Download NR565 Final Exam Questions and Answers: Thyroid, Diabetes, and Asthma and more Exams Nursing in PDF only on Docsity!
NR565 Final Exam Questions and Answers
What labs are used to diagnose hypo/hyper thyroid? - Correct answer TSH, T3, and T4. High TSH = hypo and low TSH = hyper. Opposites. Timeframe for re-check of labs after starting levothyroxine - Correct answer 6-8 weeks (long half-life). Yearly after stable. Signs and symptoms of hypothyroidism - Correct answer Dry hair, puffy face, goiter in the neck, slow heartbeat, weight gain, constipation, infertility, increased risk of miscarriages, irregular menstrual cycle, cold intolerance. Drug of choice for hypothyroidism - Correct answer Levothyroxine (Synthroid) § Signs and symptoms of hyperthyroidism - Correct answer Hair loss, bulging eyes, goiter, rapid heartbeat, weight loss, diarrhea, menstrual periods loss often or longer. Drug of choice for hyperthyroidism - Correct answer Methimazole (Tapazole) Treatment of thyroid storm - Correct answer high doses of potassium iodide or strong iodine solution are given to suppress thyroid hormone release. Methimazole is given to suppress thyroid hormone synthesis. Beta blocker given to reduce HR. additional measures include sedation, cooling, and giving glucocorticoids and IV fluids. Result of not treating hypothyroidism during pregnancy: - Correct answer Permanent neuro-psychological deficits in the child. Decrease IQ/neuropsychological function. First trimester. Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and not the hyperthyroidism itself): - Correct answer Beta blockers (tachycardia) - propranolol/atenolol most popular.Non-radioactive iodine. ADJUNCTIVE THERAPY.
Drug/Food/Supplement interactions with levothyroxine: - Correct answer Do not take antacids, Calcium or Iron, how to take it (morning 30-60 min b eat. How to confirm a diagnosis of DM prior to beginning treatment: - Correct answer Fasting plasma glucose above 126. A random plasma glucose of over 200 plus symptoms of diabetes, an oral glucose tolerance test of two hours, plasma glucose of over 200, or a A1C higher than 6.5. A1c general goals - Correct answer <7, patients that experience severe hypoglycemia/have a limited life expectancy may have an A1C goal of <8. A1c older adults - Correct answer <8, those with multiple coexisting chronic illnesses, cognitive impairment, or functional dependence should have less stringent glycemic goals such as <8.0-8.5. When should insulin be considered? - Correct answer For treatment of persistent hyperglycemia starting at a threshold of >180. Early introduction of insulin should be considered if there is evidence of ongoing weight loss, if symptoms of hyperglycemia are present, or whenA1C levels >10% or BGS > At what time interval should A1c be re-checked? How often should an A1C be monitored when stable or when unstable? - Correct answer Every 2-3 months and max of 4 times a year. If <7, every 6 months. At least two times a year if meeting goals and quarterly if meds have changed or not meeting goals. Action of Insulin - Correct answer Anabolic, energy conservation, promotes cellular growth and division. Pioglitazone contraindications: - Correct answer Heart failure (severe = no, mild = caution) and bladder cancer. Causes fluid retention. GLP-1 (abbreviation and examples) - Correct answer Glucagonlike Peptide - Subcutaneous injections - Dulaglutide (Trulicity), Semaglutide (Ozempic), Liraglutide (Victoza).
