Download Fitz test 3 ENDO (THYROID, DM), GI, STI, GU, WOMENS HEALTH Questions with complete solutio and more Exams Nursing in PDF only on Docsity!
Fitz test 3 ENDO (THYROID, DM), GI, STI,
GU, WOMENS HEALTH Questions with
complete solution 2025
Which of the following would be the least likely candidate for weight loss surgery? A. A 43-year-old man with BMI of 42 kg/m B. A 38-year-old with BMI 37 kg/m2 and type 2 diabetes mellitus C. A 29-year-old with BMI of 35 kg/m2 and who has been unable to sustain healthy weight loss with multiple prior weight loss efforts D. A 24-year-old with BMI of 31 kg/m2 who does not believe current weight is of concern - correct answer ✔D. A 24-year-old with BMI of 31 kg/m2 who does not believe current weight is of concern ideal candidates for weight loss surgery include those with a BMI=40 kg/m2 or over 100 pounds overweight, those with a BMI=35 kg/m2 and with at least one obesity-related comorbidity (such as type 2 diabetes, hypertension, sleep apnea, heart disease, etc.), or individuals who have been unable to achieve a healthy weight loss for sustained periods of time with prior weight loss efforts. **A 66-year-old woman being managed for Addison's disease presents for follow-up evaluation. Findings consistent with an excessive dose of the medication taken for this condition would include: A. Diffuse hyperpigmentation. B. Blood pressure of 168/98 mm Hg. C. Loss of axillary hair.
D. A white blood cell count of 6,000/mm3. - correct answer ✔B. Blood pressure of 168/98 mm Hg. The first-line medication for Addison's disease is the use of a systemic corticosteroid such as oral prednisone; the goal is to replace endogenous cortisol in a manner that is consistent with the normal, physiologic diurnal variation. A typical starting dose is 15 mg q AM and 10 mg q PM. If the dose of prednisone is too high for this patient, she can demonstrate signs and symptoms of hypercortisolism, such as hypertension. Mrs. Jansen is a 61-year-old patient who has difficult-to-manage type 2 diabetes mellitus. After trials of several oral and injectable medication combinations including insulin releasers, with adherence, her A1c remained significantly above goal. Three months ago, the nurse practitioner adjusted Mrs. Jansen's regimen to include basal and mealtime insulin and advised the continuation of metformin. Today Mrs. Jansen's A1c is 6.8%. The appropriate response is to: A. Increase the insulin by 20%. B. Consider discontinuing metformin. C. Continue the present regimen. D. Repeat the A1c in one month. - correct answer ✔C. Continue the present regimen. therapeutic goal of management as an A1c of <7%. At 6.8%, Mrs. Jansen has attained the therapeutic goal, and the appropriate response is to continue her present regimen. A 49-year-old female of European ancestry with type 2 diabetes mellitus was started on lisinopril 20 mg tablet daily 6 weeks ago for the management of hypertension. Today her blood pressure is 128/78 mm Hg and the patient is feeling well. The appropriate action at this time would be to:
A. Metformin B. Canagliflozin C. Glipizide D. Pioglitazone - correct answer ✔C. Glipizide After several years of supraphysiologic production, the beta cells eventually "burn out" and cannot produce significant amounts of insulin release. An insulin releaser, such as glipizide, will not be effective and exogenous insulin must be added to the regimen. Which of the following is consistent with the diagnosis of diabetes mellitus? A. Fasting plasma glucose=100-125 mg/dL (5.6-6.9 mmol/L) B. A1c >6.5% C. Plasma glucose=140-199 mg/dL (7.8-11.0 mmol/L) on the 75-g oral glucose tolerance test D. Random plasma glucose >125 mg/dL without classic diabetes mellitus symptoms - correct answer ✔B. A1c >6.5% Diagnostic criteria for diabetes mellitus include (1) fasting plasma glucose >126 mg/dL on two occasions, (2) A1c >6.5%, (3) plasma glucose tolerance >200 mg/dL 2 hours after a 75-g glucose load, or (4) a random plasma glucose >200 mg/dL along with classic symptoms of polyuria, polydipsia, or polyphagia along with unexplained weight loss or hyperglycemic crisis.
