diabetic Leik questions

Question 1

All of the following are not recommended for the outpatient treatment of mild pre eclampsia except:

a. severe sodium restriction
b. restrict fluid intake to less than 1 liter per 24 hours
c. aldomet (methyldopa) 250 mg po bid
d. bed rest on the left side with bathroom priviledges

Answer 1

d.

Outpatient treatment for mild preeclampsia includes bed rest on the left lateral side with bathroom priviledges.

Question 2

The NP who suspects that one of her hypertensive patients has Cushing’s syndrome would expect to find which of the following laboratory results?

a. hyponatremia
b. hypoglycemia
c. elevated serum cortisol levels
d. decreased urine 17 ketosteroids

Answer 2

C

Question 3

A 55 year old woman who has type 2 diabetes is concerned about her kidneys. She has a history of 3 UTIs within the past 8 months. She denies dysuria, and frequency at this visit. Which of the following is the best initial course to follow?
a. recheck the patients urine and order a urine for culture and sensitivitiy
b. order an IVP (intravenous pyelogram)
c. advise the patient to follow up with a urologist
evaluate the patient for a possible kidney infection

Answer 3

A
a UTI is defined as the presence of 100,000 organisms per mL of urine in asymptomatic patients or greater than 100 organisms per mL or urine with pyuria in a symptomatic patient

Question 4

A common side effect of metformin (Glucophage) is

a. weight gain
b. lactic acidosis
c. hypoglycemic episodes
d. gastrointestinal problems

Answer 4

D

Question 5

The following are patients who are at high risk for complications due to UTIs. Who does not belong in this category?.

a. 38 year old diabetic patient with A1c of 8.5%
b. a woman with a history of rheumatoid arthritis who is currently being treated with a regimen of methotrexate and low dose steroids
c. a 21 year old woman who is under treatment for 2 sexually transmitted diseases
d. pregnant woman

Answer 5

C

Question 6

Carol, a 30 year old, type 2 diabetic, is on regular insulin and lente insulin in the morning and in the evening. She denies changes in her diet or any illness, but recently started attending aerobic classes in the afternoon. Because of her workouts, her blood sugars have dipped below 50 mg/dL very early in the morning. her fasting blood sugar before breakfast is now elevated and higher than normal. Which of the following is best described?

a. somogyi phenomenon
b. dawn phenomenon
c. raynauds phenonmenon
d. insulin resistance

Answer 6

A
The somogyi phenomenon is when nocturnal hypoglycemia (2-3 a.m.) stimulates the liver to produce glucagon to raise the blood sugar. The fasting blood glucose levels will be elevated from this glucagon production.

Question 7

Which of the following would you recommend on an annual basis for an elderly type 2 diabetic?

a. eye exam with ophthalmologist
b. follow up visit with urologist
c. periodic visits to an optometrist
d. colonoscopy

Answer 7

A
Elderly patients with type 2 diabetes should have a dilated eye exam done annually by an ophthalmologist. It is also recommended to see a podiatrist once or twice a year. Preventative care also includes receiving a flu shot annually, receiving a pneumovax vaccine if over 60 years of age and taking a baby aspirin of 81mg each day

Question 8

Ken has type 2 diabetes and a “sensitive stomach.” Which medication is least likely to cause him GI distress:

a. naproxen sodium (anaprox)
b. aspirin
c. erythromycin
d. sucralfate (caralfate)

Answer 8

D
Sucralfate is used to protect the stomach lining by building a protective layer over the stomach lining; it allows healing to occur

Question 9

Which chronic illness disproportionately affects the Hispanic population?

a. diabetes mellitus
b. hypertension
c. alcohol abuse
d. skin cancer

Answer 9

A

DM is 2-3x higher in Mexican Americans versus non Hispanic americans

Question 10

Jim Wheeler is obese (BMI of 33), fatigued, and complaining of excessive thirst and hunger. You suspect type 2 diabetes mellitus. Initial testing to confirm diagnosis can include:

a. fasting plasma glucose level
b. glycosylated hemoglobin level (HbA1c)
c. glucose tolerance test
d. all of the above

Answer 10

D
Type 2 diabetes mellitus screening tests include:
fasting plasma glucose level >126 mg/dL
random plasma glucose level >200 mg/dL
glucose tolerance test >200 at 2 hours post 75g glucose load
Normal hbg A1c is <5.7%

Question 11

A 65 year old Hispanic woman has a history of type 2 diabetes. A routine urinalysis reveals a few epithelial cells and is negative for leukocytes, nitrites and protein. Which of the following would you recommend next?

a. order a urine C and S
b. order a 24 hour microalbumin
c. because it is negative, no further tests are necessary
d. recommend a screening IVP

Answer 11

B

With her history of type 2 diabetes, a 24 hour urine test for microalbumin should be ordered to assess kidney function.

Question 12

John, a 10 year old boy, has type 1 diabetes. His late afternoon blood sugars over the past 2 weeks have ranged between 210-230 mg/dL. He is currently on 10 units of regular insulin and 25 units of NPH in the morning and 15 units of regular insulin and 10 units of NPH in the evening. Which of the following is the best treatment plan for this patient?

a. increase both types of the morning dose
b. increase only the NPH insulin in the morning
c. decrease the afternoon dose of NPH insulin
d. decrease both the NPH and regular insulin doses in the morning.

Answer 12

B
Increase in the morning NPH is recommended to affect the late afternoon blood sugars. Increasing the NPH will lower the afternoon blood sugar readings. NPH is a long acting insulin, with onset beginning 1-2 hours and peaking in approximately 6-8 hours. Duration of NPH is approximately 18-24 hours.

Question 13

When a patient is suspected of having acute pancreatitis, initial testing should include all of the following except:

a. electrolyte panel
b. serum amylase level
c. serum lipase level
d. a barium swallow

Answer 13

D

Question 14

All of the following patients have an increased risk of developing adverse effects from metformin (Glucophage) except:

a. patients with renal disease
b. patients with hypoxia
c. obese patients
d. patients who are alcoholics

Answer 14

C
Metformin is used as a hyperglycemic agent for NIDDM. However, increased mortality has been associated with drug induced lactic acidosis.
Contraindications for use of metformin include patients with:
significant renal and hepatic disease
alcoholism
conditions associated with hypoxia (cardiac/pulmonary problems)
sepsis
dehydration
advanced age

Question 15

Which of the following classes of drugs is implicated with blunting the signs and symptoms of hypoglycemia in diabetics?

a. CCBs
b. . diuretics
c. beta-blockers
d. ARBs

Answer 15

C

Question 16

A newly diagnosed middle aged type 2 diabetic wants to start an exercise program. All of the following statements are true except:

a. if the patient is unable to eat due to illness, anti diabetic agents can be continued with frequent glucose monitoring.
b. strenuous exercise is contraindicated for type 2 diabetes because of a higher risk of hypoglycemic episodes
c. exercise increases the bodys ability to metabolize glucose
d. patients who exercise vigorously in the afternoon may have hypoglycemia episodes in the evening or at night if they do not eat.

Answer 16

B
Exercise is recommended because exercise helps to use the glucose stores and reduce blood sugar. Blood sugar should be monitored closely, especially if on insulin, when exercising to avoid hypoglycemia

Question 17

Your newly diagnosed diabetic patient reports to you that she has severe hives and swollen lips when she took Bactrim for a bladder infection 2 months ago. Which of the following statements is correct?

a. she cannot take any pills in the sulfonylurea class
b. she can take some of the pills in the sulfonylurea class
c. she can take any of the pills in the sulfonylurea class
d. none of the above

Answer 17

A

Question 18

All of the following patients should be screened for diabetes mellitus except:

a. an obese man of Hispanic descent
b. an overweight middle aged black woman whose mother has type 2 diabetes
c. a woman who delivered an infant weighing 9.5 lbs
d. a 30 year old white man with hypertension

Answer 18

D
Obesity, ethnicity, family history of diabetes, and gestational diabetes are all risk factors for diabetes. Other risk factors for diabetes include impaired glucose tolerance test, sedentary lifestyle, PCOS and hypertension.

Question 19

The somogyi effect is characterized by which of the following?

a. it is a complication of high levels of growth hormones
b. it is the physiologic spike of serum blood glucose in the early morning
c. it is characterized by high fasting blood glucose in the morning
d. it is a rare phenomenon that only occurs in type 1 diabetic patients.

Answer 19

B

Question 20

Acanthosis nigricans is associated with all of the following disorders except;

a. obesity
b. diabetes
c. colon cancer
d. tinea versicolor

Answer 20

D
it is a benign skin condition. It appears as hyperpigmented velvety areas of skin that are usually located on the neck and the axillae. it is a sign of insulin resistance.

Question 21

Mrs. Nottam, who has a BMI of 29, has a 20 year history of primary hypertension. She has been on HCTZ 25mg PO daily with excellent results. On this visit, she is complaining of feeling thirsty all the time even though she drinks more than 10 glasses of water per day. she reports to the NP that she has been having this problem for 6 months. Upon reading the chart, the NP notes that the last 2 fasting blood glucose levels have been 140 mg/dL and 168 mg/dL. A random blood glucose is at 210 mg/dL. Which of the following is the best treatment plan to follow at this visit?

a. order another random blood glucose test in 2 weeks
b. initiate a prescription of metformin 500 mg PO BID
c. order a 3 hour glucose tolerance test
d. order an A1c level

Answer 21

B
Initiating metformin is recommended because she has met the criteria for diagnosis of diabetes. Criteria for diagnosing diabetes:
fasting blood glucose >126 mg/dL
2 hours blood glucose >200 mg/dL
symptoms of diabetes: polyuria, polydipsia and polyphagia)
and random blood glucose greater than 200 mg/dL