NR565 Week 5 Endocrine System Case Study

I understand the value of doing my own work and learning this skill to support my future independent practice

as a nurse practitioner. I understand that while there may be opportunities beyond my faculty’s control to collaborate or share answers with peers, that it would not benefit my own personal and professional growth to do so. I agree to do my own work and take personal responsibility for my learning.

I do not.

I do.

Use the John Jones case study to answer the following question.

Which glucose level equates with a Hgb A1C of 8.1%?

~204 mg/dl

~160 mg/dl

~175 mg/dl

~183 mg/dl

Use the John Jones case study to answer the following question.

John calls the office and reports that he is scheduled for diagnostic testing that requires IV contrast for imaging. He inquires if there are concerns with undergoing this procedure while taking his medications. What instructions should be given to John regarding his metformin regimen?

Don’t take the metformin the day of the procedure and for 48 hours afterward.

 Take the metformin the morning of the procedure but don’t take it for 48 hours afterward.

Don’t take the metformin the day of the procedure but resume the following day.

Use the John Jones case study to answer the following question.

Which of the following lab test should be evaluated before prescribing metformin?

Complete blood count (CBC)

Complete metabolic profile (CMP)

Lipid Panel

Urinalysis

Use the John Jones case study to answer the following question.

Which behavior in John’s social history poses a potential concern with initiating metformin?

His diet largely consists of fast-food meals. He drinks sweet tea with every meal.

He reports drinking “a few beers on the weekend during football season”.

 He drinks 3-4 cups of coffee per day.

Use the John Jones case study to answer the following question.

Metformin works by decreasing               and        .

glucogenesis; incretin secretion

incretin secretion; insulin production

glucogenesis; insulin resistance

insulin resistance; incretin secretion

Use the John Jones case study to answer the following question.

Using the ADA Standards of Medical Care in Diabetes-2020, which of the following medications should be prescribed for John?

Canagliflozin

Glyburide

Dulaglutide

 Metformin

Use the John Jones case study to answer the following question.

Which of the following statements best describes John’s status?

He has diabetes and requires pharmacological intervention.

He does not have diabetes.

He has diabetes but does not require pharmacological intervention.

He has pre-diabetes.

Use the John Jones case study to answer the following question.

John’s triglycerides are 260 mg/dl and his HDL is 35mg/dl. Referring to the ADA Standards of Medical Care in Diabetes-2020, what is the correct action to take at this time?

Increase John’s atorvastatin to 20mg per day.

Leave John’s atorvastatin as is and re-check lipids when A1C is re-checked.

 Increase John’s atorvastatin to 40 mg per day.

Stop John’s atorvastatin since he is now being treated for diabetes.

Use the John Jones case study to answer the following question.

What is the recommended interval for monitoring John’s HgbA1C?

1-month

6-weeks

3-months

6-months

 

Use the John Jones case study to answer the following question.

Which of John’s behaviors should be addressed to encourage lifestyle changes and decrease A1C levels? Select all that apply.

He drinks 3-4 cups of coffee per day.

 Sits at a desk several hours a day.

Weight 235lbs

His diet largely consists of fast-food meals. He drinks sweet tea with every meal.

Family history is significant for diabetes.

BP 130/90

Use the Alfonso Giuliani case study to answer the following question.

Which lab test is necessary to evaluate before prescribing a sodium/glucose cotransporter-2 inhibitor (SGLT2i)?

CBC

LFTs

HgbA1C

CMP

Use the Alfonso Giuliani case study to answer the following question.

 Alfonso should be started on statin therapy to address his high total cholesterol and low HDL.

True

False

Identify SGLT2i agents in the list below. Select all that apply.

linagliptin

dapagliflozin

alogliptin

sitagliptin

saxagliptin

canagliflozin

empagliflozin

Question 15        Use the ASCVD Risk Estimator-Plus calculator (Links to an external site.) to estimate Alfonso’s ASCVD Risk score. Which of the following scores is his ASCVD Risk score?

 31.2%

37.6%

46.5%

52.1%

Alfonso’s ASCVD Risk score is 46.5% according to ASCVD Risk Estimator-Plus tool, which estimates risk based on age, gender, presence of diabetes, treatment for hypertension, cholesterol values, and systolic pressure.

