MARYVILLE NURS 623 EXAM 2 with correct answers

MARYVILLE NURS 623 EXAM 2 Which of the serum laboratory findings are present in the client with Cushing's syndrome? - correct answer Increased cortisol, HYPERnatremia, and HYPOkalemia Alice, age 48, has a benign thyroid nodule. The most common treatment involves: - correct answer Watchful waiting with an annual follow-up ACE inhibitors are given to clients with diabetes who have - correct answer persistent proteinuria A newly diagnosed client with diabetes who has an HbA1c of 7.5 is started on therapeutic lifestyle changes (TLC) and medical nutritional therapy (MNT). Which oral antidiabetic agent is recommended as monotherapy? - correct answer metformin An elderly client with hyperthyroidism may present with atypical symptoms. Which of the following manifestations are commonly seen in the elderly with hyperthyroidism? - correct answer a-fib, depression, weight loss Diane has had Cushing's disease for 20 years and has been taking hydrocortisone since her diagnosis. Today, she appears with a thick trunk and thin extremities. She has a "moon face," a "buffalo hump," thin skin with visible capillaries, and a number of bruises that appear to be slow in healing. To what do you attribute these symptoms? - correct answer excessive levels of cortisol The following is a client's self-monitoring blood glucose log. The client receives 20 units Novolin 70/30 in the morning (a.m.) and 20 units Novolin 70/30 in the evening (p.m.): Fasting a.m. pre-dinner: 90, 150, 105, 144, 101, 172, 98, 201. What changes would you make? - correct answer increase A.M. insulin Dan, age 45, is obese and has type 2 diabetes. He has been having trouble getting his glycohemoglobin under control. He's heard that exenatide (Byetta) causes weight loss and wants to try it. What do you tell him? - correct answer "Let's try it. You're glycohemoglobin will be lowered and you may lose weight." Which is the only treatment option that is curative for primary hyperparathyroidism? - correct answer parathyroidectomy The most common worldwide cause of hypothyroidism is: - correct answer iodine deficiency What should be assessed for during exam on pt with HYPOparathyroidism? - correct answer chvostek's sign Morton has Type 2 diabetes. His treatment, which includes diet, exercise, and oral antidiabetic agents, is insufficient to achieve acceptable glycemic control. Your next course of action is to - correct answer ADD LONG-ACTING INSULIN Joy has gout. In teaching her about her disease, which food do you tell her is allowed in her diet? - correct answer Broccoli What controls the amount of calcium in the blood? - correct answer Parathyroid Thyroid hormones regulate - correct answer metabolism Which tests should you order to confirm a diagnosis of hypothyroidism? - correct answer t3 & Free T4 (preferred over T4) What are the hallmark signs of Grave's disease? - correct answer enlarged thyroid and increased T3 What is the gold standard screening for thyroid TUMOR/NODULE? - correct answer ULTRASOUND What is the diagnostic screening for thyroid cancer? - correct answer FINE NEEDLE BIOPSY What is the preferred treatment of Grave's disease in pregnancy - correct answer Propylthiouracil (PTU): Before starting anti-thyroid meds what should be checked? - correct answer LIVER FUNCTIONS what is the goal of thyroid treatment - correct answer euthyroid state What are signs and symptoms of hypothyroidism overtreatment? - correct answer hyperglycemia; cardiac arrhythmias (Afib); adrenal insufficiency; increased myxedema. Hyperthyroidism causes an excessive secretion of which thyroid hormones? - correct answer T3 & T4 What are S/S of hyperthyroidism? - correct answer "Hot/buldging/fast" heat intolerance, eye buldge, tachycardia, weight loss, diarrhea, systolic HTN, enlarged thyroid What are S/S of HYPOthyroidism? - correct answer "cold, slow, tired" cold intolerance, slow speech, fatigue, lethargy, weight gain, constipation, brittle nail/hair What is the most common cause of hyperthyroidism? - correct answer Graves disease Name the two thyroid hormones produced by the thyroid gland? - correct answer T3 & T4 Name the hormone produced by the pituitary gland, state the purpose of the hormone - correct answer TSH; regulate the production of hormones by the thyroid gland IN GRAVES DISEASE THE THE TSH IS _________ AND THE T3/T4 ARE __________ - correct answer LOW; HIGH IN HASHIMOTO'S DISEASE THE THE TSH IS _________ AND THE T3/T4 ARE __________ - correct answer HIGH; LOW WHAT allows the resolution of hyperthyroidism, although patients then become hypothyroid and require thyroid replacement therapy for life - correct answer ABLATIVE DOSE IODINE According