Exam 3: Mod 7-9 Flashcards
lets keep that A
Both men and women experience bone loss with aging. The bones most likely to demonstrate significant loss are:
1.Cortical bones
2.Femoral neck bones
3.Cervical vertebrae
4.Pelvic bones
2.Femoral neck bones
Bisphosphonates treat or prevent osteoporosis by:
1.Inhibiting osteoclastic activity
2.Fostering bone resorption
3.Enhancing calcium uptake in the bone
4.Strengthening the osteoclastic proton pump
1.Inhibiting osteoclastic activity
Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs?
1.Selective estrogen receptor modulators
2.Aspirin
3.Glucocorticoids
4.Calcium supplements
3.Glucocorticoids
Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include:
1.“Fruity” breath odor and rapid respiration
2. Diarrhea, abdominal pain, weight loss, and hypertension
3. Dizziness, confusion, diaphoresis, and tachycardia
4. Easy bruising, palpitations, cardiac dysrhythmias, and coma
- Dizziness, confusion, diaphoresis, and tachycardia
Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true?
1. Optimal time of preprandial injection is 15 minutes.
2. Duration of action is increased when the dose is increased.
3. It is compatible with neutral protamine Hagedorn insulin.
4. It has no pronounced peak.
- Duration of action is increased when the dose is increased.
The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done:
1. The initial dose of glargine is reduced by 20% to avoid hypoglycemia.
2. The initial dose of glargine is 2 to 10 units per day.
3. Patients who have been on high doses of NPH will need tests for insulin antibodies.
4. Obese patients may require more than 100 units per day.
- The initial dose of glargine is reduced by 20% to avoid hypoglycemia.
When blood glucose levels are difficult to control in type 2 diabetes, some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research?
1. Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia.
2. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents.
3. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.
4. Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime.
- Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.
Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it:
1. Substitutes for insulin usually secreted by the pancreas
2. Decreases glycogenolysis by the liver
3. Increases the release of insulin from beta cells
4. Decreases peripheral glucose utilization
- Decreases glycogenolysis by the liver
Prior to prescribing metformin, the provider should:
1. Draw a serum creatinine to assess renal function
2. Try the patient on insulin
3. Tell the patient to increase iodine intake
4. Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions
- Draw a serum creatinine to assess renal function
The action of “gliptins” is different from other antidiabetic agents because they:
1. Have a low risk for hypoglycemia
2. Are not associated with weight gain
3. Close ATP-dependent potassium channels in the beta cell
4. Act on the incretin system to indirectly increase insulin production
- Act on the incretin system to indirectly increase insulin production
Sitagliptin has been approved for:
1. Monotherapy in once-daily doses
2. Combination therapy with metformin
3. Both 1 and 2
4. Neither 1 nor 2
- Both 1 and 2
GLP-1 agonists:
1. Directly bind to a receptor in the pancreatic beta cell
2. Have been approved for monotherapy
3. Speed gastric emptying to decrease appetite
4. Can be given orally once daily
- Directly bind to a receptor in the pancreatic beta cell
Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report:
1. Tinnitus and decreased salivation
2. Fever and sore throat
3. Hypocalcemia and osteoporosis
4. Laryngeal edema and difficulty swallowing
- Fever and sore throat
Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for:
1. Excessive sedation
2. Tachycardia and angina
3. Weight gain
4. Cold intolerance
- Tachycardia and angina
Which of the following is not an indication that growth hormone supplements should be discontinued?
1. Imaging indication of epiphyseal closure
2. Growth curve increases have plateaued
3. Complaints of mild bone pain
4. Achievement of anticipated height goals
- Complaints of mild bone pain
What is the role of calcium supplements when patients take bisphosphonates?
1. They must be restricted to allow the medication to work.
2. They must be taken in sufficient amounts to provide foundational elements for bone growth.
3. They must be taken at the same time as the bisphosphonates.
4. They only work with bisphosphonates if daily intake is restricted.
- They must be taken in sufficient amounts to provide foundational elements for bone growth.
Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90% of type 1diabetics have:
1.Autoantibodies to two tyrosine phosphatases
2.Mutation of the hepatic transcription factor on chromosome 12
3.A defective glucokinase molecule due to a defective gene on chromosome 7p
4.Mutation of the insulin promoter factor
1.Autoantibodies to two tyrosine phosphatases
Type 2 diabetes is a complex disorder involving:
1.Absence of insulin production by the beta cells
2.A suboptimal response of insulin-sensitive tissues in the liver
3.Increased levels of glucagon-like peptide in the postprandial period
4.Too much fat uptake in the intestine
2.A suboptimal response of insulin-sensitive tissues in the liver
Diagnostic criteria for diabetes include:
1.Fasting blood glucose greater than 140 mg/dl on two occasions
2.Postprandial blood glucose greater than 140 mg/dl
3.Fasting blood glucose 100 to 125 mg/dl on two occasions
4.Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl
4.Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl
Routine screening of asymptomatic adults for diabetes is appropriate for:
1.Individuals who are older than 45 and have a BMI of less than 25 kg/m2
2.Native Americans, African Americans, and Hispanics
3.Persons with HDL cholesterol greater than 100 mg/dl
4.Persons with prediabetes confirmed on at least two occasions
2.Native Americans, African Americans, and Hispanics
Screening for children who meet the following criteria should begin at age 10 and occur every 3 years thereafter:
1.BMI above the 85th percentile for age and sex
2.Family history of diabetes in first- or second-degree relative
3.Hypertension based on criteria for children
4.Any of the above
4.Any of the above
Insulin is used to treat both types of diabetes. It acts by:
1.Increasing beta cell response to low blood-glucose levels
2.Stimulating hepatic glucose production
3.Increasing peripheral glucose uptake by skeletal muscle and fat
4.Improving the circulation of free fatty acids
3.Increasing peripheral glucose uptake by skeletal muscle and fat
Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset and duration of action?
1. Lispro
2. Glulisine
3. Glargine
4. Detemir
- Glulisine
??
Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they:
1. Increase endogenous insulin secretion
2. Have a significant risk for hypoglycemia
3. Address the insulin resistance found in type 2 diabetics
4. Improve insulin binding to receptors
- Have a significant risk for hypoglycemia
Control targets for patients with diabetes include:
1. HbA1C between 7 and 8
2. Fasting blood glucose levels between 100 and 120 mg/dl
3. Blood pressure less than 130/80 mm Hg
4. LDL lipids less than 130 mg/dl
- Blood pressure less than 130/80 mm Hg
Establishing glycemic targets is the first step in the treatment of both types of diabetes. For type 1 diabetes:
1. Tight control/intensive therapy can be given to adults who are willing to test their blood glucose at least twice daily.
2. Tight control is acceptable for older adults if they are without complications.
3. Plasma glucose levels are the same for children as adults.
4. Conventional therapy has a fasting plasma glucose target between 120 and 150
- Conventional therapy has a fasting plasma glucose target between 120 and 150
Treatment with insulin for type 1 diabetics:
1. Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight
2. Divides the total doses into three injections based on meal size
3. Uses a total daily dose of insulin glargine given once daily with no other insulin required
4. Is based on the level of blood glucose
- Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight
When the total daily insulin dose is split and given twice daily, which of the following rules may be followed?
1. Give two-thirds of the total dose in the morning and one-third in the evening.
2. Give 0.3 units per kg of premixed 70/30 insulin with one-third in the morning and two-thirds in the evening.
3. Give 50% of an insulin glargine dose in the morning and 50% in the evening.
4. Give long-acting insulin in the morning and short-acting insulin at bedtime.
- Give two-thirds of the total dose in the morning and one-third in the evening.
