Herzing NU636 Quiz 4 100% graded quiz july 2020

One of your obese female patients is coming to review her recent lab results.  Her HgbA1C is 12.1.  She reports she just cannot seem to commit herself to an appropriate nutritional lifestyle.  There were no other abnormalities noted with her lab results.  With your understanding of the current ADA standards of care which of the following medications will you include in the plan for this patient?

Rosiglitazone (Avandia)

Glipizide (Glucotrol)

Acarbose (Precose)

Metformin (Glucophage)

Metformin (Glucophage)

2 . 52-year-old male patient with a family history of cardiac disease reports to the clinic with a complaint of intermittent chest pain.  A review of his medical record reveals that he was started on 112.5mcg of synthetic T4 (Synthroid) three weeks ago for a TSH level of 7.2.  While he reports improved energy and mental clarity since starting on Synthroid he is concerned about the chest pain.  You take his vital signs and find he has a BP of 142/86 and a regular pulse at 128.  Which of the following represents your best treatment plan for this patient?

Make no changes in the Synthroid dose, order a TSH and an EKG

Decrease the Synthroid dose, order a TSH and an EKG

Order a stress test because of his family history

Decrease the Synthroid dose, order a TSH and an EKG

Discontinue Synthroid as chest pain is an adverse event

3 Your 73-year-old patient reports a history thyroid hormone replacement therapy since 19 years of age secondary to having a partial thyroidectomy.  The patient is on Synthroid.  As an astute advanced practice nurse you understand that chronic treatment with a thyroid hormone can result in the development of which of the following?

Osteoporosis

Tachycardia

Insomnia

Sweating

4 Lab results reveal that your 67-year-old male patient with type 2 diabetes has a HgbA1C of 6.7%.  Presently the patient is on 1000mg of Glucophage BID.  With this lab value which of the following interventions does the advanced practice nurse anticipate for the patient’s treatment plan?

Add a sulfonylurea drug (Diabenese)

Make no change in Glucophage dose

Decrease Glucophage to 500mg BID

Make no change in Glucophage dose

5 Lab results reveal that 82-year-old male with type 2 diabetes has a HgbA1C of 10.9%.  He is presently taking glipizide (Glucotrol).  In addition to his type 2 diabetes he has renal insufficiency and moderate cardiac ischemia.  Which of the following interventions is most appropriate for management of the patient’s diabetes?

Add sitagliptin (Januvia)

Discontinue Glucotrol start insulin

Add metformin (Glucophage)

Discontinue Glucotrol start insulin

Add pioglitazone (Actos)

6 You have a 93-year-old female who is on 88mcg of Synthroid daily for hypothyroidism.  There are numerous drug interactions associated with this form of thyroid hormone therapy.  With full understanding of the potential drug:drug interactions, which of the following medications would not be problematic if prescribed for this patient?

Amitriptyline (Elvail)

Amoxicillin

Anti-coagulants

Amoxicillin

Antacids

7 The thiazolidinediones are one of the drug classes used to treat type 2 diabetes.  Included in this category of drug are Avandia and Actos.  This class of drugs is contraindicated for use in which of the following patients?

Older adults

Heart failure patients

Obese patients

Alcoholics

Heart failure patients

8 You are seeing a new older African-American male patient who comes into the office wanting to have his blood pressure checked.  The patient has a long-standing history of poorly controlled hypertension secondary to not being seen by a provider or obtaining medication.  He does not monitor his BP and his reading today is 197/86. Reports he drinks a 12 pack of beer daily. He reports an allergy to ‘Sulfa’ drugs breaking out in a miserable rash.  You do a urine dip in the office and note it is positive for 1+ glucose and protein.  Based on these findings you suspect the patient has undiagnosed diabetes type 2.  You order labs and the results come back with a random glucose value of 193, HgbA1C 8.5, a serum creatinine of 1.6mg/dL (ref range for a male is 0.70 – 1.2mg/dL for a male) and elevated LFTs (2-3x above normal range).  You negotiate with the patient a medication regimen for both his newly diagnosed diabetes and his long-standing hypertension.  Which of the following is the appropriate medication regimen for this patient?

Metformin and calcium channel blocker

Victoza and ACE inhibitor

Metformin and ACE inhibitor

Victoza and calcium channel blocker

9 The African-American male patient from the prior question has limited financial resources.  Understanding the need to assess the patient’s social determinants of health you engage the office staff in efforts to find resources for the patient to obtain his Victoza.  From your experience you know that a valuable resource for this medication is which of the following?

A prescription payment plan

The $4 list at Walmart

A patient assistance program

The $10 list at Walmart

10 With a clear understanding of the pathophysiology associated with hyperthyroidism, the advanced practice nurse identifies which of the following groupings may be utilized to treat this endocrine disorder?

Corticosteroids and antibiotics

Anti-thyroid medications, anti-inflammatories, ACE inhibitors

Corticosteroids and calcium channel blockers

Anti-thyroid medications, anti-inflammatories, beta blockers

Anti-thyroid medications, anti-inflammatories, beta blockers

11 You are Caring for a 57-year-old female with a history of ulcerative colitis.  For years she has not taken care of herself and her recent labs demonstrate a HgbA1C of 12.3 and a fasting glucose of 289 mg/dL.  Her serum creatinine is 0.9mg/dL (ref range 0.5-1.0mg/dL for a female).  Knowing the ADA diabetes care management standards direct for the use of Metformin as the initial line of treatment for diabetes type 2, what would you want to make sure you tell this patient about the adverse events associated with this drug?

