ENDO
What are some of the endocrine disorders that can increase the risk of osteoporosis? (6)
*Endocrine disorders:* a. Hyperthyroidism b. Hyperparathyroidism c. Hyperprolactinemia d. Hypogonadism e. Adrenal insufficiency f. Cushing's syndrome
The most common cause of hyperthyroidism is: 1. Graves disease. 2. A toxic uninodular goiter. 3. Subacute thyroiditis. 4. A pituitary tumor.
1. Graves disease.
Lynne has Cushing syndrome. You would expect her to have or develop: 1. Onychomycosis. 2. Generalized increased pigmentation of the skin. 3. Hair loss. 4. Excitability and nervousness.
1. Onychomycosis.
A 35-year-old female presents to your primary care office for review of her laboratory results. Her physical exam shows a blood pressure (BP) of 140/90, pulse (P) of 105, oxygen saturation of 97%, and temperature of 98.6°F. She has complaints of palpitations, weight loss, hair loss, and anxiety. Her labs are all normal except for a low thyroid-stimulating hormone (TSH) and an elevated thyroxine (T4). What would your next course of treatment be? 1. Start metoprolol and propylthiouracil (PTU). 2. Refer the patient to psychiatry for treatment of anorexia. 3. Refer the patient for radioactive iodine treatment. 4. Refer the patient for thyroidectomy.
1. Start metoprolol and propylthiouracil (PTU).
What is the usual replacement dose for levothyroxine therapy?
1.6 mcg/kg/day
You suspect that Sharon has hypoparathyroidism because, in addition to her other signs and symptoms, she has: 1.Elevated serum phosphate levels. 2.Elevated serum calcium levels. 3.Decreased neuromuscular activity. 4.Increased bone resorption, as implied by her bone density test.
1.Elevated serum phosphate levels.
What is the recommended daily intake of calcium for adults 19-50 years old?
1000 mg/day or more --> If ↑ 50, 1200 mg/day
How many grams of carbs are used to treat hypoglycemia?
15 grams of carbs (not 5 g)
Mr. Reynolds is on the antithyroid drug (ATD) methimazole (Tapazole), so you make it a point to check his: 1. Glycated hemoglobin (HbA1c). 2 .Complete blood count (CBC) and liver transaminases. 3. Uric acid level. 4. Total thyroxine (T4).
2 .Complete blood count (CBC) and liver transaminases.
A patient presents to your primary care office with abnormal lab results. On physical exam, you tap the patient's facial nerve around the zygomatic arch, just anterior to the earlobe. This describes which of the following tests and is associated with which of the following lab abnormalities? 1. Trousseau sign, hypocalcemia. 2. Chvostek sign, hypocalcemia. 3. Chvostek sign, hypercalcemia. 4. Lachman test, hypercalcemia.
2. Chvostek sign, hypocalcemia.
A 35-year-old male presents to your office complaining of fatigue, weight loss, nausea, and abdominal pain. On physical exam, you notice he has orthostatic hypotension and hyperpigmented skin. You do a morning cortisol level, which is low. The plasma adrenocorticotropic hormone (ACTH) is elevated. How would you treat this patient? 1. Oral prednisone. 2. Hydrocortisone. 3. Androgen replacement. 4. Fludrocortisone.
2. Hydrocortisone.
Joy has gout. In teaching her about her disease, which food do you tell her is allowed in the diet? 1.Asparagus. 2. Beans. 3. Broccoli. 4. Mushrooms.
3. Broccoli.
Which lab should be ordered in the event of an elevated calcium? SATA A) Intact PTH B) Ionized calcium C) Vitamin D, OH D) TSH
A) Intact PTH B) Ionized calcium C) Vitamin D, OH D) TSH
You see an obese 25-year-old man with acanthosis nigricans and consider ordering: A. FBS. B. LFT. C. RPR. D. ESR.
A. FBS.
What is the treatment of Addison's disease?
Hydrocortisone (which is both mineral and glucocorticoid).
What does Trousseau's sign assess for?
Hypocalcemia
What is a common side effect of sulfonylureas?
Hypoglycemia
Potassium levels in an Addison's crisis would be (elevated or decreased)?
