NR 566 NEWEST 2024 FORM A AND FORM B (EACH 200Q&As) ACTUAL QUESTIONS AND ANSWERS GRADED A+.

NR 566 NEWEST 2024 FORM A AND FORM B (EACH 200Q&As) ACTUAL QUESTIONS AND ANSWERS GRADED A+. Drugs associated risk for bone loss which should be monitored --------CORRECT ANSWER------Aromatase inhibitors Thyroid hormones Glucocorticoids PPIs SSRIs Clinical signs and symptoms DM --------CORRECT ANSWER------Increased thirst Frequent urination Extreme hunger Unexplained weight loss Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin) Fatigue Irritability Blurred vision Slow-healing sores Frequent infections, such as gums or skin infections and vaginal infections Bioavailability of bisphosphonate drugs and appropriate patient education --------CORRECT ANSWER------ Histamine2 blocking agents double alendronate bioavailability, but the impact is unknown. Aspirin may decrease the bioavailability of tiludronate by up to 50% when taken 2 hours after the tiludronate. Although indomethacin increases the bioavailability of tiludronate by 2- to 4-fold, the bioavailability is not significantly altered by diclofenac; therefore, each NSAID must be considered individually. Adverse effects associated with long-term use of bisphonates --------CORRECT ANSWER------Etidronate has also been associated with fractures in patients with Paget's disease when they are given high doses or when therapy lasted longer than 6 months. These patients must be carefully monitored with x-rays and laboratory work to assess for these lesions. The development of a rare form of subtrochanteric femur fracture in non-Paget's patients using bisphosphonates is under close scrutiny and has contributed to movement away from osteopenia prevention care to only osteoporosis therapy (FDA, 2010a). Specifics about administration and education regarding pancreatic enzymes --------CORRECT ANSWER------All doses are taken immediately before or with meals or snacks with a fatty component. Fruit, hard candy, fruit juice like drinks, tea or coffee, or popsicles do not require enzymes (CFF, 2009). Capsules may be opened and sprinkled on food. Capsules with enteric-coated beads should not be chewed. They may be sprinkled on soft acidic food that is not hot and that can be swallowed without chewing, such as applesauce or gelatin. Swallow immediately because the proteolytic enzymes may irritate the mucosa. Following with a glass of water or juice or eating immediately after taking the drug helps to ensure that the medication is swallowed and does not remain in contact with the mouth and esophagus for long periods. Pancrelipase is destroyed by acid. Proton pump inhibitors, sodium bicarbonate, or aluminum-based antacids may be used with preparations without enteric coating to neutralize gastric pH. Calciumand magnesium-based antacids should not be used for this purpose because they interfere with drug action. Entericcoated beads are designed to withstand the acid pH of the stomach. Enteric-coated formulations should not be mixed with alkaline food or the coating will be destroyed. NR 566 NEWEST 2024 FORM A AND FORM B (EACH 200Q&As) ACTUAL QUESTIONS AND ANSWERS GRADED A+. BETTER THE BEST. Common adverse effects with aromatase inhibitors --------CORRECT ANSWER------Adverse effects for the drug class include various pain syndromes, vertigo, insomnia resulting in daytime sleepiness and confusion, increased risk of blood clots, and hair loss. A key concern is the loss of bone mass. Bone loss can be significant when considering the concurrent osteoporotic risks of postmenopause. Closer monitoring is required. All patients should be on calcium and vitamin D supplementation. A relative leukopenia can occur, but the incidence of viral and bacteria infections is not considered greater than matched groups (about 10%). Hypertension occurs in 10% of patients. A life-threatening increase in blood clotting can result in MI, stroke, or pulmonary embolus. Hot flashes can be intense. Risk factors & associated complications of DM --------CORRECT ANSWER------Complications: stroke, heart attack, peripheral artery disease, diabetic retinopathy, cataracts, glaucoma, diabetic nephropathy, peripheral neuropathy, diabetic foot. Risk factors: 45 years old, physical inactivity, 1st degree relative relative with DM, high risk ethic group (african american, hispanic, native american, asian american, and pacific islander), hx of gest DM, htn, HDL 35, triglycerides 250, polycystic ovarian syndrome, acanthosis nigricans, hx of cardiovascular disease. Diagnostic criteria of DM --------CORRECT ANSWER------Acute symptoms of diabetes plus casual plasma glucose concentration ≥200 mg/dL. *Casual is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes are polyuria, polydipsia, and unexplained weight loss. Fasting plasma glucose ≥126 mg/dL. * Fasting is defined as no caloric intake for at least 8 h. 2-h postload plasma glucose in an oral glucose tolerance test ≥200 mg/dL. The test uses a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. Hb A1c ≥6.5%. PRE-DIABETES: Fasting plasma glucose 100-125 mg/dL (IFG) or plasma glucose 140-199 mg/dL (IGT) 2 hr post-ingestion of standard glucose load (75 g) or Hb A1c 5.7%-6.4% Criteria for screening asymptomatic adults --------CORRECT ANSWER------Individuals ≥45 yr and who have a BMI ≥25 kg/m2 should be tested. If normal, the test should be repeated at 3 yr intervals. Individuals 45 yr and who have a BMI ≥25 kg/m2 and have additional risk factors should have more frequent testing. Additional risk factors are the following: • Physically inactive • First-degree relative with diabetes • Members of high-risk ethnic group (African American, Hispanic, Native American, Asian American, Pacific Islander) • Delivered a baby weighing 9 lb or previously diagnosed with GDM • Hypertensive (B/P ≥140/90 mm Hg) • HDL cholesterol ≤35 mg/dL and/or triglyceride level ≥250 mg/dL • Have polycystic ovary syndrome (PCOS) • IGT or IFG on previous testing • Have other clinical conditions associated with insulin resistance (PCOS or acanthosis nigricans) • History of CVD Insulin Treatment Algorithm for Type 1 DM --------CORRECT ANSWER------Total daily insulin requirement is 0.3 to 0.5 units/kg body weight/d with titration to glycemic targets. Higher doses for acute illness. Adjustments made after reviewing patterns over 3 days. Hypoglycemia addressed first, then hyperglycemia. Adjustments up or down done in increments of 1 unit. A1C monitoring during oral or insulin diabetes management --------CORRECT ANSWER------Because Hb A1c reflects mean glycemia over the preceding 2 to 3 months, it should be measured at least twice a year if patients are meeting treatment goals or have stable glycemic control; it should be measured every 3 months if therapy has changed or if patients are not meeting treatment goals BETTER THE BEST. Clinical manifestations of diabetic autonomic neuropathy --------CORRECT ANSWER------Resting tachycardia, exercise intolerance, orthostatic hypotension, constipation, gastroparesis, erectile dysfunction, sweat gland dysfunction, impaired neurovascular function, and the potential for autonomic failure in response to hypoglycemia. Hypoglycemia treatment (amount of carbohydrates and examples) --------CORRECT ANSWER------They should take 15 gm of carbohydrate and recheck their sugars in 15 minutes. Drug monitoring with metformin --------CORRECT ANSWER------Monitor B12 levels Antidiabetic medications associated with photosensitivity --------CORRECT ANSWER------Sulfonylureas Antidiabetics to avoid in the elderly & why --------CORRECT ANSWER------Sulfonylureas produces severe hypoglycemia. Glimepiride produces hypoglycemia. Glyburide is the most likely to cause hypoglycemia. Metformin due to older adults often have renal insufficiency or heart failure. Alpha-glucosidase inhibitors are not well tolerated. All meds should be started at the lowest possible dose. Improving patient compliance with diabetes treatment --------CORRECT ANSWER------Nonadherence to the treatment regimen may result in increased risk for complications and reduced life expectancy. Healthcare providers should be aware of potential problems with nonadherence, discuss the importance of adherence at each follow-up visit, and assist patients in removing barriers to adherence such as lack of social support and cost of the treatment regimen. A team approach with the patient as an active partner should be maximized. Ways to deal with nonadherence are discussed in Chapter 6. Patient education booklets are available from the ADA, which can be accessed on the Internet at . Diabetic medications to avoid when taking digoxin --------CORRECT ANSWER------Metformin - dig may increase the effect of metformin leading to lactic acidosis. Rapid Acting Insulin --------CORRECT ANSWER------Humalog, Novolog, Apidra Short Acting Insulin --------CORRECT ANSWER------Regular (Humulin R, Novolin R) Intermediate Acting Insulin --------CORRECT ANSWER------Isophane (NPH, Humulin N) Long Acting Insulin --------CORRECT ANSWER------Lantus, Levimir Fixed Combo Insulin --------CORRECT ANSWER------70/30 (NPH/regular ratio) 50/50 (NPH/regular ratio) 75/25 (NPH/lispro) 70/30 (NPH/aspart) A1C Treatment Goal --------CORRECT ANSWER------Less than 7% Daily dose of insulin for