FNP BOARD REVIEW QUESTIONS WITH 100% CORRECT ANSWERS GRADED A + 2024 LATEST APPROVED (ACTU, Exams of Nursing

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FNP BOARD REVIEW QUESTIONS WITH

100% CORRECT ANSWERS GRADED A +

2024 LATEST APPROVED (ACTUAL

EXAM).

A 24-year old, otherwise healthy college student presents with c/o cough x 6 weeks. She has tried several OTC cough meds with no improvement. What is the most important information to consider when building your differential diagnoses? A) Her age B) Family hx C) Ineffectiveness of OTC cough medicines D) Length of time she has been coughing - Solution D) Length of time she has been coughing Why? This information helps you build your ddx Acute cough < 3 weeks: bronchitis, sinusitis, PND, exacerbation of COPD/asthma, pneumonia, pulmonary embolism Chronic cough (>8 weeks) GERD and Asthma are most common causes, also consider infection (e.g. pertussis, atypical pneumonia), ACE inhibitors, chronic bronchitis, bronchiectasis, lung ca) According to the CDC, what drug class is considered first-line treatment for pertussis? A) Sulfonamide B) Tetracycline C) Macrolide D) Beta-lactam - Solution C) Macrolide antiobitic (e.g. Azithromycin, clarithromycin Sulfonamides are second-line Match the antibiotics with the correct drug class:

1. Sulfonamide
2. Tetracycline
3. Macrolide
4. Beta-lactam A. Doxycyline B. Azithromycin C. Penicillins D.Trimethoprim-Sulfamethoxazole E. Cephalosporin F. Clarithromycin - Solution 1. Sulfonamide - D.Trimethoprim- Sulfamethoxazole (Bactrim)
5. Tetracycline - A. Doxycycline
6. Macrolide - B & F, Azithromycin and Clarithromycin
7. Beta-lactam - C & E, PCN and cephalosporins What are the three most common bugs in community-acquired pneumonia?

• Solution Streptococcus pneumoniae Mycoplasma pneuomiae (atypical pathogen) Chlamydophila pneumoniae (atypical pathogen) What is the treatment for CAP caused by Strep pneumo? - Solution Respiratory quinolone (e.g. Levofloxacin, moxifloxacin, gemifloxacin) OR high-dose amoxicillin OR amoxicillin with clavulanate What antibiotics are avoided in CAP caused by Strep pneumo due to high rates of resistance? - Solution Macrolides What is the treatment for CAP caused by Mycoplasma pneumoniae? - Solution Macrolide OR doxycycline What antibiotics are avoided in CAP caused by atypical pathogens? - Solution Beta-lactams (ineffective) A 38-year old mother of two teenagers recently recovered from Mycoplasma pneumonia a couple of weeks ago. She asks if she should get the "pneumonia shot." She takes levothyroxine 88 mcg daily for hypothyroidism, but is otherwise healthy. How do you respond?

A) No, it's too soon after your infection B) No, it's not indicated C) Yes, you can get it in about a month D) Yes you can get it today - Solution B) No, it's not indicated An otherwise healthy adult without immunocompromise or multiple comorbid conditions is not a "vulnerable population" The pneumonia vaccine does not prevent mycoplasma pneumonia According to GOLD, what is required to establish the diagnosis of COPD? - Solution Spirometry (FEV1/FVC ratio < 70%) A 70-year old house painter reports a 4-week history of exertional dyspnea, chest tightness, and cough for the past 3 months. He has never smoked. What diagnoses are included in your differential? Select 4. A) Asthma B) Angina C) COPD D) GERD E) Pneumonia F) Tuberculosis G) Heart Failure - Solution B) Angina C) COPD F) Tuberculosis G) Heart failure How do inhaled anticholinergics work to treat shortness of breath in COPD? A) They cause bronchodilation in the lungs B) They block the action of acetylcholine and prevent bronchoconstriction - Solution B) They block the action of acetylcholine and prevent bronchconstriction Name a short-acting inhaled anticholinergic: - Solution Ipratropium (Atrovent) Name a long-acting inhaled anticholinergic: - Solution Tiotropium (Spiriva)