Use the Alfonso Giuliani case study to answer the following question.

Which of the following benefits from GLP-1 therapy are helpful to Alfonso? Select all that apply.

appetite suppression

weight loss

low risk for hypoglycemia

blood pressure control

Question 17        Which statin agents and dosages are consistent with the statin therapy intensity Alfonso needs? Select all that apply.

 Atorvastatin 10-20 mg Correct Answer Rosuvastatin 20-40 mg

Atorvastatin 40–80 mg

Pravastatin 40-80 mg

Use the Alfonso Giuliani case study to answer the following question.

Which of the following lab values are important to monitor while taking GLP-1 agents?

hemoglobin and hematocrit

amylase and lipase

aspartate transaminase & alkaline phosphatase

magnesium and calcium

Question 19        Identify GLP-1 agents in the list below. Select all that apply.

 exenatide

semaglutide

dulaglutide

lixisenatide

liraglutide

rosiglitazone

pioglitazone

albiglutide

.

Which of the following complications may be caused by GLP-1 agents?

diverticulitis

cholecystitis

pancreatitis

cellulitis

Use the Alfonso Giuliani case study to answer the following question.

Considering Alfonso’s ASCVD risk score, which of the following diabetic drug classes should be considered in addition to metformin?

TZD

SGLT2i

GLP-1

Sulfonylurea

Question 22        Use the Alfonso Giuliani case study to answer the following question. Which of the following types of statin therapy should be started for Alonso?

High-intensity statin therapy

Low-intensity statin therapy

Moderate-intensity statin therapy

Use the Helen Smith case study to answer the following question.

Helen’s has abnormal thyroid values:

TSH 24 mU/L

Free T4 0.2 ng/dl

What condition do these tests indicate?

Hashimoto’s thyroiditis

Hypothyroidism

Grave’s Disease

Hyperthyroidism

 What are the Black Box Warnings associated with NSAIDs? Select all that apply.

Increases risk for GI bleeding, ulceration, and perforation

Increases risk for cardiovascular thrombotic event

Increases all-cause mortality

Increases risk for serious skin reactions Black Box warning on NSAIDs:

Use the Helen Smith case study to answer the following question.

Which of the following criteria support’s Helen’s diagnosis of DM? (Select all that apply)

Glucose: 189 mg/dL

T. Cholesterol 240 mg/dl

Triglycerides 260 mg/dl

HgbA1C: 9.2%

nocturia

Use the Helen Smith case study to answer the following question.

If the standard starting dose of levothyroxine 1.6 mcg/kg/dose is prescribed for Helen, what is the correct dose?

200mcg

175mcg

300mcg

150mcg

Use the Helen Smith case study to answer the following question.

 Because metformin is contraindicated with her age.

Because only diabetic medication should be prescribed.

Because heart failure can predispose patients to lactic acidosis.

Because metformin interacts with her Irbesartan.

Use the Helen Smith case study to answer the following question.

Which of the following lab values require consideration for possible treatment?

Hgb 15.3 g/dL

Alkaline phosphatase: 50 U/L

Triglycerides 260 mg/dl

TSH 24 mU/L

Total Cholesterol 240 mg/dl

HDL 35 mg/dl

 LDL 120mg/dl

AST (aspartate aminotransferase): 20

Hct 48%

Free T4 0.2 ng/dl

Use the Helen Smith case study to answer the following question.

What is the daily maximum dose of levothyroxine?

700mcg/day

500mcg/day

300mcg/day

1000mcg/day

 Use the Helen Smith case study to answer the following question.

Which of the following medical conditions will determine Helen’s diabetes treatment regimen?

Obesity

Osteoarthritis

Dyslipidemia

Heart Failure

Use the Helen Smith case study to answer the following question.

Which DM drug class is contraindicated in patients with heart failure?

Sulfonylurea

Biguanide

GLP-1

TZD

Use the Helen Smith case study to answer the following question.

There is still one important issue to address with Helen today. Which of the following concerns requires addressing?

Heart failure

Fatigue

Weight

Cholesterol

Use the Helen Smith case study to answer the following question.

Which medication should be prescribed for Helen to address her thyroid levels?

