DUNPHY CARE CORE REVIEWS ANSWERS AND
QUESTIONS SET A+
✔✔Sandra, age 28, has secondary obesity. Which of the following may have caused
this?
1.
Taking in more calories than are expended.
2.
Polycystic ovary syndrome.
3.
Antihypertensive medications.
4.
A sedentary lifestyle. - ✔✔Polycystic ovary syndrome.
Rationales
Option 1:
Essential obesity is the most prevalent type of obesity and is the result of taking in more
calories than are expended. This type of obesity results from the multiple interactions of
genetic and environmental factors (cultural, metabolic, social, and psychological).
Option 2:
Secondary obesity is rare; possible causes include Cushing disease, polycystic ovary
syndrome, hypothalamic disease, hypothyroidism, and insulinoma. Some medications
associated with weight gain include glucocorticoids, tricyclic antidepressants, and
phenothiazines.
Option 3:
Antihypertensive medications do not lead to obesity.
Option 4:
A sedentary lifestyle may lead to primary, not secondary, obesity.
✔✔When you inspect the integumentary system of clients with endocrine disorders, a
finding of coarse hair may be an indicator of:
1.
Addison disease.
2.
Diabetes mellitus.
,3.
Cushing syndrome.
4.
Hypothyroidism. - ✔✔Hypothyroidism.
Rationales
Option 1:
Indicators of Addison disease include hyperpigmentation.
Option 2:
Indicators of diabetes mellitus include hypopigmentation.
Option 3:
Indicators of Cushing syndrome include hirsutism, hyperpigmentation, purple striae over
the abdomen, and bruising.
Option 4:
During inspection of the integumentary system of clients with endocrine disorders, a
finding of coarse hair may be an indicator of hypothyroidism. Fine hair is seen in clients
with hyperthyroidism; hirsutism with Cushing syndrome; hyperpigmentation with both
Addison disease and Cushing syndrome; hypopigmentation with diabetes mellitus,
hyperthyroidism, and hypothyroidism; and purple striae over the abdomen and bruising
with Cushing syndrome.
✔✔Eunice, age 32, has type 2 diabetes. She said she heard she should take an aspirin
a day after she reaches menopause for its cardioprotective action. She does not have
coronary artery disease, but her father does. How do you respond?
1.
"You're right. Your hormones protect you against coronary artery disease until
menopause; then you should start on aspirin therapy."
2.
"The American Diabetes Association recommends that you start on low-dose aspirin
therapy now."
3.
"Aspirin therapy is recommended for all patients over age 55 as a precautionary
measure."
4.
"If you maintain good glycemic control, you don't need aspirin therapy." - ✔✔The
American Diabetes Association recommends that you start on low-dose aspirin therapy
now."
Rationales
Option 1:
The American Diabetes Association (ADA) recommends aspirin therapy as a primary
prevention strategy in high-risk men and women with diabetes who have a family history
of coronary heart disease.
Option 2:
The American Diabetes Association's position statement on aspirin therapy in patients
with diabetes recommends low-dose (81 mg) aspirin use as a secondary prevention
,strategy in men and women with diabetes who have evidence of large-vessel disease,
such as a history of myocardial infarction, vascular bypass procedures, and stroke, and
have no contraindications for the use of aspirin. They also recommend aspirin therapy
as a primary prevention strategy in high-risk men and women with type 1 or type 2
diabetes who have a family history of coronary heart disease and for individuals who
smoke, are hypertensive or obese, or who have albuminuria, cholesterol levels greater
than 200 mg/dL, low-density lipoprotein cholesterol levels greater than 130 mg/dL, high-
density lipoprotein cholesterol levels less than 40 mg/dL, and triglyceride levels greater
than 250 mg/dL.
Option 3:
Aspirin therapy is not recommended as a precautionary measure in all patients over age
55.
Option 4:
The American Diabetes Association (ADA) recommends aspirin therapy as a primary
prevention strategy in high-risk men and women with diabetes who have a family history
of coronary heart disease.
✔✔Leah, age 70, has had diabetes for many years. When teaching her about foot care,
you want to stress:
1.
That her calluses will protect her from infection.
2.
The need to assess the bottom of her feet carefully after walking barefoot.
3.
That painless ulcerations might occur and feet should be examined with a mirror.
4.
That mild pain is to be expected because of neuropathy. - ✔✔That painless ulcerations
might occur and feet should be examined with a mirror.
Rationales
Option 1:
She should try to avoid the development of calluses because preparations used to
remove them are very caustic.