How do inhaled betá-agonists work to treat shortness of breath in COPD? A) They cause bronchodilation in the lungs B) They block the action of acetylcholine and prevent bronchoconstriction - Solution A) They cause bronchodilation in the lungs What are the only 2 inhaled short-acting beta agonists (SABAs): - Solution Albuterol and levalbuterol Name an inhaled long-acting beta agonists (LABAs): - Solution Salmeterol (Serevent) What are the side effects associated with anticholinergic medications? - Solution Cognitive impairment, confusion, hallucinations, dry mouth, blurry vision, urinary retention, constipation, tachycardia, acute angle glaucoma "Can't see, can't pee, can't spit, can't shit." Name a inhaled combined short-acting anticholinergic/short-acting beta agonist: - Solution Ipratropium/albuterol (Combivent) Name a inhaled combined long-acting beta-agonist/corticosteroid - Solution Fluticasone/salmeterol (Advair) Fluticasone/vilanterol (Breo) Budesonide/formoterol (Symbicort) Mometasone/frmoterol (Dulera) Name an inhaled steroid: - Solution Fluticasone (Flovent) Budesonide (Pulmicort) Mometasone (Asmanex) Put the following in the correct order for COPD prescribing strategy: A) Long-acting anticholinergic or LABA, plus rescue med B) Inhaled corticosteroid +LABA or LA anticholinergic, plus rescue med C) Short-acting anticholinergic or SABA PRN D) Inhaled corticosteroid +LABA and/or LA anticholinergic, plus rescue med

• Solution C, A, B, D

1. Short-acting anticholinergic or SABA PRN THEN
2. Long-acting anticholinergic or LABA, plus rescue med

THEN

3. Inhaled corticosteroid +LABA or LA anticholinergic, plus rescue med THEN
4. Inhaled corticosteroid +LABA and/or LA anticholinergic, plus rescue med There is good evidence in support of oral steroids for COPD exacerbations to shorten recovery time and improve lung function. What is the correct recommended dose? A) Medrol dose-pack B) 10-day course of Prednisone 20 mg, followed by a taper C) 5-day course of Prednisone 40 mg - Solution C) 5-day course of Prednisone 40 mg Chronic use should be avoided - associated with an unfavorable risk-to- benefit ratio A patient with asthma symptoms daily with occasional nighttime awakenings has A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - Solution C) Moderate persistent asthma A patient with asthma symptoms more than twice a week, but not daily with occasional nighttime awakenings has A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - Solution B) Mild persistent asthma A patient with asthma symptoms less than twice a week has A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - Solution A) Intermittent asthma

A patient with asthma symptoms multiple times throughout the day and nighttime awakenings on most nights of the week has A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - Solution D) Severe persistent asthma What are the most common side effects of long-term inhaled steroid use? A) Osteoporosis and GERD B) Cataracts and osteopenia C) Hyperkalemia and diabetes D) Hypertension and diabetes - Solution B) Cataracts and osteopenia What medication combination is considered unsafe in a patient with asthma? A) Fluticasone and albuterol B) Mometasone, formoterol, albuterol C) Budesonide and levalbuterol D) Salmeterol and levalbuterol Why? - Solution D) Salmeterol and levalbuterol Salmeterol is a long-acting beta agonist. LABAs MUST be combined with an inhaled corticosteroid (e.g. Advair, Breo, Symbicort) A 30-year old male has persistent asthma. What daily medication regimen would be appropriate? A) Albuterol B) Low-dose fluticasone, albuterol C) Medium-dose fluticasone D) Budseonide, salmeterol, albuterol - Solution C) Medium-dose fluticasone Albuterol alone is used for intermittent asthma Albuterol should not be used daily (if the patient is using their rescue inhaler more than twice a week --> call the PCM!)