Sulfonylureas MOA - Correct answer promote insulin secretion by the pancreas. HYPOGLYCEMIA SGLT2i MOA - Correct answer Kidney tubules. Which diabetic medication(s) come with a concern of hypoglycemia? - Correct answer Insulin, meglitinides, sulfonylureas, amylin analogues Acute symptoms of diabetes plus casual plasma glucose concentration greater than or equal to 200 mg/dL. *Casual is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes are polyuria, polydipsia, and unexplained weight loss. · Diabetes mellitus · Pre-diabetes - Correct answer · Diabetes mellitus Fasting plasma glucose greater than or equal to 126 mg/dL. *Fasting is defined as no caloric intake for at least 8 hours. · Pre-diabetes · Diabetes mellitus - Correct answer · Diabetes mellitus 2 hour post-load plasma glucose in an oral glucose tolerance test greater than or equal to 200 mg/dL. The test uses a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. · Pre-diabetes · Diabetes mellitus - Correct answer · Diabetes mellitus HgbA1c greater than or equal to 6.5% · Pre-diabetes · Diabetes mellitus - Correct answer · Diabetes mellitus Fasting plasma glucose 100 to 125 mg/dL (IFG) or · Diabetes mellitus · Pre-diabetes - Correct answer · Pre-diabetes Plasma glucose 140 to 199 mg/dL (IGT) 2 hours post-ingestion of standard glucose load (75 g) or
· Diabetes mellitus · Pre-diabetes - Correct answer · Pre-diabetes HgbA1c 5.7% to 6.4% · Diabetes mellitus · Pre-diabetes - Correct answer · Pre-diabetes Methylxanthines (Theophylline) Who is at risk for toxicity and why? - Correct answer smokers require higher doses. Heart disease liver disease require lower doses. INITIAL doses are based on age and weight. P.569 low therapeutic range. Smoking causes increased clearance so if stop smoking levels will rise to toxic levels. Step 1 therapy for asthma and COPD - Correct answer Manage with a SABA (albuterol) as needed. Symptoms associated with intermittent asthma frequency - Correct answer 2 days/week or less Symptoms associated with mild-persistent asthma frequency - Correct answer More than 2 days/week but less than daily Symptoms associated with moderate-persistent asthma frequency - Correct answer Daily Symptoms associated with severe-persistent asthma frequency - Correct answer Several times a day SABA drug class examples - Correct answer Albuterol (proair, ventolin, Proventil), levalbuterol (Xopenex). LABA drug class examples - Correct answer Aclidinium bromide, arformoterol (brovana), formoterol, indacaterol, olodaterol, salemetrol. ICS (Inhaled corticosteroids) drug class examples - Correct answer Beclomethasone dipropionate (QVAR), Budesonide (Pulmicort), Ciclesonide (Alvesco), Flunisolide (Aerospan), fluticasone propionate (Flovent), Mometasone furoate (asmanex).
cannot be controlled with safer meds (inhaler glucocorticoids, inhaled B agonists). When would roflumilast be indicated for a COPD patient? (PDE4 inhibitor) - Correct answer Severe cases of COPD with a primary component of chronic bronchitis. COPD exacerbations. Smoking cessation - what works best? - Correct answer one drug and counseling work best together. Chantix most effective (cardiovascular risk). Nicotine replacement s/e - Correct answer local irritation where the substance enters the body How does nicotine replacement work - Correct answer help with withdrawal cravings Nicotine patch - Correct answer nonprescription, provides a steady level of nicotine; easy to use; unobtrusive Nicotine gum - Correct answer unpleasant taste, requires good chewing technique, can't eat or drink, can damage dental work, hard with dentures Nonprescription; user controls doses Nicotine nasal spray - Correct answer fasted nicotine delivery and highest nicotine levels that can be achieved, most irritating Wellbutrin/Bupropion are - Correct answer Nicotine free Wellbutrin contrainidications - Correct answer history of seizure, anorexia, nervosa, cocaine use and alcohol withdraw. Bupropion s/e - Correct answer serious neuropsychiatric effects Recommended length of treatment for bupropion - Correct answer 12 weeks What constitutes drug resistant TB - Correct answer Drug-resistant tuberculosis occurs when TB bacteria become resistant to the drugs used