Option 2:
Leah should not be walking barefoot because her sensation is probably decreased as a
result of neuropathy.
Option 3:
Painless ulcerations are very common in clients with diabetes, and the only way to
assess for them in the feet is for clients to use a mirror to examine the bottoms of their
feet.
Option 4:
Sensation may be decreased as a result of neuropathy.
✔✔Sara, age 40, 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?
, 1.
Macrocirculation changes.
2.
Microcirculation changes.
3.
Peripheral neuropathies.
4.
Autonomic neuropathies. - ✔✔Autonomic neuropathies.
Rationales
Option 1:
Macrocirculation changes include an early onset of atherosclerosis and peripheral
vascular insufficiency with claudication, ulcerations, and gangrene of the legs.
Option 2:
Microcirculation changes include diabetic retinopathy with retinal ischemia and loss of
vision and diabetic nephropathy with hypertension, albuminuria, edema, and
progressive renal failure.
Option 3:
Peripheral neuropathies include changes in sensation in the feet and hands; palsy of
cranial nerve III with headache, eye pain, and inability to move the eye up, down, or to
the middle; pain or loss of cutaneous sensation over the chest; and motor and sensory
deficits in the anterior thigh and medial calf.
Option 4:
Autonomic neuropathies include anhidrosis (absence of sweating) on the hands and
feet, increased sweating on the face and trunk, dysphagia, anorexia, heartburn,
constricted pupils, nausea and vomiting, constipation, and diabetic diarrhea.
✔✔Your client with diabetes asks you about insulin glargine (Lantus). You tell her that:
1.
It may be administered subcutaneously at home or intravenously in the hospital if need
be.
2.
The onset of action is 15 minutes.
3.
Insulin glargine (Lantus) stays in your system for 24 hours.
4.
It can be mixed with any other insulin. - ✔✔Insulin glargine (Lantus) stays in your
system for 24 hours.
Rationales
Option 1:
Insulin glargine (Lantus) must be administered subcutaneously, not intravenously.
Regular insulin may be administered by the intravenous route. The newer insulin
analogues, such as insulin aspart (NovoLog), are also approved for intravenous use.
Option 2:
Insulin glargine (Lantus) has an onset of action of just over 1 hour.
QUESTIONS SET A+
✔✔Sandra, age 28, has secondary obesity. Which of the following may have caused
this?
1.
Taking in more calories than are expended.
2.
Polycystic ovary syndrome.
3.
Antihypertensive medications.
4.
A sedentary lifestyle. - ✔✔Polycystic ovary syndrome.
Rationales
Option 1:
Essential obesity is the most prevalent type of obesity and is the result of taking in more
calories than are expended. This type of obesity results from the multiple interactions of
genetic and environmental factors (cultural, metabolic, social, and psychological).
Option 2:
Secondary obesity is rare; possible causes include Cushing disease, polycystic ovary
syndrome, hypothalamic disease, hypothyroidism, and insulinoma. Some medications
associated with weight gain include glucocorticoids, tricyclic antidepressants, and
phenothiazines.
Option 3:
Antihypertensive medications do not lead to obesity.
Option 4:
A sedentary lifestyle may lead to primary, not secondary, obesity.
✔✔When you inspect the integumentary system of clients with endocrine disorders, a
finding of coarse hair may be an indicator of:
1.
Addison disease.
2.
Diabetes mellitus.
,3.
Cushing syndrome.
4.
Hypothyroidism. - ✔✔Hypothyroidism.
Rationales
Option 1:
Indicators of Addison disease include hyperpigmentation.
Option 2:
Indicators of diabetes mellitus include hypopigmentation.
Option 3:
Indicators of Cushing syndrome include hirsutism, hyperpigmentation, purple striae over
the abdomen, and bruising.
Option 4:
During inspection of the integumentary system of clients with endocrine disorders, a
finding of coarse hair may be an indicator of hypothyroidism. Fine hair is seen in clients
with hyperthyroidism; hirsutism with Cushing syndrome; hyperpigmentation with both
Addison disease and Cushing syndrome; hypopigmentation with diabetes mellitus,
hyperthyroidism, and hypothyroidism; and purple striae over the abdomen and bruising
with Cushing syndrome.
✔✔Eunice, age 32, has type 2 diabetes. She said she heard she should take an aspirin
a day after she reaches menopause for its cardioprotective action. She does not have
coronary artery disease, but her father does. How do you respond?