Mr. Jones, a 45-year old drug and alcohol counselor, smokes 1 PPD and c/o cough, low-grade fever, and night sweats for the last week. His CXR show bilateral hilar nodes. What should you do next? A) Refer to Pulmonology B) Order a chest CT with contrast C) Order a TB skin test D) Repeat the CXR in 2 weeks - Solution C) Order a TB skin test A patient who takes fosinopril for HTN has been diagnosed with ACE- inhibitor cough. Which of the following statements is true? A) He could switch to lisinopril B) This cough is more likely in patients with lower airway disease C) His cough should improve over time D) The cough is related to an inability to break down bradykinin - Solution D) The cough is related to an inability to break down bradykinin A 19-year old college student (otherwise healthy, nonsmoker) was diagnosed with community-acquired pneumonia by CXR a couple days ago. She has been taking amoxillin with clavulanate 875 mg BID for the past 48 hours. She returns today for a follow-up appointment. Her vitals 2 days ago: BP 120/72, HR 96, T 103F, RR 24/min, Ó2 sats 92%. Her vitals today: BP 130/80, HR 100, T 102.2, RR 24/min, Ó2 sats 94%. How would you manager her today? A) Repeat CXR, CBC, and start levofloxacin B) Start azithromycin 5-day pack C) Continue with amoxicillin-clavulanate for another 24 hours D) Stop amoxicillin-clavulanate and start doxcycline 100 mg BID x 7 days - Solution D) Stop amoxicillin-clavulanate and start doxycycline 100 mg BID x 7 days She most likely has an atypical pathogen (mycoplasma pneumoniae or chlamydophila pneumoniae), which should be treated with a macrolide or doxycycline

If a 19-year old college female diagnosed with community acquired pneumonia was pregnant in her first trimester, how could she be managed? A) Levofloxacin 750 mg PO daily x 5 days B) Azithromycin 500 mg on day 1, then 250 mg daily on days 2-5, plus amoxicillin 1000 mg BID C) Cephalexin 500 mg PO BID x 5 days D) Doxycyline 100 mg PO BID x 5 days - Solution B) Azithromycin 500 mg on day 1, then 250 mg daily on days 2-5, plus amoxicillin 1000 mg BID Quinolones (e.g. levofloxacin) and tetracyclines (e.g. doxycycline) are teratogenic and should not be given during pregnancy A 63-year old patient w/ COPD c/o a pounding heart after using his inhaler. Which of the following is the least likely culprit? A) Fluticasone B) Albuterol C) Iptratropium D) Salmeterol - Solution A) Fluticasone Mr. Smith, an 80-year old smoker, has stage II COPD. Based on his medications, what is the most predictable drug-disease interaction? Losartan 50 mg, HCTZ 12.5 mg, Amlodipine 5 mg daily, Tamsulosin (Flomax) 0.8 mg daily, Atorvastatin (Lipitor) 10 mg daily, Albuterol inhaler 2 puffs PRN for SOB, tiotropium (Spiriva) once daily A) Glaucoma B) Frequent urination C) Anxiety D) Pruritis E) Hyperglycemia F) Fatigue G) Constipation - Solution G) Constipation Amlodipine (CCB) and tiotropium (short-acting anti-cholinergic)

An obese 55-year old woman with a history of moderate persistent asthma has a temperature of 101F, bilateral wheezes, mild shortness of breath, and purulent sputum. Her med list includes: fluticasone/salmeterol BID, albuterol PRN, amlodipine 5 mg, levothyroxine 99 mcg daily, and metformin 1000 mg BID. How should she be managed today? A) Treat with azithromycin daily for 5 days B) Treat with ciprofloxacin, nebulized albuterol q4-6 hours PRN for wheezing C) Treat with oral steroid and nebulized levalbuterol q8 hours PRN D) Treat with levofloxacin, nebulized albuterol q4-6 PRN for wheezing - Solution D) Treat with levofloxacin, nebulized albuterol q4-6 PRN for wheezing She is more likely to have Strep pneumoniae and should be treated with a quinolone. Ciprofloxacin is not a respiratory quinolone An obese 55-year old woman with a history of moderate persistent asthma has a temperature of 101F, bilateral wheezes, mild shortness of breath, and purulent sputum. Her med list includes: fluticasone/salmeterol BID, albuterol PRN, amlodipine 5 mg, levothyroxine 99 mcg daily, and metformin 1000 mg BID. She is being treated for pneumonia with levofloxacin and nebulized albuterol q4-6 PRN for wheezing. She develops white plaques on the buccal mucosa, palate, and tongue (thrush). What medications are the most likely cause of this? A) Levofloxacin and metformin B) Albuterol and levofloxacin C) Metformin and fluticasone D) Fluticasone and levofloxacin - Solution D) Fluticasone and levofloxacin Anemia is a reduction in one or more of what RBC measurements? - Solution RBC count (4.2-4.9 mil/microL), hemoglobin (12-15 g/dl), or hematocrit (37-51%) The patient has the following CBC results: Is the patient anemic? RBC 4. HGB 11. HCT 35.6% MCV 90

MCH 25.

