NSG 533 ULTIMATE STUDY PACK 2023
BUNDLED EXAM QUESTIONS WITH ACCURATE
VERIFIED ANSWERS
◉ JR is a 68-year-old African American man with a new diagnosis of
T2DM. He was classified as having prediabetes (at risk for developing
diabetes) 5 years before the diagnosis and has a strong family history of
type 2 diabetes. JR's blood pressure was 150/92 mm Hg. His laboratory
results revealed an A1C of 8.1%, normal cholesterol panel, and normal
renal/hepatic function were noted with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia
(diagnosed 2 y ago) Pancreatitis (idiopathic) (acute hospitalization 3 y
ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist
Circumference: 46 in Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
Despite improvements in the past six weeks due to lifestyle changes and
exercise, drug therapy is to be started for JR's diabet. Answer:
Metformin is the drug of choice recommended for most patients with
diabetes in addition to lifestyle modifications assuming no
contraindications or intolerabilities are present upon evaluation.
Metformin has also shown to provide positive weight neutral/loss effects
,in obese patients. It is crucial to know the renal status of patients
commencing metformin therapy to limit the risk of lactic acidosis (JR is
without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are
several potential choices. The second step can be a dipeptidyl peptidase-
4 inhibitor, it can be a glucagon-like peptide-1 (GLP-1) receptor agonist,
it can be a TZD, it can be a sulfonylurea agent, it can be a SGLT2
inhibitor, or it could be basal insulin. Anything next can be tried
depending on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect
profile. Sitagliptin has been associated with case reports of pancreatitis,
so this specific agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduction necessary to
gain glycemic control and may assist with weight loss goals for this
patient. New information suggests these agents may provide benefits in
those with ASCVD. JR has a past history of pancreatitis and GLP-1
analogs are not recommended due to this contraindication
TZDs have data to support an A1C reduction necessary to gain glycemic
control, but are associated with weight gain, negative effects on lipids
and increased risk of fracture. Until recently, TZDs have also been
linked to increased CV events and use has fallen out of favor
Sulfonylureas provide excellent A1C lowering, but are also associated
with weight gain. They also have the potential to cause hypoglycemia,
so patient education is crucial. Because of his allergies to "sulfa", use
would be contr
,◉ A patient with type 1 diabetes reports taking propranolol for
hypertension. What concern does this information present for the
provider?. Answer: A patient with Type 1 DM is insulin dependent for
glucose control and at high risk for hypoglycemic episodes. Propanolol
causes prolonged hypoglycemic episodes. Needs to switch to ACE or
ARB.
◉ A provider teaches a patient who has been diagnosed with
hypothyroidism about a new prescription for levothyroxine. Which
statement by the patient indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my
provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my
provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the
levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of
levothyroxine.". Answer: D. Calcium may reduce levothyroxine
absorption. Further education is needed if the patient feels she can take
half of a prescribed medication.
◉ MC has undiagnosed multiple gastric ulcers. Shortly after consuming
a large meal and alcohol he experiences significant GI distress. He takes
an OTC heartburn remedy. Within a minute or two he develops what he
will later describe as "belching, nausea and a bad bloated feeling".
Several of the ulcers began to bleed and he becomes profoundly
hypotensive from the blood loss and is taken to the ED. Endoscopy
, confirms multiple bleeds; the endoscopist remarks that it appears as if
the lesions had been literally stretched apart causing additional tissue
damage. What did the patient most likely take (i.e. what was the OTC
remedy)?. Answer: I would accept Alka-Selzer. I contains NaHCO3 (as
well as ASA). In the presence of HCL it Liberates CO2, that can cause
gastric distention, belching and nausea. The reaction is fairly swift
allowing little time for dissipation. Tums, its primary ingredient calcium
carbonate which when taken cause a reaction with the stomach acid such
as production of carbon dioxide gas which can cause bloating and the
stomach to stretch to tear the ulcers open.
◉ On your way to this examination, you experience the vulnerable
feeling that an attack of acute diarrhea is imminent! If you stop at a drug
store, which anti-diarrheal drugs could you buy without a prescription
even though it is chemically related to the strong opioid analgesic
meperidine (but acts only on the peripheral opioid receptor)?. Answer:
Loperamide
◉ JA has multiple medical problems and is taking several drugs
including theophylline, warfarin and phenytoin. His conditions were
well controlled, but recently he started to experience some GI distress
for which of his "well intentioned friends" gave him some medication.
