Fitzgerald diabetes questions Flashcards by Sabrina Stephens

Which of the following characteristics applies to type 1 diabetes mellitus?

a. significant hyperglycemia and ketoacidosis result from lack of insulin
b. this condition is commonly diagnosed on routine exam or work up for other health problems
c. initial response to oral sulfonylureas is usually favorable
d. insulin resistance is a significant part of the disease

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Which of the following characteristic 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 enahances insulin resistance

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You consider prescribing insuin glargine (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

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After use, the onset of action of lispro (Humalog) occurs in

a. less than 30 minutes
b. approx. 1 hour
c. 1-2 hours
d. 3-4 hours

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Which of the following medications should be used with caution in a person with suspected or known sulfa allergy

a. metformin
b. glyburide
c. rosiglitazone
d. NPH insulin

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The mechanism of action of metformin 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

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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

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You are seeing 17 year old Cynthia. 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 PCOS

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Criteria for the diagnosis of type 2 DM include:

a. classic symptoms regardless of fasting blood glucose measurement
b. plasma glucose level of 126 mg/dL
c. a 2 hour glucose measurement of 156 mg/dL after a 75 g glucose load
d. a plasma glucose level of 126 mg/dL or greater after an 8 hour fast on more than one occasion

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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

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Which of the following should be the goal measurement in treating a person with DM and HTN?

a. blood pressure less than 140 mmHg systolic and less than 90mm Hg diastolic
b. hgb A1C equal to or greater than 7%
c. triglyceride 200-300 mg/dL
d. HDL 35-40 mg/dL

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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

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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

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When caring for a patient with DM, hypertension and persistent proteinuria, the NP prioritizes the choice of antihypertension and prescribes;

a. furosemide
b. methylodopa
c. fosinopril
d. nifedipine

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Clinical presentation of type 1 DM usually includes all of the following except:

a. report of recent unintended weight gain
b. ketosis
c. thirst
d. polyphagia

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Which of the following should be periodically monitored with the use of a biguanide?

a. creatine kinase
b. alkaline phosphatase (ALP)
c. alanine aminotransferase (ALT)
d. creatinine

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Which of the following should be periodically monitored with the use of thiazolidinedione

a. CK
b. ALP
c. ALT
d. creatinine

All of the following are risks for lactic acidosis in individuals taking metformin except:

a. presence of chronic renal insufficiency
b. acute dehydration
c. radiographic contrast dye use
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

Hgb A1C best provides information on glucose control over the past

a. 1-29 days
b. 21-47 days
c. 48-63 days
d. 64-90 days

Which of the following statements is not true concerning the effects of exercise and insulin resistance?

a. approx. 80% of the body’s insulin mediated glucose uptake occurs in skeletal muscle
b. with regular aerobic exercise, insulin resistance is reduced by approx. 40%
c. the insulin resistance reducing effects of exercise persist for 48 hours after the activity
d. hyperglycemia can occur as a result of aerobic exercise

With an 8 am dose of the following insulin forms, followed by an inadequate dietary intake and/or excessive energy use, at approx. what time would hypoglycemia be most likely to occur?

a. Lispro
b. Regular Insulin
c. NPH insulin
d. insulin glargine (lantus)

a. approx. 8:30-9:30 a.m. (with peak of insulin dose)
b. approx. 10-11 a.m. (with peak of insulin dose)
c. approx. 2-10 p.m.
d. Because insulin glargine (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

What is the most common adverse effect noted with alpha-glucosidase inhibitor use?

a. GI upset
b. hepatotoxicity
c. renal impairment
d. symptomatic hypoglycemia

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

Intervention in microalbuminuria for a person with DM includes: (more than one can apply) a. improved glycemic control b. strict dyslipidemia control c. use of an optimized dose of an ACE inhibitor or ARB d. the use of an ACEI with an ARB

A, B, C

Hgb A1C should be tested a. at least annually for all patients b. at least 2x 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 lab testing because of inaccuracies assoc. with point of service testing

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

The mechanism of action of exenatide (byetta) is as: a. a drug that stimulates insulin production in response to 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

You see an obese 25 year old man with acanthosis nigricans and consider ordering a. FBS b. LFT c. RPR d. ESR

The use of thiazolidinedione is not recommended in all of the following 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

In an older adult with type 2 DM with gastroparesis, the use of which of the following medications should be avoided a. insulin glargine (lantus) b. insulin aspart (novolog) c. glimepiride (amaryl) d. exenatide (byetta)

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

All of the following medications are recommended for treatment of concomitant hypertension when seen with type 2 DM a. BBs b. CCBs c. Alpha adrenergic blockers d. ARB

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 for at least 30 minutes per day, at least 3x 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 3x per week d. vigorous aerobic or resistance activity is potentially contraindicated in the presence of proliferative or severe non proliferative retinopathy due to the possible risk of vitreous hemorrhage or retinal detachment

A, B, C, D

In teaching a patient with type 2 DM about using rapid acting insulin to help with the management of post prandial hyperglycemia, the NP advises that the usual dose is ____ unit per 15 grams of carbohydrate a. 1 b. 2 c. 3 d. 4

Which of the following patients has impaired glucose tolerance a. a 70 year old man with a fasting glucose of 109 mg/dL b. an 84 year old woman with a 1 hour post prandial glucose of 98mg/dL c. 33 year old man with a Hgb A1C of 5.4% d. a 58 year old woman with a 2 hour post prandial glucose of 152 mg/dL

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 glucose has been between 141-180mg/dL. 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 a day c. increase his glargine dose by 1 unit a day d. increase his glargine dose by 6 units a 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 DM? a. alpha glucosidase inhibitor b. meglitidine c. thiazolidinedione 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 as 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

In a healthy person, what percentage of the body's total daily physiological insulin secretion is released as basally a. 10% b. 25% c. 50% d. 75%

Five years or more after type 2 DM diagnosis, which of the following medications is less likely to be effective in controlling plasma glucose a. metformin b. pioglitazone c. glipizide d. insulin