Studies have shown that control targets that reduce the HbA1C to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include:
1. Those with long-standing diabetes
2. Older adults
3. Those with no significant cardiovascular disease
4. Young children who are early in their disease
- Those with no significant cardiovascular disease
Prevention of conversion from prediabetes to diabetes in young children must take the highest priority and should focus on:
1. Aggressive dietary manipulation to prevent obesity
2. Fostering LDL levels less than 100 mg/dl and total cholesterol less than 170 mg/dl to prevent cardiovascular disease
3. Maintaining a blood pressure that is less than 80% based on weight and height to prevent hypertension
4. All of the above
- Fostering LDL levels less than 100 mg/dl and total cholesterol less than 170 mg/dl to prevent cardiovascular disease
The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are:
1. Metformin and insulin
2. Sulfonylureas and insulin glargine
3. Split-mixed dose insulin and GPL-1 agonists
4. Biguanides and insulin lispro
- Metformin and insulin
The drugs recommended for older adults with type 2 diabetes include:
1. Second-generation sulfonylureas
2. Metformin
3. Pioglitazone
4. Third-generation sulfonylureas
- Third-generation sulfonylureas
The American Heart Association states that people with diabetes have a 2- to 4-fold increase in the risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include:
1. Glycemic targets between 7% and 7.5%
2. Use of insulin in type 2 diabetics
3. Control of hypertension and hyperlipidemia
4. Stopping smoking
- Glycemic targets between 7% and 7.5%
All diabetic patients with known cardiovascular disease should be treated with:
1. Beta blockers to prevent MIs
2. Angiotensin-converting enzyme inhibitors and aspirin to reduce risk of cardiovascular events
3. Sulfonylureas to decrease cardiovascular mortality
4. Pioglitazone to decrease atherosclerotic plaque buildup
- Angiotensin-converting enzyme inhibitors and aspirin to reduce risk of cardiovascular events
All diabetic patients with hyperlipidemia should be treated with:
1. HMG-CoA reductase inhibitors
2. Fibric acid derivatives
3. Nicotinic acid
4. Colestipol
- HMG-CoA reductase inhibitors
??
Both angiotensin converting enzyme inhibitors and some angiotensin II receptor blockers have been approved in treating:
1. Hypertension in diabetic patients
2. Diabetic nephropathy
3. Both 1 and 2
4. Neither 1 nor 2
- Both 1 and 2
Protein restriction helps slow the progression of albuminuria, glomerular filtration rate, decline, and end stage renal disease in some patients with diabetes. It is useful for patients who:
1. Cannot tolerate angiotensin converting enzyme inhibitors or angiotensin receptor blockers
2. Have uncontrolled hypertension
3. Have HbA1C levels above 7%
4. Show progression of diabetic nephropathy despite optimal glucose and blood pressure control
- Show progression of diabetic nephropathy despite optimal glucose and blood pressure control
Diabetic autonomic neuropathy (DAN) is the earliest and most common complication of diabetes. Symptoms associated with DAN include:
1. Resting tachycardia, exercise intolerance, and orthostatic hypotension
2. Gastroparesis, cold intolerance, and moist skin
3. Hyperglycemia, erectile dysfunction, and deficiency of free fatty acids
4. Pain, loss of sensation, and muscle weakness
- Resting tachycardia, exercise intolerance, and orthostatic hypotension
Allison is an 18-year-old college student with type 1 diabetes. She is on NPH twice daily and Novolog before meals. She usually walks for 40 minutes each evening as part of her exercise regimen. She is beginning a 30-minute swimming class three times a week at 1 p.m. What is important for her to do with this change in routine?
1. Delay eating the midday meal until after the swimming class.
2. Increase the morning dose of NPH insulin on days of the swimming class.
3. Adjust the morning insulin injection so that the peak occurs while swimming.
4. Check glucose level before, during, and after swimming.
- Check glucose level before, during, and after swimming.
Bart is a patient is a 67-year-old male with T2 DM. He is on glipizide and metformin. He presents to the clinic with confusion, sluggishness, and extreme thirst. His wife tells you Bart does not follow his meal plan or exercise regularly and hasn’t checked his BG for 1 week. A random glucose is drawn and it is 500. What is a likely diagnosis based on a preliminary assessment?
1. Diabetic keto acidosis (DKA)
2. Hyperglycemic hyperosmolar syndrome (HHS)
3. Infection
4. Hypoglycemia
- Hyperglycemic hyperosmolar syndrome (HHS)
What would one expected assessment finding be for hyperglycemic hyperosmolar syndrome?