Increased K+ ↑, Na++ ↓, Cortisol ↓, ↓ ACTH
What lab test is ordered if Addison's disease is suspected?
Morning plasma cortisol level
Hyperparathyroidism, review s/s and electrolytes (hypercalcemia):
Most common is kidney stones, other potential symptoms include: - Weakness - Depression - Bone pains- confusion - ↑ Urination
Treatment would be recommended if the FRAX 10-year major osteoporosis fracture risk was __________ and the ten year risk of hip fracture is _______%?
Osteoporosis fracture risk: 20% Hip fracture risk: 3%
In a patient with ASCVD and recent CABG, would NSAIDs or be prednisone be preferred in the setting of a gouty attack?
Prednisone
________________ cause gout, not tyramine.
Purines
Canaglifozin (Invokana)
SGLT-2 inhibitor: Eliminates glucose through the proximal renal tubules
Liraglutide (Victoza) in an incretin mimetic similar to exenatide that has been associated with___________?
Thyroid cancer
If GI symptoms occur, colchicine should be stopped immediately regardless of the status of the joint pain: True or False?
True
PTU can impact the fetus even though it is the preferred agent in pregnancy, palpitations are not a side effect: T/F?
True
Patients with hypothyroidism have elevated lipid levels: T/F?
True
TZDs cause weight (loss or gain)?
Weight Gain
When would a thyroid ultrasound be ordered?
When goiter or nodule is palpated or patient has "pressure- symptoms"
Pt is taking metformin, what labs do you need to monitor? SATA a) Folic acid and B12 b) Kidney function c) Electrolytes
a) Folic acid and B12 b) Kidney function c) Electrolytess
Metformin should be discontinued when the eGFR is ________:
↑ 30 mL/min
What is the uric acid goal for patients with gout?
↓ 6
The clinical features of hyperparathyroidism are due to the direct and indirect effects of PTH on the bones, kidney, and intestines and include:
*Stones*: Renal stones *Bones*: Osteoporosis *Abdominal Groans*: GI upset *Psychic Moans*: Fatigue, depression, memory loss
What are the normal lab values for TSH and Free T4?
*TSH:* 0.4-4.0 *Free T4:* 0.7-1.9
Which of the following are true about hyperthyroidism: (Choose all that apply) a. The TSH is supressed b. The TSH is elevated c. The free T4 is elevated d. Bradycardia is common e. It can be caused by overuse of thyroid hormone f. A bruit may be heard over the gland g. Grave's disease is the most common cause of spontaneous hyperthyroidism in the US h. DTR's may show rapid relaxation of the reflex i. Clubbing of the digits with new bone growth called thyroid acropachy may occur with long-standing hyperthyroidism.
*a. The TSH is supressed* b. The TSH is elevated *c. The free T4 is elevated* d. Bradycardia is common *e. It can be caused by overuse of thyroid hormone* *f. A bruit may be heard over the gland* *g. Grave's disease is the most common cause of spontaneous hyperthyroidism in the US* *h. DTR's may show rapid relaxation of the reflex* *i. Clubbing of the digits with new bone growth called thyroid acropachy may occur with long-standing hyperthyroidism.*
What are side effects of colchicine?
- Diarrhea - Bone marrow suppression - Periphreal neuritis - myelosuppression - leukopenia - thrombocytopenia - granulocytopenia - pancytopenia - aplastic anemia - myopathy - rhabdomyolysis - neuropathy - hepatotoxicity - nephrotoxicity - multiple organ failure - DIC- hypersensitivity rxn - azoospermia, reversible
Allopurinol has a hypersensitivity reaction that is common and includes:
- Toxic epidermal necrolysis (TEN) - Stevens-Johnson syn (SJS)
What are s/sx of hypocalcemia?
- Trousseau's sign - Chvostek's sign - Carpal-pedal signs
Your client with diabetes asks you about insulin glargine (Lantus). You tell her that: 1. It may be administered subcutaneously at home or intravenously in the hospital if need be. 2. The onset of action is 15 minutes. 3. Insulin glargine (Lantus) stays in your system for 24 hours. 4. It can be mixed with any other insulin.
