Exam 1: NSG533/ NSG 533 (Latest 2023/ 2024 Update) Advanced Pharmacology Exam| Questions and Verified Answers with Rationales| 100% Correct| Grade A

Exam 1: NSG533/ NSG 533 (Latest 2023/ 2024 Update) Advanced Pharmacology Exam| Questions and Verified Answers with Rationales| 100% Correct| Grade A Q: In order to determine how much T4 replacement a patient needs to re-establish a euthyroid state, the NP considers: 1. the TSH value 2. the patient's T4 3. the patient's body weight 4. the patient's gender Answer: 3. the patient's body weight Replacement is based on body weight and is usually calculated in kg. The patients weight is calculated in kg and multplied by 1.6 to determine the replacement needed in one day. This is the amount that should be prescribed provided the patient is otherwise healthy, is less than 50 y/o, and has no evidence of underlying cardiac disease. Rx pearl: start low and go slow, then titrate slowly up; if you calculate dose and start that right away, you will send the heart into afib (that never goes away) Q: A patient has been diagnosed today with T2DM. A criterion for diagnosis is: 1. An abnormal blood glucose 2. Proteinuria 3. A fasting glucose or equal to 126 and confirmed on a previous day 4. An abnormal postprandial glucose Answer: 3. A fasting glucose or equal to 126 and confirmed on a previous day T2DM is dx after a random fasting glucose greater than or equal to 126 mg/dL and confirmed on a subsequent day. Other diagnostic criteria include a random glucose 200mg/dL with polyuria, polydipsia, or polyphagia; or an A1C greater than or equal to 6.5% (and confirmed on a subsequent day). A glucose tolerance test may also be used for diagnosis, but this is usually reserved for pregnant women. Q: The most appropriate screen for diabetic nephropathy is: 1. Creatinine clearance and eGFR 2. Urinary albumin to creatinine ratio and eGFR 3. microalbuminuria 4. serum creatinine Answer: 2. Urinary albumin to creatinine ratio and eGFR At least once per year in all patients who have T2DM. Q: A patient has 2 fasting glucose values (121mg/dL and 126mg/dL) that were measured on 2 seperate days in the same week. This patient : 1. has normal values 2. has impaired fasting glucose 3. has T2DM 4. should have an A1C performed Answer: 4. should have an A1C performed This patient has elevated glucose readings. One indicates impaired fasting glucose and the other T2DM. Further testing should be done. A1c is a good choice to confirm dx of T2DM (6.5%) Q: A diabetic patient with albuminuria has been placed on an ACEI. How soon can the antiproteinuric affect of the ACEI be realized for this patient? 1. 6-8 weeks 2. 3 months 3. 6 months 4. 3-5 years Answer: 1. 6-8 weeks The effect can be realized as early as 6-8 weeks after starting an ACEI or ARB. Monitor the patient's serum Cr and K levels with dose changes because both can increase to unacceptable levels when drugs affecting the RAAS are used. Q: Mr. Smith, an overweight 48 y/o with undiagnosed T2DM presents to your clinic. Which of these symptoms is not associated with T2DM. 1. fatigue 2. constipation 3. athlete's foot 4. impetigo Answer: 2. constipation Q: Hyperthyroidism may affect the blood pressure 1. by producing an increase in systolic/diastolic readings 2. by producing a decrease in diastolic 3. when the heart rate is increased 4. with unpredictable results Answer: 1. by producing an increase in systolic/diastolic readings A common effect of hyperthyroidism on BP is an increase. Hyperthyroidism is the most common endocrine cause of secondary HTN. Other endocrine causes of secondary HTN are pheochromocytoma, Cushings syndrom, and neuroblastoma. It is common to measure a resting HR of 100 in patients who have untreated hyperthyroidism. Q: When the serum fT4 falls: 1. TSH falls 2. TSH rises 3. There is no relationship between T4 and TSH 4. T3 falls Answer: 2. TSH rises Inverse relationship Q: What is the earliest detectable glycemic abnormality in a patient with T2DM? 1. Postprandial glucose elevation 2. Nighttime hyperglycemia 3. Fasting glucose elevation 4. Abnormal A1C Answer: 1. Postprandial glucose elevation The earliest glycemic abnormality is postprandial glucose elevation. Early in the pathogenesis of diabetes, glucose levels increase to abnormal after eating. Over the next few hours, if the patient does not eat, the glucose levels will fall to a normal range again. This can occur for months to years before glucose levels become consistently elevated and are not able to return to normal after eating despite long periods. Q: Which of the following would be expected to result in the greatest reduction in systolic BP in a middle aged man with HTN? a. initiating a DASH eating plan b. starting an exercise regimen involving 100min/week of dynamic resistance c. weight reduction of 4kg in an overweight individual d. limiting alcohol consumption to two drinks or less Answer: a. initiating a DASH eating plan