Endocrine

Intervention in microalbuminuria for a person with DM includes which of the following? (Select all that 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. use of an ACEI with an ARB

A, B, C

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

The mechanism of action of radioactive iodine in the treatment of Graves' disease is to: A. destroy the overactive thyroid tissue. B. reduce production of TSH. C. alter thyroid metabolic rate. D. relieve distress caused by increased thyroid size.

A. destroy the overactive thyroid tissue.

Laboratory findings in heatstroke usually include: A. elevated total creatine kinase. B. anemia. C. metabolic alkalosis. D. hypokalemia.

A. elevated total creatine kinase.

You consider prescribing insulin glargine (Toujeo®, 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. extended duration of action.

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. gastrointestinal upset

A first-line approach to treating Cushing's syndrome in a 56-year-old woman who has been taking oral corticosteroids to treat rheumatoid arthritis for the past 2 years is: A. gradually tapering corticosteroid use. B. referral for surgery. C. consideration of radiation therapy. D. prescribing mifepristone.

A. gradually tapering corticosteroid use.

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. hyperovulation

Amenorrhea or oligomenorrhea are associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism

A. hyperthyroidism.

Frequent, low-volume, loose stools are associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

A. hyperthyroidism.

Heat intolerance is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

A. hyperthyroidism.

Hyperreflexia with a characteristic "quick out-quick back" action at the patellar reflex is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

A. hyperthyroidism.

Proximal muscle weakness is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

A. hyperthyroidism.

Smooth, silky skin is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

A. hyperthyroidism.

Tachycardia with hypertension is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

A. hyperthyroidism.

The laboratory results TSH = 24 mIU/L (0.4 to 4.0 mIU/L); free T4 = 3 pmol/L (10 to 27 pmol/L) indicate which condition? A. hypothyroidism B. hyperthyroidism C. subclinical hypothyroidism

A. hypothyroidism

A program of regular aerobic physical activity can yield which of the following changes in the lipid profile? A. increases HDL, lowers VLDL and triglycerides B. lowers VLDL and LDL C. increases HDL, lowers LDL D. lowers HDL, VLDL, and triglycerides

A. increases HDL, lowers VLDL and triglycerides

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. less than 30 minutes.

Secondary adrenal insufficiency can occur with the presence of a diseased or malfunctioning: A. pituitary gland. B. thyroid. C. pancreatic beta cells. D. hypothalamus.

A. pituitary gland.

In prescribing niacin therapy for a patient with hyperlipidemia, the NP considers that: A. postdose flushing is often reported. B. periodic creatine kinase monitoring is warranted. C. low-dose therapy is usually effective in increasing LDL level. D. drug-induced thrombocytopenia is a common problem.

A. postdose flushing is often reported.

Which of the following medications is a helpful treatment option for relief of tremor and tachycardia seen with untreated hyperthyroidism? A. propranolol B. diazepam C. carbamazepine D. verapamil

A. propranolol

Clinical presentation of type 1 DM usually includes all of the following except: A. report of recent unintended weight gain. B. ketosis. C. persistent thirst. D. polyphagia.

A. report of recent unintended weight gain.

Possible adverse outcomes from heatstroke include: A. rhabdomyolysis. B. thrombocytopenia. C. hypernatremia. D. leukopenia.

A. rhabdomyolysis.

Untreated Cushing's syndrome can lead to all of the following except: A. rheumatoid arthritis. B. hypertension. C. type 2 diabetes. D. osteoporosis.

A. rheumatoid arthritis.

The use of which of the following medications is often associated with weight gain? A. risperidone (Risperdal®) B. topiramate (Topamax®) C. metformin (Glucophage®) D. sitagliptin (Januvia®)

A. risperidone (Risperdal®)

Which of the following daily doses has the lowest lipid-lowering effect? A. simvastatin 10 mg B. rosuvastatin 5 mg C. atorvastatin 10 mg D. pravastatin 40 mg

A. simvastatin 10 mg

Which is following is the least helpful test for the assessment of thyroid disease? A. total T4 B. thyroid-stimulating hormone (TSH) C. free T4 D. thyroid peroxidase (TPO) antibodies

A. total T4

When advising a person who will be using orlistat (Xenical®, Alli®) as part of a weight loss program, the NP provides the following information about when to take the medication: A. within an hour of each meal that contains fat. B. before any food with high carbohydrate content. C. only in the morning, to avoid sleep disturbance. D. up to 3 hours after any meal, regardless of types of food eaten.