Triiodothyronine

Methimazole

Levothyroxine

Propylthiouracil

Use the Helen Smith case study to answer the following question.

Medication lists should always be reviewed for evidence-based prescribing practices. Helen is taking Naproxen 500 mg PO every 12 hours.

What is the maximum dose of Naproxen per day (for 6 months)?

2000mg per day

1000mg per day

2500mg per day

1500mg per day

Use the Helen Smith case study to answer the following question.

Which of the following agents should be prescribed for Helen? (Independent searching may be required to find the answer to this question)

Glipizide

Dapagliflozin

Glimepiride

Pioglitazone

Use the Helen Smith case study to answer the following question.

Which of the following drug classes should be prescribed for Helen?

GLP-1

Biguanide

SGLTi

DPP-4i

Use the Helen Smith case study to answer the following question.

Which of the following is the recommended initial dose of levothyroxine for the general population?

1.2mcg/kg/dose daily

1.8 mcg/kg/dose daily

2.0 mcg/kg/dose daily

 1.6 mcg/kg/dose daily

In youth who are overweight or obese and have a new onset of diabetes with an A1C>8.5%, how much basal

insulin is recommended?

0.1 units/kg/da

0.8 units/kg/day

0.5 units/kg/day

1 unit/kg/day

When considering older adults in the treatment and management of diabetes, what special considerations

apply? Select all that apply.

Screening for geriatric syndromes

Current quality of life

Self-management abilities

A diabetic construction worker is seen for follow-up care. He has been taking metformin 1000mg PO twice daily for the last 3 months and his A1C is 8.7. Which section of the Standards of Medical Care in Diabetes—2020 best describes his treatment plan?

Cost is a major issue

Compelling need to minimize weight gain or promote weight loss

Compelling need to minimize hypoglycemia

ASCVD Predominates

Which of the following diabetic drug classes should be prescribed with metformin for a patient with a BMI of 52?

Select all that apply.

Insulin

TZD

 SGLT2i

GLP-1

Which of the following agents are recommended when hypoglycemia is a concern? Select all that apply,

Insulin

SGLT2i

DPP-4i

GLP-1

TZD

Sulfonylurea

 Which of the following hypertension drug classes are NOT recommended for the primary prevention of chronic

kidney disease in patients who have diabetes with normal blood pressure and GFR? (Select all that apply)

Angiotensin converting enzyme inhibitors

Calcium channel blockers

Angiotensin II receptor blockers

Thiazide diuretics 11.9

According to the ADA Standards of Medical Care in Diabetes-2020, what are the goals of care for diabetes?

Select all that apply.

Empower patients to manage their own disease process

Maintain constant control of blood sugar

Optimize quality of life

Exercise is recommended for all youth with type 1 diabetes with the goal of        min of moderate-to-vigorous

intensity aerobic activity daily, with vigorous muscle-strengthening and bone-strengthening activities at least   

days per week.

60;3

30;3

50;5

45;5

Which of the following is the preferred medication for treating hyperglycemia in gestational diabetes?

 Insulin

DPP-4i

GLP-1

Metformin

TZD

Glyburide

SGLT2i

Which classes of oral diabetic drugs carry a higher risk for hypoglycemia? (Select all that apply)

SGLT-2 inhibitors

Sulfonylureas

Biguanides

α-glucosidase inhibitors

Glinides

Which of the following DM drug class has a warning that it can cause severe and disabling joint pain at any

point in time during treatment?

Metformin

SGLT2i

DPP-4i

Insulin

Glyburide

TZD

GLP-1

Which of the following exams is important for diabetics and requires a referral?

 Eye exam

Foot exam

Gait evaluation

A single mom who makes minimum wage and struggles financially needs an additional diabetic medication

after experiencing minimal A1C improvement with metformin. Which of the following DM drugs is appropriate? Select all that apply.

Dulaglutide

Sitagliptin

Canagliflozin

Glyburide

Pioglitazone

Glucophage

NPH

Match the A1C testing recommendations to the correct patient.

Perform the A1C test at least two times a year

Perform the A1C test quarterly

A1C Testing Recommendations

                Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). E

                Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. E

                Point-of-care testing for A1C provides the opportunity for more timely treatment changes. E