to the American Association of Clinical Endocrinologists, the usual dose of levothyroxine per day for full replacement? - correct answer 1.6 mcg/kg per day 50-100 MCG DAY what pt education do you give with levothyroxine? - correct answer take meds on empty stomach 30 mins before morning meal (may cause insomnia if taken at night) How would you alter the dose for initiating synthetic thyroid replacement with an older patient with hx of cardiac issues? - correct answer Begin with one-half of the expected replacement dose or 25 to50 mcg/day PO, increasing the dose gradually by 25 mcg/day once every 4 to 6 weeks; cardiac start at 12.5 mcg/day What is the long standing effects of HYPERthyroidism? - correct answer OSTEOPOROSIS CONSIDER BONE DENSITY TESTING, VIT D, & CALCIUM SUPPLEMENTS IN OLDER PT How long will the patient require thyroid replacement therapy after ablative radioactive treatment for hyperthyroidism? - correct answer FOR LIFE Which treatment FOR hyperthyroidism is recommended for middle age and older adults? - correct answer Radioactive iodine 131 WHAT works by inhibiting thyroid hormone synthesis at multiple steps. They are used as a treatment to reduce the level of hormone on initiation of radioactive iodine therapy,( not used as primary or sole treatment) - correct answer ANTI-THYROID MED (Propylthiouracil (PTU) Methimazole (MMI) What should those treated with radioactive die be aware of? - correct answer AVOID CONTACT WITH INFANTS, CHILDREN, AND PREGNANT WOMEN FOR 7 DAYS What is the test that assesses the functional status (hot and cold spots) of the thyroid gland to differentiate between Grave's disease and subacute thyroiditis and toxic nodular goiters? - correct answer RADIO IODINE UPTAKE SCAN What is the gold standard test for confirming Hashimoto's? - correct answer THYROID PEROXIDASE [TPO] ANTIBODY What is the most common type of autoimmune hypothyroid in the US? - correct answer HASHIMOTO'S What would make you suspicious of thyroid cancer (clinical presentation)? What is the reliable method of diagnosis? - correct answer PAINLESS LUMP OR NODULE IN THE NECK; FINE NEEDLE BIOPSY What type of hypothyroidism does more than 95% of patients have where there is dysfunction or atrophy of the thyroid gland due to failure of pituitary and/or hypothalamus? - correct answer CENTRAL HYPOTHYROIDISM What is an endocrine emergency with signs and symptoms of slowed cognitive thinking, poor short-term memory, depression or dementia, hypotension and hypothermia with a mortality rate of 30-40%? - correct answer MYXEDEMA (SEVERE HYPOTHYROIDISM) What are the common causes of hypercalcemia? - correct answer PRIMARY HYPERPARATHYROIDISM AND MALIGNANCY the twitching of the facial muscles in response to tapping over the facial nerve 2 cm anterior to ear canal is considered a positive _________ sign; what does it indicate? - correct answer CHVOSTEK'S SIGN; HYPOCALCEMIA When should a referral be considered for patient with HYPERparathyroidism? - correct answer CALCIUM STARTS BECOMING HIGH may be caused by cortisol hypersecretion by the adrenal cortex due to cortical hypertrophy from a tumor of the adrenal gland or heavy use of glucosteriods - correct answer CUSHING'S SYNDROME refers specifically to pituitary adrenoCORTICtropic hormone (ACTH) excess caused by a pituitary tumor (adenoma) Too much cortisol! - correct answer CUSHING'S DISEASE What labs are done to screen for Cushing's? - correct answer serum and urine cortisol (two measurements), CMP (GLUCOSE, HYPOKALEMIA CBC (LEUKOCYTOSIS) What is the clinical presentation of Cushing disease? - correct answer GENERALIZED OR CENTRAL OBESITY MOON FACE BUFFALO HUMP red face, AND STRIAE, HYPERGLYCEMIA What is ADDISON'S DISEASE? - correct answer primary adrenal insufficiency Autoimmune; adrenal glands do not produce enough cortisol. NEED TO "ADD" ADRENAL HORMONES/ CORTISOL Describe the clinical presentation OF ADDISON'S - correct answer BRONZE SKIN, hirsutism, HYPOGLYCEMIA, POSTURAL HYPOTENSION, WEIGHT LOSS, Clinical presentation of Addison's crisis - correct answer Profound fatigue dehydration vascular collapse (↓B/P) renal shutdown What are the diagnostic criteria for DM2? List all the criteria. - correct answer -FPG > 126 -RANDOM PLASMA GLUCOSE >200 -GTT (2HR) > 200 -A1C > 6.5 Which of the following can be initial testing to confirm diagnosis of DM2? (select all that apply) -FASTING BLOOD (PLASMA) GLUCOSE -HGA1C -ORAL GLUCOSE TOLERANCE TEST - correct answer -FASTING BLOOD (PLASMA) GLUCOSE -HGA1C -ORAL GLUCOSE TOLERANCE TEST Are there any contraindications for starting the recommended first choice oral hyperglycemic medication? If so, what are the contraindications? - correct answer -LIVER DISEASE - HX ALCOHOLIC -KIDNEY DISEASE (GFR <30) -cardiopulmonary insufficiency WHAT CONDITION PRESENTS WITH LACK OF INSULIN acute decompensation; (MORE IN TYPE I DM) S/S: HYPERGLYCEMIA, KETONEMIA, ACIDOSIS; ANOREXIA, THIRST, N/V, ABDO CRAMP, KUSSMAUL RESP, DEHYDRATED, ALTERED CONSCIOUSNESS - correct answer DKA WHAT POPULATION IS MORE LIKE TO PRESENT WITH DKA? - correct answer TYPE I DM When a patient is diagnosed with DM I what are they likely to present with? - correct answer DKA Clinical presentation of DMI - correct answer polydipsia, polyuria, polyphagia, anorexia, and weight loss. WHAT CONDITION PRESENTS WITH INSIDIOUS ONSET SUBTLE INITIAL SYMPTOMS (MORE IN TYPE II DM) S/S: HYPERGLYCEMIA, NO KETOSIS, HYPEROSMOLALITY; POLYURIA •POLYDIPSIA •WEAKNESS •NO KETOACIDOSIS •LETHARGY AND CONFUSION, COMA - correct answer HHS Which meds can cause DM and iatrogenic hyperglycemia? - correct answer GLUCOCORTICOID STEROIDS, ORAL CONTRACEPTIVES, THIAZIDES, CHANNEL BLOCKERS, CLONIDINE, NIACIN, ANTIPSYCHOTICS (CLONAZAPINE) WHAT POPULATION IS MORE LIKE TO PRESENT WITH HHS - correct answer TYPE II DM What is the goal of treatment for TYPE 1 DM? - correct answer PREVENT DKA; PREVENT SEVERE HYPOGLYCEMIA; MAINTAIN NORMAL GROWTH AND DEVELOPMENT; AND PREVENT LONG-TERM DIABETIC COMPLICATIONS With a newly diagnosed case of DM Type 2 where the fasting blood glucose is below 200 and symptoms are not severe what is the treatment? - correct answer TRIAL DIET AND EXERCISE Which longer-acting insulins (lasting up to 24 hours) may be utilized to prevent early morning hyperglycemia? - correct answer LANTUS AND LEVEMIR What is the classification of the recommended first choice of oral antihyperglycemic medication in Type 2 DM? - correct answer BIGUANIDE - METFORMIN What periodic testing should you order if a patient has been on the first choice oral antihyperglycemic medicine long term and complains of neuropathy? Why? (hint: hematological) - correct answer ●Vitamin B12 annually (CAN CAUSE B12 DEF) What is the goal of treatment for DM2? - correct answer A1C <7%; PREVENT FURTHER ORGAN DAMAGE What subsequent laboratory tests are needed to evaluate the general health of patients with DM2 (consider co-morbidities)? - correct answer CMP (liver, kidney, glucose), Lipids, serum creatinine, and urine albumin What is the treatment for acute hypoglycemia in an alert patient? - correct answer 6 to 12 ounces of orange juice or another fruit juice without additional sugar. One cup (8 oz) of milk can be substituted if juice is not available. Glucose tablets, If available What is the primary cause of mortality in DM patients? - correct answer ISCHEMIC HEART FAILURE You are Seeing a patient in the office and you determine they need to start insulin for DM2, what type of insulin would you select and how would you initiate their dosing regimen? - correct answer A1C <8% BASAL (LONG ACTING) 0.1-0.2 U/KG A1C >8% BASAL (LONG ACTING) 0.2-0.3 U/KG TITRATE EVERY 2-3 DAYS DEPENDING ON FINGER STICK GLUCOSE Middle-aged man presents with a painful, hot, red, swollen MTP joint of great toe. Precipitated by weekend of binge drinking. What is the likely diagnosis? - correct answer GOUT What are the PRIMARY risk factors for gout? - correct answer PRIMARY: ENZYME DEFECT & DECREASED RENAL CLEARANCE OF URIC ACID What are the SECONDARY risk factors for gout? - correct answer EXCESSIVE PURINE OBESITY STARVATION ALCOHOL ABUSE MEDS: THIAZIDES, NIACIN What diagnostic results would be seen with gout? - correct answer elevated serum uric acid levels, ESR and WBCs; What is the initial management for an acute attack of gout? - correct answer COLCHICINE 1.2mg PO X 1 then 0.6mg in 1 hour (within 36 hrs of onset up to 0.6 mg) NSAIDs, AND CORTICOSTEROIDS; rest, elevation, immobilization What is the subsequent pharmacological management used to prevent further attacks of prophylaxis? - correct answer ALLOPURINOL (wait 4-6 week to after acute attack to start) What educational information should you discuss with a patient diagnosed with gout? - correct answer AVOID FOODS HIGH IN PURINE (MEAT & SEAFOOD, YEAST, BEER/ALCOHOL, BEANS, PEAS, LENTILS, OATS, SPINACH, ASPARAGUS, CAULIFLOWER, MUSHROOMS How is obesity classified? - correct answer BMI >30, WAIST >40" MEN & >35" WOMEN What are the consequences of obesity? - correct answer CAD, CHF, HTN, HYPERLIPIDS, TYPE II DM, SLEEP APNEA, RESTRICTIVE LUNGS, GOUT, VENOUS INSUFF, GERD, GALLBLADDER, BLOOD CLOTS The cluster of factors for metabolic syndrome include? - correct answer HTN, HYPERLIPIDEMIA, INSULIN RESISTANCE Patients with metabolic syndrome are twice at risk for developing _____ over 5 yrs and have a 5-fold risk of ____? - correct answer CVD; DM II