A. within an hour of each meal that contains fat.

Phentermine's mechanism of action in weight loss is as a product that reduces gastrointestinal (GI) motility. A. True B. False

B. False

Which of the following is a mineralocorticoid? A. cortisol B. aldosterone C. insulin D. hydrocortisone

B. aldosterone

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.

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

Which of the following is an example of moderate-intensity statin therapy? A. fluvastatin 10 mg B. atorvastatin 10 mg C. simvastatin 10 mg D. pravastatin 20 mg

B. atorvastatin 10 mg

The anticipated effect on the lipid profile with plant stanol and sterol use includes: A. increase in HDL. B. decrease in LDL. C. decrease in select lipoprotein subfractions. D. decrease in triglycerides

B. decrease in LDL.

Which of the following medications should be used with caution in a person with severe sulfa allergy? A. metformin B. glyburide C. rosiglitazone D. NPH insulin

B. glyburide

The laboratory results TSH less than 0.15 mIU/L (0.4 to 4.0 mIU/L); free T4 = 79 pmol/L (10 to 27 pmol/L) indicate which condition? A. hypothyroidism B. hyperthyroidism C. subclinical hypothyroidism

B. hyperthyroidism

Hyporeflexia with a characteristic slow relaxation phase, the "hung-up" reflex, is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

B. hypothyroidism

Coarse hair with tendency to break easily is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

B. hypothyroidism.

Coarse, dry skin is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

B. hypothyroidism.

Constipation is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

B. hypothyroidism.

Menorrhagia is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

B. hypothyroidism.

Secondary hypertriglyceridemia is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

B. hypothyroidism.

Thick, dry nails are associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

B. hypothyroidism.

When prescribing a fibrate, the NP expects to see which of the following changes in lipid profile? A. marked decrease in LDL level B. increase in HDL level C. no effect on triglyceride level D. increase in very low-density lipoprotein (VLDL) level

B. increase in HDL level

When prescribing niacin, the NP expects to see which of the following changes in lipid profile? A. marked decrease in LDL level B. increase in HDL level C. no effect on triglyceride level D. increase in VLDL level

B. increase in HDL level

The hormone cortisol plays a role in all of the following processes except: A. maintaining glucose control. B. maintaining thyroid function. C. suppressing the immune response. D. helping the body respond to stress.

B. maintaining thyroid function.

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.

B. notation of ethnic-specific waist circumference measurements.

The use of GLP-1 agonist has been associated with the development of: A. leukopenia. B. pancreatitis. C. lymphoma. D. vitiligo.

B. pancreatitis.

The most commonly utilized intervention for patients with heatstroke is: A. total body ice packing. B. rehydration. C. management of hyperammonemia. D. electrolyte supplementation.

B. rehydration.

Which of the following medications is representative of high-intensity statin therapy? A. pravastatin 40 mg B. rosuvastatin 20 mg C. simvastatin 40 mg D. lovastatin 20 mg

B. rosuvastatin 20 mg

A 48-year-old woman with newly diagnosed hypothyroidism asks about a "natural thyroid" medication she read about online and provides the drug's name: desiccated thyroid. As you counsel her about this medication, you consider all of the following except: A. this product contains a fixed dose of T3 and T4. B. the medication is a plant-based product. C. its pharmacokinetics differ significantly when compared to levothyroxine. D. the majority of the study on treatment for hypothyroidism has been done using levothyroxine.

B. the medication is a plant-based product.

You are seeing a patient who is taking warfarin and cholestyramine and provide the following advice: A. "Take both medications together." B. "You need to have additional hepatic and renal monitoring tests while on this combination." C. "Separate the cholestyramine from other medications by at least 2 hours." D. "Make sure you take these medications on an empty stomach."

C. "Separate the cholestyramine from other medications by at least 2 hours."

A pound of fat contains approximately ______ stored calories. A. 2500 B. 3000 C. 3500 D. 4000

C. 3500

In a healthy person, what percentage of the body's total daily physiological insulin secretion is released as basally? A. 10%-20% B. 25%-35% C. 50%-60% D. 75%-85%

C. 50%-60%

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%.