1. Low hemoglobin
2. Ketones in the urine
3. Deep, labored breathing
4. pH of 7.35
- Ketones in the urine
The nurse is teaching the patient, newly diagnosed with Graves’ disease, about the normal functioning of the thyroid gland. What hormone will the nurse tell the patient controls production and release of thyroid hormones?
1.Thyrotropin-releasing hormone (TRH)
2.Thyroid-stimulating hormone (TSH)
3.Tetraiodothyronine
4.Triiodothyronine
2.Thyroid-stimulating hormone (TSH)
The nurse is providing patient teaching regarding the administration of levothyroxine (Synthroid). What is the nurse’s priority teaching point?
1. Take the medication after breakfast.
2. Take the medication with a full glass of water.
3. Remain in the upright position for 30 minutes after administering.
4. Take the medication before going to bed at night.
- Take the medication with a full glass of water.
The nurse instructs the patient with a new prescription to treat hyperthyroidism and includes the importance of regular lab studies to monitor for bone marrow suppression, which can be an adverse effect of this drug. What drug is the nurse teaching the patient about?
1. Methimazole (Tapazole)
2. Propylthiouracil (PTU)
3. Sodium iodide I131 (Generic)
4. Potassium iodide (Thyro-Block)
- Methimazole (Tapazole)
A patient is seen in the clinic and diagnosed with hyperthyroidism. Potassium iodide is prescribed. The nurse reviews the patient’s medical record before administering the drug. What assessment finding would cause the nurse to alter the plan of care?
1. A daily walk of 3 miles a day
2. A low fat, low sodium diet
3. A bowel movement every 2 to 3 days
4. Digoxin 0.125 mg daily
- Digoxin 0.125 mg daily
A patient with Pagets disease calls the clinic and tells the nurse that she is experiencing flushing of the face and hands and a rash. The patient states that she is taking calcitonin, salmon (Calcimar) for her Pagets disease. What is the nurses best response?
1. We expected this to happen. Just ignore it and please do not worry about it.
2. You will need to see the doctor immediately. Come in as soon as possible.
3. This is a common adverse effect of your medication that will lessen with time.
4. This is a serious adverse effect. Stop taking the drug and see the doctor today.
- This is a common adverse effect of your medication that will lessen with time.
The nurse admits an elderly patient in thyroid crisis for whom surgery is not an option. What antithyroid drug would the nurse expect will be ordered?
1. Methimazole (Tapazole)
2. Radioactive iodine (Generic)
3. Propylthiouracil (PTU)
4. Potassium iodide (Thyro-Block)
- Radioactive iodine (Generic)
After administering propylthiouracil (PTU), what effect would the nurse anticipate the drug will have in the patient’s body?
1. To destroy part of the thyroid gland
2. To inhibit production of thyroid hormone in the thyroid gland
3. To suppress the anterior pituitary glands secretion of thyroid-stimulating hormone (TSH)
4. To suppress the hypothalamuss production of thyrotropin-releasing hormone (TRH)
- To inhibit production of thyroid hormone in the thyroid gland
What assessment findings would the nurse expect to see in a patient who overdosed on levothyroxine (Synthroid)?
1. Nervousness, tachycardia, tremors
2. Somnolence, bradycardia, paresthesia
3. Hyperglycemia, hypertension, edema
4. Buffalo hump, constipation, sodium loss
- Nervousness, tachycardia, tremors
The nurse, developing a care plan for a patient diagnosed with hypothyroidism, creates what appropriate nursing diagnosis?
1. Imbalanced nutrition: Less than body requirements
2. Ineffective thermoregulation: Excess or ineffective airway clearance
3. Decreased cardiac output
4. Ineffective airway clearance
- Decreased cardiac output
A patient is diagnosed with a simple goiter and asks the nurse what caused it. What is the nurses best response?
1. A goiter is the result of too much thyroxine.
2. A goiter is the result of a chloride deficiency.
3. A goiter is the result of too much TSH.
4. A goiter is the result of an iodine deficiency.
- A goiter is the result of too much TSH.