Which of the following best describes a component of sitagliptin's mechanism of action? A. Increases hepatic glucose utilization B. Glucose-dependent insulin release C. Facilitates renal glucose excretion D. Diminishes glucose absorption in gastrointestinal tract - correct answer ✔B. Glucose-dependent insulin release Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor. DPP-4 inhibitors slow inactivation of two incretin hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). This ultimately increases glucose-dependent insulin release and inhibits hepatic gluconeogenesis. Mrs. Griffin is a 46-year-old woman with type 2 diabetes mellitus who is using metformin and a single 10-unit daily dose of the long-acting insulin, glargine. Her fasting blood glucose has been between 120-140 mg/dL (6.7-7.8 mmol/L). Which of the following best describes the next step in her therapy? A. Continue on the current glargine dose B. Increase her glargine dose by 2 units per day C. Increase her glargine dose by 4 units per day D. Increase her glargine dose by 6 units per day - correct answer ✔B. Increase her glargine dose by 2 units per day The current approach to the management of type 2 diabetes mellitus is that when added, glargine insulin should begin at 10 units daily and then titrated
Insulin resistance is now recognized as a root cause (along with genetics and other factors) of polycystic ovary syndrome (PCOS). When patients are insulin resistant, the body perceives this as an insulin deficiency and the pancreas compensates by making more insulin, resulting in hyperinsulinemia. For several years, the elevated insulin levels will compensate for the insulin resistance, and the patient remains normoglycemic. However, the hyperinsulinemia can also trigger increased production and release of androgens, which in turn leads to the development of ovarian cysts and impaired fertility, in part due to anovulation. If hyperinsulinemia and insulin resistance are left untreated for several years, type 2 diabetes mellitus will likely develop. From a clinical perspective, the insulin-resistant patient presents with PCOS years before developing type 2 diabetes mellitus. Which of the following characteristics applies to type 2 diabetes mellitus? A. Inactivity is a potent risk factor for the condition. B. Genetic influences are associated with type 1 but not type 2 diabetes mellitus risk. C. Exogenous insulin is consistently needed throughout the course of the disease. D. "Pear-shaped" body habitus is often noted. - correct answer ✔A. Inactivity is a potent risk factor for the condition. ype 2 diabetes mellitus is a complex metabolic disorder characterized by a variety of risk factors including inactivity, obesity, genetics, medication, and aging. Obesity is more often abdominal (rather than pear-shaped body habitus) and hyperinsulinemia is often noted in early disease; thus, exogenous insulin is typically not needed. You are teaching a 62-year-old patient with type 2 diabetes mellitus about using mealtime insulin to help with the management of post-prandial hyperglycemia. You describe a situation where blood sugar is between 200
and 250 mg/dL (11.1-13.9 mmol/L) and advise the appropriate dose of rapid- acting insulin to attain a goal of <150 mg/dL (8.3 mmol/L) is: A. 1 unit. B. 2 units. C. 4 units. D. 8 units. - correct answer ✔B. 2 units. The (ADA) endorses the use of mealtime insulin to achieve glycemic control in patients whose A1c remains >6.5% after 3 months of optimal oral therapy. One unit of rapid-acting insulin will result in a blood sugar decrease of approximately 50 mg/dL (2.78 mmol/L). Therefore, in the example above, 2 units will be needed to attain the goal of <150 mg/dL. 1 unit equals 50 mg/dL decrease Which of the following best describes the appropriate use of insulin lispro? A. In an insulin pump B. As a mealtime insulin C. As a basal insulin D. To prevent the Somogyi effect - correct answer ✔B. As a mealtime insulin Insulin lispro is ultra-short-acting, with an onset 15-30 minutes after administration and a peak of 30 minutes to 2.5 hours. This insulin is typically used as a mealtime insulin. The American Diabetes Association (ADA) endorses the use of mealtime insulin to achieve glycemic control in patients whose A1c and post-meal blood glucose remains elevated with the use of optimized therapy, particularly with basal insulin.
