Dibetes FITZ Flashcards
- Which of the following characteristics applies to type 1 diabetes mellitus (DM)?
A. Significant hyperglycemia and ketoacidosis result
from lack of insulin.
B. This condition is commonly diagnosed on routine
examination or workup for other health problems.
C. Initial response to oral sulfonylureas is usually
favorable.
D. Insulin resistance (IR) is a significant part of the
disease.
A. Significant hyperglycemia and ketoacidosis result
from lack of insulin.
- Which of the following characteristics applies to
type 2 DM?
A. Major risk factors are heredity and obesity.
B. Pear-shaped body type is commonly found.
C. Exogenous insulin is needed for control of disease.
D. Physical activity enhances IR.
A. Major risk factors are heredity and obesity.
- You consider prescribing insulin glargine (Toujeo®,
Lantus®) because of its:
A. extended duration of action.
B. rapid onset of action.
C. ability to prevent diabetic end-organ damage.
D. ability to preserve pancreatic function.
A. extended duration of action.
4. After use, the onset of action of lispro (Humalog®) occurs in: A. less than 30 minutes. B. approximately 1 hour. C. 1 to 2 hours. D. 3 to 4 hours.
A. less than 30 minutes.
5. Which of the following medications should be used with caution in a person with severe sulfa allergy? A. metformin B. glyburide C. rosiglitazone D. NPH insulin
B. glyburide
- The mechanism of action of metformin (Glucophage®)
is as:
A. an insulin-production enhancer.
B. a product virtually identical in action to
sulfonylureas.
C. a drug that increases insulin action in the peripheral
tissues and reduces hepatic glucose production.
D. a facilitator of renal glucose excretion.
C. a drug that increases insulin action in the peripheral
tissues and reduces hepatic glucose production.
- Generally, testing for type 2 DM in asymptomatic,
undiagnosed individuals older than 45 years should
be conducted every .
A. year.
B. 3 years
C. 5 years
D. 10 years
B. 3 years
- You are seeing 17-year-old Amanda. As part of the
visit, you consider her risk factors for type 2 DM would
likely include all of the following except:
A. obesity.
B. Native American ancestry.
C. family history of type 1 DM.
D. personal history of polycystic ovary syndrome.
C. family history of type 1 DM.
- Criteria for the diagnosis of type 2 DM include:
A. classic symptoms regardless of fasting plasma
glucose measurement.
B. plasma glucose level of 126 mg/dL (7 mmol/L)
as a random measurement.
C. a 2-hour glucose measurement of 156 mg/dL
(8.6 mmol/L) after a 75 g anhydrous glucose load.
D. a plasma glucose level of 126 mg/dL (7 mmol/L)
or greater after an 8 hour or greater fast on more
than one occasion.
D. a plasma glucose level of 126 mg/dL (7 mmol/L)
or greater after an 8 hour or greater fast on more
than one occasion.
- The mechanism of action of pioglitazone is as:
A. an insulin-production enhancer.
B. a reducer of pancreatic glucose output.
C. an insulin sensitizer.
D. a facilitator of renal glucose excretion.
C. an insulin sensitizer.
- Which of the following should be the goal measurement in treating a 45-year-old man with DM and hypertension?
A. blood pressure less than 140 mm Hg systolic and less than 90 mm Hg diastolic
B. hemoglobin A1c equal to or greater than 7%
C. triglyceride 200 to 300 mg/dL (11.1 to 16.6 mmol/L)
D. high-density lipoprotein (HDL) 35 to 40 mg/dL
(0.9 to 1.03 mmol/L)
A. blood pressure less than 140 mm Hg systolic and less than 90 mm Hg diastolic
- In caring for a patient with DM, microalbuminuria
measurement should be obtained:
A. annually if urine protein is present.
B. periodically in relationship to glycemia control.
C. yearly.
D. with each office visit related to DM.
C. yearly.
- The mechanism of action of sulfonylureas is as:
A. an antagonist of insulin receptor site activity.
B. a product that enhances insulin release.
C. a facilitator of renal glucose excretion.
D. an agent that can reduce hepatic glucose production.
B. a product that enhances insulin release.
14. When caring for a patient with DM, hypertension, and persistent proteinuria, the nurse practitioner (NP) prioritizes the choice of antihypertension and prescribes: A. furosemide. B. methyldopa. C. fosinopril. D. nifedipine.