MCHC 33.

RDW 14.

PLT 265

MPV 7.1 - Solution Yes Name 3 causes of anemia. Which is the most common reason in the US? - Solution Blood loss (most common), sick bone marrow, increased RBC destruction

1. Blood loss - melena, hematemesis, trauma
2. Bone marrow does not make enough RBCs -not enough iron, folate, B -bone marrow disorders (e.g. aplastic anemia)-bone marrow suppression (e.g. chemo) -low levels of erythropoietin (e.g. chronic renal failure) -anemia of inflammation (e.g. malignancy, anemia of chronic disease)
3. Increased RBC destruction -inherited disorders (e.g. thalassemia, sickle cell anemia) -malaria -hemolytic anemia (e.g. G6PD deficiency) How do the following conditions affect Hgb/Hct? (e.g. Increase, Decrease, Neutral) COPD: CKD: HTN: DM w/ AIC 14: Aspirin use: Testosterone use: Resident of Denver, CO: Age > 80: - Solution COPD: Increase (tissues are chronically deprived of oxygen) CKD: Decrease HTN: Neutral DM w/ AIC 14: Decrease (poorly controlled disease, strains RBCs and causes them to die early) Aspirin use: Neutral

Testosterone use: Increase Resident of Denver, CO: Increase (r/t high altitude) Age > 80: Decreased (bone marrow is not as robust...RBC production is decreased, but DO NOT assume that anemia in an older patient is due to aging!) Which of the RBC indices tells you about RBC size? What level is normal? What level indicates microcytic (small) RBCs? What level indicates macrocytic (large) RBCs? - Solution Mean Corpuscular Volume (MCV) = Hct/RBC Normal = 80- Microcytic < Macrocytic > Which of the RBC indices tells you about the RBC color? What does a low level tell you about the RBC color? - Solution Mean corpuscular hemoglobin (MCH) Low MCH = hypochromic (pale) RBC Match the lab with the definition

1. Serum iron
2. Serum ferritin
3. Reticulocyte count
4. Peripheral smear A. A visual description of red blood cells B. Measure of iron in circulation C. Indicative of the bone marrow's ability to produce RBCs D. Measure of iron in storage - Solution 1. Serum Iron - B. Measure of iron in circulation
5. Serum ferritin - D. Measure of iron in storage
6. Reticulocyte Count - C. Indicative of the bone marrow's ability to produce RBCs
7. Peripheral Smear - A. A visual description of red blood cells When the iron count is HIGH, the TIBC (total iron binding capacity) is _________ - Solution Low

When the iron count is LOW, the TIBC (total iron binding capacity) is _________ - Solution High Iron deficiency aemia is a _______cytic, ______chromic anemia. What is the most common cause? - Solution Microcytic, hypochromic Blood loss is the most common cause (Patients are usually asymptomatic until H/H < 10/30) A patient's hemoglobin is 10.2 and hematocrit is 30.6%. Which findings are consistent with an iron deficiency anemia? A) MCV 76, MCH 28 B) MCV 84, MCH 26 C) MCV 75, MCH 25 D) MCV 120, MCH 30 - Solution C) MCV 75 (low), MCH 25 (low) Microcytic, hypochromic anemia In new onset iron deficiency anemia, the RDW (red cell distribution width) is ___________. - Solution > 15% In ____________ iron deficiency anemia, the RDW is < 15%. - Solution Longstanding, chronic (all RBCs are small) A 24-year old woman was diagnosed with iron deficiency anemia 4 weeks ago (Hgb 11.5, Hct 34.5%). Today her Hgb is 12.8 and her Hct is 38.4%. How do you proceed? A) Stop iron supplementation since she is no longer anemic B) Order a reticuloctye count C) Order a TIBC D) Consider continued iron supplementation for another 3-5 months - Solution D) Consider continued iron supplementation for another 3- months (to replace iron stores) In addition to acanthosis nigricans, which of the following is a risk factor for insulin resistance? A) Delivery of infant > 9 lbs B) Severe obesity C) Age > 65 D) Sleep Apnea - Solution B) Severe obesity

