NR565 Week 5 Endocrine System Case Study - Helen Smith (1)

Question 1 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. 

Question 2 Use the Helen Smith case study to answer the following question.

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

   Dyslipidemia

   Obesity

   Heart Failure

   Osteoarthritis

Question 3 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)

   Glimepiride

   Pioglitazone

Dapagliflozin

   Glipizide

Question 4 What are the Black Box Warnings associated with NSAIDs? Select all that apply.

Increases risk for serious skin reactions

   Increases all-cause mortality

Increases risk for cardiovascular thrombotic event

   Increases risk for GI bleeding, ulceration, and perforation

Black Box warning on NSAIDs:

Question 5 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?

 Cholesterol

Weight

   Fatigue

   Heart failure

Question 6 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?

175mcg

   200mcg

   300mcg

   150mcg

Question 7 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

   Hyperthyroidism

Hypothyroidism

   Grave’s Disease

 Question 8 Use the Helen Smith case study to answer the following question.

What is the daily maximum dose of levothyroxine?

1000mcg/day

300mcg/day

500mcg/day

700mcg/day

Question 9 Use the Helen Smith case study to answer the following question.

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

LDL?120mg/dl

   Free T4 0.2 ng/dl

   TSH 24 mU/L

Hgb?15.3?g/dL

Hct?48%

AST?(aspartate aminotransferase): 20

HDL?35?mg/dl

Triglycerides?260?mg/dl

Total?Cholesterol?240?mg/dl

   ALT?(alanine aminotransferase): 18 U/L

   Alkaline phosphatase: 50 U/L

The following lab values require consideration for possible treatment as they are not within normal limits:

Total?Cholesterol?240?mg/dl?

HDL?35?mg/dl?

LDL?120mg/dl?

Triglycerides?260?mg/dl?

TSH 24 mU/L

Free T4 0.2 ng/dl

 Question 10 Use the Helen Smith case study to answer the following question.

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

SGLTi

DPP-4i

GLP-1

   Biguanide

Question 11 Use the Helen Smith case study to answer the following question.

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

Triiodothyronine

   Propylthiouracil

Methimazole

Levothyroxine

Question 12 Use the Helen Smith case study to answer the following question.

Why is caution indicated if metformin was prescribed for Helen?

 Because heart failure can predispose patients to lactic acidosis.

   Because metformin interacts with her Irbesartan.

Because only diabetic medication should be prescribed.

Because metformin is contraindicated with her age.

Question 13 Use the Helen Smith case study to answer the following question.

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

GLP-1

Sulfonylurea

Biguanide

TZD

Question 14 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.

Triglycerides?260?mg/dl

nocturia

polyuria

T.?Cholesterol?240?mg/dl

HgbA1C: 9.2%

Question 15 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

   1500mg per day

   1000mg per day

   2500mg per day

Question 16 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

1.6 mcg/kg/dose daily

1.8 mcg/kg/dose daily

2.0 mcg/kg/dose daily

Question 17 Which of the following diabetic drug classes should be prescribed with metformin for a patient with a BMI of 52? Select all that apply. 

TZD

SGLT2i

Insulin

GLP-1

   DPP-4i

Question 18 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.?

   45;5

30;3

50;5

60;3

Question 19 Which of the following agents are recommended when hypoglycemia is a concern? Select all that apply, 

SGLT2i

TZD

GLP-1

DPP-4i

Sulfonylurea

Insulin

Question 20 Which of the following is the preferred medication for treating hyperglycemia in gestational diabetes? 

Metformin

GLP-1

SGLT2i

Insulin

TZD

Glyburide

DPP-4i

 Question 21 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

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

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

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

Question 22 When considering older adults in the treatment and management of diabetes, what special considerations apply? Select all that apply. 

Social geriatric domains

Screening for geriatric syndromes

   Mini-Cognitive Assessment Instrument

Self-management abilities

Question 23 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

   Prevent diabetic complications

Maintain constant control of blood sugar

   Optimize quality of life

 Question 24 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?

 Glyburide

GLP-1

TZD

   SGLT2i

   Metformin

Insulin

DPP-4i

DPP-4i has a warning that these medications can cause severe and disabling joint pain at any point in time during treatment.

 Question 25 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? 

1 unit/kg/day

0.5 units/kg/day

0.1 units/kg/day

   0.8 units/kg/day

Question 26 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)

Thiazide diuretics

Angiotensin converting enzyme inhibitors

Calcium channel blockers

Angiotensin II receptor blockers

11.9?

Question 27 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? 

Compelling need to minimize weight gain or promote weight loss

Compelling need to minimize hypoglycemia

ASCVD Predominates

Cost is a major issue

Question 28 Which of the following exams is important for diabetics and requires a referral? 

Foot exam

Eye exam

   Gait evaluation

   Colonoscopy

Question 29 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. 

Sitagliptin

Dulaglutide

   Glucophage

Canagliflozin

Pioglitazone

Glyburide

Humalog

Question 30 Which classes of oral diabetic drugs carry a higher risk for hypoglycemia?

   SGLT-2 inhibitors

α-glucosidase inhibitors

Sulfonylureas

Biguanides

Glinides