to treat the disease and includes multidrug-resistant (MDR TB) and extensively drug-resistant (XDR TB). Treatment of TB in a pregnant person, what all should be included? - Correct answer A 9-month regimen of isoniazid is recommended for pregnant women and should also receive pyridoxine supplements. Isoniazid (INH) - Correct answer a drug that can be used to prevent TB in people that have been exposed. Rifabutin TB - Correct answer deemed the safest during pregnancy. cold and cough meds actions (3) - Correct answer Decongestants decrease stuffiness. Antitussives suppress coughing. Expectorants help to clear out mucous. examples of decongestants - Correct answer Beclomethasone dipropionate, budesonide, fluticasone, triamcinolone. Which drug class has no significant drug interactions: cold and cough - Correct answer expectorants H2 receptor antagonists examples - Correct answer Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), ranitidine (Zantac). Which is most likely to interact due to CYP450 enzyme system? - Correct answer Cimetidine (Tagamet) Proton Pump Inhibitors - Correct answer First-line therapy. Omeprazole (Prilosec), esomeprazole (nexium), pantoprazole (protonix) Associated vitamin and/or mineral deficiencies with PPI - Correct answer Decreased absorption of calcium, magnesium, and vitamin B12. Short term use increases risk of what with PPI - Correct answer Community-acquired pneumonia (CAP, first few days), rebound GERD- use lowest does for shortest period of time and tapper. Can persist for several months after PPI dc, diarrhea (dose related) Cdiff
Lifestyle modifications to suggest prior to treatment - Correct answer Increasing fiber and fluid in the diet, mild exercise. Risks of laxatives during pregnancy - Correct answer Gastrointestinal stimulation can induce labor. Preferred treatment during breastfeeding constipation - Correct answer senna Psyllium - Correct answer bulk forming laxative and can cause fecal impaction or obstruction. How psyllium works and what to assess for if it doesn't produce a bowel - Correct answer Absorb water, thereby softening and enlarging the fecal mass. obstruction Irritable Bowel Syndrome (IBS) - Correct answer A diary can be helpful to aid in diagnosis and treatment. Logging food and stressors that trigger symptoms, different for different people. Diagnosed by Rome IV criteria. Nonspecific drugs to treat IBS - Correct answer Antispasmodics (Hyoscyamine and dicyclomine), bulk-forming agents (psyllium and polycarbophil), antidiarrheals (loperamide), and tricyclic antidepressants (TCAs). How to treat gastroparesis: - Correct answer Prokinetic drug is best Black box warning associated with treatment (prokinetic drug) - Correct answer Risk of developing tardive dyskinesia Patient teaching needed with Metronidazole - Correct answer Tardive dyskinesia risk increases with length of treatment, treatment should not exceed 12 weeks, immediately discontinue with signs of movement disorder including repetitive involuntary movements of arms, legs, and facial muscles. Older adults are especially vulnerable. Never used during first trimester of pregnancy
The parent of a child with cerebral palsy reports that the child has pebble- like stools most of the time and seems uncomfortable if several days have passed between stools. Which of the following medications should be recommended to alleviate the child's constipation? · Magnesium citrate · Methylcellulose · Bisacodyl suppositories · Polyethylene glycol - Correct answer · Polyethylene glycol Sodium phosphate is a routine order for bowel cleansing before a colonoscopy. The patient's lab tests report an elevated creatinine clearance and blood urea nitrogen. What is the best course of action for this patient? · Prescribe polyethylene glycol and electrolytes (PEG-ELS) instead · Suggest that the patient reduce the dietary sodium intake · Reduce the amount of fluid given with the laxative to prevent fluid retention · Prescribe a laxative suppository instead - Correct answer · Prescribe polyethylene glycol and electrolytes (PEG-ELS) instead An older adult patient takes an opioid analgesic after a right-hip open reduction internal fixation (ORIF). Which of the following medications should be prescribed to prevent constipation? · GoLYTELY · Docusate sodium · Glycerin suppositories · Polyethylene glycol - Correct answer · Docusate sodium A patient reports taking an oral bisacodyl laxative for several years. Which of the following instructions should be given to guide the discontinuation of the laxative? · Withdraw from the laxative slowly to avoid a rebound constipation effect. · Stop taking the oral laxative and use a suppository until normal motility resumes. · Stop taking the laxative immediately and expect no stool for several days. · Switch to a bulk-forming laxative, such as methylcellulose. - Correct answer · Stop taking the laxative immediately and expect no stool for several days.
