Deck 14: Endocrine, metabolic, and Nutritional Disorders

Question 1

Feeding gastrostomy tubes at end-of-life Alzheimer's disease patients have been associated with:

A) Prolongation of life
B) Aspirational pneumonia
C) Increase in skin infections
D) Reversal of any clinical signs of failure to thrive

Answer 1

Aspirational pneumonia

Question 2

Which of the following signs of hyperthyroidism commonly manifest in younger populations,but is notably lacking in the elderly?

A) Weight gain
B) Constipation
C) Bradycardia
D) Exophthalmos

Answer 2

Exophthalmos

Question 3

A patient has been prescribed metformin (Glucophage).One week later he returns with lowered blood sugars but complains of some loose stools during the week.How should the nurse practitioner respond?

A) Discontinue the medication immediately
B) Reassure the patient that this is an anticipated side effect
C) Double the dosage of medication and have patient return in 1 week
D) Order a chem.7 to check for lactic acidosis

Answer 3

Reassure the patient that this is an anticipated side effect

Question 4

Six months ago an elderly patient was diagnosed with subclinical hypothyroidism.Today the patient returns and has a TSH of 11.0 and complains of fatigue.He has taken Synthroid 25 mcg daily as prescribed.What is the best course of action for the nurse practitioner?

A) Assess further for a cause of fatigue
B) Double the dose of Synthroid
C) Discontinue the Synthroid
D) Prescribe Liotrix (T3 & T4 combination)

Question 5

The primary reason levothyroxine sodium is initiated at a low dose in an elderly patient with hypothyroidism is to prevent which of the following untoward effects?

A) Angina and arrhythmia
B) Nausea and diarrhea
C) Confusion and delirium
D) Osteoporosis and muscle weakness

Question 6

During a routine physical examination of a 62-year-old female patient,the nurse practitioner identifies xanthelasma around both his eyes.What is the significance of this finding?

A) High potential for future blindness and requires immediate referral
B) None,normal variant of aging process
C) Abnormal lipid metabolism requiring medical management
D) Hereditary variant that is of no consequence but requires watchful waiting

Question 7

What is a sign of insulin resistance that can present in African American patients?

A) Acanthosis Nigricans
B) Psoriasis Nigricans
C) Seborrheic Nigricans
D) Bullemic Nigricans

Question 8

An elderly client presents with a new onset of feeling her heart race and fatigue.An EKG reveals atrial fibrillation with rate >110.The patient also has a new fine tremor of both hands.Which of the following would the nurse practitioner suspect?

A) Hypothyroidism
B) Hyperthyroidism
C) Congestive heart failure
D) Type 2 diabetes mellitus

Question 9

Which patient is most likely to have osteoporosis?

A) An 80-year-old underweight male who smokes and has been on steroids for psoriasis
B) A 90-year-old female with no family history of osteoporosis who is on hormone replacement therapy
C) A 68-year-old overweight female who drinks 1-2 drinks alcohol/day
D) An 82-year-old female with a normal BMI takes calcium and performs weight-bearing exercise daily

Question 10

You are working as a nurse practitioner in the Fast Track of the emergency room.A 76-year-old male presents with left upper quadrant abdominal pain.There can be many conditions that present as left upper quadrant pain,but which of the following is least likely to cause pain in the left upper quadrant?

A) Splenic abscess
B) Left pyelonephritis
C) Splenic rupture
D) Acute pancreatitis

Question 11

A fluoroquinolone (Ciprofloxin)is prescribed for a male patient with a UTI.What should the nurse practitioner teach the patient regarding taking this medication?

A) It must be taken on an empty stomach
B) Its effectiveness is decreased by antacids,iron,or caffeine ingestion
C) It may cause a metallic aftertaste
D) Its effectiveness is not a concern and it can be taken with any medications

Question 12

When evaluating the expected outcome for a hypothyroid elderly patient placed on levothyroxine,the nurse practitioner will:

A) Assess a weekly TSH
B) Assess the TSH in 4-6 weeks
C) Ask the patient if the symptoms have subsided and adjust dosage accordingly
D) Decrease the dosage should a cardiac event occur

Question 13

Mrs.Black,an 87-year-old patient,has been taking 100 mcg of Synthroid for 10 years.She comes to your office for a routine follow-up,feeling well.Her heart rate is 90.Your first response is to:

A) Increase the Synthroid
B) Order TSH
C) Start a beta-blocker
D) Order thyroid scan

Question 14

Which is a "cardinal feature" of failure to thrive?

A) Decline in toileting ability
B) Gait disturbance
C) Poor nutritional status
D) Spiritual distress

Question 15

A diabetic patient presents with the complaint of right foot pain but denies any recent known injury.He states it has gotten progressively worse over the past few months.On exam,vibratory sense,as well as sensation tested with a monofilament,was abnormal.The patient's foot is warm,edematous,and misshapen.The nurse practitioner suspects Charcot foot.What intervention is indicated?

A) Warm soaks and return for follow-up in 1 week
B) Referral to a pain management clinic
C) Referral to an orthopedist
D) Referral to a cardiologist for evaluation of peripheral vascular disease

Question 16

A 60-year-old obese male client has type 2 diabetes mellitus and a lipid panel of TC = 250,HDL = 32,LDL = 165.The nurse practitioner teaches the patient about his modifiable cardiac risk factors,which include:

A) Advancing age,diabetes,hyperlipidemia,and male gender
B) Diabetes,obesity,and hyperlipidemia
C) Hyperlipidemia,smoking,and family history of heart disease
D) Male with age > 45,diabetes mellitus,and hyperlipidemia

Question 17

A 62-year-old female complains of fatigue and lack of energy.Constipation has increased and the patient has gained ten pounds in the past 3 months.Depression is denied although the patient reports a lack of interest in usual hobbies.Vital signs are within normal limits and the patient's skin is dry and cool.Which of the following must be included in the differential?

A) Hyperthyroidism
B) Hypothyroidism
C) Hyperparathyroidism
D) Grave's disease

Question 18

A postmenopausal woman with osteoporosis is taking a bisphosphonate daily by mouth.What action information statement would indicate the patient understood the nurse practitioner's instructions regarding this medication?

A) Takes medication at bedtime with a full glass of water
B) Takes medication with a full glass of water when up in a.m.30 minutes prior to other food and medications
C) Takes medication when up in a.m.with a glass of orange juice to increase absorption
D) Takes medication sitting up and with a meal to avoid gastrointestinal distress

Question 19

Which of the following nutritional indicators is not an indication of poor nutritional status in an older person?

A) Albumin of < 3.5 g/dl
B) Body mass index of 25
C) Total cholesterol < 150 mg/dl
D) Loss of 10% body weight in 180 days

Question 20

Mr.White is 62 years old and has chronic kidney disease that has been relatively stable.He also has a history of hyperlipidemia,osteoarthritis,and hypertension.He is compliant with his medications,and his BP has been well controlled on a calcium channel blocker.His last lipid panel showed: TC = 201,HDL = 40,TG = 180,LDL = 98.He currently takes Crestor 20 mg daily.In the office today,his BP is 188/90,and his urine dip now shows significant proteinuria.He denies any changes in his dietary habits or medication regimen.What would be the best medication change for Mr.White at this point?

A) No change-have him return in 4 weeks for a re-check of his blood pressure and urine
B) Increase the dose of the calcium channel blocker for his hypertension
C) Change the calcium channel blocker to an ACE-I
D) Increase the dose of his Crestor and have him return in 3 months for a re-check of his BP