Final Exam Questions 7 Flashcards
- A 59-year-old male is following up with you on his Type 2 Diabetes Mellitus. His repeat A1C is 8.0. He is currently on Metformin 1000mg twice daily. His BMI is 32 and he wishes to lose some weight. Which medication would be the most appropriate as add on therapy?
a. Semaglutide (Ozempic)
b. Glipizide (Glucotrol)
c. Pioglitazone (Actos)
d. Lantus insulin
a. Semaglutide (Ozempic)
Rationale: GLP-1 receptor agonists, such as Semaglutide, lower A1C levels and are known to aid with
weight loss. Glipizide, Pioglitazone, and Lantus insulin do lower A1C levels, but additionally can cause
weight gain and would not be the next best option for this patient.
- A 29-year-old female is seeing you for a routine physical. She tells you she has a family history of Type 2 Diabetes Mellitus and wants to know what symptoms are suggestive of insulin resistance. All of the following are correct answers except:
a. Acanthosis nigricans
b. Chronic infections of the skin
c. Intermittent nausea and vomiting
d. Frequent vulvovaginitis infections
c. Intermittent nausea and vomiting
- A 46-year-old patient who was recently diagnosed with diabetes presents to your clinic for his follow-up visit. He was started on Metformin three months ago at his last appointment and reported that he stopped taking the medication due to developing diarrhea. The NP can help minimize GI upset by doing all the following except:
a. taking the medication with food
b. switching from immediate-release to extended-release metformin
c. taking the medication at bedtime
d. start with a low dose of Metformin
c. taking the medication at bedtime
Rationale: Metformin is the first line treatment for Diabetes Mellitus. The patient should initially be started on the lowest dose of Metformin of 500mg three times daily with meals to reduce GI upset. The patient could also be switched to a comparable dose of extended-release Metformin to reduce side effects.
- A 52-year-old diabetic patient comes to your clinic with complaints of frequent episodes of hypoglycemia over the past 2 weeks. After reviewing his medication list, which of the following medications would you have the patient stop taking?
a. Metformin
b. pioglitazone (Actos)
c. glipizide (Glucotrol)
d. sitagliptin (Januvia)
c. glipizide (Glucotrol)
Rationale: Glipizide is a second-generation sulfonylurea. The primary action of sulfonylureas is to stimulate insulin release from the pancreas, and it is used only in patients with Type 2 Diabetes. A common adverse reaction with sulfonylureas and insulin is hypoglycemia.
- Jessica is a 36-year-old patient who presents to your clinic complaining of weight gain, lethargy, constipation, and thinning hair. She reports no known medical history. As the nurse practitioner, which of the following labs will be most important to include in your decision making?
a. Amylase
b. Lipase
c. Vitamin D
d. TSH
d. TSH
Rationale: Hypothyroidism symptoms are typically nonspecific and include such as fatigue, weight gain, depression, lethargy, dyspnea on exertion, weakness, arthralgias/myalgias, menorrhagia, muscle cramps, constipation, cold intolerance, carpal tunnel syndrome, and/or Raynaud syndrome. The best screening laboratory test for hypothyroidism is the serum TSH. You can then break it down further to include use of the serum T3 and T4 for treatment purposes.
- A 32-year-old patient diagnosed with hypothyroidism presents to your office for a routine follow-up. She states she recently became pregnant and would like to know if her treatment plan will change. As a NP, you know that:
a. Pregnancy has no effect on TSH levels.
b. Pregnancy increases the levothyroxine dosage requirement.
c. Serum TSH levels should be measured every 4 months during pregnancy.
d. Levothyroxine dosage must be titrated downward immediately as Levothyroxine is harmful to the fetus.
b. Pregnancy increases the levothyroxine dosage requirement.
Rationale: Pregnancy commonly increases a woman’s levothyroxine requirement. By 20 weeks, patients require a nearly 50% increase in their levothyroxine dosage. It is recommended to immediately start pregnant patients with overt hypothyroidism on full replacement dosing (100-150 mcg daily). Thyroid levels should be obtained every 4-6 weeks during pregnancy and levothyroxine doses adjusted as needed to keep serum TSH level between 0.4-2.0 mIU/L.