Attenuated vaccine - Correct answer Composed of live microbes that have been weakened or rendered completely avirulent. Live virus vaccine - Correct answer Composed of living microbes that have been weakened or rendered completely avirulent. Toxoid vaccine - Correct answer A bacterial toxin changed to a nontoxic form. Administration causes the receipt's immune system to manufacture antibodies. DTAP, TETANUS immunity - What are they and how is each one achieved? - Correct answer Immunity is achieved through the occurrence of antibodies to a specific disease. Herd (Community) immunity: - Correct answer The resistance to an infectious organism because a large group of people is immune to the infectious organism through vaccine. Active immunity: - Correct answer The immune system produces antibodies in response to an antigen by the vaccine, or by the infection itself. Passive immunity - Correct answer The immunity that occurs naturally. Definition of vaccine - Correct answer A preparation containing whole or fractioned microorganisms. Administration causes recipient's immune system to manufacture antibodies directed against the microbe from which the vaccine was made. Post exposure prophylaxis for suspected rabies bite - Correct answer Post exposure prophylaxis (PEP) consists of a dose of human rabies immune globulin (HRIG) and rabies vaccine given on the day of the rabies exposure, and then a dose of vaccine given again on days 3, 7, and 14. Patient teaching and assessments for post vaccine side effects: - Correct answer Local reactions (discomfort, swelling, erythema at the injection site), fever, rare is anaphylaxis, acute encephalopathy, and vaccine- associated paralytic poliomyelitis.
Who can receive attenuated influenza vaccine (FluMist)? - Correct answer individuals >2yo an d less than 50. non pregnant, and those who are not immunocompromised Measles, mumps, and rubella virus vaccine (MMR) Measles, mumps, and rubella, and varicella virus vaccine (MMRV) Varicella virus vaccine Influenza vaccine Rotavirus vaccine · Recombinant protein solution · Live virus · Toxoids · Bacterial polysaccharide conjugated to protein - Correct answer · Live virus Diphtheria and tetanus and acellular pertussis vaccine (DTaP) Diphtheria and tetanus and acellular pertussis adsorbed, hepatitis B (recombinant), and inactivated poliovirus vaccine Tetanus and diphtheria · Bacterial polysaccharide conjugated to protein · Recombinant protein solution · DNA-free virus-like particles · Toxoids - Correct answer · Toxoids Poliovirus vaccine, inactivated (IPV, Salk vaccine) Hepatitis A vaccine (HepA) Hepatitis B vaccine (HepB) Influenza vaccine · Bacterial polysaccharide conjugated to protein · Inactive viral antigen · Recombinant protein solution · Toxoids - Correct answer · Inactive viral antigen Human papillomavirus vaccine · Recombinant protein solution · DNA-free virus-like particles · Inactive viral antigen · Bacterial polysaccharide conjugated to protein - Correct answer · DNA- free virus-like particles
What is the role of Radioactive Iodine and what is a possible adverse effect? - Correct answer TO destroy thyroid tissue with those with hyperthyroidism. And/or have not responded to therapy. Beta blockers in diabetes - Correct answer Can mask the signs/symptoms of hypoglycemia A1C target in children/adolescents - Correct answer <7% Insulin dose calculations - Correct answer 1: calculate TDD by using 0.6units/kg/day 2: calculate mealtime carbohydrate-to-insulin dose by dividing 500 (for rapid acting) or 450 (for regular insulin) by TDD 3: round your number 4: now you have your carbohydrate-to-insulin ratio such as 1: Example: if meal is 60g of carbs, 60g divided by 10 is the # of units of insulin A patient receives his first lab results showing an AIC of 7.2%. What is the diagnosis? - Correct answer Repeat for confirmation A random glucose of ________ is considered diabetic? - Correct answer A random plasma glucose of over 200 A person with diabetes has recurrent severe hypoglycemia events. What should his A1C goal be? - Correct answer Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long- standing diabetes in whom the goal is difficult to achieve despite DS When is it okay for a patient to have an A1C goal of 6.5%? - Correct answer When there are no hypoglycemic events and the patient can handle it. A person comes in with an A1C of 10% and a fasting glucose of >300, what are the next steps for the provider? - Correct answer Combination injectable therapy immediately. IF 9% can start at step 2 with dual therapy. P
