NM703 EXAM 2 QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED
What is Hyperthyroidism?
too much iodine ingestion, autoimmune, postpartum, viral illness
What other history besides GDM, 25 wt gain, fatigue, polyuria and unknown
family hx would the APRN want to obtain?
Physical activity level; Hx of HTN, cardiovascular disease, heritage; Other risk factors:
weight, abdominal circumference, blood pressure, current med
Describe the physical examination the APRN should conduct for a patient with
diabetes.
Focuses on dehydration, weight loss, and precipitating causes such as illness, infx, or
stress; Dry and flushed; Assess skin (inspect for signs of irritation, infection, redness,
ulcers and ancanthosis nigricans), eyes (funduscopic exam for hemorrhages or
exudates), heart (auscultate heart rate rhythm, murmurs, clicks or extra heart sounds)
and lungs; Palpate thyroid for enlargement; Mouth (examine for gum disease, fungal
infx or lesions); Feet (palpate pulses for presence and quality, note presence of patellar
and Achilles reflexes perform monofilament examination to assess protective
sensation); Weight, height, BMI, blood pressure, review of glycemic control, evaluation
of target end-organ damage; Neuro (especially if neuropathy is suspected)
List the laboratory tests that should be drawn for type 2 diabetes.
Fasting plasma glucose; OGTT
What are the diagnostic criteria for type 2 diabetes?
,Normal: Fasting plasma glucose <100 mg/dL , Random plasma glucose N/A, Oral
glucose tolerance test (75 g glucose 2hr plasma glucose) <140 mg/dL, HbA1c
<5.7%; Prediabetes:Fasting plasma glucose 100-125 mg/dL, Random plasma
glucose N/A, Oral glucose tolerance test (75 g glucose 2hr plasma glucose) 140-190
mg/dL, HbA1c 5.7-6.4%; Diabetes: Fasting plasma glucose >126 mg/dL, Random
plasma glucose >200 mg/dL w/classic symptoms, Oral glucose tolerance test* (75 g
glucose 2hr plasma glucose) >200 mg/dL, HbA1c >6.5%
If the office based tests indicate type 2 diabetes, what medication would be
prescribed today?
Metformin (Glucophage) if not contraindicated
What education would the APRN start with type 2 diabetes?
Educate regarding side effects of metformin which are nausea and diarrhea - mild and
temporary; education on diet and exercise, achievement and maintenance of desirable
body weight; educate how to monitor blood glucose - fasting 70-130 mg/dL and 2 hr
post prandial should be <180 mg/dL
Under what conditions would the APRN consult or refer to a physician with type 2
diabetes?
End-organ complications (cardiac, kidney, thyroid, eyes, feet, vascular), pregnancy
What is the follow-up plan most appropriate for a patient with type 2 diabetes?
Follow-up every month until stable blood glucose with b/p wt, ht, BMI, eye/foot exam,
review glucometer readings, hbA1c Q3 months, lipid profile annually, serum creatinine
annually
, What further history (pt reports "just not feeling well" 6 mo PP and being
depressed, Mother & sister have Hashimoto) would the APRN want to obtain?
Dietary history; Medical hx; Medications she takes
Describe the physical examination the APRN should conduct for a pt with
hypothyroidism.
Assess for fatigue, increased sensitivity to cold, weight gain, hoarseness, puffiness of
the face and hands, heavy and irregular menstrual periods, dry skin, dry/brittle nails,
depression, paresthesias, muscles aches, constipation
List the laboratory tests that should be drawn for hypothyroidism.
TSH - first diagnostic test; if elevated then free T4
What is the diagnostic criteria for Hashimoto thyroiditis?
elevated TSH, decreased Free T4, elevated antimicrosomal antibodies
Under what conditions would the APRN consult or refer to a physician with a pt
with hypothyroidism?
Large obstructive goiter; solitary nodule or if difficultly regulating medications
What is the follow-up plan most appropriate for a client with hypothyroidism?
Follow up in 4-6 weeks
What further history (pt reports wt loss, heat intolerance, insomnia &
nervousness, has goiter and exopthalmia) would the APRN want to obtain from
BH?
Past medical hx; Medication taking; Family hx
list the laboratory tests that should be drawn today for possible hyperthyroidism?
