MARYVILLE NURS 623 EXAM 2 AND STUDY
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AND VERIFIED DETAILED ANSWERS
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MARYVILLE UNIVERSITY NURS 623 EXAM 2
What are the PRIMARY risk factors for gout?
PRIMARY: ENZYME DEFECT & DECREASED RENAL CLEARANCE OF URIC ACID
What are the SECONDARY risk factors for gout?
EXCESSIVE PURINE
OBESITY
STARVATION
ALCOHOL ABUSE
MEDS: THIAZIDES, NIACIN
What diagnostic results would be seen with gout?
elevated serum uric acid levels, ESR and WBCs;
What is the initial management for an acute attack of gout?
COLCHICINE 1.2mg PO X 1 then 0.6mg in 1 hour (within 36 hrs of onset up to 0.6 mg) NSAIDs, AND
CORTICOSTEROIDS; rest, elevation, immobilization
What is the subsequent pharmacological management used to prevent further attacks of prophylaxis?
ALLOPURINOL (wait 4-6 week to after acute attack to start)
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,What educational information should you discuss with a patient diagnosed with gout?
AVOID FOODS HIGH IN PURINE (MEAT & SEAFOOD, YEAST, BEER/ALCOHOL, BEANS, PEAS, LENTILS,
OATS, SPINACH, ASPARAGUS, CAULIFLOWER, MUSHROOMS
How is obesity classified?
BMI >30, WAIST >40" MEN & >35" WOMEN
What are the consequences of obesity?
CAD, CHF, HTN, HYPERLIPIDS, TYPE II DM, SLEEP APNEA, RESTRICTIVE LUNGS, GOUT, VENOUS INSUFF,
GERD, GALLBLADDER, BLOOD CLOTS
The cluster of factors for metabolic syndrome include?
HTN, HYPERLIPIDEMIA, INSULIN RESISTANCE
Patients with metabolic syndrome are twice at risk for developing _____ over 5 yrs and have a 5-fold risk
of ____?
CVD; DM II
Which of the serum laboratory findings are present in the client with Cushing's syndrome?
Increased cortisol, HYPERnatremia, and HYPOkalemia
Alice, age 48, has a benign thyroid nodule. The most common treatment involves:
Watchful waiting with an annual follow-up
ACE inhibitors are given to clients with diabetes who have
persistent proteinuria
A newly diagnosed client with diabetes who has an HbA1c of 7.5 is started on therapeutic lifestyle
changes (TLC) and medical nutritional therapy (MNT). Which oral antidiabetic agent is recommended as
monotherapy?
metformin
An elderly client with hyperthyroidism may present with atypical symptoms. Which of the following
manifestations are commonly seen in the elderly with hyperthyroidism?
a-fib, depression, weight loss
Diane has had Cushing's disease for 20 years and has been taking hydrocortisone since her diagnosis.
Today, she appears with a thick trunk and thin extremities. She has a "moon face," a "buffalo hump,"
thin skin with visible capillaries, and a number of bruises that appear to be slow in healing. To what do
you attribute these symptoms?
excessive levels of cortisol
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,The following is a client's self-monitoring blood glucose log. The client receives 20 units Novolin 70/30 in
the morning (a.m.) and 20 units Novolin 70/30 in the evening (p.m.): Fasting a.m. pre-dinner: 90, 150,
105, 144, 101, 172, 98, 201. What changes would you make?
increase A.M. insulin
Dan, age 45, is obese and has type 2 diabetes. He has been having trouble getting his glycohemoglobin
under control. He's heard that exenatide (Byetta) causes weight loss and wants to try it. What do you
tell him?
"Let's try it. You're glycohemoglobin will be lowered and you may lose weight."
Which is the only treatment option that is curative for primary hyperparathyroidism?
parathyroidectomy
The most common worldwide cause of hypothyroidism is:
iodine deficiency
What should be assessed for during exam on pt with HYPOparathyroidism?
chvostek's sign
Morton has Type 2 diabetes. His treatment, which includes diet, exercise, and oral antidiabetic agents, is
insufficient to achieve acceptable glycemic control. Your next course of action is to
ADD LONG-ACTING INSULIN
Joy has gout. In teaching her about her disease, which food do you tell her is allowed in her diet?
Broccoli
What controls the amount of calcium in the blood?
Parathyroid
Thyroid hormones regulate
metabolism
Which tests should you order to confirm a diagnosis of hypothyroidism?
t3 & Free T4 (preferred over T4)
What are the hallmark signs of Grave's disease?
enlarged thyroid and increased T3
What is the gold standard screening for thyroid TUMOR/NODULE?
ULTRASOUND
What is the diagnostic screening for thyroid cancer?
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, FINE NEEDLE BIOPSY
What is the preferred treatment of Grave's disease in pregnancy
Propylthiouracil (PTU):
Before starting anti-thyroid meds what should be checked?
LIVER FUNCTIONS
what is the goal of thyroid treatment
euthyroid state
What are signs and symptoms of hypothyroidism overtreatment?
hyperglycemia; cardiac arrhythmias (Afib); adrenal insufficiency; increased myxedema.
Hyperthyroidism causes an excessive secretion of which thyroid hormones?
T3 & T4
What are S/S of hyperthyroidism?
"Hot/buldging/fast" heat intolerance, eye buldge, tachycardia, weight loss, diarrhea, systolic HTN,
enlarged thyroid
What are S/S of HYPOthyroidism?
"cold, slow, tired" cold intolerance, slow speech, fatigue, lethargy, weight gain, constipation, brittle
nail/hair
What is the most common cause of hyperthyroidism?
Graves disease
Name the two thyroid hormones produced by the thyroid gland?
T3 & T4
Name the hormone produced by the pituitary gland, state the purpose of the hormone
TSH; regulate the production of hormones by the thyroid gland
IN GRAVES DISEASE THE THE TSH IS _________ AND THE T3/T4 ARE __________
LOW; HIGH
IN HASHIMOTO'S DISEASE THE THE TSH IS _________ AND THE T3/T4 ARE __________
HIGH; LOW
WHAT allows the resolution of hyperthyroidism, although patients then become hypothyroid and
require thyroid replacement therapy for life
ABLATIVE DOSE IODINE
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