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Maryville NUR 615 Exam 3 with Complete & Verified Solutions
Mr. Holloway presents to your clinic with a significantly swollen, painful big toe and you diagnose him with gout. Of the following options which would be the best treatment for Mr. Holloway? - Answer ✔️ ✔️ -Low-dose colchicine
How is low dose colchicine prescribed? - Answer ✔️ ✔️ -1.2 mg followed by 0.6 mg one hour later or 1.8 mg total
How is high dose colchicine prescribed? - Answer ✔️ ✔️ -1.2 mg followed by 0.6 mg Q4/Q6 or 4.8 mg total
Patient education when prescribing colchicine includes? - Answer ✔️ ✔️ -Colchicine always causes some degree of diarrhea
You have a patient who is taking allopurinol to prevent gout. What labs will you monitor for this patient on allopurinol? - Answer ✔️ ✔️ -BUN, creatinine, and creatinine clearance
Mr. Thompson has just started taking febuxostat (Uloric) to treat his gout and he needs to be educated on what to expect. - Answer ✔️ ✔️ -Gout may worsen with therapy
Ms. Jensen has been on prednisone for 6 months. Patients who have been on prednisone for some time should be assessed for what - Answer ✔️ ✔️ -Osteoporosis
What dose predinisone do in diabetics? - Answer ✔️ ✔️ -Worsen blood glucose control
What teaching do you given patients taking prednisone? - Answer ✔️ ✔️ -report and black, tarry stools or abdominal pain
When you place a patient on prednisone and the total dose exceeds 1 gram, what additional drug should you prescribe - Answer ✔️ ✔️ -Omeprazole, a proton-pump inhibitor to prevent PUD
Janet has fractured her ankle and you give her a prescription for Vicodin (acetaminophen +hydrocodone). What education should you provide before they leave your clinic? - Answer ✔️ ✔️ -Patient should not take any other medications that contain acetaminophen
What is the first line of pain control? - Answer ✔️ ✔️ -NSAIDS
Margaret has been on 60 mg of prednisone for 10 days for her severe asthma exacerbation. Since she is breathing much better it is time to discontinue the medication. What should you know when discontinuing this drug? - Answer ✔️ ✔️ - Develop a tapering schedule to slowly wean Margaret off the prednisone
Why must steroids be tapered? - Answer ✔️ ✔️ -avoid both recurrent activity of the underlying disease process and possible cortisol deficiency resulting from the hypothalamic-pituitary-adrenal axis (HPA) suppression during the period of steroid therapy.
Patients who are currently on or will start chronic corticosteroid therapy should be monitored for what? - Answer ✔️ ✔️ -serum glucose
Patients with rheumatoid arthritis who are on a chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects - Answer ✔️ ✔️ -Vitamin D, calcium supplement, and bisphosphate
Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include - Answer ✔️ ✔️ -Dizziness, confusion, diaphoresis, and tachycardia
What are the signs and symptoms of hyperglycemia? - Answer ✔️ ✔️ -polyuria, polydispsia, weight loss
DKA- Fruity breath, tachypnea, lethargy, obtunded
Nonselective beta-blockers and consuming alcohol can create serious drug interactions with insulin because they do what? - Answer ✔️ ✔️ -Mask the s/s of altered glucose levels
Lispro is an insulin analogue produced by recombinant DNA technology. Based on the statements below which is NOT TRUE?
a. Duration of action is increased when the dose in increased
b. Optimal time of preprandial injection is 15 minutes
c. It has no pronounced peak
d. It is compatible with neutral protamine Hagedorn insulin - Answer ✔️ ✔️ -a. Duration of action is increased when the dose in increased
Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it: - Answer ✔️ ✔️ -Decreases glycogneolysis by the liver
When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research?
a. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.
b. Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia.
c. Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime.
d. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents. - Answer ✔️ ✔️ -a. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.
