Chapter 14: Endocrine, Metabolic, and Nutritional Disorders Flashcards
An elderly client presents with a new onset of feeling her heart race and fatigue. An EKG reveals atrial fibrillation with rate >110. The patient also has a new fine tremor of both hands. Which of the following would the nurse practitioner suspect?
Hyperthyroidism
A 62-year-old female complains of fatigue and lack of energy. Constipation has increased and the patient has gained ten pounds in the past 3 months. Depression is denied although the patient reports a lack of interest in usual hobbies. Vital signs are within normal limits and the patient’s skin is dry and cool. Which of the following must be included in the differential?
Hypothyroidism
Mrs. Black, an 87-year-old patient, has been taking 100 mcg of Synthroid for 10 years. She comes to your office for a routine follow-up, feeling well. Her heart rate is 90. Your first response is to:
Order TSH
Which patient is most likely to have osteoporosis?
An 80-year-old underweight male who smokes and has been on steroids for psoriasis
When evaluating the expected outcome for a hypothyroid elderly patient placed on levothyroxine, the nurse practitioner will:
Assess the TSH in 4-6 weeks
A postmenopausal woman with osteoporosis is taking a bisphosphonate daily by mouth. What action information statement would indicate the patient understood the nurse practitioner’s instructions regarding this medication?
Takes medication with a full glass of water when up in a.m. 30 minutes prior to other food and medications
The primary reason levothyroxine sodium is initiated at a low dose in an elderly patient with hypothyroidism is to prevent which of the following untoward effects?
Angina and arrhythmia
Six months ago an elderly patient was diagnosed with subclinical hypothyroidism. Today the patient returns and has a TSH of 11.0 and complains of fatigue. He has taken Synthroid 25 mcg daily as prescribed. What is the best course of action for the nurse practitioner?
Double the dose of Synthroid
A fluoroquinolone (Ciprofloxin) is prescribed for a male patient with a UTI. What should the nurse practitioner teach the patient regarding taking this medication?
Its effectiveness is decreased by antacids, iron, or caffeine ingestion
A patient has been prescribed metformin (Glucophage). One week later he returns with lowered blood sugars but complains of some loose stools during the week. How should the nurse practitioner respond?
Reassure the patient that this is an anticipated side effect
Which of the following signs of hyperthyroidism commonly manifest in younger populations, but is notably lacking in the elderly?
Exophthalmos
A 60-year-old obese male client has type 2 diabetes mellitus and a lipid panel of TC = 250, HDL = 32, LDL = 165. The nurse practitioner teaches the patient about his modifiable cardiac risk factors, which include:
Diabetes, obesity, and hyperlipidemia
A diabetic patient presents with the complaint of right foot pain but denies any recent known injury. He states it has gotten progressively worse over the past few months. On exam, vibratory sense, as well as sensation tested with a monofilament, was abnormal. The patient’s foot is warm, edematous, and misshapen. The nurse practitioner suspects Charcot foot. What intervention is indicated?
Referral to an orthopedist
What is a sign of insulin resistance that can present in African American patients?
Acanthosis Nigricans
During a routine physical examination of a 62-year-old female patient, the nurse practitioner identifies xanthelasma around both his eyes. What is the significance of this finding?
Abnormal lipid metabolism requiring medical management
