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NURS 5334 EXAM 3 QUESTIONS WITH CORRECT
VERIFIED SOLUTIONS 100% GUARANTEED PASS
(LATEST UPDATE)
How does colesevelam work in treatment of DM? Bromocriptine? - ANS
✓Colesevelam—bile acid sequestrant used to lower cholesterol and helps lower
blood
glucose
Many with diabetes also have high cholesterol so 2 birds-1 stone
o Bromocriptine—adjunct to diet and exercise (0.5% reduction)
Injectables:
o Amylin memetics? - ANS ✓Pramlintide
Side effects—hypoglycemia when used with insulin
Drug/Drug—insulin
o GLP-1 receptor agonists (or incretin mimetics)
Can cause medullary thyroid cancer
What is treatment of diabetic ketoacidosis (DKA)? Hypoglycemia? - ANS ✓o
Insulin replacement, reverse acidosis with bicarbonate, replace water, sodium,
potassium, normalize glucose levels
o Hypoglycemia—IV glucose, glucagon is glucose not available
What is hyperosmolar hyperglycemia state (HHS)?
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o When does this occur?
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o Treatment? - ANS ✓o Large amount of glucose excreted in the urine and
results in dehydration and loss of
blood volume
o Increases blood concentration of electrolytes and nonelectrolytes, particularly
glucose
and hematocrit
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Most frequently with type 2 diabetics with acute infection or illness or other
stressors
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Correcting hyperglycemia and dehydration with IV insulin, fluids, and
electrolytes
What effect does iodine have on thyroid? - ANS ✓o When iodine availability is
low production of thyroid hormones decrease
Why is normal thyroid function important in first trimester of pregnancy? How
much does
requirement unusually increase in pregnant women taking thyroid
supplements? - ANS ✓o Fetus is unable to produce its own hormones, without
can result in permanent
neuropsychologic deficits
o Usually increases as much as 50%
When is fetal thyroid gland full functional? - ANS ✓o 16 weeks
If not treated, what does hypothyroidism cause in an infant? - ANS ✓o Large
protruding tongue, potbelly, and dwarfish stature
o The development of the nervous system, bones, and teeth is impaired
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When should treatment be stopped? How long? - ANS ✓o At 3 years of age for
4 weeks, then TSH is checked
o If rise—deficiency is permanent, thyroid replacement needed
o If normalize—transient deficiency, no further replacement required
How is Graves' Disease treated? - ANS ✓o Surgical removal, destruction of the
thyroid tissue, suppression of the thyroid hormone
synthesis and/or beta blockers
o Non-radioactive iodine can be used to distract the thyroid tissue
Thyroid Storm? - ANS ✓o Hyperthermia, severe tachycardia, restlessness,
agitation, tremor
o Unconscious, hypotensive, heart failure
o Cannot be identified by lab testing, not triggered by a rise in thyroid hormones
o Treatment—methimazole, beta blocker, sedation, cooling, glucocorticoids, IV
fluids
Levothyroxine - ANS ✓o T4
o Long half life
o How should this be taken?
In the morning, at least 30 to 60 minutes before breakfast
o Side effects—tachycardia, angina tremors
o Drug/Drug
Warfarin—intensify effects
Drugs that reduce absorption
H2 receptor blockers, PPIs, cholestyramine, colestipol, Maalox, Mylanta,
calcium supplements, iron, magnesium, orlistat
Accelerate metabolism
Phenytoin, carbamazepine, rifampin, sertraline, phenobarbital
Catecholamines—increase cardiac responses
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Increase requirements of insulin and digoxin
How is this dosed? How does dosage differ for someone over 50? 65 and older?
Someone with heart disease? Overweight? Underweight? - ANS ✓1.6-1.8
mcg/kg/day
Obese—go by ideal body weight
Underweight—actual weight
Older patients with CAD—start with 12.5-25 mcg
Elderly—start low and go slow
Younger than 3 months—10 to 15 mcg/kg/day
Children (3-5 months)—8 to 10 mcg/kg/day
Children (6-11 months)—6 to 8 mcg/kg/day
Children 1-5 years—5 to 6 mcg/kg/day
Children 6-12—4 to 5 mcg/kg/day
Liotrix—a mixture of synthetic T4 plus synthetic T3 in a 4:1 fixed ratio -
ANS ✓o Because levothyroxine alone produces the same ratio of T4 to T3, Liotrix
offers no
advantage over levothyroxine for most indications
Armour—consists of desiccated animal thyroid glands. - ANS ✓o
Standardization is based on content of iodine, levothyroxine, and liothyronine.
o The ratio of levothyroxine to lipthyronine is not less than 5:1
o Thyroid is available in tablets (15-300 mg)
Methimazole—used in hyperthyroidism - ANS ✓o Cell form of therapy for
Graves' disease
o Adjunct to radiation therapy until the effects of radiation become manifested
o Suppresses the thyroid hormone synthesis in preparation for thyroid gland
surgery
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