The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemic control throughout the day. If this is done: - Answer ✔️ ✔️ -The initial dose of glargine is reduced by 20% to avoid hypoglycemia
Prior to prescribing metformin, you as the provider should - Answer ✔️ ✔️ -Draw a serum creatinine to assess renal function
Type 2 diabetes is a complex disorder involving - Answer ✔️ ✔️ -a suboptimal response of insulin sensitive tissues in the liver
Routine screening of asymptomatic adults for diabetes is appropriate for: - Answer ✔️ ✔️ - Native americans
African americans
Hispanics
In hyperthyroid states, what organ system other than CV must be evaluated to establish potential adverse issues - Answer ✔️ ✔️ -they eyes
Treatment of a patient with hypothyroidism and cardiovascular disease consists of:
- Answer ✔️ ✔️ -levothyroxine
A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with - Answer ✔️ ✔️ -Propylthiouracil (PTU)
Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored with TSH and free T4 levels every - Answer ✔️ ✔️ - 6 months
What lab values will you as a provider monitor in your patient on levothyroxine? - Answer ✔️ ✔️ -Blood free thyroxine and TSH levels
Goals when treating hypothyroidism with thyroid replacement include: - Answer ✔️ ✔️ - Normal TSH and free T 4 levels
Resolution of fatigue Weight loss to baseline
Insulin is used to treat both types of diabetes. It acts by - Answer ✔️ ✔️ -Increasing peripheral glucose uptake by skeletal muscle and fat
Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they - Answer ✔️ ✔️ - Have a significant risk for hypoglycemia
Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include - Answer ✔️ ✔️ -Low risk for hypoglycemia
What contraindications for therapy with alpha-glucosidase inhibitors - Answer ✔️ ✔️ - Patients with IBS because of flatulence this drug can produce
What is the dosage schedule for alpha-glucosidase inhibitors - Answer ✔️ ✔️ -Take within the first bite of each meal
Ethnic groups differ in their risk for and presentation of diabetes. Hispanics: - Answer ✔️ ✔️ -Have a high incidence of obesity, elevated triglycerides, and hypertension and
Do best with drugs that foster weight loss, such as metformin
The drugs recommended for older adults with type 2 diabetes include - Answer ✔️ ✔️ - Third-generation sulfonylureas
Treatment with insulin for type 1 diabetics - Answer ✔️ ✔️ -Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight
Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset and duration of action - Answer ✔️ ✔️ - Glulisine
The American Heart Association states that people with diabetes have a 2- to 4- fold increase in the risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include - Answer ✔️ ✔️ -Glycemic targets between 7% and 7.5%
Intermediate acting like NPH is mixed with protamine delaying absorption. Insulin looks cloudy and has to be mixed before injected. Its onset is 1 to 1-1/2 and hours; peak of 4 to 10 hours, and duration of 12 to 24 hours.
Long acting like Glargine or Levemir(detemir) insulins onset 2 to 4 hours; duration 24 hours with little or no peak.
When changing from NPH to Glargine insulin, how will you adjust the patient's dose? - Answer ✔️ ✔️ -The initial dose of glargine is reduced by 20% to avoid hypoglycemia
What are the side effects of insulin therapy? - Answer ✔️ ✔️ -Hypoglycemia and hypokalemia
Bridgette is a 19-year-old college student with type 1 diabetes. She is on NPH twice daily and Novolog before meals. She usually walks for 40 minutes each evening as part of her exercise regimen. She is beginning a 30-minute swimming class three times a week at 1 p.m. What is important for her to do with this change in routine? - Answer ✔️ ✔️ -Check glucose before, during, and after swimming. Exercise can lower BG
Bridgette is a 19-year-old college student with type 1 diabetes. Bridgette's pre-meal BG at 11:30 a.m. is 130. She eats an apple and has a sugar-free soft drink. At 1 p.m. before swimming her BG is 80. What should she do - Answer ✔️ ✔️ -Eat a granola bar or other snack with carbs
Mrs. Johnson is on metformin and glipizide arrives at her 11:30 a.m. clinic appointment diaphoretic and dizzy. She reports taking her medication this morning and ate a bagel and coffee for breakfast. BP is 110/70 and random finger-stick
glucose is 64. How should this Mrs. Johnson be treated? - Answer ✔️ ✔️ -8 oz milk or 4 oz orange juice
Max is a patient is a 67-year-old male with T2 DM. He is on glipizide and metformin. He presents to the clinic with confusion, sluggishness, and extreme thirst. His wife tells you Max does not follow his meal plan or exercise regularly, and hasn't checked his BG for 1 week. A random glucose is drawn and it is 500. What is a likely diagnosis based on preliminary assessment? - Answer ✔️ ✔️ - Hyperglycemic hyperosmolar syndrom (HHS)
What would one expected assessment finding be for hyperglycemic hyperosmolar syndrome - Answer ✔️ ✔️ -ketones in urine and normal pH
What assessment should be made before prescribing any antihypertensive agent - Answer ✔️ ✔️ -liver and renal function
Why are ACE inhibitors the drug of choice for diabetic patients with hypertension
- Answer ✔️ ✔️ -Reduce adverse effects of diabetes on the kidneys
What's the most common adverse effect of ACE inhibitors - Answer ✔️ ✔️ -Dry hacking cough
Which of the following disease processes could be made worse by taking a nonselective beta blocker? - Answer ✔️ ✔️ -Asthma and diabetes
Angiotensin-converting enzyme (ACE) inhibitors treat hypertension because they:
- Answer ✔️ ✔️ -Reduce sodium and water retention
decrease vasoconstriction
increase vasodilitation
by blocking calcium signal on adrenal cortex cells, they reduce aldosterone production which collaborates to lower blood pressure.
