Review Questions for Nurs623 Exam 2 with correct answers

Review Questions for Nurs623 Exam 2 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 a dosage of long-acting insulin at bedtime to the regimen. Alice, age 48, has a benign thyroid nodule. The most common treatment involves: - correct answer Watchful waiting with an annual follow-up Which of the following is a sign of hypothyroidism? - correct answer Brittle Hair 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 (Glucophage). 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 Atrial fibrillation, depression, and 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 circulating 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 the 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. Margie has hypoparathyroidism. Which of the following would you assess during your examination? - correct answer Chvostek's sign Jane has insulin-dependent diabetes mellitus and has been experiencing hyperglycemia before dinner. A possible solution to this problem is to: - correct answer Add physical activity between lunch and dinner. After a subtotal thyroidectomy, it is crucial to assess: - correct answer Speaking ability. Mandy has type 2 diabetes. She says she heard that if she becomes pregnant, she must go on insulin therapy. How do you respond? - correct answer "Insulin is commonly used during pregnancy. Some oral agents are now being used." Minnie is pregnant. She has hypothyroidism and has been on the same levothyroxine medication for years. What might you expect to do with her levothyroxine medication? - correct answer Increase the dosage. Which of the following medications can produce gynecomastia? - correct answer Cimetidine (Tagamet) Sandy is being treated for chronic hypocalcemia. When her serum calcium level returns to normal, you assess her urinary calcium level and note that it is greater than 250 mg in a 24-hour sample. This indicates that: - correct answer Her vitamin D dosage should be decreased. Which of the following serum laboratory findings are present in the client with Cushing's syndrome? - correct answer Increased cortisol, increased sodium, and decreased potassium levels Sidney has been taking a sulfonylurea for 5 years to treat his type 2 diabetes. He asks how long he needs to take the medication before he tries another medication. You tell him: - correct answer "Sulfonylureas are usually effective for 7 to 10 years in most clients." Sara has diabetes and is now experiencing anhidrosis on the hands and feet, increased sweating on the face and trunk, dysphagia, anorexia, and heartburn. Which complication of diabetes do you suspect? - correct answer Visceral neuropathies Joy has gout. In teaching her about her disease, which food do you tell her is allowed in her diet? - correct answer Broccoli 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 a nighttime dosage of long-acting insulin to the regimen. Why is parathyroid hormone secretion increased during pregnancy? - correct answer To meet the increased requirements for calcium and vitamin D for fetal skeletal growth When teaching Marcy how to use her new insulin pump, you tell her that she needs to monitor her blood glucose level: - correct answer At least four times a day. What happens where there is accelerated bone reabsorption, excessive GI absorption, or decreased renal excretion? - correct answer Entry of calcium into the circulation exceeds the excretion of calcium in the urine or deposition in the bones. What are the two primary causes of hypercalcemia? - correct answer hyperparathyroidism or malignancy What type of autoimmune disorder causes hypercalcemia? - correct answer Familial hypocalciuric hypercalcemia What controls the amount of calcium in the blood? - correct answer Parathyroid Excessive levels of Vitamin D can cause? - correct answer hypercalcemia in the blood stream Patient taking lithium can be at risk for developing which type of electrolyte imbalance? - correct answer hypercalcemia What are signs and symptoms of hyperparathyroidism? - correct answer abdominal pain; anorexia; weakness and fatigue; bone pain; kidney stones; nephrolithiasis; lethargy; depressed mood What is a good way to remember the sxs of hyperparathyroidism? - correct answer "Bones, stones, abdominal moans, and psychic groans." What are some early sxs of hypothyroidism? - correct answer Fatigue; dry skin; weight