C. 8%.

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

C. ALT

Periodic routine screening for hypothyroidism is indicated in the presence of which of the following clinical conditions? A. digoxin use B. male gender C. Down syndrome D. alcoholism

C. Down syndrome

You advise a 58-year-old woman with hypothyroidism about the correct use of levothyroxine. She also takes a calcium supplement. All of the following should be shared with the patient except which instruction? A. "Take the medication on an empty stomach." B. "To help with adherence, take your calcium supplement at the same time as your thyroid medication." C. "You should take the medication at approximately the same time every day." D. "Do not take your medication with soy milk."

B. "To help with adherence, take your calcium supplement at the same time as your thyroid medication."

A 46-year-old woman complains of fatigue, weakness, lethargy, decreased concentration and memory, and increased facial hair over the past 12 months. She also reports gaining over 30 pounds (13.6 kg) in the past 2 months. She has a history of asthma with repeated flares during the past 6 months requiring multiple courses of prednisone therapy. A likely diagnosis for this patient is: A. type 2 diabetes. B. Cushing's syndrome. C. Cushing's disease. D. central obesity.

B. Cushing's syndrome.

All the following medications are recommended as possible first-line medications for treatment of concomitant hypertension when seen with type 2 DM in a 48-year-old man of European ancestry except: A. thiazide diuretic. B. calcium channel blocker. C. alpha-adrenergic receptor antagonist. D. angiotensin receptor blocker.

C. alpha-adrenergic receptor antagonist.

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.

C. an insulin sensitizer.

Hypothyroidism most often develops as a result of: A. primary pituitary failure. B. thyroid neoplasia. C. autoimmune thyroiditis. D. radioactive iodine exposure.

C. autoimmune thyroiditis.

Goiter is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism

C. both hyperthyroidism and hypothyroidism

Atypical presentation in an elderly person is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

C. both hyperthyroidism and hypothyroidism.

Change in mental status is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

C. both hyperthyroidism and hypothyroidism.

Cushing's syndrome results from an excess of: A. luteinizing hormone. B. follicle-stimulating hormone. C. cortisol. D. aldosterone.

C. cortisol.

A 24-year-old female runner is diagnosed with Addison's disease. In counseling her about exercise, you recommend: A. tapering her running to only 10 minutes per day for 2 to 3 days per week. B. ceasing any prolonged strenuous exercise. C. ensuring an ample amount of sodium is ingested. D. switching to a nonimpact exercise.

C. ensuring an ample amount of sodium is ingested.

Physical examination findings in patients with Graves' disease include: A. muscle tenderness. B. coarse, dry skin. C. eyelid retraction. D. delayed relaxation phase of the patellar reflex.

C. eyelid retraction.

You are seeing 17-year-old Amanda. 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.

C. family history of type 1 DM.

Which of the following is the most cost-effective method of distinguishing a malignant from a benign thyroid nodule? A. ultrasound B. magnetic resonance (MRI) imaging C. fine-needle aspiration biopsy D. radioactive iodine scan

C. fine-needle aspiration biopsy

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

C. fosinopril.

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

C. glipizide

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

C. greater responsiveness to angiotensin II.

Untreated hypothyroidism can result in which of the following changes in the lipid profile? A. increased HDL and decreased triglycerides B. increased LDL and total cholesterol C. increased LDL, total cholesterol, and triglycerides D. decreased LDL and HDL

C. increased LDL, total cholesterol, and triglycerides

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.

C. lactic acidosis.

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.

C. postprandial hyperglycemia.

The laboratory results TSH = 8.9 mIU/L (0.4 to 4.0 mIU/L); free T4 = 15 pmol/L (10 to 27 pmol/L) indicate which condition? A. hypothyroidism B. hyperthyroidism C. subclinical hypothyroidism

C. subclinical hypothyroidism

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

D. biguanide

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)

D. creatinine (Cr)

The anticipated effect on the lipid profile with high-dose omega-3 fatty acid use includes: A. increase in HDL. B. decrease in LDL. C. decrease in total cholesterol. D. decrease in triglycerides.

D. decrease in triglycerides.

Increased risk of thyroid disorder is found in individuals who are: A. obese. B. hypertensive. C. treated with systemic corticosteroids. D. elderly.

