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NR566 midterm Exam Study Guide2 with Questions and 100% Correct Answers
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NR566 midterm Exam Study Guide2 withQuestions and 100% Correct Answers
Differentiate between primary and secondary hypothyroidism - Answer
Primary disorders include the following:
• Defective hormone synthesis resulting from autoimmune thyroiditis, endemic
iodine deficiency, or antithyroid drugs that were used to treat hyperthyroidism
• Congenital defects or loss of tissue after treatment for hyperthyroidism
Secondary causes of hypothyroidism, which are less common, include conditions that
cause either pituitary or hypothalamic failure. In secondary disorders, the TSH
response is inadequate so that the gland is normal or reduced in size, with both T3 and
T4 synthesis equally reduced.
Differentiate between primary and secondary hyperthyroidism - Answer Primary is the
term used when the pathology is within the thyroid gland. Secondary hyperthyroidism
is the term used when the thyroid gland is stimulated by excessive TSH in circulation.
Precautions and testing for xanthine derivatives - Answer Monitored closely for signs
of toxicity
When therapy is initiated, theophylline levels should be drawn frequently as the
dosage is titrated.
,Signs of toxicity- serum theophylline level should be drawn
Once stabilized, monitoring should be done every 6 to 12 months
Bioavailability of bisphosphonate drugs and appropriate patient education - Answer
Histamine2 blocking agents double alendronate bioavailability, but the impact is
unknown. Aspirin may decrease the bioavailability of tiludronate by up to 50% when
taken 2 hours after the tiludronate. Although indomethacin increases the bioavailability
of tiludronate by 2- to 4-fold, the bioavailability is not significantly altered by
diclofenac; therefore, each NSAID must be considered individually.
Adverse effects associated with long-term use of bisphonates - Answer Etidronate has
also been associated with fractures in patients with Paget's disease when they are
given high doses or when therapy lasted longer than 6 months. These patients must be
carefully monitored with x-rays and laboratory work to assess for these lesions. The
development of a rare form of subtrochanteric femur fracture in non-Paget's patients
using bisphosphonates is under close scrutiny and has contributed to movement away
from osteopenia prevention care to only osteoporosis therapy (FDA, 2010a).
Specifics about administration and education regarding pancreatic enzymes - Answer All
doses are taken immediately before or with meals or snacks with a fatty component.
Fruit, hard candy, fruit juice like drinks, tea or coffee, or popsicles do not require
enzymes (CFF, 2009). Capsules may be opened and sprinkled on food. Capsules with
enteric-coated beads should not be chewed. They may be sprinkled on soft acidic food
that is not hot and that can be swallowed without chewing, such as applesauce or
gelatin. Swallow immediately because the proteolytic enzymes may irritate the mucosa.
Following with a glass of water or juice or eating immediately after taking the drug
helps to ensure that the medication is swallowed and does not remain in contact with
the mouth and esophagus for long periods. Pancrelipase is destroyed by acid. Proton
pump inhibitors, sodium bicarbonate, or aluminum-based antacids may be used with
preparations without enteric coating to neutralize gastric pH. Calcium- and magnesium-
based antacids should not be used for this purpose because they interfere with drug
action. Enteric-coated beads are designed to withstand the acid pH of the stomach.
Enteric-coated formulations should not be mixed with alkaline food or the coating will
be destroyed.
,Common adverse effects with aromatase inhibitors - Answer Adverse effects for the
drug class include various pain syndromes, vertigo, insomnia resulting in daytime
sleepiness and confusion, increased risk of blood clots, and hair loss. A key concern is
the loss of bone mass. Bone loss can be significant when considering the concurrent
osteoporotic risks of postmenopause. Closer monitoring is required. All patients should
be on calcium and vitamin D supplementation. A relative leukopenia can occur, but the
incidence of viral and bacteria infections is not considered greater than matched
groups (about 10%). Hypertension occurs in 10% of patients. A life-threatening increase
in blood clotting can result in MI, stroke, or pulmonary embolus. Hot flashes can be
intense.
Drugs associated risk for bone loss which should be monitored - Answer Aromatase
inhibitors
Thyroid hormones
Glucocorticoids
PPIs
SSRIs
Clinical signs and symptoms DM - Answer Increased thirst
Frequent urination
Extreme hunger
Unexplained weight loss
Presence of ketones in the urine (ketones are a byproduct of the breakdown of
muscle and fat that happens when there's not enough available insulin)
Fatigue
Irritability
Blurred vision
Slow-healing sores
Frequent infections, such as gums or skin infections and vaginal infections
, Risk factors & associated complications of DM - Answer Complications: stroke,
heart attack, peripheral artery disease, diabetic retinopathy, cataracts, glaucoma,
diabetic nephropathy, peripheral neuropathy, diabetic foot.
Risk factors: >45 years old, physical inactivity, 1st degree relative relative with DM, high
risk ethic group (african american, hispanic, native american, asian american, and pacific
islander), hx of gest DM, htn, HDL < 35, triglycerides >250, polycystic ovarian syndrome,
acanthosis nigricans, hx of cardiovascular disease.
Diagnostic criteria of DM - Answer Acute symptoms of diabetes plus casual
plasma glucose concentration ≥200 mg/dL.
*Casual is defined as any time of day without regard to time since last meal. The classic
symptoms of diabetes are polyuria, polydipsia, and unexplained weight loss.
Fasting plasma glucose ≥126 mg/dL. * Fasting is defined as no caloric intake for at least 8
h.
2-h postload plasma glucose in an oral glucose tolerance test ≥200 mg/dL. The test uses
a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.
Hb A1c ≥6.5%.
PRE-DIABETES:
Fasting plasma glucose 100-125 mg/dL (IFG) or
plasma glucose 140-199 mg/dL (IGT) 2 hr post-ingestion of standard glucose load (75
g) or
Hb A1c 5.7%-6.4%
Criteria for screening asymptomatic adults - Answer Individuals ≥45 yr and who have a BMI
≥25 kg/m2 should be tested. If normal, the test should be repeated at 3 yr intervals.
Individuals <45 yr and who have a BMI ≥25 kg/m2 and have additional risk factors
should have more frequent testing.
Additional risk factors are the following:
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