Hypertensive African Americans are typically listed as not being as responsive to which drug groups - Answer ✔️ ✔️ -ACE Inhibitors
What are the adverse effects of dihydropyridine-type calcium channel blockers (nifedipine and nicardipine) which work on the vasculature and do not work on the heart - Answer ✔️ ✔️ -Reflex tachycardia, worsen proteinuria in patients with neuropathy, edema in hands and feet
What are the adverse effects of statins? - Answer ✔️ ✔️ -Rhandomyolysis, increased risk of DM, increase in liver enzymes, cognitive loss, neuropathy, pancreatic/hepatic/sexual dysfuntion
Annamarie has type 2 diabetes and a high triglyceride level. She has gemfibrozil prescribed to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug - Answer ✔️ ✔️ -Gallbladder disease
When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment? - Answer ✔️ ✔️ -Coronary artery disease risk level
First-line therapy for hyperlipidemia is - Answer ✔️ ✔️ -lifestyle changes
What lipid disorders do fibric acids derivatives treat - Answer ✔️ ✔️ -elevated tyiglycerides
Jacob is a 49-year-old patient with an LDL level of 120 and normal triglycerides. Appropriate first-line therapy for Jacob may include diet counseling, increased physical activity, and: - Answer ✔️ ✔️ -sterols
Mary is a 60-year-old patient with an LDL of 132 and a family history of coronary artery disease. She has already tried diet changes (increased fiber and plant sterols) to lower her LDL and after 6 months her LDL is slightly higher. The next step in her treatment would be - Answer ✔️ ✔️ -statin
Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct. - Answer ✔️ ✔️ -Reductase inhibitors, due to an increased risk for rhabdomyolysis
Cynthia is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterol margarine daily for the past 3 months. Her LDL is 135 mg/dL. An appropriate treatment for her would be: - Answer ✔️ ✔️ -determined by her risk factors
Randy is a 54-year-old male with multiple risk factors who has been on a high- dose statin for 3 months to treat his high LDL level. His LDL is 135 mg/dL and his triglycerides are elevated. A reasonable change in therapy would be to: - Answer ✔️ ✔️ - continue the statin and add ezetimibe
Before starting therapy with a statin, the following baseline laboratory values should be evaluated - Answer ✔️ ✔️ -Liver function (AST/ALT) and creatinine kinase
Monitoring of a patient who is on a lipid-lowering drug includes - Answer ✔️ ✔️ - Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy, then again in 6 weeks
What lipid disorders do bile acid sequestrants treat (cholestyramine, Cholybar, Oletyr) since they bind bile in the GI tract to prevent its reabsorption - Answer ✔️ ✔️ - they reduce LDL cholesterol levels
What would you recommend to a patient who is experiencing flushing with niacin therapy - Answer ✔️ ✔️ -Take ASA 300 mg 30 minutes prior to taking niacin
What is considered the order of statin strength from lowest effect to highest - Answer ✔️ ✔️ -Lovastatin, Simvastatin, Rosuvastatin
How is amlodipine metabolized? - Answer ✔️ ✔️ -in the liver by CYP 3 A 4 &
Patient teaching releated to amlodipine includes: - Answer ✔️ ✔️ -avoid grapefruit juices as it effects metabolism of the drug
What are the side effects of amlodipine while treating HTN and to prevent chest pain and/or heart failure? - Answer ✔️ ✔️ -common and dose-related can see peripheral edema, dizziness and palpitations, and flushing.
common not dose-related: include fatigue, nausea, abdominal pain, and somnolence.
rare side effects include: blood disorders, impotence, depression, insomnia, tachycardia, gingival enlargement, hepatitis, and jaundice.
The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not have thyroid disease and wants to know why the test is ordered. Which is a correct response? - Answer ✔️ ✔️ -Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism.
What dermatological issue is linked to Amiodarone use? - Answer ✔️ ✔️ -progressive changes of skin tone toward the blue spectrum
Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why? - Answer ✔️ ✔️ -profound hypotension
What patient teaching will you provide when prescribing amiodarone? - Answer ✔️ ✔️ - Eyes: side effects include corneal micro deposits and optic neuropathy can occur. So any visual problems using amiodarone definitely see the doctor or provider right away.
Skin: you can see a bluish-gray discoloration of the skin and photosensitivity so make sure that your patients use sunscreen.
Lung: you can see some interstitial lung disease.
You can see both hypo and hyperthyroidism and they should monitor their blood pressure daily!
What are the drug interactions with digoxin since it is a purified cardio-glycoside similar to digitoxin extracted from the foxglove plant digitalas lanata? - Answer ✔️ ✔️ - Verapamil, amiodarone, erythromyacin, and epinepherine
Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct - Answer ✔️ ✔️ -older adults because of reduced renal function
Serum digoxin levels are monitored for potential toxicity. Monitoring should occur: - Answer ✔️ ✔️ -Because a reference point is needed in adjusting a dose
Because primary hypertension has no identifiable cause, treatment is based on interfering with the physiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension because they: - Answer ✔️ ✔️ -Deplete body sodium ad reduce fluid volume