The ADA recommends annual screening for diabetes for patients with a BMI greater than _______ and one ore more risk factors. - Solution 25 The ADA recommends screening for the entire population over the age of _____________ every ____ years if the screening is normal. - Solution 45; 3 Mr.Smith is a 75-year old man with an Ā1C of 8.9%. Which of the following should be the provider's first action? A) Start metformin B) Discuss exercise, weight loss C) Establish an Ā1C goal of < 7% D) Establish a target Ā1C goal - Solution D) Establish a target Ā1C goal Match the Suggested Ā1C goals for T2DM A) Patient with T1DM B) Most pregnant patients C) Older patients D) Most adults with T2DM

1. Ā1C < 7%
2. Ā1C < 6%
3. Ā1C < 8%
4. Ā1C < 6% - Solution A - 2) Patients with T1DM = goal < 6% B - 4) Most pregnant patients = goal <6 % C - 3) Older patients = goal < 8% D - 1) Most adults with T2DM = goal < 7& Mr. Johnson is a 72-year old newly diagnosed Type 2 diabetic. Which of the choices below must be considered prior to starting Metformin in this patient? Select 4. A) CBC B) eGFR C) LFTs D) Presence of heart failure E) Presence of binge drinking F) Use of CCBs G) Presence of BPH - Solution B) eGFR

C) LFTs D) Presence of heart failure E) Presence of binge drinking Mr. Johnson is a 72-year old newly diagnosed Type 2 diabetic. Which of the following characteristics increase the likelihood of lactic acidosis? Select 4. A) Concurrent use of contrast dye B) eGFR > 45 C) Dehydration D) Presence of heart failure E) Presence of binge drinking F) Use of CCBs G) Presence of BPH - Solution A) Concurrent use of contrast dye C) Dehydration D) Presence of heart failure E) Presence of binge drinking What are the two most common side effects of Metformin? A) Diarrhea B) Weight gain C) Headaches D) Flatulence - Solution A) Diarrhea D) Flatulence Mr. Johnson is a 62-year old T2DM with an Ā1C of 7.3%. He has been started on low-dose Metformin. Over the last few weeks he has tolerated increasing doses and now takes 1000 mg twice daily. What would you expect his Ā1C to be when you recheck it in 3 months? A) 7.0% B) 6.8% C) 6.5% D) 6.0% - Solution D) 6.0% Metformin 1000 mg BID can produce a 1-2% drop in Ā1C Based on the primary mechanism of action of Metformin, what lab value must be evaluated and monitored?

A) ALT, AST

B) BUN, Cre C) eGFR D) Potassium - Solution A) AST, ALT Metformin works in the liver to decrease hepatic glucose output 35-year old female with newly diagnosed impaired fasting glucose and Ā1C of 5.9%

1. What medication is first-line?
2. What if she is contemplating pregnancy? - Solution 1) Metformin
3. Metformin is OK in pregnancy A 48-year old postmenopausal woman with T2DM diagnosed 6 weeks ago c/o persistent diarrhea with Metformin. Her Ā1C is 9.2% (goal < 7%)
4. What is the primary prescribing strategy?
5. What medication should you avoid in this patient? - Solution 1) Dual therapy (Ā1C > 9%)
6. TZDs (Actos, Avandia) increase the risk of fracture, avoid in postmenopausal women A 77-year old female with newly diagnosed T2DM and Ā1C of 9.5%.
7. What is her Ā1C goal?
8. What occurrence should be avoided if at all possible?
9. What age-related prescribing strategy would you consider in this patient with an Ā1C of 9.5%? - Solution 1) < 8%
10. Hypoglycemia
11. Monotherapy (older adult patient) A 62-year old male is taking Metformin and has an Ā1C of 7.9% and is on a fixed budget. His Ā1C goal is < 7%.
12. What med class would be your first choice? - Solution 1) Sulfonylurea - lowers Ā1C by 1-2% 27-year old male with lupus has a eGFR of 48 and Ā1C of 7.2%, newly diagnosed with T2DM.
13. What medication is first choice in this patient? - Solution 1) Metformin (can be given as long as the GFT is > 45, monitor closely)

35-year old obese male with hx of T2DM is on the max dose of Metformin. His Ā1C is 7.6 (goal < 7%). He desires weight loss and is needle-phobic.