D. elderly.

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

D. face.

A 34-year-old woman complains of progressive weakness, fatigue, poor appetite, and weight loss. She has also noticed the development of hyperpigmentation, mainly on the knuckles, elbows, and knees. All of the following blood tests can be used to help confirm a diagnosis of Addison's disease except: A. sodium. B. potassium. C. cortisol. D. folate.

D. folate.

All of the following are risks for lactic acidosis in individuals taking metformin except: A. presence of chronic renal insufficiency. B. acute dehydration. C. recent radiographic contrast dye use. D. history of allergic reaction to sulfonamides.

D. history of allergic reaction to sulfonamides.

A 43-year-old man is experiencing an acute adrenal crisis and presents with prominent nausea, vomiting, and low blood pressure. He appears cyanotic and confused. The most appropriate treatment is an injection of: A. epinephrine. B. insulin. C. adrenaline. D. hydrocortisone.

D. hydrocortisone.

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 low-density lipoprotein (LDL) cholesterol production.

D. increased low-density lipoprotein (LDL) cholesterol production.

In an older adult with type 2 DM with gastroparesis, the use of which of the following medications should be avoided? A. insulin glargine (Toujeo®, Lantus®) B. insulin aspart (NovoLog®) C. glimepiride (Amaryl®) D. liraglutide (Victoza®)

D. liraglutide (Victoza®)

The use of which of the following medications can induce thyroid dysfunction? A. sertraline B. venlafaxine C. bupropion D. lithium

D. lithium

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.

D. low-dose angiotensin receptor blockers.

The action of which of the following is believed to be most responsible for the sensation of satiety? A. norepinephrine B. epinephrine C. dopamine D. serotonin

D. serotonin

The most commonly recommended treatment of Cushing's disease is: A. tapering or ceasing corticosteroid use. B. eliminating trigger medications. C. antineoplastic therapy. D. surgical intervention.

D. surgical intervention.

In the report of a thyroid scan done on a 48-year-old woman with a thyroid mass, a "cold spot" is reported. This finding is most consistent with: A. autonomously functioning adenoma. B. Graves' disease. C. Hashimoto's disease. D. thyroid cyst.

D. thyroid cyst.

A fixed, painless thyroid mass accompanied by hoarseness and dysphagia should raise the suspicion of: A. adenomatous lesion. B. Graves' disease. C. Hashimoto's disease. D. thyroid malignancy.

D. thyroid malignancy.

Risk factors for heatstroke include all of the following except: A. obesity. B. use of beta-adrenergic antagonists. C. excessive activity. D. use of a vasodilator.

D. use of a vasodilator.

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.

C. yearly.

The commonly recommended physical activity level of 10,000 steps per day is roughly the equivalent of walking ______ miles. A. 1 to 2 B. 2 to 3 C. 3 to 4 D. 4 to 5

D. 4 to 5

At minimum, at what interval should TSH be reassessed after a levothyroxine dosage is adjusted? A. 1 to 2 weeks B. 2 to 4 weeks C. 4 to 6 weeks D. 6 to 8 weeks

D. 6 to 8 weeks

Hemoglobin A1c best provides information on glucose control over the past: A. 21 to 47. B. 48 to 68. C. 69 to 89. D. 90 to 120.

D. 90 to 120.

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

D. an insulin form

TSH is released by the: A. thyroid follicles. B. adrenal cortex. C. hypothalamus. D. anterior lobe of the pituitary.

D. anterior lobe of the pituitary.

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? (Select all that 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 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 two times per week. D. Vigorous aerobic or resistance activity is potentially contraindicated in the presence of proliferative or severe nonproliferative retinopathy because of the possible risk of vitreous hemorrhage or retinal detachment.

A, B, C, D

Which of the following is a possible consequence of obesity? (Select all that apply.) A. obstructive apnea B. steatohepatitis C. female infertility D. endometrial cancer

A, B, C, D

You are counseling a patient who is considering gastric bypass surgery for weight loss. You advise the following. (Select all that apply.) A. Calcium absorption will be reduced. B. Rapid weight loss after obesity surgery can contribute to the development of gallstones. C. Chronic constipation is a common postoperative adverse effect. D. Lifelong vitamin B12 supplementation is recommended.

A, B, D

Which of the following is an example of an appropriate question to pose to a person with obesity who is in the precontemplation change stage? A. "How do you feel about your weight?" B. "What are barriers you see to losing weight?" C. "What is your personal goal for weight loss?" D. "How do you envision my helping you meet your weight loss goal?"

