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MARYVILLE NURS 623 EXAM 2
VERIFIED QUESTIONS & ANSWERS
1. Which of the serum laboratory findings are present in the client with
Cushing's syndrome? ANS Increased cortisol, HYPERnatremia, and HYPOkalemia
2. Alice, age 48, has a benign thyroid nodule. The most common treatment
involves ANS Watchful waiting with an annual follow-up
3. ACE inhibitors are given to clients with diabetes who have
ANS persistent proteinuria
4. 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? ANS metformin
5. An elderly client with hyperthyroidism may present with atypical symp-
toms. Which of the following manifestations are commonly seen in the el- derly with hyperthyroidism? ANS a-fib, depression, weight loss
6. Diane has had Cushing's disease for 20 years and has been taking hydro-
cortisone 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?
ANS excessive levels of cortisol
7. 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? ANS increase A.M. insulin
8. 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? ANS "Let's try it. You're glycohemoglobin will be lowered and you may lose weight."
9. Which is the only treatment option that is curative for primary hyper-
parathyroidism? ANS parathyroidectomy
10. The most common worldwide cause of hypothyroidism is
ANS iodine deficien- cy
11. What should be assessed for during exam on pt with HYPOparathy-
roidism? ANS chvostek's sign
12. 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 ANS ADD LONG-ACTING INSULIN
23. What are signs and symptoms of hypothyroidism overtreatment?
ANS hyper- glycemia; cardiac arrhythmias (Afib); adrenal insufficiency; increased myxedema.
24. Hyperthyroidism causes an excessive secretion of which thyroid hor-
mones? ANS T3 & T
25. What are S/S of hyperthyroidism?
ANS "Hot/buldging/fast" heat intolerance, eye buldge, tachycardia, weight loss, diarrhea, systolic HTN, enlarged thyroid
26. What are S/S of HYPOthyroidism?
ANS "cold, slow, tired" cold intolerance, slow speech, fatigue, lethargy, weight gain, constipation, brittle nail/hair
27. What is the most common cause of hyperthyroidism?
ANS Graves disease
28. Name the two thyroid hormones produced by the thyroid gland?
ANS T3 & T
29. Name the hormone produced by the pituitary gland, state the purpose of
the hormone ANS TSH; regulate the production of hormones by the thyroid gland
30. IN GRAVES DISEASE THE THE TSH IS AND THE T3/T4 ARE
ANS LOW; HIGH
31. IN HASHIMOTO'S DISEASE THE THE TSH IS AND THE
T3/T4 ARE
ANS HIGH; LOW
39. WHAT works by inhibiting thyroid hormone synthesis at multiple steps.
They are used as a treatment to reduce the level of hormone on initiation of radioactive iodine therapy,( not used as primary or sole treatment) ANS - ANTI-THYROID MED (Propylthiouracil (PTU) Methimazole (MMI)
40. What should those treated with radioactive die be aware of?
ANS AVOID CONTACT WITH INFANTS, CHILDREN, AND PREGNANT WOMEN FOR
7 DAYS
41. What is the test that assesses the functional status (hot and cold spots) of
the thyroid gland to differentiate between Grave's disease and subacute thyroiditis and toxic nodular goiters? ANS RADIO IODINE UPTAKE SCAN
42. What is the gold standard test for confirming Hashimoto's?
ANS THYROID PEROXIDASE [TPO] ANTIBODY
43. What is the most common type of autoimmune hypothyroid in the US?
ANS -
HASHIMOTO'S
44. What would make you suspicious of thyroid cancer (clinical presenta-
tion)?
What is the reliable method of diagnosis? ANS PAINLESS LUMP OR NODULE IN THE NECK; FINE NEEDLE BIOPSY
45. What type of hypothyroidism does more than 95% of patients have where
there is dysfunction or atrophy of the thyroid gland due to failure of pituitary and/or hypothalamus? ANS CENTRAL HYPOTHYROIDISM
46. What is an endocrine emergency with signs and symptoms of slowed
cognitive thinking, poor short-term memory, depression or dementia, hy- potension and hypothermia with a mortality rate of 30-40%? ANS MYXEDEMA (SEVERE HYPOTHYROIDISM)
47. What are the common causes of hypercalcemia?
ANS PRIMARY HYPER- PARATHYROIDISM AND MALIGNANCY
48. the twitching of the facial muscles in response to tapping over the facial
nerve 2 cm anterior to ear canal is considered a positive sign; what does it indicate? ANS CHVOSTEK'S SIGN; HYPOCALCEMIA
49. When should a referral be considered for patient with HYPERparathy-
roidism? ANS CALCIUM STARTS BECOMING HIGH
50. may be caused by cortisol hypersecretion by the adrenal cortex due to
cortical hypertrophy from a tumor of the adrenal gland or heavy use of glucosteriods ANS CUSHING'S SYNDROME
56. Clinical presentation of Addison's crisis
ANS Profound fatigue dehydration vascular collapse (“B/P) renal shutdown
57. What are the diagnostic criteria for DM2? List all the criteria.
ANS -FPG > 126
-RANDOM PLASMA GLUCOSE >
-GTT (2HR) > 200
-A1C > 6.