C. fosinopril.
- Clinical presentation of type 1 DM usually includes all of the following except:
A. report of recent unintended weight gain.
B. ketosis.
C. persistent thirst.
D. polyphagia.
A. report of recent unintended weight gain.
16. Which of the following should be periodically monitored with the use of a biguanide? A. creatine kinase (CK) B. alkaline phosphatase (ALP) C. alanine aminotransferase (ALT) D. creatinine (Cr)
D. creatinine (Cr)
17. Which of the following should be periodically monitored with the use of a thiazolidinedione? A. CK B. ALP C. ALT D. Cr
C. ALT
- All of the following are risks for lactic acidosis in
individuals taking metformin except:
A. presence of chronic renal insufficiency.
B. acute dehydration.
C. recent radiographic contrast dye use.
D. history of allergic reaction to sulfonamides.
D. history of allergic reaction to sulfonamides.
- Secondary causes of hyperglycemia potentially
include the use of all of the following medications
except:
A. high-dose niacin.
B. systemic corticosteroids.
C. high-dose thiazide diuretics.
D. low-dose angiotensin receptor blockers.
D. low-dose angiotensin receptor blockers.
20. Hemoglobin A1c best provides information on glucose control over the past: A. 21 to 47. B. 48 to 68. C. 69 to 89. D. 90 to 120.
D. 90 to 120.
- Which of the following statements is not true concerning the effects of exercise and IR?
A. Approximately 80% of the body’s insulin-mediated
glucose uptake occurs in skeletal muscle.
B. With regular aerobic exercise, IR is reduced by
approximately 40%.
C. The IR-reducing effects of exercise persist for
48 hours after the activity.
D. Hyperglycemia can occur as a result of aerobic
exercise.
D. Hyperglycemia can occur as a result of aerobic
exercise.
22 to 25. With an 8 a.m. dose of the following insulin
forms, followed by an inadequate dietary intake
and/or excessive energy use, at approximately
what time would hypoglycemia be most likely
to occur?
- lispro
Approximately 8:30 to
9:30 a.m. (with peak of
insulin dose)
22 to 25. With an 8 a.m. dose of the following insulin
forms, followed by an inadequate dietary intake
and/or excessive energy use, at approximately
what time would hypoglycemia be most likely
to occur?
- regular insulin
Approximately 10 to
11 a.m. (with peak of
insulin dose)
22 to 25. With an 8 a.m. dose of the following insulin
forms, followed by an inadequate dietary intake
and/or excessive energy use, at approximately
what time would hypoglycemia be most likely
to occur?
- NPH insulin
Approximately 2 to
10 p.m. (with peak of
insulin dose)
22 to 25. With an 8 a.m. dose of the following insulin
forms, followed by an inadequate dietary intake
and/or excessive energy use, at approximately
what time would hypoglycemia be most likely
to occur?
- insulin glargine (Toujeo®, Lantus®)
Because insulin glargine (Toujeo®, Lantus®) has no peak, an episode of hypoglycemia is unlikely. If hypoglycemia were to occur, the episode could be protracted if left untreated because of the protracted duration of activity of the medication.
- The meglitinide analogues are particularly
helpful adjuncts in type 2 DM care to minimize
risk of:
A. fasting hypoglycemia.
B. nocturnal hyperglycemia.
C. postprandial hyperglycemia.
D. postprandial hypoglycemia
C. postprandial hyperglycemia.
27. What is the most common adverse effect noted with alpha-glucosidase inhibitor use? A. gastrointestinal upset B. hepatotoxicity C. renal impairment D. symptomatic hypoglycemia
A. gastrointestinal upset
- Which of the following statements best describes the
Somogyi effect?
A. Insulin-induced hypoglycemia triggers excess
secretion of glucagon and cortisol, leading to
hyperglycemia.
B. Early morning elevated blood glucose levels result in
part from growth hormone and cortisol-triggering
hepatic glucose release.
C. Late evening hyperglycemia is induced by inadequate
insulin dose.
D. Episodes of postprandial hypoglycemia occur as a
result of inadequate food intake.
A. Insulin-induced hypoglycemia triggers excess
secretion of glucagon and cortisol, leading to
hyperglycemia.
- Intervention in microalbuminuria for a person with
DM includes which of the following? (More than one
can apply.)
A. improved glycemic control
B. strict dyslipidemia control
C. use of an optimized dose of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB)
D. use of an ACEI with an ARB
A. improved glycemic control
B. strict dyslipidemia control
C. use of an optimized dose of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB)
- Hemoglobin A1c should be tested:
A. at least annually for all patients.
B. at least two times a year in patients who are meeting
treatment goals and who have stable glycemic control.