- A 63-year-old patient with history of hypothyroidism currently taking levothyroxine presents for follow up of lab work that shows an elevated TSH with normal T4. Which of the following would be the first action for the provider to take?
a. Decrease current levothyroxine dose
b. Advise patient to continue medication at same dose
c. Advise patient to immediately stop levothyroxine
d. Ask patient details regarding how she is taking current levothyroxine dose
d. Ask patient details regarding how she is taking current levothyroxine dose
Rationale: With elevated TSH it is important to confirm with patient how they are taking their levothyroxine and confirm that they are taking it at the appropriate time without other medications that could be altering the absorption.
- A patient presents to the clinic with complaints of fatigue, weight gain, weakness, and dry skin. A review of her recent labs shows TSH 5.1 and FT4 0.5. You diagnosis this patient with which disorder and prescribe which medication?
a. Hyperthyroidism, Levothyroxine 88mcg
b. Hypothyroidism, Levothyroxine 12.5mcg
c. Thyroiditis, Levothyroxine 88mcg
d. Thyrotoxicosis, Levothyroxine 12.5mcg
b. Hypothyroidism, Levothyroxine 12.5mcg
Rationale: Elevated TSH and low free T4 with nonspecific symptoms of weight gain, fatigue, lethargy, depression, weakness, shortness of breath on exertion, dry skin, headache, cold intolerance suggests hypothyroidism and the treatment is levothyroxine 1.6mcg/kg/dose.
- A 41-year-old female is being treated with Methimazole (Tapazole) for her Hyperthyroidism. While taking this medication, which potentially serious symptoms should the Family Nurse Practitioner tell the patient to monitor for?
a. Swelling of the hands and feet
b. Headache
c. Nausea and vomiting
d. Easy bruising and bleeding
d. Easy bruising and bleeding
Rationale: Easy bruising and bleeding may indicate a low platelet count which is frequently seen with
pancytopenia. Pancytopenia and agranulocytosis are two serious conditions that should be monitored
for in patients receiving Thiourea drugs such as Methimazole. Edema, nausea, vomiting, and headache
are common side effects with Methimazole but are not considered life threatening
- A 35 year old woman presents to the office complaining of a fine tremor that is interrupting her daily life. On assessment, you note her to have exophthalmos and palpate a small unilateral nodule. What is likely her diagnosis?
a. Hypothyroidism
b. Thyrotoxicosis
c. Hyperthyroidism
d. Thyroid cancer
c. Hyperthyroidism
Rationale: Hyperthyroidism is often found in women 30-50 years old. If it is untreated symptoms include fine tremor and exophthalmos. There can be an active thyroid nodule associated with hyperthyroidism.
- Results from a recent lab review shows a urine microalbumin level of 100mg. The patient has type 2 diabetes mellitus and is currently on a SGLT2 inhibitor and a sulfonylurea. Which medication aids in reducing urine microalbumin in patients with diabetes mellitus and without hypertension?
a. Captopril
b. Nifedipine
c. Metformin
d. Losartan
a. Captopril
Rationale: ACE-inhibitors in patients with diabetes and without hypertension is effective at limiting the
excretion rate of albumin.
- An NP is aware of the increased risk of peripheral artery disease (PAD) all the following patients except?
a. History of tobacco use
b. History of diabetes
c. Patient who is 55 years old
d. History of thrombocytopenia
d. History of thrombocytopenia
Rationale: PAD risk increases in patient who are 50 years or older, smokers, and diabetics. Patients with history of high blood pressure and high cholesterol as well as history of leg injury are also at increased risk. Thrombocytopenia is a low platelet count and is associated with the lack of ability to blood to clot.
- A 25-year-old patient comes into your clinic several times a month with the same complaint. Patient has persistent thoughts that symptoms are more serious and that they “might need surgery” based off what they have read online. They have expressed that previous health care professionals have been dismissive about similar complaints and were told they “just have anxiety”. After a reasonable workup of this patient that comes back negative for any of their complaints, you are concerned this patient has:
a. Somatic Symptom Disorder
b. Factitious Disorder
c. Schizophrenia
d. Insomnia
a. Somatic Symptom Disorder
Rationale: Somatic Symptom disorder is characterized by one or more somatic symptoms that are
associated with significant distress or disability; associated with disproportionate and persistent thoughts about the seriousness of the symptoms. Patient’s focus on symptoms is usually chronic. Usually occurs before age 30. Factitious Disorder would be considered if the patient was altering their lab tests or suspicion of causing injury or symptoms.
