NR 565|| STUDY GUIDE BEST FOR
MIDTERM EXAM 100% ASSURED
WELL GRADED A+
What labs are used to diagnose Thyroid? - correct Answer-TSH, total T4 and T3, free
T4 and T3
Timeframe for re-check of labs after starting levothyroxine - correct Answer-6-8 wks
after starting therapy
Signs and symptoms of hypothyroidism - correct Answer-Face: Pale, puffy,
expressionless
Skin: Cold and dry
Hair: Brittle and hair loss
Heart rate and temp are lowered
Complaints by patient: lethargy, fatigue, intolerance to cold
Mentation may be impaired
Thyroid enlargement if ↓'d levels of T3 and T4 promoting excessive release of TSH
Treatment of thyroid storm - correct Answer-High dose potassium iodide or strong
iodine solution to suppress thyroid hormone release,
methimazole to suppress thyroid hormone synthesis,
beta blocker to reduce heart rate, sedation cooling glucocorticoids and IV fluids
Result of not treating hypothyroidism during pregnancy - correct Answer-permanent
neurological defects, ↓'d IQ, large protruding tongue, potbelly dwarfish stature, impaired
development of nervous system bone teeth and muscles.
Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and
not the hyperthyroidism itself) - correct Answer-Metoprolol could be used to treat
tachycardia experienced with hyperthyroidism, but it does not treat hyperthyroidism
itself.
Drug/Food/Supplement interactions with levothyroxine Absorption REDUCED by: -
correct Answer-Histamine 2 receptor blockers (Cimetidine [Tagamet])
Proton pump inhibitors (Lansoprazole)
Sucralfate (Carafate)
Cholestyramine (Questran)
Colestipol (Colestid)
Aluminum containing antacids (maalox, mylanta)
Calcium supplements (tums, os-cal)
Iron supplements
, Magnesium salts
Orlistat (Xenical)
* 4 hours between levothyroxine and the above meds is recommended and food
reduces absorption as well
How to treat h. Pylori - correct Answer-Treatment is not recommended for asymptomatic
individuals who test positive for H. pylori.
Otherwise treat with clarithromycin, amoxicillin, bismuth, metronidazole, and
tetracycline. Drug resistance may occur, so the recommendations is to use at least two
antibiotics preferably three, and an antisecretory agent or H2RA.
PUD o Lifestyle modifications to support ulcer healing - correct Answer-change in eating
pattern
consumption of five or six small meals a day, rather than 3 large ones, can reduce
fluctuations in intragastric pH and may facilitate recovery.
Avoid smoking, aspirin and NSAIDS should be avoided. Stop ETOH if causal
relationship of symptoms exist
Anti-diarrheal o Which one contradicted in children during or after chickenpox - correct
Answer-Bismuth subsalicylate (Pepto Bismol) increase risk of Reye's syndrome
Patient teaching for ciprofloxacin for traveler's diarrhea - correct Answer-generally
caused by Escherichia coli; treatment is usually unnecessary because the disease runs
its course in a few days. If symptoms are severe or prolonged, an antibiotic, such as
ciprofloxacin, may be helpful only in nonpregnant women
. This agent should be taken only if needed as antidiarrheal medications may slow the
export of the organism and prolong the course of the disease. Prophylactic treatment
with antibiotics is not recommended. Ciprofloxacin is taken twice daily, avoiding meals.
Which Anti-diarrheal is associated with gray/black stools and black tongue - correct
Answer-Bismuth
Constipation o Lifestyle modifications to suggest prior to treatment - correct Answer-
•Increasing fiber and fluid in diet
*Mild exercise, especially after meals
Risks of laxatives during pregnancy - correct Answer-oGI stimulation might induce labor
Preferred Constipation treatment during breastfeeding - correct Answer-oSenna is safe
for use during breastfeeding.
Psyllium How it works and what to assess for if it doesn't produce a bowel movement -
correct Answer-oAbsorb water in the small intestine and colon, thereby softening and
enlarging the fecal mass; fecal swelling promotes peristalsis.
If bowel movement does not occur assess for intestinal obstruction or impaction.