1. What medication class should be considered
2. Which med class(es) should be avoided? - Solution 1) SGLT-2 inhibitor (canagliflozin - Invokana, empagliflozin - Jardiance) 2)Sulfonylureas (a/w weight gain) GLP-1, insulin (injectables) 82-year old male with T2DM is currently on max dose of Metformin. His Ā1C is 7.9%.
3. What is your plan at this visit for his Ā1C? - Solution 1) A reasonable Ā1C goal for his age is <8%. Review lifestyle modifications and decrease carb intake A 60-year old mane with T2DM takes Metformin and Glipizide. His Ā1C is 10.2 (goal < 7%). The NP decides to start basal insulin.
4. What should be done with Metformin and glipizide?
5. How much insulin would you start this patient on? - Solution 1) Continue Metformin. STOP glipizide.
6. Start at 0.1-0.2 units/kg/day or 10 units A 50-year old self-employed man drives a bread truck and takes max dose Metformin. He cannot tolerate hypoglycemia. His current Ā1C is 8.0 (goal < 7%). He has limited funds but has an affordable generic co-pay.
7. What medication would you start this patient on? - Solution 1) TZD (Actos or Avandia), DPP-4 (sitagliptin)? The typical patient with primary hypothyroidism has: A) skin, hair, and nail changes B) an abnormal lipid panel C) failure of the thyroid gland D) involvement of the pituitary-hypothalamic axis - Solution C) failure of the thyroid gland - PRIMARY hypothyroidism (the thyroid gland cannot produce thyroid hormones) ~95% of hypothyroidism is due to primary hypothyroidism SECONDARY hypothyroidism involves the pituitary-hypothalamic axis A patient who complains of fatigue has a TSH of 13.4 (normal 0.4-4. mU/ml). What should be done next?

A) Order a TSH next week B) Order a thyroid panel C) Repeat the TSH and add a free T D) Prescribe levothyroxine - Solution C) Repeat the TSH and add a free T L-thyroxine (synthetic T4) is given PO daily in the morning on an empty stomach. The usual replacement dose is based on ideal body weight. How much L-thyroxine would you start a healthy, young adult? - Solution 1. mcg/kg/day (e.g. 120 lbs = 55 kg --> replacement 88 mcg) Levothyroxine tabs: 25 mcg, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 A 58-year old man has the following lab results. TSH 13.5 (normal 0.4-4.8), T4 1.1 (norm 0.8-1.8) 6 weeks later: TSH 15.6, T4 0. Select the best answer. A) Diagnose as primary hypothyroidism, treat with levothyroxine B) Diagnose as subclinical hypothyroidism, treat with levothyroxine C) Diagnose as subclinical hypothyroidism, do not treat D) Diagnose as subclinical hyperthyroidism, treat with methimazole - Solution B) Diagnose as subclinical hypothyroidism, treat with levothyroxine Treatment of subclinical hypothyroidism is controversial.... If patient has subclinical hypothyroidism with TSH > 10 --> Treat to PREVENT conversion to primary hypothyroidism If TSH < 10 --> monitor. Associated with risk of afib (immediate risk), accelarated bone loss (long-term risk, leeches calcium and vit D from the bones) A 45-year old patient has subclinical hypothyroidism. Her TSH is 6.2. What are the major risks of prescribing levothyroxine? A) There are very few risks B) Hyperlipidemia, atrial fibrillation C) Accelerated bone loss, atrial fibrillation