58. Which of the following can be initial testing to confirm diagnosis of DM2?
(select all that apply) -FASTING BLOOD (PLASMA) GLUCOSE -HGA1C -ORAL GLUCOSE TOLERANCE TEST ANS -FASTING BLOOD (PLASMA) GLU- COSE -HGA1C -ORAL GLUCOSE TOLERANCE TEST
59. Are there any contraindications for starting the recommended first
choice oral hyperglycemic medication? If so, what are the contraindica- tions? ANS -LIVER DISEASE
- HX ALCOHOLIC -KIDNEY DISEASE (GFR <30) -cardiopulmonary insufficiency
60. WHAT CONDITION PRESENTS WITH LACK OF INSULIN acute decompen-
sation; (MORE IN TYPE I DM) S/S ANS HYPERGLYCEMIA, KETONEMIA, ACIDOSIS; ANOREXIA, THIRST, N/V, ABDO CRAMP, KUSSMAUL RESP, DEHYDRATED, ALTERED CONSCIOUS- NESS ANS DKA
61. WHAT POPULATION IS MORE LIKE TO PRESENT WITH DKA?
ANS TYPE I DM
62. When a patient is diagnosed with DM I what are they likely to present
with? ANS DKA
63. Clinical presentation of DMI
ANS polydipsia, polyuria, polyphagia, anorexia, and weight loss.
64. WHAT CONDITION PRESENTS WITH INSIDIOUS ONSET SUBTLE INITIAL
SYMPTOMS (MORE IN TYPE II DM)
S/S HYPERGLYCEMIA, NO KETOSIS, HYPEROSMOLALITY; POLYURIA
first choice oral antihyperglycemic medicine long term and complains of neuropathy? Why? (hint hematological) ANS ÏVitamin B12 annually (CAN CAUSE B12 DEF)
72. What is the goal of treatment for DM2?
ANS A1C <7%; PREVENT FURTHER ORGAN DAMAGE
73. What subsequent laboratory tests are needed to evaluate the general
health of patients with DM2 (consider co-morbidities)? ANS CMP (liver, kidney, glucose), Lipids, serum creatinine, and urine albumin
74. What is the treatment for acute hypoglycemia in an alert patient?
ANS 6 to 12 ounces of orange juice or another fruit juice without additional sugar. One cup (8 oz) of milk can be substituted if juice is not available. Glucose tablets, If available
75. What is the primary cause of mortality in DM patients?
ANS ISCHEMIC HEART FAILURE
76. You are Seeing a patient in the office and you determine they need to
start insulin for DM2, what type of insulin would you select and how would you initiate their dosing regimen? ANS A1C <8% BASAL (LONG ACTING) 0.1-0.2 U/KG
A1C >8% BASAL (LONG ACTING) 0.2-0.3 U/KG
TITRATE EVERY 2-3 DAYS DEPENDING ON FINGER STICK GLUCOSE
77. Middle-aged man presents with a painful, hot, red, swollen MTP joint of
great toe. Precipitated by weekend of binge drinking. What is the likely diagnosis? ANS GOUT
78. What are the PRIMARY risk factors for gout?
ANS PRIMARY ENZYME DE- FECT & DECREASED RENAL CLEARANCE OF
URIC ACID
79. What are the SECONDARY risk factors for gout?
ANS EXCESSIVE PURINE OBESITY
STARVATION
ALCOHOL ABUSE
MEDS THIAZIDES, NIACIN
80. What diagnostic results would be seen with gout?
ANS elevated serum uric acid levels, ESR and WBCs;
81. What is the initial management for an acute attack of gout?
ANS COLCHICINE 1.2mg PO X 1 then 0.6mg in 1 hour (within 36 hrs of onset up to 0.6 mg) NSAIDs, AND CORTICOSTEROIDS; rest, elevation, immobilization
82. What is the subsequent pharmacological management used to prevent
further attacks of prophylaxis? ANS ALLOPURINOL (wait 4-6 week to after acute attack to start)
83. What educational information should you discuss with a patient diag-
