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NURP 502 - Ex 3 > Practice Questions 2 > Flashcards

Practice Questions 2 Flashcards

1
Q

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 work-up 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

A. Significant hyperglycemia and ketoacidosis result from lack of insulin.

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2
Q

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

A. Major risk factors are heredity and obesity.

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3
Q

You consider prescribing insulin 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.

A

A. extended duration of action.

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4
Q 
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

A. less than 30 minutes.

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5
Q 
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
A

B. glyburide

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6
Q

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.

A

C. a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production.

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7
Q 
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
A

B. 3 years

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8
Q

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 polycystic ovary syndrome.

A

C. family history of type 1 DM.

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9
Q

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.

A

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.

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10
Q

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.

A

C. an insulin sensitizer.

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11
Q

Which of the following should be the goal measurement in treating a person 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

A. blood pressure less than 140 mm Hg systolic and less than 90 mm Hg diastolic

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12
Q

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.

A

C. yearly.

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13
Q

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.

A

B. a product that enhances insulin release.

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14
Q 
When caring for a patient with DM, hypertension and persistent proteinuria, the NP prioritizes the choice of antihypertension and prescribes:
A. furosemide.
B. methyldopa.
C. fosinopril.
D. nifedipine.
A

C. fosinopril.

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15
Q

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.

A

A. report of recent unintended weight gain.

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16
Q 
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)
A

D. creatinine (Cr)

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17
Q 
Which of the following should be periodically monitored with the use of a thiazolidinedione?
A. CK
B. ALP
C. ALT
D. Cr
A

C. ALT

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18
Q

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.

A

D. history of allergic reaction to sulfonamides.

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19
Q

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.

A

D. low dose angiotensin receptor blockers.

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20
Q 
Hemoglobin A1c best provides information on glucose control over the past:
A. 1 to 29 days
B. 21 to 47 days.
C. 48 to 63 days.
D. 64 to 90 days.
A

D. 64 to 90 days.

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21
Q

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.

A

D. Hyperglycemia can occur as a result of aerobic exercise.

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22
Q

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

A

Approximately 8:30 to 9:30 a.m. (with peak of insulin dose)

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23
Q

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

A

Approximately 10 to 11 a.m. (with peak of insulin dose)

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24
Q

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

A

Approximately 2 to 10 p.m. (with peak of insulin dose)

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25
Q 
With an 8 a.m. dose of the following insulin forms, followed by and inadequate dietary intake and/or excessive energy use, at approximately what time would hypoglycemia be most likely to occur?
Insulin glargine (Lantus)
A

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.

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26
Q 
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

A. gastrointestinal upset

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27
Q

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

A. Insulin-induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia.

28
Q

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 angiotensin converting
enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB).
D. The use of an ACEI with an ARB.

A

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).
29
Q

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.

A

B. at least two times a year in patients who are meeting treatment goals and who have stable glycemic control.

30
Q

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. a drug that increases levels of incretin, increasing synthesis and release of insulin from pancreatic beta cells.

31
Q

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.

A

A. a drug that stimulates insulin production in response to increase in plasma glucose.

32
Q 
You see an obese 25-year-old man with acanthosis nigricans and consider ordering:
A. FBS.
B. LFT.
C. RPR.
D. ESR.
A

A. FBS.

33
Q

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.

A

D. a 35-year-old patient with newly diagnosed type 2 DM.

34
Q 
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)
A

D. exenatide (Byetta)

35
Q

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.

A

C. lactic acidosis.

36
Q 
All the following medications are recommended for treatment of concomitant hypertension when seen with type 2 DM except:
A. beta blockers.
B. calcium channel blockers
C. alpha adrenergic receptor antagonist.
D. angiotensin receptor blockers.
A

C. alpha adrenergic receptor antagonist.

37
Q

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 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 three times per week.
D. Vigorous aerobic or resistance activity is potentially contraindicated in the presence of proliferative or severe nonproliferative retinopathy due to the possible risk of vitreous hemorrhage or retinal detachment.

A

All of them

38
Q 
In teaching a patient with type 2 diabetes mellitus 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
A

B. 2

39
Q

Which of the following patients has impaired glucose tolerance?
A. a 70-year-old man with a fasting glucose of 109 mg/dl (6.05 mmol/L)
B. an 84-year-old woman with a 1 hour post-prandial 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 post-prandial glucose of 152 mg/dl (8.44 mmol/L)

A

D. a 58-year-old woman with a 2 hour post-prandial glucose of 152 mg/dl (8.44 mmol/L)

40
Q

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.

A

B. Increase his glargine dose by 4 units per day.

41
Q 
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
A

D. Biguanide

42
Q

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

A. The use of this type of sliding-scale insulin therapy is discouraged as this method treats hyperglycemia after it has already occurred.

43
Q 
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%
A

C. 50%

44
Q 
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
A

C. Glipizide

45
Q 
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
A

D. An insulin form

46
Q

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 to people of European ancestry.
C. Mexican Americans are likely the most insulin sensitive ethnic group residing in North America.
D. The degree of insulin sensitivity has little influence on insulin production.