MIDTERM EXAM 100% ASSURED
WELL GRADED A+
What labs are used to diagnose Thyroid? - correct Answer-TSH, total T4 and T3, free
T4 and T3
Timeframe for re-check of labs after starting levothyroxine - correct Answer-6-8 wks
after starting therapy
Signs and symptoms of hypothyroidism - correct Answer-Face: Pale, puffy,
expressionless
Skin: Cold and dry
Hair: Brittle and hair loss
Heart rate and temp are lowered
Complaints by patient: lethargy, fatigue, intolerance to cold
Mentation may be impaired
Thyroid enlargement if ↓'d levels of T3 and T4 promoting excessive release of TSH
Treatment of thyroid storm - correct Answer-High dose potassium iodide or strong
iodine solution to suppress thyroid hormone release,
methimazole to suppress thyroid hormone synthesis,
beta blocker to reduce heart rate, sedation cooling glucocorticoids and IV fluids
Result of not treating hypothyroidism during pregnancy - correct Answer-permanent
neurological defects, ↓'d IQ, large protruding tongue, potbelly dwarfish stature, impaired
development of nervous system bone teeth and muscles.
Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and
not the hyperthyroidism itself) - correct Answer-Metoprolol could be used to treat
tachycardia experienced with hyperthyroidism, but it does not treat hyperthyroidism
itself.
Drug/Food/Supplement interactions with levothyroxine Absorption REDUCED by: -
correct Answer-Histamine 2 receptor blockers (Cimetidine [Tagamet])
Proton pump inhibitors (Lansoprazole)
Sucralfate (Carafate)
Cholestyramine (Questran)
Colestipol (Colestid)
Aluminum containing antacids (maalox, mylanta)
Calcium supplements (tums, os-cal)
Iron supplements
, Magnesium salts
Orlistat (Xenical)
* 4 hours between levothyroxine and the above meds is recommended and food
reduces absorption as well
How to treat h. Pylori - correct Answer-Treatment is not recommended for asymptomatic
individuals who test positive for H. pylori.
Otherwise treat with clarithromycin, amoxicillin, bismuth, metronidazole, and
tetracycline. Drug resistance may occur, so the recommendations is to use at least two
antibiotics preferably three, and an antisecretory agent or H2RA.
PUD o Lifestyle modifications to support ulcer healing - correct Answer-change in eating
pattern
consumption of five or six small meals a day, rather than 3 large ones, can reduce
fluctuations in intragastric pH and may facilitate recovery.
Avoid smoking, aspirin and NSAIDS should be avoided. Stop ETOH if causal
relationship of symptoms exist
Anti-diarrheal o Which one contradicted in children during or after chickenpox - correct
Answer-Bismuth subsalicylate (Pepto Bismol) increase risk of Reye's syndrome
Patient teaching for ciprofloxacin for traveler's diarrhea - correct Answer-generally
caused by Escherichia coli; treatment is usually unnecessary because the disease runs
its course in a few days. If symptoms are severe or prolonged, an antibiotic, such as
ciprofloxacin, may be helpful only in nonpregnant women
. This agent should be taken only if needed as antidiarrheal medications may slow the
export of the organism and prolong the course of the disease. Prophylactic treatment
with antibiotics is not recommended. Ciprofloxacin is taken twice daily, avoiding meals.
Which Anti-diarrheal is associated with gray/black stools and black tongue - correct
Answer-Bismuth
Constipation o Lifestyle modifications to suggest prior to treatment - correct Answer-
•Increasing fiber and fluid in diet
*Mild exercise, especially after meals
Risks of laxatives during pregnancy - correct Answer-oGI stimulation might induce labor
Preferred Constipation treatment during breastfeeding - correct Answer-oSenna is safe
for use during breastfeeding.
Psyllium How it works and what to assess for if it doesn't produce a bowel movement -
correct Answer-oAbsorb water in the small intestine and colon, thereby softening and
enlarging the fecal mass; fecal swelling promotes peristalsis.
If bowel movement does not occur assess for intestinal obstruction or impaction.