3. Insulin glargine (Lantus) stays in your system for 24 hours.
Which is the only curative treatment option for primary hyperparathyroidism (PHPT)? 1. Type II calcimimetic cinacalcet. 2. Hormone therapy. 3. Parathyroidectomy. 4. Bisphosphonates.
3. Parathyroidectomy.
An elderly client presents with atrial fibrillation. Which of the following lab tests is important in forming the diagnosis? 1 .Complete blood count (CBC). 2. C-reactive protein (CRP). 3. Comprehensive metabolic panel (CMP). 4. Thyroid-stimulating hormone (TSH
4. Thyroid-stimulating hormone (TSH
For a patient on carb coverage, how many units of insulin are given for 50 carbs?
5 units (1 per 10 carbs)
Basal insulin accounts for _______ % of the total daily dose:
50%
Normal serum calcium:
8.5-10.2 mg/dL
Minnie is pregnant. She has hypothyroidism and has been on the same levothyroxine medication for years. What might you expect to do with her levothyroxine medication? SATA A. Increase the dosage by 30% B. Maintain her established dose. C. Decrease her dosage. D. Increase the dose during the first trimester,then decrease it during the second and third trimesters. E. Take 2 tabs on Saturday and Sunday or write a new prescription F. Recheck TSH in the third trimester
A. Increase the dosage by 30% E. Take 2 tabs on Saturday and Sunday or write a new prescription F. Recheck TSH in the third trimester
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 are true regarding pharmacologic treatment of hyperthyroidism: (Choose all that apply) A. Propranolol is a beta adrenergic antagonist used to treat hyperthyroidism B. Propylthiouracil PTU is preferred in pregnancy C. Methimazole and piopylthiouracil (PTU) can cause agranulocytosis D. Antithyroid medications are continued after treatment with radioactive iodine E. Baseline CBC, and liver function should be tested
A. Propranolol is a beta adrenergic antagonist used to treat hyperthyroidism B. Propylthiouracil PTU is preferred in pregnancy C. Methimazole and piopylthiouracil (PTU) can cause agranulocytosis E. Baseline CBC, and liver function should be tested
Which of the following are true about hyperthyroidism: (Choose all that apply) A. The TSH is suppressed B. The TSH is elevated C. The free T4 is elevated D. Bradycardia is common E. It can be caused by overuse of thyroid hormone F. A bruit may be heard over the gland G. Grave's disease is the most common cause of spontaneous hyperthyroidism in the US H. DTR's may show rapid relaxation of the reflex
A. The TSH is suppressed C. The free T4 is elevated E. It can be caused by overuse of thyroid hormone F. A bruit may be heard over the gland G. Grave's disease is the most common cause of spontaneous hyperthyroidism in the US H. DTR's may show rapid relaxation of the reflex
Possible consequences of excessive levothyroxine use include: A. bone thinning. B. fatigue. C. renal impairment. D. constipation.
A. bone thinning.
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.
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.
Risk factors for acute gouty arthritis include: A. obesity. B. female gender. C. rheumatoid arthritis. D. joint trauma.
A. obesity. Also includes: - Men ages 40-50 - Black - DM - Family history
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.
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.
Name drugs that can cause osteoporosis. (6)
ALLCHG a. Anticonvulsants b. Lithium c. Levothyroxine (over replacement) d. Cytotoxic drugs f. Heparin g. Glucocorticoids
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.
Which of the following patients would be an appropriate candidate for treatment with teriparatide (Forteo)? A. a 54-year-old woman with osteopenia B. a 64-year-old woman with bone mineral density (BMD) T-score of -2.5 and prior hip fracture C. a 67-year-old man with a BMD T-score of -1 D. a 72-year-old woman who has a stable BMD T-score of -1.5 with bisphosphonate treatment for the past 3 years
B. a 64-year-old woman with bone mineral density (BMD) T-score of -2.5 and prior hip fracture
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.
Which of the following is a mineralocorticoid? A. cortisol B. aldosterone C. insulin D. hydrocortisone
B. aldosterone
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.
First-line therapy for treating patients with acute gouty arthritis usually includes: A. aspirin. B. naproxen sodium. C. allopurinol. D. probenecid.
B. naproxen sodium.
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.