Q: Enhanced intake of which of the following is recommended to decrease BP? Exam 1: NSG533/ NSG 533 (Latest 2023/ 2024 Update) Advanced Pharmacology Exam| Questions and Verified Answers with Rationales| 100% Correct| Grade A Q: In order to determine how much T4 replacement a patient needs to re-establish a euthyroid state, the NP considers: 1. the TSH value 2. the patient's T4 3. the patient's body weight 4. the patient's gender Answer: 3. the patient's body weight Replacement is based on body weight and is usually calculated in kg. The patients weight is calculated in kg and multplied by 1.6 to determine the replacement needed in one day. This is the amount that should be prescribed provided the patient is otherwise healthy, is less than 50 y/o, and has no evidence of underlying cardiac disease. Rx pearl: start low and go slow, then titrate slowly up; if you calculate dose and start that right away, you will send the heart into afib (that never goes away) Q: A patient has been diagnosed today with T2DM. A criterion for diagnosis is: 1. An abnormal blood glucose 2. Proteinuria 3. A fasting glucose or equal to 126 and confirmed on a previous day 4. An abnormal postprandial glucose Answer: 3. A fasting glucose or equal to 126 and confirmed on a previous day T2DM is dx after a random fasting glucose greater than or equal to 126 mg/dL and confirmed on a subsequent day. Other diagnostic criteria include a random glucose 200mg/dL with polyuria, polydipsia, or polyphagia; or an A1C greater than or equal to 6.5% (and confirmed on a subsequent day). A glucose tolerance test may also be used for diagnosis, but this is usually reserved for pregnant women. Q: The most appropriate screen for diabetic nephropathy is: 1. Creatinine clearance and eGFR 2. Urinary albumin to creatinine ratio and eGFR 3. microalbuminuria 4. serum creatinine Answer: 2. Urinary albumin to creatinine ratio and eGFR At least once per year in all patients who have T2DM. Q: A patient has 2 fasting glucose values (121mg/dL and 126mg/dL) that were measured on 2 seperate days in the same week. This patient : 1. has normal values 2. has impaired fasting glucose 3. has T2DM 4. should have an A1C performed Answer: 4. should have an A1C performed This patient has elevated glucose readings. One indicates impaired fasting glucose and the other T2DM. Further testing should be done. A1c is a good choice to confirm dx of T2DM (6.5%) Q: A diabetic patient with albuminuria has been placed on an ACEI. How soon can the antiproteinuric affect of the ACEI be realized for this patient? 1. 6-8 weeks 2. 3 months 3. 6 months 4. 3-5 years Answer: 1. 6-8 weeks The effect can be realized as early as 6-8 weeks after starting an ACEI or ARB. Monitor the patient's serum Cr and K levels with dose changes because both can increase to unacceptable levels when drugs affecting the RAAS are used. Q: Mr. Smith, an overweight 48 y/o with undiagnosed T2DM presents to your clinic. Which of these symptoms is not associated with T2DM. 1. fatigue 2. constipation 3. athlete's foot 4. impetigo Answer: 2. constipation Q: Hyperthyroidism may affect the blood pressure 1. by producing an increase in systolic/diastolic readings 2. by producing a decrease in diastolic 3. when the heart rate is increased 4. with unpredictable results Answer: 1. by producing an increase in systolic/diastolic readings A common effect of hyperthyroidism on BP is an increase. Hyperthyroidism is the most common endocrine cause of secondary HTN. Other endocrine causes of secondary HTN are pheochromocytoma, Cushings syndrom, and neuroblastoma. It is common to measure a resting HR of 100 in patients who have untreated hyperthyroidism. Q: When the serum fT4 falls: 1. TSH falls 2. TSH rises 3. There is no relationship between T4 and TSH 4. T3 falls Answer: 2. TSH rises Inverse relationship Q: What is the earliest detectable glycemic abnormality in a patient with T2DM? 1. Postprandial glucose elevation 2. Nighttime hyperglycemia 3. Fasting glucose elevation 4. Abnormal A1C Answer: 1. Postprandial glucose elevation The earliest glycemic abnormality is postprandial glucose elevation. Early in the pathogenesis of diabetes, glucose levels increase to abnormal after eating. Over the next few hours, if the patient does not eat, the glucose levels will fall to a normal range again. This can occur for months to years before glucose levels become consistently elevated and are not able to return to normal after eating despite long periods. Q: Which of the following would be expected to result in the greatest reduction in systolic BP in a middle aged man with HTN? a. initiating a DASH eating plan b. starting an exercise regimen involving 100min/week of dynamic resistance c. weight reduction of 4kg in an overweight individual d. limiting alcohol consumption to two drinks or less Answer: a. initiating a DASH eating plan Q: Enhanced intake of which of the following is recommended to decrease BP?