Pioglitazone is an insulin receptor sensitizer. Acarbose blocks gastric absorption of sucrose but does not impact gastric motility. Glyburide is an insulinogenic drug that impacts the beta cell of the pancreas and has no impact on the gut SGLT2 inhibitors work by: A.Increasing glucose utilization in the muscle. B. Reducing insulin resistance in the skeletal muscle and adipose tissue. C. Increasing urinary glucose excretion. D. Increasing pancreatic insulin release. - correct answer ✔C. Increasing urinary glucose excretion. SGLT2 inhibitors increase urinary glucose excretion and can be used in combination with one or more agents, but not as a first-line choice. These agents do not enhance insulin secretion or sensitivity. Use of these agents is associated with increased risk of genital candidiasis, UTI, and dehydration. You see a 24-year-old African American male with a BMI=34 kg/m2 and type 2 diabetes mellitus and extensive acanthosis nigricans. He works on a rotating shift at a factory and eats irregularly. He was initiated on metformin monotherapy 3 months ago and his A1c decreased from 9.8% to 8.7%. Which of the following is the most appropriate next step in the management of this patient? A. Follow up in 4 weeks as he is at goal B. Add a sliding scale insulin
C. Add a thiazolidinedione D. Add a sulfonylurea - correct answer ✔C. Add a thiazolidinedione The A1c goal for this patient is generally <7% and thus an additional antihyperglycemic should be used to reduce blood glucose levels. Thiazolidinediones (TZD) are primary insulin receptor sensitizers that can be used as adjunct to metformin to address insulin resistance. Sliding scale insulin is generally not recommended as this is more of a reactive rather than proactive approach to address hyperglycemia. Sulfonylureas act as an insulin secretagogue that promotes constant insulin release. For an individual with an irregular eating schedule, this can increase the risk of hypoglycemia. The dyslipidemia pattern most often seen in a person with untreated or poorly- controlled type 2 diabetes mellitus is one of: A. High TG, normal LDL-C and HDL-C. B. High TG, high LDL-C, and low HDL-C. C. Normal TG, high LDL-C and HDL-C. D. Low TG, low LDL-C, and high HDL-C. - correct answer ✔B. High TG, high LDL-C, and low HDL-C. Type 2 diabetes mellitus (DM) is an endocrine abnormality characterized by decreased storage of the metabolic fuel sources (glucose, amino acids, and triglycerides). As a result of decreased insulin activity, there is an increase in unstored triglycerides, producing the characteristic hypertriglyceridemia of diabetes mellitus. Similarly, there can be decreased hepatic uptake of LDL-C resulting in elevated plasma LDL-C levels. The mechanism of low HDL-C is unclear but has been linked to insulin resistance. When prescribing glargine or detemir, the clinician should consider that:
metformin use include concomitant use of certain medications (e.g., topiramate), age 65 years and older, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, and hepatic impairment. Nancy is a 22-year-old woman who initially presented with significant thyrotoxicosis. She was subsequently diagnosed with Graves' disease. She was then referred to endocrinology and ultimately treated with radioactive iodine. Follow-up laboratory assessment would be expected to reveal: A. Absence of thyroid-stimulating antibodies. B. An increase in TSH as compared to pretreatment. C. An increase in free T3 as compared to pretreatment. D. Absence of thyroid peroxidase (TPO) antibodies. - correct answer ✔B. An increase in TSH as compared to pretreatment. Graves' disease is characterized by biologically active thyroid-stimulating antibodies that stimulate the thyroid gland and suppress endogenous TSH. As a result, pretreatment TSH is very low and sometimes undetectable. Following radioactive ablation of the gland, thyroxine output falls, circulating levels drop, and the anterior pituitary increases TSH production in an attempt to stimulate thyroxine release. Thyroid-stimulating antibodies can still be present, but the gland can no longer respond to them. T3 will not increase as the ablated gland cannot produce adequate levels of hormone. TPO antibodies are not characteristic of either treated or untreated Graves' disease; they are a marker for Hashimoto's thyroiditis. A 45-year-old woman with hypothyroidism as a result of Hashimoto's thyroiditis was started on an appropriately-calculated dose of levothyroxine. Eight weeks later, the nurse practitioner expects that the patient will report: A. A modest weight gain.