Osteoporosis is defined as having a bone density more than ____ standard deviation(s) below the average bone mass for a healthy young adult. A. 1 B. 1.5 C. 2.5 D. 4
C. 2.5
Which of the following should be periodically monitored with the use of a thiazolidinedione? A. CK B. ALP C. ALT D. Cr
C. ALT
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.
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.
Secondary gout can be caused by all of the following conditions except: A. psoriasis. B. hemolytic anemia. C. bacterial cellulitis. D. renal failure.
C. bacterial cellulitis.
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.
Clinical disorders that increase the risk for osteoporosis include all of the following except: A. rheumatoid arthritis. B. celiac disease. C. hyperlipidemia. D. hyperprolactinemia.
C. hyperlipidemia.
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.
Osteoporosis prevention measures include all of the following except: A. calcium supplementation. B. selective estrogen receptor modulator use. C. vitamin B6 supplementation. D. weight-bearing and muscle-strengthening exercises.
C. vitamin B6 supplementation.
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.
You see a 46-year-old woman diagnosed with vitamin D deficiency with a serum 25-hydroxyvitamin D (25[OH]D) level of 18 ng/mL. Treatment should be initiated with which of the following vitamin D dosing regimens? A. 400 IU twice a day B. 1000 IU daily C. 10,000 IU twice a week D. 50,000 IU weekly
D. 50,000 IU weekly
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
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.
An 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)
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
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.
Sodium levels is a patient with Addison's disease would be (elevated or decreased)?
Decreased
Addison's disease is a (deficiency or excess) in glucocorticoids and mineralcorticoids?
Deficiency
Sitagliptin (Januvia)
GLP-1 antagonist/incretin ENHANCER: Inhibits the release of the enzyme that breaks down incretin
Liraglutide (Victoza)
GLP-1 antagonist/incretin mimetic: Mimics the effects of incretin
Glimepiride (Amaryl)
Sulfonylurea: Secretes insulin through stimulation of beta-cells
A patient with DM is taking metformin and recently started on a combination DPP-4/SGLT-2 inhibitor. Which of the following questions by the NP reflects knowledge of the side effects of SGLT-2 inhibitors? (select all that apply) a. "Do you have any dysuria?" b. "Are experiencing any dizziness?" c. "Do you have any itching in the genital area?" d. "Do you have any diarrhea?"
a. "Do you have any dysuria?" b. "Are experiencing any dizziness?" c. "Do you have any itching in the genital area?" --> Think GU/renal issues
Which of the following situations can increase the risk of lactic acidosis in a patient taking metformin? (Select all that apply) a. A patient that drinks alcohol b. A patient with liver or renal disease c. A patient with heart failure d. A patient with a history of pancreatitis
a. A patient that drinks alcohol b. A patient with liver or renal disease c. A patient with heart failure
A patient with a history of esophagitis would not be a candidate for treatment with: a. Alendronate (Fosamax) b. Calcium and Vitamin D c. Raloxifene (Evista) d. Pepcid
a. Alendronate (Fosamax)
Which class of drugs used to treat diabetes can cause excessive GI symptoms such as flatulence? a. Alpha-Glucosidase Inhibitors (Precose and Glyset) b. TZDs c. Sulfonlyureas d. Meglinides (Prandin and Starlix)
a. Alpha-Glucosidase Inhibitors (Precose and Glyset)
A patient with Grave's disease is started on methimazole. In addition to thyroid function tests, what other labs will be needed? a. CBC & CMP b. HbA1c c. Fecal occult blood test d. Uric acid
a. CBC & CMP
Which disorder is characterized by an excess of circulating corticosteriods and causes obesity, hyperglycemia, hypertension and electrolyte imbalances? a. Cushing's disease b. Addison's disease c. Acromegaly D. Diabetes insipidis
a. Cushing's disease
A nurse is providing education to a patient who will begin taking alendronate [Fosamax]. Which complication should the patient be instructed to report immediately? a. Difficulty swallowing b. Dizziness c. Drowsiness d. Pallor a. Difficulty swallowing