A

B. African Americans are typically less sensitive to the effects of insulin when compared to people of European ancestry.

47
Q 
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%
A

C. 8%

48
Q 
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 notcomorbid conditions equal to or at less than:
A. 5.5%
B. 6%
C. 6.5%
D. 7%
A

B. 6%

49
Q 
The use of exenatide has been associated with the development of:
A. leukopenia.
B. pancreatitis.
C. lymphoma.
D. vitiligo
A

B. pancreatitis.

50
Q

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.

A

B. notation of ethnic-specific waist circumference measurements.

51
Q

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 LDL cholesterol production.

A

C. enhanced fibrinolysis.

52
Q

Cardiovascular effects of hyperinsulinemia include:
A. decreased renal sodium reabsorption.
B. constricted circulating volume.
C. greater responsiveness to angiotensin II.
D. diminished sympathetic activation.

A

C. greater responsiveness to angiotensin II.

53
Q 
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

A. hyperovulation

54
Q 
Acanthosis nigricans is commonly noted in all of the following areas except:
A. groin folds.
B. axilla.
C. nape of the neck.
D. face.
A

D. face.

55
Q 
Acanthosis nigricans is commonly noted in all of the following areas except:
A. groin folds.
B. axilla.
C. nape of the neck.
D. face.
A

D. face.

56
Q

The following are risk factors for type 2 diabetes mellitus in children and teens (choose all that apply):
A. hyperinsulinemia.
B. abnormal weight-to-height ratio.
C. onset of nonorganic failure to thrive in the toddler years.
D. Native American ancestry.

A

A. hyperinsulinemia.

B. abnormal weight-to-height ratio.

D. Native American ancestry.

57
Q

Screening children with a known risk factor for type 2 diabetes mellitus is recommended at age 10 or at onset of puberty, and should be repeated how often?
A. every other year.
B. every year.
C. every six months.
D. if child presents with a body mass index in the 85th percentile or higher.

A

A. every other year.

58
Q

Prediabetes in children is defined as (choose all that apply):
A. impaired fasting glucose (glucose level ≥100 mg/dL or 6.2 mmol/L) but ≤125 mg/dL or 7 mmol/L).
B. impaired glucose tolerance (2-hour postprandial ≥140–199 mg/dL or 7.8 mmol/L–11 mmol/L).
C. body mass index in the 85th percentile or higher.
D. body mass index in the 60th percentile or higher.

A

A. impaired fasting glucose (glucose level ≥100 mg/dL or 6.2 mmol/L) but ≤125 mg/dL or 7 mmol/L).

B. impaired glucose tolerance (2-hour postprandial ≥140–199 mg/dL or 7.8 mmol/L–11 mmol/L).

59
Q 
Hydration status can be determined by evaluating (choose all that apply):
A. blood pressure.
B. heart rate.
C. skin turgor.
D. heart rate.
E. presence of dry lips and oral mucosa.
A

All of them

60
Q

Signs of severe dehydration include (choose all that apply):
A. anuria.
B. tears absent.
C. capillary refill of approximately 3 seconds.
D. elevated blood pressure.

A

A. anuria.

B. tears absent.

C. capillary refill of approximately 3 seconds.

61
Q

What advice should you give to a breastfeeding mother whose 4-month-old has gastroenteritis and reports 2 loose stools and 2 episodes of vomiting within the past 4 hours?
A. Switch to soy-based formula.
B. Give the infant oral rehydration solution only.
C. Continue breastfeeding.
D. Supplement with a sugar water solution.

A

C. Continue breastfeeding.

62
Q

What advice should you give to the parents of a toddler with gastroenteritis?
A. Give the child sips of room temperature cola.
B. Give the child sips of an oral rehydration solution.
C. Give the child sips of a sports drink such as Gatorade.
D. Try sips of apple juice mixed 1:1 with tap water.

A

B. Give the child sips of an oral rehydration solution.

63
Q 
The onset of symptoms of food poisoning caused by Staphylococcus species is typically how many hours after the ingestion of the offending substance?
A. 0.5 to 1
B. 1 to 4
C. 4 to 8
D. 8 to 12
A

B. 1 to 4

64
Q 
The onset of symptoms in food poisoning caused by Salmonella species is typically how many hours after the ingestion of the offending substance?
A. 2 to 8
B. 8 to 12
C. 12 to 24
D. 24 to 36
A

C. 12 to 24

65
Q

To obtain the most accurate hydration status in a child with acute gastroenteritis, the NP should ask about:
A. the time of last urination.
B. thirst.
C. quantity of liquids taken.
D. number of episodes of vomiting and diarrhea.

A

A. the time of last urination.

66
Q 
What percentage of body weight is typically lost in a child with moderate dehydration?
A. 2% to 3%
B. 3% to 5%
C. 6% to 10%
D. 11% to 15%
A

C. 6% to 10%

67
Q 
Clinical features of shigellosis include all of the following except:
A. bloody diarrhea.
B. high fever.
C. malaise.
D. vomiting.
A

D. vomiting.

NURP 502 - Ex 3 (37 decks)

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