C. monthly in patients whose therapy has changed or
who are not meeting glycemic goals.
D. only via standardized laboratory testing because of
inaccuracies associated with point-of-service testing.
B. at least two times a year in patients who are meeting
treatment goals and who have stable glycemic control.
- The mechanism of action of the DPP-4 inhibitors is as:
A. a drug that increases levels of incretin, increasing
synthesis and release of insulin from pancreatic
beta cells.
B. a product virtually identical in action to sulfonylureas.
C. a drug that increases insulin action in the peripheral
tissues and reduces hepatic glucose production.
D. a facilitator of renal glucose excretion.
A. a drug that increases levels of incretin, increasing
synthesis and release of insulin from pancreatic
beta cells.
- The mechanism of action of a GLP-1 agonist such as exenatide (Byetta®) is as:
A. a drug that stimulates insulin production in
response to an increase in plasma glucose.
B. a product virtually identical in action to
sulfonylureas.
C. a drug that increases insulin action in the peripheral
tissues and reduces hepatic glucose production.
D. a facilitator of renal glucose excretion
A. a drug that stimulates insulin production in
response to an increase in plasma glucose.
33. You see an obese 25-year-old man with acanthosis nigricans and consider ordering: A. FBS. B. LFT. C. RPR. D. ESR.
A. FBS.
- The use of a thiazolidinedione is not recommended in all of the following clinical scenarios except:
A. a 57-year-old man who is taking a nitrate.
B. a 62-year-old woman with heart failure.
C. a 45-year-old man who is using insulin.
D. a 35-year-old patient with newly diagnosed
type 2 DM.
D. a 35-year-old patient with newly diagnosed
type 2 DM.
35. In an older adult with type 2 DM with gastroparesis, the use of which of the following medications should be avoided? A. insulin glargine (Toujeo®, Lantus®) B. insulin aspart (NovoLog®) C. glimepiride (Amaryl®) D. liraglutide (Victoza®)
D. liraglutide (Victoza®)
- Metformin should be discontinued for the day of and up to 48 hours after surgery because of increased risk of:
A. hypoglycemia.
B. hepatic impairment.
C. lactic acidosis.
D. interaction with most anesthetic agents.
C. lactic acidosis.
- All the following medications are recommended as
possible first-line medications for treatment of
concomitant hypertension when seen with type 2 DM
in a 48-year-old man of European ancestry except:
A. thiazide diuretic.
B. calcium channel blocker.
C. alpha-adrenergic receptor antagonist.
D. angiotensin receptor blocker.
C. alpha-adrenergic receptor antagonist.
- Which of the following best describes the physical
activity recommendations such as brisk walking for
a 55-year-old woman with newly diagnosed type 2
diabetes mellitus? (More than one can apply.)
A. The goal should be for a total increased physical
activity of 150 min per week or more.
B. Increased physical activity is recommended at least
three times per week with no more than 48 hours
without exercise
C. Some form of resistance exercise such as lifting
dumbbells or using an exercise band should be
included at least two times per week.
D. Vigorous aerobic or resistance activity is potentially
contraindicated in the presence of proliferative or
severe nonproliferative retinopathy because of the
possible risk of vitreous hemorrhage or retinal
detachment.
A. The goal should be for a total increased physical
activity of 150 min per week or more.
B. Increased physical activity is recommended at least
three times per week with no more than 48 hours
without exercise
C. Some form of resistance exercise such as lifting
dumbbells or using an exercise band should be
included at least two times per week.
D. Vigorous aerobic or resistance activity is potentially
contraindicated in the presence of proliferative or
severe nonproliferative retinopathy because of the
possible risk of vitreous hemorrhage or retinal
detachment.
- In teaching a patient with type 2 diabetes mellitus and taking basal insulin such as degludec (Tresiba®) about using rapid-acting insulin such as aspart (Novolog®) to help with the management of postprandial hyperglycemia,
the NP advises first starting an injection
of unit(s) prior to the largest meal.
A. 1
B. 4
C. 8
D. 12
B. 4
- Which of the following patients has prediabetes?
A. a 70-year-old man with a fasting glucose of
99 mg/dL (6.05 mmol/L)
B. an 84-year-old woman with a 1-hour postprandial
glucose of 98 mg/dL (5.44 mmol/L)
C. a 33-year-old man with a hemoglobin A1c of 5.4%
D. a 58-year-old woman with a 2-hour postprandial
glucose of 152 mg/dL (8.44 mmol/L)
D. a 58-year-old woman with a 2-hour postprandial
glucose of 152 mg/dL (8.44 mmol/L)
- Mr. Samuels is a 58-year-old man with type 2 DM who is using a single 10 unit daily dose of the long-acting insulin glargine. His fasting blood glucose has been between 141 to 180 mg/dL (7.8 to 10 mmol/L). Which of the following best describes the next step in his therapy?