a. Difficulty swallowing
Which of the following findings are consistent with hypothyroidism: SATA a. Elevated TSH b. Elevated free T4 c. Suppressed free T4 d. Frequent low volume stools e. Constipation f. Bradycardia
a. Elevated TSH c. Suppressed free T4 e. Constipation f. Bradycardia
The nurse manages care for a patient with diabetes who takes metformin. Which laboratory result would cause the greatest concern? a. Elevated creatinine b. Anemia c. Decreased platelets d. Increased iron
a. Elevated creatinine
Which of the following statements are true regarding insulin therapy: (Choose all that apply) a. Excess night-time insulin leading to early AM hypoglycemia can cause morning hyperglycemia (Somoygi effect) b. Insulin glargine (Lantus) has a rapid onset of action c. Hypoglycemia should be treated with 5 grams of carbohydrates d. Insulin therapy usually causes weight loss e. 70/30 insulin mix should be given before bedtime f. NovoLog 70/30 mix should be given twice a day 15 minutes prior to morning and evening meals g. It is recommend to mix insuline glargine (Lantus) with a rapid acting insulin h. An average total daily dose of insulin is 0.5 units/kg/day
a. Excess night-time insulin leading to early AM hypoglycemia can cause morning hyperglycemia (Somoygi effect) f. NovoLog 70/30 mix should be given twice a day 15 minutes prior to morning and evening meals h. An average total daily dose of insulin is 0.5 units/kg/day
A patient with a history of pancreatitis should not be started on: a. Exenatide (Byetta) or oral incretins b. TZDs c. Insulin d. Sulfonlyureas
a. Exenatide (Byetta) or oral incretins
The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following tests should the clinician order on the initial visit? a. High sensitivity thyroid-stimulating hormone (TSH) and free T4 b. Free T4 and serum calcium c. Free T3 and T4 d. TSH and thyroxin antibodies
a. High sensitivity thyroid-stimulating hormone (TSH) and free T4
Which of the following medications can cause hyperglycemia? a. Prednisone b. Metformin c. Synthroid d. Cephalexin
a. Prednisone
A patient presents with Grave's disease complaining of tremor, anxiety, and tachycardia. Which of the following drugs will provide the most rapid and best symptom control? a. Propranolol b. Metoprolol c. Levothyroxine d. Methimazole
a. Propranolol
Which of the following are true regarding pharmacologic treatment of hyperthyroidism: (Choose all that apply) a. Propranolol is a beta adrenergic antagonist used to treat hyperthyroidism b. Propylthiouracil PTU is preferred in pregnancy c. Methimazole and piopylthiouracil (PTU) can cause agranulocytosis d. Antithyroid medications are continued after treatment with radioactive iodine e. Baseline CBC, and liver function should be tested
a. Propranolol is a beta adrenergic antagonist used to treat hyperthyroidism b. Propylthiouracil PTU is preferred in pregnancy c. Methimazole and piopylthiouracil (PTU) can cause agranulocytosis e. Baseline CBC, and liver function should be tested
Which class of antiretroviral medications can lead to hyperglycemia/diabetes, fat maldistribution, hyperlipidemia, reduced bone density, hepatotoxicity, and drug interactions? a. Protease inhibitors b. Integrase inhibitors c. Fusion inhibitors d. CCR5 antagonists
a. Protease inhibitors
In a teenager with gynecomastia, which of the following symptoms are cause for further workup? SATA a. Raised unilaterally b. Greater than 6 cm c. Lasting longer than 1 year d. Nipple pain
a. Raised unilaterally b. Greater than 6 cm c. Lasting longer than 1 year
What will happen to the TSH and free T4 in a patient with hypothyroidism if they do not take thyroid replacement? a. The TSH will rise and the FT4 will decrease b. The FT4 will rise and the TSH will decrease
a. The TSH will rise and the FT4 will decrease
A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of "my feet feel like they are on fire." He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment? a. Tricyclic antidepressants b. Capsaicin cream c. Vitamin B12 injections d. Insulin
a. Tricyclic antidepressants (Cymbalta)