D) She may develop hypertension and tachycardia - Solution C) Accelerated bone loss, atrial fibrillation A 45- year old patient was diagnosed with hypothyroidism 12 weeks ago. 12 weeks ago: TSH 14.3 (normal 0.4-4.8). On Levothyroxine 50 mcg 6 weeks ago: TSH 5.4. On 75 Levothyroxine 75 mcg Today: TSH 0. How shoulder her levothyroxine dose be managed today? A) Refer to endocrinology B) Decrease levothyroxine to 50 mcg daily C) Discontinue levothyroxine D) Resume levothyroxine 50 mcg daily and have her take 2 tabs on Saturdays/Sundays - Solution D) Resume levothyroxine 50 mcg daily and have her take 2 tabs on Saturdays/Sundays 50 mcg daily x 7 days = 350 mcg weekly (not enough, patient was not at goal after 6 weeks) 75 mcg daily x 7 days = 525 mcg weekly (too much her TSH decreased to 0.4 after 6 weeks) 50 mcg M-F = 250 mcg 100 mcg Sat/Sun = 200 mcg 250+200 = 450 mcg weekly A patient has hypothyroidism. Her last TSH was 2.5. She takes her levothyroxine in the AM on an empty stomach. What will happen to her TSH if she takes the levothyroxine after dinner? - Solution TSH will INCREASE (due to decreased absorption of levothyroxine) A patient has hypothyroidism. Her last TSH was 2.5. She takes her levothyroxine in the AM on an empty stomach. What will happen to her TSH if she takes two pills instead of one? - Solution TSH will DECREASE A patient has hypothyroidism. Her last TSH was 2.5. She takes her levothyroxine in the AM on an empty stomach. What will happen to her TSH if she takes the levothyroxine with an OTC PPI? - Solution TSH will INCREASE (PPIs increase gastric acid and affect absorption)

A patient has hypothyroidism. Her last TSH was 2.5. She takes her levothyroxine in the AM on an empty stomach. What will happen to her TSH if she takes the levothyroxine with her morning coffee? - Solution TSH will INCREASE A patient has hypothyroidism. Her last TSH was 2.5. She takes her levothyroxine in the AM on an empty stomach. What will happen to her TSH if she swtiches to a GENERIC form of levothyroxine? - Solution TSH could go up, or down, or stay the same... Which medication combination presents the lowest risk for hypoglycemia to a patient? A) Metformin + NPH insulin B) Metformin + sulfonylurea C) TZD + DPP- D) SGLT2 + basal insulin - Solution C) TZD + DPP- A 75-year old patient was diagnosed with hypothyroidism today. Her calculated levothyroxine replacement is 88 mcg daily. How shoulder her levothyroxine dose be managed? A) Refer to endocrinology B) Start Levothyroxine 25 mcg daily C) Start Levothyroxine 44 mcg daily D) Start Levothyroxine 50 mcg daily - Solution B) Start Levothyroxine 25 mcg daily Older patients and those with underlying cardiac issues or multiple comorbidites should start low and titrate slowly a 58-year old female w/ hypothyroidism is taking 88 mcg of synthroid daily. She has a routine TSH with her annual labs. Today her TSH was 1.4 mU/L (normal 0.5-4.5) and T4 was 2.5 (normal 0.8-1.8). What action is appropriate? A) Increase her dose to 100 mcg daily B) Increase her dose to 112 mcg daily C) Decrease her dose D) Continue the same dose - Solution D) Continue the same dose Her TSH is normal

What class of diabetes medications is considered weight neutral? - Solution DPP-4 inhibitors "gliptins" sitagliptin (Januvia), linagrliptin (Tradjenta) Which diabetes medications are associated with weight loss? - Solution GLP-1 agonists - exenatide (Byetta, Bydureon), liraglutide (Victoza) -AND- SGLT 2 inhibitors - canagliflozin (Invokana), dapagliflozin (Farxiga) Which diabetes medications are associated with weight gain? - Solution Sulfonylureas - glipizide (Glucotrol), glyburide (DiaBeta), glimeperide (Amaryl) -AND- Insulin Which of the following characteristics apply to T1DM? A) significant hyperglycemia and ketoacidosis results from lack of insulin B)T1DM is commonly diagnosed on routine exam or workup for other health problems C) Initial response to oral sulfonylureas is usually favorable D) Insulin resistance is a significant part of the disease - Solution A) significant hyperglycemia and ketoacidosis results from lack of insulin Which of the following characteristics apply to T2DM? A) Heredity and obesity are major risk factors B) Pear-shaped body type is common C) Exogenous insulin is needed for control of disease D) Physical activity enhances insulin resistance - Solution A) Heredity and obesity are major risk factors 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 - Solution A) extended duration of action

After use, the onset of action of lispro (Humalog) occurs in A) less than 30 minutes B) approximately 1 hour C) 1-2 hours D) 3-4 hours - Solution A) less than 30 minutes Which of the following medications should be used with caution in a person with a known or suspected sulfa allergy? A) metformin B) glyburide C) rosglitazone D) NPH insulin - Solution 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 - Solution C) a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production Generally, testing for T2DM in asymptomatic, undiagnosed individuals over the age of 45 years, should be done every ______________. A) year B) 3 years C) 5 years D) 10 years - Solution B) 3 years You are seeing a 17-year old girl. All of the following would be considered risk factors for T2DM except: A) obesity B) Native American ancestry C) Family history of T1 DM