gain; cold intolerance; constipation; heavy menses; myalgia; muscle cramps; and headaches. What are late sxs of hypothyroidism? - correct answer Very dry skin; course hair; loss of lateral eyebrows; alopecia; hoarseness; continued weight gain; decreased libido; slight decline in mental ability; depression and hypersomnia. What should your assessment of a patient that has developed hypothyroidism (untreated) reveal? - correct answer course/thinning hair; brittle nails; thickened tongue; enlarged thyroid (possibly tender); thyroid nodules; pitting edema of the lower extremities; heart hypertrophy; bradycardia; lungs could have pleural effusion; and decreased bowel sounds. Which tests should you order to confirm a diagnosis of hypothyroidism? - correct answer Free T4 (preferred over T4) What is the last thyroid level to fall in hypothyroidism? - correct answer T3 (so should be used for txt not dx) In Hashimoto's disease what level falls? - correct answer Anti-microsomal antibodies (anti-TPO antibodies) What other tests might be ordered for hypothyroidism diagnosis? - correct answer CBC; CMP; UA to check protein; lipid panel; ultrasound to check for nodules. For a new onset of Diabetes Mellitus Type 2 what is the HgA1c goal? - correct answer Less than 7.0 For DM Type 2 a HgA1C of less than ___________ significantly decreases the occurrence of complications? - correct answer Less than 6.0 What are signs and symptoms of new onset DM Type 2? - correct answer Pruritus; Numbness and/or tingling; Increase urination; Nocturia; Polydipsia; Infections (especially vaginitis); Angina Why is exercise so important for diabetic patients? - correct answer Exercise decreases insulin resistance and improves glucose tolerance. Over treatment of hypothyroidism can lead to? - correct answer Osteoporosis What are the hallmark signs of Grave's disease? - correct answer enlarged thyroid and increased T3 What is the definitive test to diagnose thyroid cancer? - correct answer Fine needle biopsy Due to the high risk of developing macrovascular disease what should DM Type 2 patients be screened for on every visit? - correct answer PVD and neuropathy What can occur with over treatment of Levothyroxine? - correct answer Thyrotoxicity or thyroid storm What are signs and symptoms of hypothyroidism overtreatment? - correct answer hyperglycemia; cardiac arrhythmias (Afib); adrenal insufficiency; increased myxedema. Which type of thyroid medication should not be prescribed a substitute formulary? - correct answer All types. Do not switch up from one type to another because it can cause imbalances for the client due to not all formulations being exactly equal. What is Thyrotoxicosis factitia? - correct answer refers to a condition caused by the ingestion of exogenous hormone. It can be the result of mistaken ingestion of excess drug, such as levothyroxine, or as a symptom of Munchausen syndrome. Which type of antihypertensive medications reduce insulin sensitivity for patients with DM Type 2 by increasing the iatrogenic hyperglycemia and development of DM? - correct answer Beta blockers; CCB; Thiazide diuretics; and clonidine. What is the treatment for Grave's Disease? - correct answer Ablative dosing of radioactive iodine to destroy the thyroid. Hyperthyroidism causes an excessive secretion of which thyroid hormones? - correct answer T3 and T4 What are sxs of hyperthyroidism? - correct answer Increased total body heat production; diaphoresis; flushing; increased heart rate, contractility, and vasodilation (flushing). Hyperthyroidism sxs? - correct answer Anxiety; Nervousness; Heat intolerance; Diaphoresis; Unintentional weight loss with increased appetite; Insomnia; Weakness; Extreme fatigue; Exercise intolerance; Tremors; Irritability; Inability to concentrate; Emotionally liable; Diarrhea; Myxedema; Blurred vision; Proptosis; Exophalomos; Photophobia; Diplopia; Hyperpigmentation; Hyper DTR (Achilles); Lymphadenopathy; Hepatosplenomegaly; Thyroid acropathy. What labs should you check for hyperthyroidism? - correct answer TSH and T4 What lab values indicate hyperthyroidism? - correct answer TSH less than 0.35 and elevated FT4 greater than 12.5. (If T4 is normal order T3 because 5% of patients have a normal T4). Which diagnostics should you consider ordering for hyperthyroidism? - correct answer Nuclear scintigraphy with radioactive iodine (thyroid scan with cold