initiation --------CORRECT ANSWER------0.1/kg or 10 units Diabetic medications with need for renal dose adjustment --------CORRECT ANSWER------Metformin Diabetic medications associated with increased risk for genital mycotic infections --------CORRECT ANSWER------ Selective Sodium Glucose Co-transporter 2 (SGLT-2) BETTER THE BEST. Time anticipated for total reversal of hyperthyroid symptoms with methimazole --------CORRECT ANSWER------A treatment typically requires 6 to 12 months for total reversal of hyperthyroid symptoms. Routine testing with drug therapy --------CORRECT ANSWER------TSH and free T4 levels Every 4 to 8 weeks until euthyroid During pregnancy evaluate at 8 weeks' and 6 months' gestation Recommend dietary iodine intake --------CORRECT ANSWER------100-150 mcg/day for normal thyroid function Drugs that increase metabolism of T4 --------CORRECT ANSWER------Carbamazepine, Phenytoin Symptoms of Hyperthyroidism --------CORRECT ANSWER------increased CO, decreased peripheral vascular resistance, tachycardia at rest, arrhythmias, dyspnea and reduced vital capacity, increased appetite with weight loss, diarrhea, nausea, vomiting, abdominal pain, sweating, flushing warm skin, hair loss, nails grow away from nail beds, oligo/amenorrhea, impotence/decreased libido in men, restlessness, short attention span, fatigue, insomnia, emotional lability, enlarged gland. Symptoms of Hypothyroidism --------CORRECT ANSWER------reduced stroke volume and HR, increased peripheral resistance to maintain BP, bradycardia, macrocytic anemia assoc. With B12 deficiency, dyspnea, hypoventilation, CO2 retention, decreased appetite, constipation, weight gain, fluid retention, dry flaky skin, dry hair, slow wound healing, cool skin, decreased libido, confusion, slow speech, memory loss, clumsy movements. Hyperthyroid drugs with risk for hepatic toxicity --------CORRECT ANSWER------propylthiouracil Bile acid sequestrants absorption and administration --------CORRECT ANSWER------affect LDL-C with a modest increase in HDL-C. They are not commonly prescribed to treat dyslipidemias in patients with diabetes. Not only do they increase TGs but they may pose problems for patients with diabetic gastroparesis. The increase in TG is especially of concern in diabetics because the pancreas is already under stress. Levothyroxine administration instructions --------CORRECT ANSWER------Take first thing in the morning at least 30, preferably one hour before eating. On an empty stomach with only water. Achieve consistency in taking the med to avoid fluctuating thyroid levels. Differentiate between primary and secondary hypothyroidism --------CORRECT ANSWER------Primary disorders include the following: • Defective hormone synthesis resulting from autoimmune thyroiditis, endemic iodine deficiency, or antithyroid drugs that were used to treat hyperthyroidism • Congenital defects or loss of tissue after treatment for hyperthyroidism Secondary causes of hypothyroidism, which are less common, include conditions that cause either pituitary or hypothalamic failure. In secondary disorders, the TSH response is inadequate so that the gland is normal or reduced in size, with both T3 and T4 synthesis equally reduced. Differentiate between primary and secondary hyperthyroidism --------CORRECT ANSWER------Primary is the term used when the pathology is within the thyroid gland. Secondary hyperthyroidism is the term used when the thyroid gland is stimulated by excessive TSH in circulation. Precautions and testing for xanthine derivatives --------CORRECT ANSWER------Monitored closely for signs of toxicity When therapy is initiated, theophylline levels should be drawn frequently as the dosage is titrated. Signs of toxicity- serum theophylline level should be drawn Once stabilized, monitoring should be done every 6 to 12 months Mild intermittent asthma --------CORRECT ANSWER------Symptoms occur less often than twice a week and the patient is asymptomatic between exacerbations; nighttime symptoms occur less than twice a month; and peak expiratory flow (PEF) is greater than 80% predicted. The use of short-acting beta2 agonists (SABA) should be less than twice a week, unless used for exercise-induced bronchospasm (EIB). BETTER THE BEST. Mild persistent asthma --------CORRECT ANSWER------Symptoms occur more often than twice a week but less often than once a day and exacerbations may affect activity; nighttime symptoms occur 3 to 4 times a month; and PEF is greater than 80% predicted. Patients with mild persistent asthma may use their short-acting beta2 agonists more than twice a week but not daily, and not more than once daily.