Which of the following are components of the metabolic syndrome (choose all that apply): a. Waist circumference ↑ 35 inches in a man b. Triglycerides greater than 100 mg/dL c. HDL ↓ 50 mg/dL in a woman d. Blood pressure ↑ 130/85 mm Hg e. Fasting glucose ↑ 100 mg/dL f. Triglycerides ↑ 150 mg/dL
a. Waist circumference ↑ 35 inches in a man b. Triglycerides greater than 100 mg/dL *c. HDL ↓ 50 mg/dL in a woman* *d. Blood pressure ↑ 130/85 mm Hg* *e. Fasting glucose ↑ 100 mg/dL* *f. Triglycerides ↑ 150 mg/d*
A patient presents with an elevated TSH and suppressed free T4. This is an indication of: (select all that apply) a. hypothyroidism b. insufficient replacement with levothyroxine c. too much levothyroxine d. hyperthyroidism
a. hypothyroidism b. insufficient replacement with levothyroxine
Which of the following agents are associated with pancreatitis (select all that apply) a. liraglutide b. exenetide c. sitagliptin d. canagliflozin e. insulin glargine
a. liraglu*tide* (Victoza) b. exene*tide* (Byetta) c. sitagliptin (Januvia)
Patients with osteoporosis that are unable to take bisphosphonates may be prescribed raloxifene (Evista) which is a selective estrogen receptor modulator (SERMs). Which of the following are adverse effects of raloxifine: (Select all that apply) a. venous thromboembolism b. esophagitis c. hot flashes d. increased risk of breast cancer
a. venous thromboembolism c. hot flashes
Review the generic names and peak: 1. NovoLog 2. Humalog
a.(Novalog) lispro --> 1-3 hrs b. (Humalog) aspart --> peak 1-1.5 hrs
Presentation of thyroxine excess in the elderly includes:
angina
A patient on Novolin 70/30 BID lost his insurance and the NP offers to give him insulin from stock that is NPH and Regular insulin vials and syringes. The patient was at one time on this combination and is comfortable mixing insulins. The Novolin 70/30 was being given 20 units before breakfast and 10 units prior to dinner. What is the equivalent amount of N and R that will be given in the AM? a. 20 units N and 10 units R b. 14 units N and 6 units R c. 12 units N and 8 units R d. 10 units N and 6 units R
b. 14 units N and 6 units R
Calculate the dosage of NPH and R for a 105 kg male. Use 0.4 units/kg/day and round to nearest even number since you will be using U100 insulin syringes (select all that apply) a. 28 units NPH in the AM and 14 units NPH in the PM b. 18 units NPH and 10 units of regular before breakfast c. 10 units of NPH and 4 units of regular at HS d. 22 units of NPH and 10 units of regular before breakfast
b. 18 units NPH and 10 units of regular before breakfast
Calculate the dose of Novolin 70/30 for a patient weighing 150 lbs. (Use 0.5 units/kg/d) a. 60 units AM and 30 units PM 30 minutes prior to meal b. 22 units AM and 12 units PM 30 minutes prior to the meal c. 17 units AM and 15 units PM 15 minutes prior to the meal d. 10 units AM and 3 units PM 15 minutes prior to the meal
b. 22 units AM and 12 units PM 30 minutes prior to the meal
Which drug would be used for a patient with a bone density scan revealing a T-score of -1.2? a. Raloxifene (Evista) b. Calcium and vitamin D c. Alendronate (Fosamax) d. Calcitonin-Salmon
b. Calcium and vitamin D
A patient presents to the clinic with a history of hypothyroidism. A pregnancy test is found to be positive. How will the dosage of 100 micrograms of levothyroxine daily be adjusted? a. The levothyroxine is Pregnancy Category D and will be discontinued b. Increased to 137 micrograms per day c. Doubled (200 micrograms per day) d. Decreased to 75 micrograms per day
b. Increased to 137 micrograms per day
A patient with an acute attack of gout can be treated with: (Choose all that apply) a. Allopurinol b. NSAIDs c. Glucocorticoids d. Colchicine
b. NSAIDs c. Glucocorticoids d. Colchicine
Which insulin has the most rapid onset of action? a. NPH b. Novolog or Humalog or Apidra c. Lantus d. Regular
b. Novolog or Humalog or Apidra
Which of the following drugs or conditions can cause hyperglycemia: (Choose all that apply) a. Metformin b. Prednisone c. Diuretics d. Estrogen-containing products e. Beta blockers f. Nicotinic acid g. Hypothyroidism h. Cushing's disease i. Pheochromocytoma j. Acromegaly
b. Prednisone c. Diuretics d. Estrogen-containing products e. Beta blockers f. Nicotinic acid h. Cushing's disease i. Pheochromocytoma j. Acromegaly