and hot spots-cold spots indicative of CA). What is the most common cause of hyperthyroidism? - correct answer Grave's Disease What are some other causes of hyperthyroidism? - correct answer toxic nodular goiter; subacute thyroiditis; thyrotoxicosis factitia; Jod-Basedow phenomenon What are rare causes of hyperthyroidism? - correct answer Pituitary adenoma; stuma ovarii; metastatic thyroid cancer; high-dose amiodarone; pregnancy; trophoblastic tumors What is a contraindication for taking metformin? - correct answer Renal disease; liver impairment; alcoholism; cardiopulmonary insufficiency When does metformin have to be stopped? - correct answer Before any type of contrast dye is injected and up to six hours afterwards. With a newly diagnosed case of DM Type 1 what is the treatment and goal? - correct answer Normalize blood sugar with intensive insulin therapy. 80-120 before meals; 100-140 at bedtime; and Hgb A1C below 7%. 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 With a newly diagnosed case of DM Type 2 where the fasting blood glucose is 300 or above and symptoms are present what is the treatment? - correct answer Initiate oral agent What do you do when 3 months of diet and exercise fail to reduce fasting glucose to less than 126 or the Hgb A1C 6%? - correct answer Initiate medications How often should thyroid testing be repeated for hyperthyroidism? - correct answer After any radioiodine therapy, thyroid function tests should be performed at 6 weeks, 12 weeks, 6 months and then annually. How often should a repeat thyroid test be done if treating hyperthyroidism with propylthiouracil or Methimazole? - correct answer Every 4 to 6 weeks for a 3-4 month period while medication is being titrated. Once labs are stable, extend to follow up and thyroid testing every 3-4 months. When treating hypothyroidism how often should a thyroid level be checked? - correct answer TSH should be assessed every 6 to 8 weeks after initiating therapy and before each dosage increase. Once stable level is achieved, check TSH or FT4 biannually or annually. What should be done if during a physical exam you find a nodule on the thyroid gland? - correct answer Refer to an endocrinologist for further testing and evaluation. For patients with DM Type 1 that experience the "Dawn Phenomenon" (early morning hyperglycemia) what should be adjusted for this patient? - correct answer The time at which the nighttime insulin is given should be later or they should be switched to a longer acting form of insulin. What is the definitive test for Gout? - correct answer Joint fluid aspiration that is positive for the presence of urate crystals. What do most patient's with Gout have that is elevated in the absence of an elevated BUN? - correct answer serum urate levels What level is serum urate above in most patient's with Gout? - correct answer 7.5 mg/dl What is the initial management of Gout? - correct answer NSAIDS, colchicine, and corticosteroids. What foods should be avoided for patients with Gout? - correct answer Foods high in purine (etc. meats, seafood, organ meat, yeast, beer, beans, peas, lentils, oatmeal, spinach, asparagus, cauliflower, and mushrooms). When should Glipizide be prescribed? - correct answer They should be given as adjunct therapy to diet and exercise. To which patients should Glipizide not be prescribed? - correct answer Those with liver damage Which type of DM Type 1 accounts for 90%? - correct answer Immune mediated DM Which type of DM Type 1 accounts for 10%? - correct answer Idiopathic DM When is the diagnosis of DM Type 1 often given? - correct answer When a patient with Diabetic Ketoacidosis What are classic symptoms of DM Type 1? - correct answer Polydipsia; polyuria; polyphagia; anorexia; weight loss; nocturnal enuresis; visual disturbances-blurred vision; weakness; fatigue; nausea and or abdominal pain; impaired immunity leading to repeated infections, delayed wound healing and unusual types of infections, such as staph and klebsiella pneumoniae. What is the importance of ACE inhibitors for DM? - correct answer Slows the progression of microalbuminemia to overt disease which is the leading cause of ESRD. Underweight BMI? - correct answer <18.5 Normal weight BMI? - correct answer 18.5 -24.9 Overweight BMI? - correct answer 25 - 27.5 Mild obesity BMI? - correct answer 27.5 - 30 Moderate obesity? - correct answer 30 - 40 Severe Obesity (morbid obesity) BMI? - correct answer 40 or greater What is myxedema? - correct answer Thickening and swelling of the skin due to insufficient thyroid hormones. How long does a person have to be on thyroid hormones? - correct answer Usually the remainder of their life Is hypothyroidism more common in men or women? - correct answer Women (especially those over 50 years of age) What is the medical diagnosis for a person that suffers from prolonged exposure of the body's tissues to high levels of the hormone cortisol? - correct answer Cushing Syndrome (hypercortisolism) What are signs and symptoms of hypercortisolism? - correct answer Upper body obesity; rounded face; increased fat around the neck; thinning arms and legs; fatigue; weakness; hypertension; and mood disorders. (Children tend to be obese with delayed growth rates). What is the most common cause of Cushing's Syndrome? - correct answer Pituitary tumors that are benign which secrete increased amounts of ACTH. What are secondary causes of Cushing's syndrome? - correct answer Glucocorticoid hormones (such as prednisone); immune suppression. What is the treatment for Cushing's Syndrome? - correct answer Depends on the cause but may include surgery, radiation, chemotherapy, or cortisol-inhibiting drugs. Physical findings in patient's with Cushing's include: - correct answer fragile and thin skin that bruises easy and heals poorly; purplish-pink stretch marks on the abdomen, thighs, buttocks, arms, and breasts; weak bones; severe fatigue; weak muscles; hypertension; hyperglycemia; irritability; anxiety; and depression; hirsutism; irregular menses; decreased libido What is panhypopituitarism? - correct answer is a condition of inadequate or absent production of the anterior pituitary hormones. What are sxs of panhypoituitarism? - correct answer Micropenis; midline defects; optic atrophy; hypoglycemia; and poor growth Radioactive iodine - correct answer it destroys thyroid cells causing a mass release of thyroid at first and then, potentially life long HYPOthryroid after treatment has destroyed the thyroid. Hashimoto's disease affects lab data, how? - correct answer anti-thyroid antibody titers (of course expect HIGH TSH, normal to low FT4) Symptoms: specific to Hashi's - correct answer is thyroid enlargement, feeling full in throat, neck pain, sore throat, low grade fever and exhaustion. How does synthroid therapy affect the lab values on on T3? - correct answer It increases it How does synthroid therapy affect the lab values on Free T4? - correct answer It increases it Sulfonylurea agents: - correct answer •potentiate insulin secretion (secretagogue) Reduces A1c: 1-2% •DPP-4: slows inactivation of the incretin hormones, which lowers blood glucose levels) Reduces A1c: 0.7% (ex: glipizide, glyburide, glimepiride) Thiazolidinediones (TZDs) - correct answer Preserves beta cell function, improves insulin insensitivity. Reduces A1c: 0.7% (ex: -glitazones, pioglitazone (actos), rosiglitazone (Avandia)). GLP-Agonists: - correct answer Increases the production of insulin in response to elevated blood glucose levels. Slows gastric emptying. Reduces A1c: 1-1.5% (ex: exenatide (Byetta or Bydureon), liraglutide (Victoza)). Metformin: - correct answer reduces hepatic glucose production and intestinal glucose absorption, insulin sensitizer via increased peripheral glucose uptake and utilization. Reduces A1c: 1-2%. (class: Biguanide) SGLT-2 inhibitors: - correct answer Lowers renal glucose threshold, increases urinary glucose excretion. Reduces A1c: 0.7-1.0% (ex: Canagliflozin (Invokana), dapagliflozin (Farxiga)) Alpha-glucosidase inhibitors: - correct answer delays intestinal carbohydrate absorption by reducing postprandial digestion of starches and disaccharides via enzyme action inhibition. Reduces A1c: 0.3-0.9% (ex. Acarbose (Precose), miglitol (Glyset). A patient is on Levothyroxine for a good period of time so what are the symptoms they may exhibit? - correct answer bone loss, osteoporosis Which labs value in a patient on metformin you would monitor closely? - correct answer Creatine, BUN, LFTs, Lactate What typically presents with the following signs and symptoms: hyperglycemia, often presents with DKA; polydipsia, polyuria, polyphagia, anorexia and weight loss, nocturnal enuresis, visual changes/blurred vision, weakness, fatigue, impaired immunity (repeat infections), decreased wound