Side effects include N&V, diarrhea and anorexia

Due to its mechanism of action it can cause hypoglycemia

It cannot be combined with a healthy dietary lifestyle

Side effects include N&V, diarrhea and anorexia

She will not need to have her labs checked for 6 months

12 You are working with an individual newly diagnosed with type 2 diabetes.  The patient reports they can adhere to the appropriate dietary lifestyle and want to trial this along with something 'natural' in addition to dietary changes to see if they can bring their fasting blood glucose level down.  Based on USDA research, which of the following can the advanced practice nurse recommend?

Tumeric

Cinnamon

Cinnamon

Niacin

Licorice

13 A patient reports to you that they utilize glargine (Lantus) insulin for management of their type 2 diabetes.  You know that Lantus is an insulin analogue that has no peak with a duration of 24 hours.  Based on this understanding, your recommended dosing for Lantus would be:

 Before meals

Once a day

Before breakfast and dinner

With Humalog together in a syringe

14 One of your post-menopausal patients recently weaned off her Estradiol that she had been on for about 5 years.  She complains of feeling anxious, having palpitations and losing her hair at a rapid pace.  As a starting point for working up the patient you ordered a ‘health panel’.  Lab results were within the normal ranges except for her TSH level came back at <0.01 mU/l (ref range 0.4 – 4.0 mU/l).  Based on her symptoms and her TSH level you diagnose her with hyperthyroidism (Grave’s Disease).  The advanced practice nurse anticipates the initiation of which of the following medications?

Levothyroxine (Synthroid, Levoxyl, etc.)

Liothyronine sodium (Cytomel)

Methimazole (Tapazole)

Levothyroxine/Liothyronine combo (Armour Thyroid, NP, etc.)

15 Although reported to be less of a problem with Methimazole (Tapazole) than with Propylthiouracil (PTU), patients on antithyroid drug patients are at risk for the development of the adverse event of agranulocytosis.  Understanding the pharmacotherapeutic and adverse effects, which of the following lab order sets would the advanced practice nurse routinely monitor for patients on Tapazole?

 TSH, free T4 and CBC with differential

CBC with differential

TSH, free T4 and CBC with differential

TSH, free T4 and CBC

CBC without differential

16 Initiation of thyroid hormone replacement commenced 4 weeks ago for your 41-year-old female patient.  With your knowledge that the half-life of synthetic T4 (Synthroid, Levoxyl, etc.), the optimum window to obtain another TSH on this patient is which of the following?

 4 to 6 weeks

2 to 4 weeks

6 to 8 weeks

1 to 2 weeks

17 A 9-year-old child with type 1 diabetes is in your office for evaluation.  You know that about 3 months ago the child was hospitalized for an elevated glucose level, elevated T4 and ketonuria.  The parents indicate they have been doing very well with managing glucose levels until recently.  They report that for the past three mornings the patient has had elevated blood glucose levels with glucose levels in the target range the rest of the day.  They are measuring his blood glucose at 6:30am and currently dosing his evening dose of NPH insulin at 6:00pm.  Understanding the actions of insulin you recommend which of the following?

Decrease evening dose of NPH insulin which works from bedtime to morning

Increase evening dose of regular insulin which works from bedtime to morning

Increase the evening does of NPH insulin that works from bedtime to morning

Decrease evening dose of regular insulin that works from bedtime to morning

Increase the evening does of NPH insulin that works from bedtime to morning

18 Your best friend’s mother-in-law is a patient in an assisted living facility.  She has been doing well and is considered a social butterfly as she is highly engaged with the staff and the other residents. The patient’s medications include Metformin 500mg BID for type 2 diabetes and Lisinopril 20mg a day for both HTN and preservation of renal function.  The patient develops a severe case of c. diff after receiving a round of clindamycin for a dental infection.  Within five days of developing the c.diff the patient dies despite treatment with oral vancomycin.  A review of her medication administration record reveals no interruption of any of her medications. Understanding the mechanism of action and the adverse events associated with the patient’s drug regimen you suspect which of the following adverse event lead to her death?

A deep vein thrombosis secondary to being confined to be

Severe dehydration secondary to the c. diff

Lactic acidosis secondary to continuance of Metformin

Loss of a will to live secondary to embarrassment

Lactic acidosis secondary to continuance of Metformin

19 You are seeing a new patient to the practice.  The patient is 66 years old and is on metoprolol Xl for management of PSVT and HCTZ for her blood pressure.  She states she has been thirstier lately and wonders if that has something to do with her HCTZ. As a part of your work up you order a ‘health panel’.  The patient’s fasting glucose is 157, creatinine is 1.0, and her TSH is 3.0.  Based on her symptoms and her lab results she is diagnosed with type 2 diabetes.  With your knowledge of pharmacodynamics and pharmacotherapeutics, you recognize there is a need for a change in her current medications due to which of the following?

Diuretics and beta blockers decrease insulin sensitivity

Diuretics and beta blockers increase insulin sensitivity

Beta blockers cause renal nephropathy

Diuretics and beta blockers increase insulin sensitivity

Beta blockers cause peripheral neuropathy

20 A patient comes in with complaints of fatigue, weight gain, dry skin, cold intolerance and abnormally heavy menstrual activity for the last 3 or 4 months.  She is 29 years old and had her last baby a little over a year ago.  She just recently weaned the baby off the breast.  Her vital signs today are a BP of 100/60 and a pulse of 56.  On exam you note excessively dry skin, a mild goiter and a delayed Achilles reflex.  You order labs and of note her TSH comes back at 53 mU/l (reference 0.4 – 4.0 mUl).  Based on her history, her symptoms, your exam and her lab results she is diagnosed with hypothyroidism.  Which of the following does the advanced practice nurse anticipate will be prescribed for this patient?

Levothyroxine 100mcg a day

Levothyroxine 12.5mcg a day

Levothyroxine 100mcg a day

Levothyroxine 250 mcg a day

Levothyroxine 0.5mcg a day