NR 565 Final Exam with Complete
Solutions
What labs are used to diagnose thyroid problems? - ANS-Free and total T3
Free and total T4
TSH
Anti-TPO
Hypothyroidism labs - ANS-increased TSH, decreased T3 &T4
hyperthyroidism labs - ANS-decreased TSH and increased T3 &T4
When to recheck labs after starting levothyroxine? - ANS-6-8 weeks or after dose
change, then 12 months once stabilized
S/S hypothyroidism - ANS-pale, puffy, and expressionless face, cold and dry skin, brittle
hair/hair loss, low heart rate and body temperature, lethargy, fatigue, cold intolerance,
mental status changes, thyroid enlargement
Think "hypo low and slow"
S/S hyperthyroidism - ANS-strong and rapid heart rate, dysrhythmias, angina,
nervousness, insomnia, rapid thought flow and speech, muscle weakness/atrophy,
increased metabolic rate (increased heat production, increased body temperature, heat
intolerance), warm/moist skin, increased appetite, weight loss despite increased caloric
intake
think "hyper as in fast"
result of not treating hypothyroidism during pregnancy - ANS-permanent
neuropsychological deficits in the child. First trimester: fetus unable to produce their
own thyroid hormones. Fetal thyroid gland is fully functional in the second trimester.
Medication to treat SYMPTOMS of hyperthyroidism - ANS-beta blocker (decrease HR)
non-radioactive iodine
How to take levothyroxine with food? - ANS-take on an empty stomach in the morning,
30-60 minutes before breakfast
Supplement/drug interactions with levothyroxine - ANS-antacids, iron, calcium
, Confirm diabetes diagnosis prior to treatment - ANS-fasting plasma glucose greater
than or equal to 126, A random plasma glucose of greater than or equal to 200 plus
symptoms of diabetes, an oral glucose tolerance test of two hours, plasma glucose of
greater than or equal to 200, or a hemoglobin A1c, a 6.5 or higher (on two occasions)
A1c general goal - ANS-<7%
Older adult A1c goal - ANS-<8%
When should insulin be considered? - ANS-For patients with an A1c >10%, a fasting
blood glucose >300 or are markedly symptomatic
At what interval should A1c be rechecked? - ANS-2-4 times a year (every 3 months)
until A1c drops to 7% and at least every 6 months there after
action of insulin - ANS-regulation of glucose metabolism. Insulin promotes glucose and
amino acid uptake into muscle and adipose tissues, and other tissues except brain and
liver. It also has an anabolic role in stimulating glycogen, fatty acid, and protein
synthesis
First, it stimulates cellular transport (uptake) of glucose, amino acids, nucleotides, and
potassium. Second, insulin promotes synthesis of complex organic molecules. Under
the influence of insulin and other factors, glucose is converted into glycogen, amino
acids are assembled into proteins, and fatty acids are incorporated into triglycerides
Pioglitazone (TZD) contraindications - ANS-do not give to patients with heart failure or
history of bladder cancer
GLP-1 - ANS-glucagon-like peptide-1 receptor agonist
ending in -glutide/tide
ex. semaglutide
TZD - ANS-Thiazolidinedione's
end in -ones
ex. glitazones
DPP4-1 - ANS-Dipeptidyl Peptidase-4 inhibitors
end in -gliptin
ex. gliptins
SGLT2i - ANS-sodium-glucose contransporter 2 inhibitors
end in-flozin
Solutions
What labs are used to diagnose thyroid problems? - ANS-Free and total T3
Free and total T4
TSH
Anti-TPO
Hypothyroidism labs - ANS-increased TSH, decreased T3 &T4
hyperthyroidism labs - ANS-decreased TSH and increased T3 &T4
When to recheck labs after starting levothyroxine? - ANS-6-8 weeks or after dose
change, then 12 months once stabilized
S/S hypothyroidism - ANS-pale, puffy, and expressionless face, cold and dry skin, brittle
hair/hair loss, low heart rate and body temperature, lethargy, fatigue, cold intolerance,
mental status changes, thyroid enlargement
Think "hypo low and slow"
S/S hyperthyroidism - ANS-strong and rapid heart rate, dysrhythmias, angina,
nervousness, insomnia, rapid thought flow and speech, muscle weakness/atrophy,
increased metabolic rate (increased heat production, increased body temperature, heat
intolerance), warm/moist skin, increased appetite, weight loss despite increased caloric
intake
think "hyper as in fast"
result of not treating hypothyroidism during pregnancy - ANS-permanent
neuropsychological deficits in the child. First trimester: fetus unable to produce their
own thyroid hormones. Fetal thyroid gland is fully functional in the second trimester.
Medication to treat SYMPTOMS of hyperthyroidism - ANS-beta blocker (decrease HR)
non-radioactive iodine
How to take levothyroxine with food? - ANS-take on an empty stomach in the morning,
30-60 minutes before breakfast
Supplement/drug interactions with levothyroxine - ANS-antacids, iron, calcium
, Confirm diabetes diagnosis prior to treatment - ANS-fasting plasma glucose greater
than or equal to 126, A random plasma glucose of greater than or equal to 200 plus
symptoms of diabetes, an oral glucose tolerance test of two hours, plasma glucose of
greater than or equal to 200, or a hemoglobin A1c, a 6.5 or higher (on two occasions)
A1c general goal - ANS-<7%
Older adult A1c goal - ANS-<8%
When should insulin be considered? - ANS-For patients with an A1c >10%, a fasting
blood glucose >300 or are markedly symptomatic
At what interval should A1c be rechecked? - ANS-2-4 times a year (every 3 months)
until A1c drops to 7% and at least every 6 months there after
action of insulin - ANS-regulation of glucose metabolism. Insulin promotes glucose and
amino acid uptake into muscle and adipose tissues, and other tissues except brain and
liver. It also has an anabolic role in stimulating glycogen, fatty acid, and protein
synthesis
First, it stimulates cellular transport (uptake) of glucose, amino acids, nucleotides, and
potassium. Second, insulin promotes synthesis of complex organic molecules. Under
the influence of insulin and other factors, glucose is converted into glycogen, amino
acids are assembled into proteins, and fatty acids are incorporated into triglycerides
Pioglitazone (TZD) contraindications - ANS-do not give to patients with heart failure or
history of bladder cancer
GLP-1 - ANS-glucagon-like peptide-1 receptor agonist
ending in -glutide/tide
ex. semaglutide
TZD - ANS-Thiazolidinedione's
end in -ones
ex. glitazones
DPP4-1 - ANS-Dipeptidyl Peptidase-4 inhibitors
end in -gliptin
ex. gliptins
SGLT2i - ANS-sodium-glucose contransporter 2 inhibitors
end in-flozin