healing. - correct answer Diabetes Type 1 What typically presents with the following symptoms: usually insidious onset, initially pruritus or neuro such as N&T; increased urination, nocturia, thirst, polydipsia, infection such as vaginitis, or skin infection, CV such as angina. Patient is often obese, HX of high lipids, HTN, CAD, abnormal healing, increased infection, Hyperosmolar hyperglycemic syndrome (HHS) is profound dehydration that results from prolonged hyperglycemia. - correct answer Diabetes Type II High TSH, Low T3 T4 but ALSO High anti-TPO antibody- this is the diagnostic indicator for? - correct answer Hashimotos disease A morning cortisol level of less than 3mcg/dl when accompanied with a ACTH greater than 200pg/ML is consistent with? - correct answer Addison's Disease Hypercortisolemia impairs _____________ _________ and often produces______________ and ______________________. - correct answer glucose tolerance and hypokalemia and leukocytosis Elevated TSH, Low FT4 and T3 is indicative of? - correct answer Hypothyroidism Low or undetected TSH (<0.35mIU/L), and high t4 (hyperthyroid) Ft4 (>12.5mcg/dL) is indicative of? - correct answer Graves Disease Enlarged thyroid and increased t3 are hallmark signs of which disease process? - correct answer Grave's Disease What hormones does the anterior pituitary secrete? - correct answer ACTH; TSH; FSH; LH; GH; Prolactin What is the function of the anterior pituitary gland? - correct answer It regulates the release of several hormones and bodily functions. What dietary restrictions are placed on a patient during Gout exacerbation? - correct answer Patients should avoid foods high in purine like: all meats and seafood, especially organ meat. Meat extracts and gravies should also be avoided, yeast and yeast extracts, beer and alcoholic beverages, beans, peas, lentils, oatmeal, spinach, asparagus, cauliflower and mushrooms. Normal Uric Acid Levels: - correct answer 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male) Acute gout attack presents as: - correct answer •pain, tenderness, erythema and swelling. Usually only 1 joint is affected (monoarticular) most often first metatarsal. Midfoot, knees, fingers, wrists, and elbows also common. Excruciating pain wakes them at night. Throbbing, crushing, and pulsating pain. Relieved with rest and position change. Usually non-weight-bearing d/t pain. Can not tolerate anything coming in contact with affected area. Ask about precipitating factors (illness, surgery, stress, binge drinking, etc). Diagnostic tool to identify thyroid nodules: - correct answer Thyroid ultrasound Diagnostic tool to identify thyroid cancer: - correct answer fine needle aspiration What is the effect of steroids on blood sugar? - correct answer It increases blood glucose levels ASA should be started after the age of 30 if? - correct answer at risk for cardiovascular disease and history of DM Why do diabetics need to be on an ACE inhibitor? - correct answer preventing Neuropathy, Albuminuria, kidney-protective, small doses. Ischemic heart failure is leading cause of death, so earlier tight control, ACE, the better. For a newly diagnosed DM patient what would be your initial recommendation? - correct answer Diet and exercise and re-evaluate in 3 months; Pharmacotherapeutics if so then the drugs of choice Symptoms of Grave's disease: - correct answer Smooth skin, fine hair, brittle nails, heat intolerance, diarrhea, blurred vision (and other eye problems), tachycardia, anxiety, nervousness, weight loss, bulging eyes.... Everything is FAST What is common with Cushing's Disease? - correct answer Fungal infections, onychomycosis What has typical gradual onset (months to years)HYPERcortisolism and androgen excess? - correct answer Cushing's Disease Cushing's Disease presents with: - correct answer General or centralized obesity. "Moon face" "Buffalo hump" Atrophy of the skin- leads to easy bruising. Hirsutism, acne striae. Muscle weakness and osteoporosis Addison's Disease presents with: - correct answer Weakness, fatigue, anorexia, weight loss, nausea, abdominal pain, diarrhea, hypoglycemia, hypotension (orthostatic in particular). Hyperpigmentation (as a result of elevated ACTH). Addison's in a result of? - correct answer HYPOcortisolism and HYPOadlosteronism Addison's Disease is caused by? - correct answer 80% caused by autoimmune destruction of the adrenal cortex