D) personal history of polycystic ovary syndrome - Solution C) family history of T1DM Criteria for the diagnosis of T2DM includes: A) classic symptoms, regardless of fasting plasma glucose measurement B) plasma glucose level of 126 mg/dL as a random measurement C) a 2-hour glucose measurement of 156 mg/dl after a 75-gram anhydrous glucose load D) a plasma glucose level of 126 mg/dl or greater after an 8-hour fast on more than one occasion - Solution D) a plasma glucose level of 126 mg/dl or greater after an 8-hour 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 sensititizer D) a facilitator of renal glucose excretion - Solution C) an insulin sensititizer pioglitazone (Actos) is a thiazolidinedione Which of the following should be the goal measurement in a person with DM and hypertension? A) SBP < 140 and DBP < 90 B) Ā1C equal to or greater than 7% C) Triglyceride level 200-300 D) HDL level 35-40 - Solution A) SBP < 140 and DBP < 90 In caring for a patient with DM, micoralbuminuria measurement should be obtained A) annually if urine protein is present B) periodically in relation to glycemic control C) yearly D) with every diabetes-related office visit - Solution 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 - Solution B) a product that enhances insulin release When caring for a patient with DM, HTN, and persistent proteinuria, the NP should prescribe ___________. A) furosemide B) methyldopa C) fosinopril D) nifedipine - Solution C) fosinopril Clinical presentation of T1DM usually includes all of the following, except A) report of recent unintentional weight gain B) ketosis C) thirst D) polyphagia - Solution A) report of recent unintentional weight gain Which of the following should be periodically monitoring when using a thiazolidinedione? A) CK B) ALP C) ALT D) Cr - Solution C) ALT Which of the following should be periodically monitoring when using a biguanide? A) CK B) ALP C) ALT D) Cr - Solution D) Cr All of the following are risks for lactic acidosis in individuals taking metformin, except A) the presence of chronic renal insufficiency

B) acute dehydration C) recent use of radiographic contrast dye D) history of allergic reaction to sulfonamides - Solution 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 - Solution D) low dose angiotensin receptor blockers Hemoglobin Ā1C 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 - Solution D) 64-90 days Which of the following statements is not true concerning the effects of exercise and insulin resistance? A) Approximately 80% of the body's insulin-mediated glucose uptake occurs in the skeletal muscle B) With regular aerobic exercise, insulin resistance is reduced by approximately 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 - Solution D) hyperglycemia can occur as a result of aerobic exercise With an 0800 dose of the following insulin types, followed by inadequate dietary intake and/or excessive energy use, at what time would you expect hypoglycemia to most likely occur? A) Humalog (Lispro) B) Regular insulin (Humulin R, Novolin R)

C) NPH insulin (Humulin N, Novolin N) D) Insulin glargine (Lantus) - Solution A) Humalog (Lispro) at ~ 0830-0900 (short-acting, rapid onset insulin at peak onset of 30 minutes) B) Regular insulin (Humulin R, Novolin R) at ~1000-1100 (short acting insulin at peak onset of 2-3 hours) C) NPH insulin (Humulin N, Novolin N) at ~1400-2200 (intermediate-acting insulin at peak onset of 6 to 14 hours) D) Insulin glargine (Lantus) - hypoglycemia is unlikely because Lantus does not have a peak and duration of action is 24 hours The meglitinide analogues (e.g. repaglinide [Prandin]) are particularly helpful adjuncts in T2DM care to minimize the risk of A) fasting hypoglycemia B) nocturnal hyperglycemia C) postprandial hyperglycemia D) postprandial hypoglycemia - Solution C) postprandial hyperglycemia What is the most common adverse effect noted with alpha-glucosidase inhibitor use (e.g. acarbose [Precose])? A) GI upset B) hepatotoxicity C) renal impairment D) symptomatic hypoglycemia - Solution A) GI 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) Episode of postprandial hypoglycemia occur as a result of inadequate food intake - Solution A) Insulin-induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia