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in prescribing levothyroxine therapy for an elderly pt, which of the following statements is true?
the levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults
An NP palpates a thyroid nodule. Which of the following is the next best step in management?
Measurement of TSH and ultrasound of the thyroid.
A client with Graves's disease is to have radioactive iodine therapy. When teaching about this treatment, what information should the NP include?
Clients may experience hypothyroidism after this treatment and will need regular TSH and T4 levels determined and may require thyroid hormone replacement therapy.
A 30 yo male with DM type 2 takes regular insulin with meals and a basal insulin in the evening. He has recently been playing rugby every afternoon and has noticed a drop in his blood glucose to levels below 50 mg/dL in the early hours of the morning. Just before breakfast, he checks his blood glucose levels and it has been higher than normal. Which of the following is responsible for the variation in his blood glucose?
B. Somogyi phenomenon.Explanation: The Somogyi phenomenon occurs when patients experience nocturnal hypoglycemia, in this case most likely due to the vigorous exercise during rugby. As a result, the liver is stimulated to produce glucagon to increase blood glucose. Fasting Blood glucose in the morning will be elevated as a result.
A female patient with concerns of bone loss enters the clinic. The best test to determine how much calcium is in the bone is:
Upon examination of a 14 yo female patient who has a positive psoas and obturator sign. What do you suspect?
A 24 yo female presents with depression, wt gain, and delayed tendon reflexes. What additional clinical findings are expected in this patient?
Edema of the face and eyelids.
For a diagnosis of diabetes to be made, the client must have 2 fasting plasma glucose levels documented on 2 different occasions greater than or equal to:
The nurse practitioner finds a solitary nodule on the clients' thyroid gland during a routine physical exam. How should the NP proceed with a management of this case?
B. Thyroid hormone levels and sonogram
Explanation: the NP should obtain thyroid function studies and antibody levels, with subsequent referral to an endocrinologist for fine needle aspiration.
Which of the following is a risk factor for osteoporosis that is seen primary in men?
low testosterone level
While taking a history from a client, the NP identifies what finding that may be associated with osteopenia/osteoporosis?
Smoking 1 pack of cigarettes per day X 20 years.Explanation: Smoking has been associated with thinning of the bones and lead to the development of osteopenia/osteoporosis.
A 45 yo female is evaluated for CHF. In additon ot dilated cardiomyopathy, she displays multiple symptoms including slow speech and intellectual function, fatigue, lethargy, cold intolerence, listlessness, thickend facial features, preorbital edema, dry and coarse skin, peripherla edema. Serum studies demonstrate a T4 og 1.5 and TSH of 15 Which of the following diagnosis is most likely according to the data provided?
You see an obese 25-year-old man with acanthosis nigricans and consider ordering:A. FBS.B. LFT.C. RPR.D. ESR.
The use of a thiazolidinedione is not recommended in all of the following clinical scenarios except:
a 35-year-old patient with newly diagnosed type 2 DM
Metformin should be discontinued for the day of and up to 48 hours after surgery because of increased risk of:
All the following medications are recommended as possible first-line medications for treatment of concomitant hypertension when seen with type 2 DM in a 48-year-old man of European ancestry except:
alpha-adrenergic receptor antagonist.
Physical examination findings in patients with Graves' disease include:
At minimum, at what interval should TSH be reassessed after a levothyroxine dosage is adjusted?
A 46-year-old woman complains of fatigue, weakness, lethargy, decreased concentration and memory, and increased facial hair over the past 12 months. She also reports gaining over 30 pounds (13.6 kg) in the past 2 months. She has a history of asthma with repeated flares during the past 6 months requiring multiple courses of prednisone therapy. A likely diagnosis for this patient is:
Cushing's syndrome results from an excess of:A. luteinizing hormone.B. follicle-stimulating hormone.C. cortisol.D. aldosterone.
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