diameter

E=enlarging or elevated v v

,characteristic of shingles - Correct Answer - single dermatome affected v v v v v v v v v




an example of a premalignant lesion that develops on sun-damaged skin is: - Correct Answer - actinic
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keratosis
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A patient w/Diabetes has right anterior shin edema, erythema, warmth, and tenderness to touch. This
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developed over the past 3 past. There is no visible pus. What is the most likely diagnosis to consider? -
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Correct Answer - cellulitis
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A pt. was burned w/hot water. He has several 2-3 cm fluid-filled lesions. What are theses termed? -
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Correct Answer - bullae
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A wound has the following characteristics; partial thickness loss of dermis, a shallow open ulcer
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w/red/pink bed, and no evidence of sloughing. What stage of pressure ulcer does this describe? - Correct
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Answer - stage II
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A pt. present w/plaques on the extensor surface of the elbows, knees, and back. The plaques are
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erythematous and thick, silvery scale are present. This is likely: - Correct Answer - Plaque psoriasis
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An adolescent has acne. The NP prescribed a benzoyl peroxide product for him. What important teaching
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point should be given to this adolescent regarding the benzoyl peroxide. - Correct Answer -
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photosensitivity of the skin can occur
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A 76-year-old obese pt. has fatigue, thirst, and frequent urination. She was asked to measure AM fasting
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glucose values for 1 week. The values range from 142-175 this pt: - Correct Answer - can be dx w/DMT2
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The most appropriate time to begin screening for renal nephropathy in a pt w/ T2DM - Correct Answer - at
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diagnosis
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In order to determine how much T4 replacement a pt. needs to reestablish a euthyroid state, the NP
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vconsiders: - Correct Answer - the pt.'s body weight v v v v v v v v




A pt. has been dx w/T2DM. A criterion for dx is: - Correct Answer - a fasting glucose > or equal to 126 and
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confirmed on a previous day.
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the most appropriate screen for diabetic nephropathy - Correct Answer - urinary albumin to creatinine
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ration and eGFR
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a 38-year-old male pt. presents for his annual exam. He reports nervousness and weight loss, but denies
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any change in his dietary intake or exercise level. Based on this findings and the following lab values: TSH
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0.01, free T4 6, free T3 205. what is the most likely dx? - Correct Answer - Hyperthyroidism
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a pt. has two fasting glucose values of 121 and 136 that were measured on 2 separate days in the same
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week. This pt: - Correct Answer - should have an Hgb A1C performed
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a diabetic pt. w/albuminuria has been placed on an ACE inhibitor. How soon can the antiproteinuric effect
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of the ACEi be realized for this pt. - Correct Answer - 6-8 weeks
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how does hyperthyroidism affect b/p - Correct Answer - by producing an increase in systolic and diastolic
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readings
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, Symptoms least likely associated with DMT2 v v v v v




fatigue, constipation, athletes foot, impetigo - Correct Answer - constipation
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What is the relationship between Hgb A1C and lipid values? - Correct Answer - As Hgb A1C decreases,
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triglycerides decrease
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when the serum free T4 falls: - Correct Answer - the TSH rises
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earliest detectable glycemic abnormality in a pt. w/t2DM - Correct Answer - postprandial glucose
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elevation
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acanthosis nigricans in a teen suggest? - Correct Answer - insulin resistantv v v v v v v v v v v




risk factor for T2DM? - Correct Answer - History of gestational diabetes
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a 40-year-old pt. with newly dx of T2DM asks what his target b/p should be. the most correct answer is: -
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Correct Answer - less than 140/90
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the following values TSH 14, free T4 0.1 is indicative of? - Correct Answer - hypothyroidism
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diabetic medication associated with diarrhea and flatulence - Correct Answer - metformin
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A 45-year-old female pt has fatigue for the past 3 months and a 10-lbs weight gain. She previously had
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regular menses occurring about every 30 days, but in the last 3 months her menses have varied between
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30-45 days . Her TSH value is 13. It was repeated 1week later and found to be 15. What explains this
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finding? - Correct Answer - hypothyroidism
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A pt. who is taking who is taking a long-acting insulin basal insulin has elevated blood sugars. Which blood
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sugars are important to review in order to increase the dose of insulin? - Correct Answer - AM fasting
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A pt. has a TSH value of 13.1 today. The NP has decided to initiate replacement with levothyroxine 88mcg
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daily. When should the NP recheck pt's TSH levels - Correct Answer - 6 weeks
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A pt. presents with consistently elevated blood glucose before his evening meal. What choice below
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represents an insulin change that would improve his evening glucose?
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current AM regimen 22u NPH, 12u short-acting insulin
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Current PM regimen 10u NPH, 8u short-acting insulin - Correct Answer - 24u NPH insulin in AM
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A 30-year-old female pt. with complaints of fatigue undergoes a screening TSH. Her TSH is 8 what should
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be done next? - Correct Answer - repeat the TSH and add T4
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A 65-year-old diabetic has been on oral antihyperglycemic agents and is still having poor glycemic control.
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His AM fasting glucose range from 140-160. You decide to add insulin. He weighs 127 kg. What should the
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NP order as an initial starting dose? - Correct Answer - 10u of long-acting insulin at bedtime
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the most appropriate time to screen for renal nephropathy in a pt. with type 1 diabetes is - Correct
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Answer - 5 years after diagnosis
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what is the most sensitive lab assay for screening and identifying the vast majority of ambulatory pt.'s w/
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primary hypothyroidism - Correct Answer - TSH only
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