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NR 565 EXAM QUESTIONS WITH COMPLETE SOLUTIONS
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NR 565 EXAM QUESTIONS WITH COMPLETE SOLUTIONS
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NR 565 EXAM QUESTIONS WITHCOMPLETE SOLUTIONS
What labs are used to diagnose Thyroid dysfunction? - Answer-TSH, free T3, total T3,
free T4 and total T4.
Thyroid function in hypothyroidism? - Answer-T3 and T4 are lower, TSH is higher.
Thyroid function in hyperthyroidism? - Answer-TSH low, free T4 is normal and T3 is
high.
What is the timeframe for re-check of labs after starting Levothyroxine? - Answer-Check
TSH 6-8 weeks after initiating therapy and after dosage changes. Check TSH annually
once TSH is stablizied.
Signs and symptoms of hypothyroidism? - Answer-Pale, puffy, expressionless face,
cold, dry skin, brittle hair, hair loss, low temperature/HR, lethargy, fatigue, constipation,
weight gain, intolerance to cold, menstruation impairment, thyroid enlargement.
Signs and symptoms of hyperthyroidism? - Answer-Rapid strong heartbeat,
dysrhythmias, angina, CNS stimulation, nervousness, insomnia, rapid thought process,
rapid speech, skeletal muscles weaken, atrophy, metabolic rate increased, increased
heat production, increased body temperature, increased appetite, weight loss,
exophthalmos.
What is the treatment of thyroid storm? - Answer-High doses of potassium iodide or
strong iodine solution, methimazole suppresses hormone synthesis, beta blockers
reduce heart rate, sedation, cooling, and giving glucocorticoids and IV fluids can also
help.
First line treatment for hypothyroidism? - Answer-Levothyroxine.
First line treatment for hyperthyroidism? - Answer-Methimazole.
Why does the FDA recommend against using PTU as first line treatment of Thyroid
storm? - Answer-Hepatic toxicity.
What can happen if hypothyroidism is not treated during pregnancy? - Answer-
Permanent neuropsychological deficits in the child, congenital hypothyroidism,
decreased IQ (mainly occurs during the 1st trimester and increases up to 50%).
What medication is used to treat symptoms associated with hyperthyroidism? - Answer-
Beta blockers to suppress tachycardia.
, Medications that accelerate metabolism of Levothyroxine (may need to increase their
levothyroxine dosage)? - Answer-phenytoin (Dilantin), carbamazepine (Tegretol,
Carbatrol), rifampin (Rifadin), sertraline (Zoloft).
Think about the CYP450 inducers that increase medication metabolism: CRAP GPS
Medications that reduce Levothyroxine absorption? - Answer-Histamine 2 receptor
blockers (cimetidine [Tagamet], PPIs (lansoprazole [Prevacid], sucralfate [carafate],
colestipol [colestid]), aluminum containing antacids (Maalox, Mylanta), calcium
supplements (Tums, Os-cal), iron supplements (ferrous sulfate), magnesium salts,
Orlistat (Xenical).
Medications whose metabolism is altered by Levothyroxine? - Answer-Warfarin (doses
of medication may need to be reduced), catecholamines, insulin, digoxin (may need to
be increased).
How to confirm a diagnosis of DM prior to beginning treatment? - Answer-Fasting
plasma greater than or equal to 126 (on 2 occasions), random plasma glucose greater
than or equal to 200 plus symptoms of DM, oral glucose tolerance test 2 hr. plasma
glucose greater than or equal to 200, and hemoglobin A1C 6.5% or higher.
General Goals and older adult goals for A1C? - Answer-General Goals: less than 7%
Older Adult Goals: less than 8%
When should insulin be considered in DM? - Answer-After the 3 drug combination is
unsuccessful or patients who have A1C 10% or greater, fasting glucose greater than
300 or are markedly symptomatic.
What time interval should A1C be re-checked? - Answer-3-6 months.
MOA of insulin? - Answer-Anabolic, promotes energy conservation and storage of
glycogen, cell growth, and division, and transport of glucose, amino acids, nucleotides,
and potassium. It stimulates the synthesis of complex organic molecules.
What are the contraindications of Pioglitazone? - Answer-Avoid in those with CHF
(causes water retention and edema), with or history of bladder cancer, active liver
disease, type I DM, or pregnancy. This drug can increase the risk of ovulation, bladder
cancer, and fractures in women, cause hepatic cancer and affect cholesterol levels.
What does GLP-1 stand for and list examples? - Answer-Glucagon-like peptide 1
receptor agonist.
Dulaglutide (Trulicity), semaglutide (Ozempic), Liraglutide (Victoza).
What does TZD stand for and list examples? - Answer-Thiazolidinediones.
Rosiglitzaone (Avandia), Pioglitazone (Actos).
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