TSH, T3, Free T4
SOLUTIONS VERIFIED
What is Hyperthyroidism?
too much iodine ingestion, autoimmune, postpartum, viral illness
What other history besides GDM, 25 wt gain, fatigue, polyuria and unknown
family hx would the APRN want to obtain?
Physical activity level; Hx of HTN, cardiovascular disease, heritage; Other risk factors:
weight, abdominal circumference, blood pressure, current med
Describe the physical examination the APRN should conduct for a patient with
diabetes.
Focuses on dehydration, weight loss, and precipitating causes such as illness, infx, or
stress; Dry and flushed; Assess skin (inspect for signs of irritation, infection, redness,
ulcers and ancanthosis nigricans), eyes (funduscopic exam for hemorrhages or
exudates), heart (auscultate heart rate rhythm, murmurs, clicks or extra heart sounds)
and lungs; Palpate thyroid for enlargement; Mouth (examine for gum disease, fungal
infx or lesions); Feet (palpate pulses for presence and quality, note presence of patellar
and Achilles reflexes perform monofilament examination to assess protective
sensation); Weight, height, BMI, blood pressure, review of glycemic control, evaluation
of target end-organ damage; Neuro (especially if neuropathy is suspected)
List the laboratory tests that should be drawn for type 2 diabetes.
Fasting plasma glucose; OGTT
What are the diagnostic criteria for type 2 diabetes?
,Normal: Fasting plasma glucose <100 mg/dL , Random plasma glucose N/A, Oral
glucose tolerance test (75 g glucose 2hr plasma glucose) <140 mg/dL, HbA1c
<5.7%; Prediabetes:Fasting plasma glucose 100-125 mg/dL, Random plasma
glucose N/A, Oral glucose tolerance test (75 g glucose 2hr plasma glucose) 140-190
mg/dL, HbA1c 5.7-6.4%; Diabetes: Fasting plasma glucose >126 mg/dL, Random
plasma glucose >200 mg/dL w/classic symptoms, Oral glucose tolerance test* (75 g
glucose 2hr plasma glucose) >200 mg/dL, HbA1c >6.5%
If the office based tests indicate type 2 diabetes, what medication would be
prescribed today?
Metformin (Glucophage) if not contraindicated
What education would the APRN start with type 2 diabetes?
Educate regarding side effects of metformin which are nausea and diarrhea - mild and
temporary; education on diet and exercise, achievement and maintenance of desirable
body weight; educate how to monitor blood glucose - fasting 70-130 mg/dL and 2 hr
post prandial should be <180 mg/dL
Under what conditions would the APRN consult or refer to a physician with type 2
diabetes?
End-organ complications (cardiac, kidney, thyroid, eyes, feet, vascular), pregnancy
What is the follow-up plan most appropriate for a patient with type 2 diabetes?
Follow-up every month until stable blood glucose with b/p wt, ht, BMI, eye/foot exam,
review glucometer readings, hbA1c Q3 months, lipid profile annually, serum creatinine
annually
, What further history (pt reports "just not feeling well" 6 mo PP and being
depressed, Mother & sister have Hashimoto) would the APRN want to obtain?
Dietary history; Medical hx; Medications she takes
Describe the physical examination the APRN should conduct for a pt with
hypothyroidism.
Assess for fatigue, increased sensitivity to cold, weight gain, hoarseness, puffiness of
the face and hands, heavy and irregular menstrual periods, dry skin, dry/brittle nails,
depression, paresthesias, muscles aches, constipation
List the laboratory tests that should be drawn for hypothyroidism.
TSH - first diagnostic test; if elevated then free T4
What is the diagnostic criteria for Hashimoto thyroiditis?
elevated TSH, decreased Free T4, elevated antimicrosomal antibodies
Under what conditions would the APRN consult or refer to a physician with a pt
with hypothyroidism?
Large obstructive goiter; solitary nodule or if difficultly regulating medications
What is the follow-up plan most appropriate for a client with hypothyroidism?
Follow up in 4-6 weeks
What further history (pt reports wt loss, heat intolerance, insomnia &
nervousness, has goiter and exopthalmia) would the APRN want to obtain from
BH?
Past medical hx; Medication taking; Family hx
list the laboratory tests that should be drawn today for possible hyperthyroidism?
TSH, T3, Free T4
