Nursing 633: Endocrinology Week 3 Questions and Answers,100% CORRECT

Nursing 633: Endocrinology Week 3 Questions and Answers,100% CORRECT Week 3 – Endocrinology A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient? Beta blocker medications A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit? C-peptide level Hemoglobin A1C Random serum glucose Thyroid studies In order to determine how much T4 replacement of patient needs to reestablish a euthyroid state, the nurse practitioner considers: Patient's body weight Replacement as based on body weight and is usually calculated in kilograms. Body weight is multiplied by 1.6 to determine replacement needed in one day. This is the amount that should be prescribed in otherwise healthy, less than 50 years old, no evidence of underlying cardiac disease patients Which findings are part of the 2009 diagnostic criteria for metabolic syndrome? (Select all that apply.) Triglycerides ≧150 mg/dL HDL cholesterol /= 40 mg/dL Elevated waist circumference Fasting plasma glucose ≧100 mg/dL Decreased plasminogen activator inhibitor 1 levels A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The provider notes that the patient appears confused and irritable and is sweating and shaking. What intervention will the provider expect to perform once the point of care blood glucose level is known? Giving a rapid-acting carbohydrate A 38-year-old male patient presents for his annual exam. He reports nervousness and weight loss, but denies any changes in his dietary intake or exercise level. Based on these findings and the following lab values, more what is the most likely diagnosis? TSH 0.01 (normal 0.4-3.8) Free T4 6 (normal 0.8-2.8) Free T3 205 (normal 70-205) Hyperthyroidism TSH is low and T4 is high indicating hyperthyroidism Excessive thirst and volume of dilute urine may be a symptom of: Diabetes insipidus Diabetes insipidus is a condition in which the kidneys are unable to conserve water, often because there is insufficient antidiuretic hormone (ADH) or the kidneys are unable to respond to ADH. Although diabetes mellitus may present with similar symptoms, the disorders are different. Diabetes insipidus does not involve hyperglycemia. Which findings are symptoms of hyperparathyroidism? (Select all that apply.) Cognitive impairment Chvostek’s sign Renal calculi Lef t ventricular hypertrophy Perioral paresthesias Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? 2.4 uIU/L 0.4 uIU/L 0.2 uIU/L 4.2 uIU/L Some of the hallmark characteristics of hyperosmolar hyperglycemic state are: Blood glucose over 1000 mg/dL Slow onset (over days) Higher prevalence in type 1 diabetics Negative ketones The patient comes into the clinic complaining of weight gain and brings in a nonfasting glucose log indicating glucose ranging from 110-170 mg/dL. This patient: Has impaired fasting glucose Should have a hemoglobin A1c performed Has normal blood glucose values Should continue to monitor glucose at home A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? A thyroidectomy will be necessary. She will need lifelong medication. This condition may be transient. She should be referred to an endocrinologist. A 76-year-old obese patient has fatigue, thirst, and frequent urination. She was asked to measure a.m. fasting glucose value for one week. The values range from 142-1 75 mg/dL. She is now back to your clinic due to persistent symptoms, this patient: Should have a hemoglobin A1C performed for diagnosis Can be diagnosed with type 2 diabetes Has prediabetes Has impaired fasting glucose Impaired fasting glucose can be diagnosed when to fasting glucose readings are between 100-125 mg/dL. The conjunction of classic symptoms of hyperglycemia with a fasting blood glucose over 126 mg/dL consistently is diagnostic for diabetes. A1c is not required to diagnose diabetes in this case, but can be done to establish a baseline. Untreated hyperglycemia may lead to all of the following complications except: Vitiligo Excessively high blood sugar or prolonged hyperglycemia can cause diabetic ketoacidosis, the condition in which the body breaks down fat for energy and ketones spill into the urine. Diabetic hyperosmolar syndrome occurs when blood sugar is excessively high and available insulin is ineffective. In this case, the body cannot use glucose or fat for energy and glucose is excreted in the urine. Without immediate medical attention, both conditions may result in coma or death. Which choice best describes the most common presentation of a patient with type 2 diabetes? Insidious onset of hyperglycemia with weight gain Most patient's with type 2 diabetes are asymptomatic at presentation. They are identified because of screening and identification of risk factors. Diabetes usually has an insidious onset and is associated with weight gain. An acute onset is typical of patients with type 1 diabetes. Microalbuminuria develops after several years of having diabetes Mr. Jones is a type I diabetic that presents to your clinic with nausea/vomiting and weakness. You do random blood sugar test in clinic and his blood sugar is 550. You are not able to obtain a urine sample at this time. What is your next action? Treat with insulin and order chemistry and urine labs Treat with insulin Send to ED Order a urine test to be done at the lab This patient is a type I diabetic with symptoms and blood glucose that should lead NP to consider DKA. DKA is treated in the inpatient setting as it requires insulin, IV rehydration, and careful monitoring of electrolytes. The patient has a TSH value of 13.1 today. The nurse practitioner had decided to initiate replacement therapy with levothyroxine 88 µg daily. When should the NP recheck the patient's TSH level? 10 weeks 2 weeks 4 weeks 6 weeks Symptoms of hypothyroidism can improve post levothyroxine therapy within 2-3 weeks; however steady TSH concentration are not achieved for at least 6 weeks. TSH can then be monitored annually unless the patient asymptomatic. In order to determine how much T4 replacement of patient needs to reestablish a euthyroid state, the nurse practitioner considers: Patient's body weight A patient who has diabetes has a blood pressure of 140/90 mm Hg and significant 2mg/dL albuminuria. Which initial action by the primary care provider is indicated for management of this patient? 1. Referring to an ophthalmologist 2. Consulting with a nephrologist 3. Prescribing an antihypertensive medication 4. Limiting protein intake Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? 1. 0.4 2. 4.2 3. 0.2 4. 2.4 A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit? 1. Thyroid studies 2. Hemoglobin A1c 3. Random serum glucose 4. C-peptide level Mr. Smith, an overweight 48-year-old male with undiagnosed type 2 diabetes mellitus presents to your clinic. Which symptom is least likely associated with type 2 diabetes mellitus? 1. Constipation 2. Impetigo 3. Fatigue 4. Athlete’s foot A 52-year-old presents with thirst and frequent urination today. His glucose is 352. How should this be managed today? 1. Start metformin 2. Have him return tomorrow to recheck his blood glucose 3. Start metformin plus pioglitazone 4. Start insulin A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? 1. This condition may be transient 2. She should be referred to an endocrinologist 3. A thyroidectomy will be necessary 4. She will need lifelong medication A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit? 1. Random serum glucose 2. Hemoglobin a1c 3. Thyroid studies 4. c-peptide Excessive thirst and volume of dilute urine may be a symptom of: 1. Diabetes insipidus 2. Viral gastroenteritis 3. Urinary tract infection 4. hypoglycemia A 45-year-old female patient has fatigue for the past 3 months and a 10 pound weight gain. She previously had regular menses occurring about every 30 days, but in the last 3 months her menses have varied. She has high TSH. It was repeated one week later and found to be even higher. Would explain this finding? 1. Hypothyroidism 2. Subclinical hypothyroidism 3. Perimenopause 4. Transient hypothyroidism