B. Less fatigue. C. A decrease in palpitations. D. Longer sleeping hours. - correct answer ✔B. Less fatigue. Hashimoto's thyroiditis is an autoimmune disorder characterized by the production of thyroid peroxidase (TPO) antibodies that block thyroid- stimulating hormone (TSH) receptors on the thyroid gland and thus block the action of TSH. In the first months of disease, there will be a fluctuation in symptoms as the body attempts to compensate, but eventually, the patient will become symptomatic of hypothyroidism. Replacing thyroid hormone is expected to improve symptoms of hypothyroidism. As a result, it is expected that the patient will report a decrease in the fatigue that is characteristic of thyroid hypofunction. The results of a radioactive iodine uptake scan of a 52-year-old woman with a thyroid mass reveal a cold spot. This finding is most consistent with: A. Amiodarone-induced thyroid disease. B. Thyroid cyst. C. Metabolically-active thyroid nodule. D. Graves' disease. - correct answer ✔B. Thyroid cyst. A thyroid cyst is a nonfunctional collection of tissue on the thyroid gland. Nonfunctional tissue does not uptake iodine, and on a radioactive iodine uptake scan a cyst will appear as nonfunctional or "cold." Amiodarone- induced thyroid disease, active thyroid nodule, and Graves' disease are all conditions of increased gland function, and nodules would scan as hyperfunctioning or "hot."
releasing TSH. In cases of untreated hypothyroidism, it is expected that the TSH level will be elevated, and free T4 level will be low A 27-year-old woman is newly diagnosed with Graves' disease that will be treated with methimazole or propylthiouracil. In counseling the patient, the NP mentions a potential risk for: A. Renal dysfunction. B. Weight gain. C. Liver toxicity. D. Peripheral neuropathy. - correct answer ✔C. Liver toxicity. Treatment of Grave's disease typically includes the use of antithyroid medications, such as methimazole or propylthiouracil. Both of these drugs are associated with increased risk of liver toxicity even in the absence of other risk factors for hepatotoxicity. Following treatment, radioactive iodine for thyroid ablation is the usual next step. Which of the following is most consistent with findings in thyroid cancer? A. Hard, fixed thyroid mass of 2 cm in diameter B. "Hot spot" on thyroid scan C. Abnormally low TSH D. Presence of TPO antibodies - correct answer ✔A. Hard, fixed thyroid mass of 2 cm in diameter Cancerous thyroid nodules tend to be nonproductive "dead" tissue that does not produce thyroid hormone. As a result, cancerous nodules do not actively pump iodine from plasma, and an iodine-uptake scan will reveal this absence
of activity as a "cold spot" of unproductive tissue. Conversely, toxic nodules that autonomously produce thyroxine will demonstrate hyperactivity or "hot nodules." Because thyroid cancer is a nonfunctioning tissue, thyroid hormone levels can fall, resulting in a compensatory increase in thyroid stimulating hormone (TSH). Presence of TPO antibodies suggests autoimmune thyroid disease but not cancer. A hard, fixed mass larger than 1?1.5 cm should raise suspicion of malignancy and be referred for fine-needle aspiration biopsy. Which is most likely to be reported in Graves' disease? A. Free T4=7.2 pmol/L (NL=10-27 pmol/L) B. TSH=0.09 mIU/L (NL=0.15-4.0 mIU/L) C. ESR=22 mm/h (NL <15 mm/h) D. TWBC=4,200/mm3, 0% Neutrophils w/ hypersegmentation (NL=6,000- 10,000/mm3, 50%-70% Neutrophils) - correct answer ✔B. TSH=0.09 mIU/L (NL=0.15-4.0 mIU/L) Graves' disease is an autoimmune disorder characterized by the pathologic production of thyroid-stimulating immunoglobulins (TSI) that stimulate the thyroid gland and lead to elevated thyroxine levels. The elevated thyroxine levels suppress pituitary production of thyroid stimulating hormone (TSH). As a result, TSH levels will become very low, often undetectable. According to the American Thyroid Association (ATA), the TSH is the most sensitive indicator of thyroid function. A 67-year-old woman is diagnosed with hypothyroidism and requires levothyroxine therapy. When considering initiation of levothyroxine therapy for this patient, the NP realizes that: A. The therapeutic dose should be lower than what is used in a younger patient.