Which of the following agents can be beneficial for osteoporosis and the genital urinary symptoms of menopause, and does not cause a risk of breast cancer but can increase hot flashes and DVTs? a. Estradiol b. Raloxifene (Evista) SERM c. Progestins d. Soy
b. Raloxifene (Evista) SERM
The nurse is caring for a client who has normal glucose levels at bedtime, hypoglycemia at 2 AM, and hyperglyccemia in the morning. What is this client likely experiencing? a. Dawn phenomenon b. Somogyi effect c. An insulin spike d. Excessive corticosteroids
b. Somogyi effect
Morris has had type 1 diabetes for 10years. Several recent urinalysis reports have shownmicroalbuminuria. Your next step would be to: a. Order a 24-hour urinalysis. b. Start him on an angiotensin-converting enzyme (ACE) inhibitor. c. Stress the importance of strict blood sugar control. Send him to a dietitian because he obviously has not been following his diet
b. Start him on an angiotensin-converting enzyme (ACE) inhibitor.
A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next? a. Serum calcium b. TSH c. Electrolytes d. Urine specific gravity
b. TSH
Joyce is seen in the clinic complaining of vague symptoms of nervousness and irritability. She says that her hair will not hold a permanent wave anymore. On physical examination, the clinician finds an irregular heartbeat and brisk reflexes. The differential diagnosis should include which of the following conditions? a. Myxedema b. Thyrotoxicosis c. Cushing's syndrome d. Pan-hypopituitarism
b. Thyrotoxicosis
A patient on methimazole presents with an elevated TSH and a low free T4. Which of the following actions are necessary: (select all that apply) a. discontinue the methimazole b. decrease the methimazole c. increase the methimazole d. order a CBC and CMP
b. decrease the methimazole d. order a CBC and CMP
Which of the following is most consistent with subclinical hypothyroidism? a. elevated thyroxine (T4) and TSH levels b. normal free T4 and elevated TSH levels c. elevated TSH and low free T4 levels d. low TSH and free T4 levels
b. normal free T4 and elevated TSH levels
A patient presents with an elevated TSH and depressed Free T4. The patient is 30 years old and weighs 138 lbs. Calculate the estimated thyroxine replacement needed: a. 50 micrograms daily b. 88 micrograms daily c. 100 micrograms daily d. 125 micrograms daily
c. 100 micrograms daily
A patient presents with a blood glucose of 350 mg/dL and an A1C of 10.5% and the NP initiates basal bolus insulin. The patient weighs 125 lbs. Calculate 0.5 units/kg/day. a. 30 units of Lantus HS and 10 units of Novolog 30 minutes prior to meals TID b. 14 units Lantus at night and 4 units of Novolog 30 minutes prior to the meal TID c. 14 units Lantus at night and 4 units of Novolog 10-15 minutes before the meal TID d. 30 units of Lantus HS and 10 units of Novolog 10-15 minutes prior to meals TID
c. 14 units Lantus at night and 4 units of Novolog 10-15 minutes before the meal TID
The half-life of levothyroxine is about 7 days. How long should it take for the drug to reach plateau? a. 3 days b. 2 weeks c. 4 weeks d. 3 months
c. 4 weeks
A patient weighing 210 lbs is in need of insulin. The total daily dose (TDD) for this patient is: (use 0.5 units/kg/day) a. 16 units b. 30 c. 47 d. 105
c. 47
Growth hormone (GH) is indicated for pediatric and adult hormone deficiency. Which of the following is an adverse effect of GH? a. Hyperkalemia b. Hypokalemia c. Hyperglycemia d. Hypoglycemia
c. Hyperglycemia
A patient presents with a corrected serum calcium level of 11.5 mg/dl. PMH is significant for nephrolithiasis and she is c/o bone pain, abdominal discomfort, memory loss, depression, and fatigue. The NP orders various tests and finds the PTH to be elevated. Which of the following criteria in this patient with hyperparathyroidism will be indications for surgical management? (Select all that apply) a. Serum calcium greater than .5 mg/dL above the upper limit of normal b. T-score of 2.0 SD below the mean c. Urine calcium ↑ 400 mg/24 hours d. T-score 2.7 SD below the mean at the hip
c. Urine calcium >400 mg/24 hours d. T-score 2.7 SD below the mean at the hip
Ace inhibitors are given to clients with diabetes who have: a. An elevated glycohemoglobin level. b. Insulin sensitivity. c. Urine microalbuminuria d. an elevated serum creatinine level.