A. "How do you feel about your weight?"

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

A. FBS.

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

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. Major risk factors are heredity and obesity.

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

In general, weight lost post-gastric bypass is significantly more when compared with the postoperative course of a restrictive procedure such as adjustable gastric band or gastric sleeve. A. True B. False

A. True

The weight loss medication Lorcaserin (Belviq®) should not be used with medications that have a serotonergic effect. A. True B. False

A. True

The weight loss medication Phentermine/topiramate (Qsymia®) carries a warning about potential teratogenic effects. A. True B. False

A. True

Use of naltrexone/bupropion (Contrave®) for weight loss is associated with increased risk of suicidal ideation. A. True B. False

A. True

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

The mechanism of action of a GLP-1 agonist such as exenatide (Byetta®) is as: A. a drug that stimulates insulin production in response to an 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 drug that stimulates insulin production in response to an increase in plasma glucose.

The findings of a painless thyroid mass and TSH level of less than 0.1 IU/mL in a 35-year-old woman is most consistent with: A. autonomously functioning adenoma. B. Graves' disease. C. Hashimoto's disease. D. thyroid malignancy.

A. autonomously functioning adenoma.

Which of the following should be the goal measurement in treating a 45-year-old man 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. blood pressure less than 140 mm Hg systolic and less than 90 mm Hg diastolic

Possible consequences of excessive levothyroxine use include: A. bone thinning. B. fatigue. C. renal impairment. D. constipation.

A. bone thinning.

Which of the following is an example of an appropriate question to pose to a person with obesity who is in the contemplation change stage? A. "How do you feel about your weight?" B. "What are barriers you see to losing weight?" C. "What is your personal goal for weight loss?" D. "How do you envision my helping you meet your weight loss goal?"

B. "What are barriers you see to losing weight?"

For patients with documented coronary heart disease, the American Heart Association advises intake of approximately _____ of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day, preferably from oily fish. A. 500 mg B. 1 g C. 2 g D. 4 g

B. 1 g

In a person with obesity, weight loss of ______% or more yields an immediate reduction in death rates from cardiovascular and cerebrovascular disease. A. 5 B. 10 C. 15 D. 20

B. 10

With the use of weight loss medications, if the patient has not achieved a 5% weight loss by week ______ of treatment, the therapy should be discontinued. A. 6 B. 12 C. 18 D. 24

B. 12

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

B. 3 years

Obesity is defined as having a body mass index (BMI) equal to or greater than ___ kg/m2. A. 25 B. 30 C. 35 D. 40

B. 30

In teaching a patient with type 2 diabetes mellitus and taking basal insulin such as degludec (Tresiba®) about using rapid-acting insulin such as aspart (Novolog®) to help with the management of postprandial hyperglycemia, the NP advises first starting an injection of ________ unit(s) prior to the largest meal. A. 1 B. 4 C. 8 D. 12

B. 4

What is the average LDL reduction achieved with a change in diet as a single lifestyle modification? A. less than 5% B. 5% to 10% C. 11% to 15% D. 16% to 20% or more

B. 5% to 10%

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 no comorbid conditions equal to or at less than: A. 5.5%. B. 6%. C. 6.5%. D. 7%.

B. 6%.

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 with 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.

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

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.

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

A 78-year-old woman has hypertension, a 100 pack-year history of cigarette smoking, peripheral vascular disease, and reduced renal function (GFR = 47 mL/min/1.73 m2). Triglyceride level is 280 mg/dL (3.164 mmol/L); high-density lipoprotein (HDL) level is 48 mg/dL (1 mmol/L); and low-density lipoprotein (LDL) level is 135 mg/dL (3.5 mmol/L). Which of the following represents the most appropriate pharmacologic intervention for this patient's lipid disorders? A. Owing to her age and comorbidity, no further intervention is required. B. Moderate-intensity statin therapy is the preferred treatment option. C. A resin should be prescribed. D. The use of ezetimibe (Zetia®) will likely be sufficient to achieve dyslipidemia control.

B. Moderate-intensity statin therapy is the preferred treatment option.

When counseling about malabsorptive bariatric surgery, the NP provides the following information: A. Most people achieve ideal BMI postoperatively. B. The most dramatic weight losses are seen in the first few postoperative months. C. The death rate directly attributable to surgery is about 10%. D. Weight loss will continue for years postoperatively in most patients.