1.
"You're right. Your hormones protect you against coronary artery disease until
menopause; then you should start on aspirin therapy."
2.
"The American Diabetes Association recommends that you start on low-dose aspirin
therapy now."
3.
"Aspirin therapy is recommended for all patients over age 55 as a precautionary
measure."
4.
"If you maintain good glycemic control, you don't need aspirin therapy." - ✔✔The
American Diabetes Association recommends that you start on low-dose aspirin therapy
now."
Rationales
Option 1:
The American Diabetes Association (ADA) recommends aspirin therapy as a primary
prevention strategy in high-risk men and women with diabetes who have a family history
of coronary heart disease.
Option 2:
The American Diabetes Association's position statement on aspirin therapy in patients
with diabetes recommends low-dose (81 mg) aspirin use as a secondary prevention
,strategy in men and women with diabetes who have evidence of large-vessel disease,
such as a history of myocardial infarction, vascular bypass procedures, and stroke, and
have no contraindications for the use of aspirin. They also recommend aspirin therapy
as a primary prevention strategy in high-risk men and women with type 1 or type 2
diabetes who have a family history of coronary heart disease and for individuals who
smoke, are hypertensive or obese, or who have albuminuria, cholesterol levels greater
than 200 mg/dL, low-density lipoprotein cholesterol levels greater than 130 mg/dL, high-
density lipoprotein cholesterol levels less than 40 mg/dL, and triglyceride levels greater
than 250 mg/dL.
Option 3:
Aspirin therapy is not recommended as a precautionary measure in all patients over age
55.
Option 4:
The American Diabetes Association (ADA) recommends aspirin therapy as a primary
prevention strategy in high-risk men and women with diabetes who have a family history
of coronary heart disease.
✔✔Leah, age 70, has had diabetes for many years. When teaching her about foot care,
you want to stress:
1.
That her calluses will protect her from infection.
2.
The need to assess the bottom of her feet carefully after walking barefoot.
3.
That painless ulcerations might occur and feet should be examined with a mirror.
4.
That mild pain is to be expected because of neuropathy. - ✔✔That painless ulcerations
might occur and feet should be examined with a mirror.
Rationales
Option 1:
She should try to avoid the development of calluses because preparations used to
remove them are very caustic.
Option 2:
Leah should not be walking barefoot because her sensation is probably decreased as a
result of neuropathy.
Option 3:
Painless ulcerations are very common in clients with diabetes, and the only way to
assess for them in the feet is for clients to use a mirror to examine the bottoms of their
feet.
Option 4:
Sensation may be decreased as a result of neuropathy.
✔✔Sara, age 40, 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?
, 1.
Macrocirculation changes.
2.
Microcirculation changes.
3.
Peripheral neuropathies.
4.
Autonomic neuropathies. - ✔✔Autonomic neuropathies.
Rationales
Option 1:
Macrocirculation changes include an early onset of atherosclerosis and peripheral
vascular insufficiency with claudication, ulcerations, and gangrene of the legs.
Option 2:
Microcirculation changes include diabetic retinopathy with retinal ischemia and loss of
vision and diabetic nephropathy with hypertension, albuminuria, edema, and
progressive renal failure.
Option 3:
Peripheral neuropathies include changes in sensation in the feet and hands; palsy of
cranial nerve III with headache, eye pain, and inability to move the eye up, down, or to
the middle; pain or loss of cutaneous sensation over the chest; and motor and sensory
deficits in the anterior thigh and medial calf.
Option 4:
Autonomic neuropathies include anhidrosis (absence of sweating) on the hands and
feet, increased sweating on the face and trunk, dysphagia, anorexia, heartburn,
constricted pupils, nausea and vomiting, constipation, and diabetic diarrhea.
✔✔Your client with diabetes asks you about insulin glargine (Lantus). You tell her that:
1.
It may be administered subcutaneously at home or intravenously in the hospital if need
be.
2.
The onset of action is 15 minutes.
3.
Insulin glargine (Lantus) stays in your system for 24 hours.
4.
It can be mixed with any other insulin. - ✔✔Insulin glargine (Lantus) stays in your
system for 24 hours.
Rationales
Option 1:
Insulin glargine (Lantus) must be administered subcutaneously, not intravenously.
Regular insulin may be administered by the intravenous route. The newer insulin
analogues, such as insulin aspart (NovoLog), are also approved for intravenous use.
Option 2:
Insulin glargine (Lantus) has an onset of action of just over 1 hour.