c. Urine microalbuminuria
A patient presents with osteoporosis and HTN. Which agents will be of benefit for both conditions? SATA a. amlodipine b. losartan c. hydrochlorothiazide d. spironolactone
c. hydrochlorothiazide
A patient who has developed postmenopausal osteoporosis will begin taking alendronate [Fosamax]. The nurse will teach this patient to take the drug: a. at bedtime to minimize adverse effects. b. for a maximum of 1 to 2 years. c. while sitting upright with plenty of water. d. with coffee or orange juice to increase absorption.
c. while sitting upright with plenty of water.
Mary, age 72, has been taking insulin for several years. She just called you because she realized that yesterday she put her short-acting insulin in the long-acting insulin box and vice versa. She just took 22 units of regular insulin when she was supposed to take only 5 units. She says that she tried to do a fingerstick to test her glucose level but was unable to obtain any blood. She states that she feels fine. What do you tell her to do first? a. "Keep trying to get a fingerstick and call me back with results." b. "Call 911 before you collapse." c. "Drive immediately to the ER." d. "Drink 4 oz of fruit juice."
d. "Drink 4 oz of fruit juice."
The late president J.F. Kennedy was treated with corticosteroids and fludrocortisone becase he suffered from: a. Diabetes mellitus b. Acromegaly c. Diabetes insipidus d. Addison's disease
d. Addison's disease
A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin? a. Ketoacidosis b. Cirrhosis c. Hypoglycemic episodes d. All of the above
d. All of the above
A patient on 125 micrograms of levothyroxine presents with a TSH of 0.001 mIU/L and complains of insomnia, nervousness and hyper-defecation. The DTRs are exaggerated and the patient has a fine tremor. The next step is to: a. Discontinue the levothyroxine b. Increase the levothyroxine c. Send the patient to the ED d. Decrease the dose to 100 micrograms per day
d. Decrease the dose to 100 micrograms per day
Early-morning increases in blood glucose concentration that occur with no corresponding hypoglycemia during the night are referred to as: a. The Somogyi phenomenon. b. Insulin shock. c. Diabetic ketoacidosis. d. The Dawn phenomenon.
d. The Dawn phenomenon.
A patient presents after 8 weeks of levothyroxine treatment with a depressed TSH and an elevated free T4. The NP will: a. refer the patient for a stat endocrinology consult b. keep the same dose c. increase the dose d. decrease the dose
d. decrease the dose
A patient with diabetes has consistent blood pressure readings 152/88 and below. The spot urine microalbumin is elevated. The following drug should be added to increase glomerular blood flow and slow the progression of nephropathy: a. amlodipine b. metoprolol c. HCTZ d. lisinopril
d. lisinopril
A 72 year old patient with type 2 diabetes has a blood creatinine level of 3.0 mg/dL. Which of the following drugs is contraindicated? a. NovoLog b. NPH insulin c. regular insulin d. metformin (Glucophage)
d. metformin (Glucophage)
A patient with diabetes on insulin reports taking propranolol for hypertension. This provokes the concern that: a. the beta blocker can produce insulin resistance b. the two agents used together will increase the risk of ketoacidosis c. propranolol will increase insulin requirements because of receptor blocking d. the beta blocker can mask the symptoms of hypoglycemia
d. the beta blocker can mask the symptoms of hypoglycemia
Which drug class used to treat diabetes causes fluid retention and should not be used in patients with heart failure? a. sulfonylureas b. biguanides c. gliptins d. thiazolidinediones
d. thiazolidinediones