B. The most dramatic weight losses are seen in the first few postoperative months.

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.

B. a product that enhances insulin release.

With the use of ezetimibe (Zetia®), the NP expects to see: A. a marked increase in HDL cholesterol. B. a reduction in LDL cholesterol. C. a significant reduction in triglyceride levels. D. increased rhabdomyolysis when the drug is used in conjunction with HMG-CoA reductase inhibitor.

B. a reduction in LDL cholesterol.

When providing care for a patient taking an HMG-CoA reductase inhibitor, initial evaluation when starting medication includes checking which of the following serological parameters? A. potassium B. alanine aminotransferase C. bilirubin D. alkaline phosphatase

B. alanine aminotransferase

As part of an evaluation of a 3-cm, round, mobile thyroid mass, you obtain a thyroid ultrasound scan revealing a fluid-filled structure. The most likely diagnosis is: A. adenoma. B. thyroid cyst. C. multinodular goiter. D. vascular lesion.

B. thyroid cyst.

All of the following are risks for statin-induced myositis except: A. advanced age. B. use of a low-intensity statin therapy with a resin. C. low body weight. D. high-intensity statin therapy.

B. use of a low-intensity statin therapy with a resin.

You examine a 64-year-old man with hypertension and type 2 DM. Lipid profile results are as follows: HDL level is 38 mg/dL (1 mmol/), LDL level is 135 mg/dL (3.5 mmol/L), and triglyceride level is 180 mg/dL (1.9 mmol/L). His estimated 10-year ASCVD risk is 5%. His current medications include a sulfonylurea, a biguanide, an angiotensin-converting enzyme inhibitor, and a thiazide diuretic, and he has acceptable glycemic and blood pressure control. He states, "I really watch the fats and sugars in my diet." Which of the following is the most appropriate advice? A. No further intervention is needed. B. His lipid profile should be repeated in 6 months. C. Lipid-lowering drug therapy with a moderate-intensity statin should be initiated. D. The patient's dietary intervention appears adequate.

C. Lipid-lowering drug therapy with a moderate-intensity statin should be initiated.

In prescribing levothyroxine therapy for an elderly patient, which of the following statements is true? A. Elderly persons require a rapid initiation of levothyroxine therapy. B. TSH should be checked about 2 days after dosage adjustment. C. The levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults. D. TSH should be suppressed to a nondetectable level.

C. The levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults.

Cushing's disease is the specific type of Cushing's syndrome that is caused by: A. long-term exposure to corticosteroids. B. a benign tumor of the adrenal gland. C. a benign pituitary tumor. D. an ectopic tumor that produces ACTH.

C. a benign pituitary tumor.

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.

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

You examine a 46-year-old male who is a one-half pack per day cigarette smoker with hypertension. He has no evidence of clinical atherosclerotic cardiovascular disease (ASCVD), and his estimated 10-year ASCVD risk is 10%. His lipid profile is as follows: HDL level is 48 mg/dL (1.24 mmol/L); LDL level is 192 mg/dL (4.9 mmol/L); and triglyceride level is 110 mg/dL (1.3 mmol/L). He had been on a low-cholesterol diet for 6 months when these tests were taken. Which of the following represents the best next step? A. No further intervention is required. B. A fibrate should be prescribed. C. A low-intensity 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor should be prescribed. D. A high-intensity HMG-CoA reductase inhibitor regimen should be initiated.

D. A high-intensity HMG-CoA reductase inhibitor regimen should be initiated.

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.

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

With the use of a lipid-lowering resin such as cholestyramine, which of the following enzymes should be periodically monitored? A. ALP B. LDH C. aspartate aminotransferase (AST) D. No particular monitoring is recommended.

D. No particular monitoring is recommended.

With ezetimibe (Zetia®), which of the following should be periodically monitored? A. alkaline phosphatase (ALP) B. lactate dehydrogenase (LDH) C. creatinine phosphokinase (CPK) D. No special laboratory monitoring is recommended.

D. No special laboratory monitoring is recommended.

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.

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

Which of the following patients has prediabetes? A. a 70-year-old man with a fasting glucose of 99 mg/dL (6.05 mmol/L) B. an 84-year-old woman with a 1-hour postprandial 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 postprandial glucose of 152 mg/dL (8.44 mmol/L)

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

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.

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.