He presents to you with toxic effects of all his other medications and
plasma levels of those medications elevated. What was most likely the
medication he took?. Answer: Cimetidine
◉ What lifestyle modifications should be recommended?. Answer: -
losing weight if overweight
BUNDLED EXAM QUESTIONS WITH ACCURATE
VERIFIED ANSWERS
◉ JR is a 68-year-old African American man with a new diagnosis of
T2DM. He was classified as having prediabetes (at risk for developing
diabetes) 5 years before the diagnosis and has a strong family history of
type 2 diabetes. JR's blood pressure was 150/92 mm Hg. His laboratory
results revealed an A1C of 8.1%, normal cholesterol panel, and normal
renal/hepatic function were noted with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia
(diagnosed 2 y ago) Pancreatitis (idiopathic) (acute hospitalization 3 y
ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist
Circumference: 46 in Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
Despite improvements in the past six weeks due to lifestyle changes and
exercise, drug therapy is to be started for JR's diabet. Answer:
Metformin is the drug of choice recommended for most patients with
diabetes in addition to lifestyle modifications assuming no
contraindications or intolerabilities are present upon evaluation.
Metformin has also shown to provide positive weight neutral/loss effects
,in obese patients. It is crucial to know the renal status of patients
commencing metformin therapy to limit the risk of lactic acidosis (JR is
without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are
several potential choices. The second step can be a dipeptidyl peptidase-
4 inhibitor, it can be a glucagon-like peptide-1 (GLP-1) receptor agonist,
it can be a TZD, it can be a sulfonylurea agent, it can be a SGLT2
inhibitor, or it could be basal insulin. Anything next can be tried
depending on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect
profile. Sitagliptin has been associated with case reports of pancreatitis,
so this specific agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduction necessary to
gain glycemic control and may assist with weight loss goals for this
patient. New information suggests these agents may provide benefits in
those with ASCVD. JR has a past history of pancreatitis and GLP-1
analogs are not recommended due to this contraindication
TZDs have data to support an A1C reduction necessary to gain glycemic
control, but are associated with weight gain, negative effects on lipids
and increased risk of fracture. Until recently, TZDs have also been
linked to increased CV events and use has fallen out of favor
Sulfonylureas provide excellent A1C lowering, but are also associated
with weight gain. They also have the potential to cause hypoglycemia,
so patient education is crucial. Because of his allergies to "sulfa", use
would be contr
,◉ A patient with type 1 diabetes reports taking propranolol for
hypertension. What concern does this information present for the
provider?. Answer: A patient with Type 1 DM is insulin dependent for
glucose control and at high risk for hypoglycemic episodes. Propanolol
causes prolonged hypoglycemic episodes. Needs to switch to ACE or
ARB.
◉ A provider teaches a patient who has been diagnosed with
hypothyroidism about a new prescription for levothyroxine. Which
statement by the patient indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my
provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my
provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the
levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of
levothyroxine.". Answer: D. Calcium may reduce levothyroxine
absorption. Further education is needed if the patient feels she can take
half of a prescribed medication.
◉ MC has undiagnosed multiple gastric ulcers. Shortly after consuming
a large meal and alcohol he experiences significant GI distress. He takes
an OTC heartburn remedy. Within a minute or two he develops what he
will later describe as "belching, nausea and a bad bloated feeling".
Several of the ulcers began to bleed and he becomes profoundly
hypotensive from the blood loss and is taken to the ED. Endoscopy
, confirms multiple bleeds; the endoscopist remarks that it appears as if
the lesions had been literally stretched apart causing additional tissue
damage. What did the patient most likely take (i.e. what was the OTC
remedy)?. Answer: I would accept Alka-Selzer. I contains NaHCO3 (as
well as ASA). In the presence of HCL it Liberates CO2, that can cause
gastric distention, belching and nausea. The reaction is fairly swift
allowing little time for dissipation. Tums, its primary ingredient calcium
carbonate which when taken cause a reaction with the stomach acid such
as production of carbon dioxide gas which can cause bloating and the
stomach to stretch to tear the ulcers open.
◉ On your way to this examination, you experience the vulnerable
feeling that an attack of acute diarrhea is imminent! If you stop at a drug
store, which anti-diarrheal drugs could you buy without a prescription
even though it is chemically related to the strong opioid analgesic
meperidine (but acts only on the peripheral opioid receptor)?. Answer:
Loperamide
◉ JA has multiple medical problems and is taking several drugs
including theophylline, warfarin and phenytoin. His conditions were
well controlled, but recently he started to experience some GI distress
for which of his "well intentioned friends" gave him some medication.
He presents to you with toxic effects of all his other medications and
plasma levels of those medications elevated. What was most likely the
medication he took?. Answer: Cimetidine
◉ What lifestyle modifications should be recommended?. Answer: -
losing weight if overweight