Biguanide (metformin) - Correct answer Decreases glucose production by the liver Who should not take metformin? - Correct answer Severe metabolic acidosis can occur with accumulation of metformin. Highest risk occurs in diabetic patients with significant renal impairment. liver disease, severe infection, or a history of lactic acidosis contraindicated for people with failing hearts Sulfonylureas should not be used during __________ or with _______ or _______ impairment. - Correct answer Not used during pregnancy; liver or renal impairment What is the TDD of a person that weighs 70kg? If a person is eating a 50 carb meal, how much insulin will be needed based on the TDD from the above question? - Correct answer TDD = 42 500/42 = 12 rounded 50/12 = 4 units of insulin A patients states that she will take her Insulin lispro 30-60 minutes before a meal. - Correct answer Lispro onset is 15-30 mins Mixing insulins - Correct answer When a mixture is prepared, the short- acting insulin should be drawn into the syringe first to avoid contaminating the stock vial of the short-acting insulin with NPH insulin. Canagliflozin s/e - Correct answer female genital fungal infections, urinary tract infections, and increased urination. A patient taking Sitagliptin reports abdominal pain with vomiting. What are your next steps? - Correct answer Concern for pancreatitis Lifespan considerations formethylxanthines - Correct answer •Rates of metabolism are affected by age. For nonsmoking adults half-life is about 8 hours. Smoking can accelerate it.Half-life in kids is 4hrs LABA MOA - Correct answer A sympathomimetic drug that activates B adrenergic receptors. This promotes broncho dilation and thus relieving
IF a person is eating a 50 carb meal, how much insulin will be needed based on the TDD from the above question? - Correct answer 42 TDD : 21 basal 21 bolus (Wt in kg x 0.6; 50% long acting and 50% rapid acting) 500 divided by (the TDD) 42 = 12. (carb to insulin ratio) then (meal carbs) 50 divided 12= 4.1 units with short acting insulin "As long as the short-acting insulin is drawn up first I can mix my insulin glargine with it." - Correct answer Of the long-acting medications, ONLY NPH the intermediate duration is suitable for mixing with the short action insulins. A women who is taking Pioglitazone states, "I'm glad that this medication promotes weight loss." - Correct answer First this medication promotes increase in LDL levels, which increases cardiovascular risk. Also, she's a female so speak about exercise and weight bearing exercise d/t possible increased risk for fractures. Glucocorticoid MOA - Correct answer Most effective in long-term control of airway inflammation Cromolyn MOA - Correct answer Used as prophylaxis for mild to moderate asthma Monoclonal Antibodies MOA - Correct answer Used for allergy-related asthma and Eosinophilic asthma. Omalizumab for allergy related and Ben ralizumab, mepliz, and resliz are for eosinophilic Leukotriene MOA - Correct answer Second-line therapy to reduce inflammation and bronchoconstriction B2 adrenergic agonists MOA - Correct answer Can be used PRN, for EIB, COPD exacerbations, and maintenance therapy methylxanthines MOA - Correct answer Maintenance therapy for chronic stable asthma (theophylline). P. 570. Use ONLY if B2 or anticholinergics are not appropriate. anticholinergic MOA - Correct answer Approved for bronchospasm related to COPD
•What are some risk factors of fatal asthma attacks? - Correct answer Uncontrolled, hospitalized recently, triggers, •Roflumilast (select all that apply) 1.Reduces inflammation 2.Not intended during pregnancy 3.Approved for asthma
- First-line drug for COPD - Correct answer Reduces inflammation, not intended for pregnancy, approved only for COPD, Second-line drug for COPD Uses for exacerbations prophylaxis in pts with severe COPD with a primary chronic bronchitis component. What pt education can you provide a patient for ICS use? - Correct answer Rinse d/t oropharyngeal candidiasis and dysphonia (hoarseness, difficulty speaking). What patient teaching can a provider give when prescribing a PPI? - Correct answer Hypomagnesia symptoms: muscle cramps, tremors, cramps, and palpitations. Check Mg levels periodically especially in the elderly. Get enough calcium and VIT D. call if having diarrhea (Cdiff) What patient teaching can a provider give when prescribing an H2RA? - Correct answer Report lethargy, solmnolance, restlessness, confusion or hallucinations. (CNS effects). Teach about possible reduced libido, impotence, gynecomastia, pneumonia. P.594 Cimetidine interacts with CYP system so check with pt if they are taking warfarin, phenytoin, theophylline, lidocaine. A patient presents with a complaint of reflux and constipation. He states that he drinks enough water, and admits he has gained 30lbs. He also states that he has been having "reflux" type symptoms. What are your next steps for education? - Correct answer Educate that weight gain can promote reflux symptoms, ask about any otc use such as antacids which may cause constipation.