A. Continue on the current glargine dose.
B. Increase his glargine dose by 4 units per day.
C. Increase his glargine dose by 1 unit per day.
D. Increase his glargine dose by 6 units per day.
B. Increase his glargine dose by 4 units per day.
- Which of the following classes of medications is commonly
recommended as part of first-line therapy in the
newly diagnosed person with type 2 diabetes?
A. alpha-glucosidase inhibitor
B. meglitinide
C. thiazolidinedione
D. biguanide
D. biguanide
- Pertaining to the use of sliding-scale insulin in response to elevated blood glucose, which of the following best describes current best practice?
A. The use of this type of sliding-scale insulin therapy
is discouraged as this method treats hyperglycemia
after it has already occurred.
B. Sliding-scale insulin in response to elevated glucose is a safe and helpful method of treating hyperglycemia.
C. Delivering insulin in this manner is acceptable
within the acute care hospital setting only.
D. The use of the sliding insulin scale is appropriate in
the treatment of type 1 DM only.
A. The use of this type of sliding-scale insulin therapy
is discouraged as this method treats hyperglycemia
after it has already occurred.
44. In a healthy person, what percentage of the body’s total daily physiological insulin secretion is released as basally? A. 10%–20% B. 25%–35% C. 50%–60% D. 75%–85%
C. 50%–60%
45. Five years or more after type 2 diabetes mellitus diagnosis, which of the following medications is less likely to be effective in controlling plasma glucose? A. metformin B. pioglitazone C. glipizide D. insulin
C. glipizide
46. The use of which of the following medications has the potential for causing the greatest reduction in HbA1c? A. a biguanide B. a thiazolidinedione C. a sulfonylurea D. an insulin form
D. an insulin form
- Which of the following best describes ethnicity and
insulin sensitivity?
A. Little variation exists in insulin sensitivity among
different ethnic groups.
B. African Americans are typically less sensitive to the
effects of insulin when compared with people of
European ancestry.
C. Mexican Americans are likely the most insulinsensitive
ethnic group residing in North America.
D. The degree of insulin sensitivity has little influence
on insulin production
B. African Americans are typically less sensitive to the
effects of insulin when compared with people of
European ancestry.
48. Recommended A1c goal in a 79-year-old woman with a 20-year history of type 2 diabetes mellitus who has difficulty ambulating, uses a walker, and has a cardiac ejection fraction of 35% and a history of heart failure should be equal to or less than: A. 7%. B. 7.5%. C. 8%. D. 8.5%.
C. 8%.
49. Consideration should be given to setting A1c goal in a 22-year-old man with a 8-year history of type 1 diabetes mellitus who has no comorbid conditions equal to or at less than: A. 5.5%. B. 6%. C. 6.5%. D. 7%.
B. 6%.
50. The use of GLP-1 agonist has been associated with the development of: A. leukopenia. B. pancreatitis. C. lymphoma. D. vitiligo.
B. pancreatitis.
- The International Diabetes Federation’s diagnostic
criteria for metabolic syndrome include:
A. an obligatory finding of persistent hyperglycemia.
B. notation of ethnic-specific waist circumference
measurements.
C. documentation of microalbuminuria.
D. a family history of type 2 DM.
B. notation of ethnic-specific waist circumference
measurements.
- Metformin has all of the following effects except:
A. improved insulin-mediated glucose uptake.
B. modest weight loss with initial use.
C. enhanced fibrinolysis.
D. increased low-density lipoprotein (LDL) cholesterol
production.
D. increased low-density lipoprotein (LDL) cholesterol
production.
- Cardiovascular effects of hyperinsulinemia include:
A. decreased renal sodium reabsorption.
B. constricted circulating volume.
C. greater responsiveness to angiotensin II.
D. diminished sympathetic activation.
C. greater responsiveness to angiotensin II.
54. Which of the following is an unlikely consequence of untreated metabolic syndrome and IR in a woman of reproductive age? A. hyperovulation B. irregular menses C. acne D. hirsutism
A. hyperovulation
55. Acanthosis nigricans is commonly noted in all of the following areas except: A. groin folds. B. axilla. C. nape of the neck. D. face.
D. face.