Positive obturator and psoas signs are both consistent with pain during peritoneal stretch in the region of the appendix and are closely associated with appendicitis; the coincident abdominal pain, anorexia, and nausea strengthen the diagnosis. Consequently, the white blood cell (WBC) count will likely demonstrate an increase characterized by elevated neutrophils and bands. A TWBC of 5,200/mm3 and lymphocytes of 57% is more consistent with viral infection. A total WBC of 8,300/mm3 with neutrophils=58%, Bands=2%, Lymphocytes=40% is within normal limits. However, the patient with a TWBC of 17,600/mm3 and neutrophils of 64% has an absolute neutrophil count of 11,264/mm3. This, along with the 8% bands, is highly suggestive of bacterial infection consistent with appendicitis. Oral antimicrobials commonly used to treat H. pylori gastrointestinal tract infection include all of the following except: A.Metronidazole. B.Vancomycin. C. Clarithromycin. D. Amoxicillin. - correct answer ✔B.Vancomycin. Helicobacter pylori, a Gram-negative spiral-shaped organism, is found in at least 90% of patients with duodenal ulcer and 40%-70% of individuals with gastric ulcer. Eradication of the organism dramatically reduces the risk of a relapse, and several antimicrobial combinations can be used to effectively treat symptomatic H. pylori infection. Amoxicillin and metronidazole are effective agents, and H. pylori resistance to these agents is uncommon. Clarithromycin can also be used though resistance to this agent is increasing. Vancomycin is used to treat infections caused by Gram-positive organisms and is usually given parenterally (except for the treatment of C. difficile infection).
Which of the following signs is most consistent with a diagnosis of Crohn's disease involving the small intestine? A. Diffuse maculopapular rash B. Vomiting C. Constipation D. Blood in the stool - correct answer ✔D. Blood in the stool Inflammatory bowel disease (IBD) is a disease of unclear etiology, but likely involves an autoimmune response to the GI tract. The two major types of IBD are ulcerative colitis (UC, characterized by pathological changes limited to the colon) and Crohn's disease (changes can involve any part of the GI tract). The inflammation that occurs in Crohn's disease causes cells in the affected areas of the intestines to secrete large amounts of water and salt, which cannot be completely reabsorbed. The manifestations of IBD generally depend on the area of the intestinal tract involved. Patients with Crohn's disease involving the small intestine frequently have abdominal pain and cramping, reduced appetite and unintended weight loss, blood in the stool, and diarrhea. 37-year-old man presents complaining of recurrent abdominal pain that is relieved with defecation. Symptom onset is often accompanied by bloating and a change in stool frequency and form. He denies seeing blood in the stool, weight is stable, and his hematocrit is within normal limits. The most likely diagnosis is: A. Irritable bowel syndrome. B. Paralytic ileus. C. Peptic ulcer disease. D. Ulcerative colitis. - correct answer ✔A. Irritable bowel syndrome.
