Question 1

An admission history on an adult patient notes that the patient has a heart rate of 62 beats/minute, a blood pressure of 105/62 mm Hg, and a temperature of 96.2 $\degree$F. The patient appears pale and reports always feeling cold and tired. The provider and patient will discuss tests to rule out what possible cause of these signs symptoms?

Accepted Answer

The patient's symptoms of a low heart rate, low blood pressure, low body temperature, paleness, and chronic fatigue are indicative of hypothyroidism, a condition where the thyroid gland is underactive and does not produce enough thyroid hormones.

Question 2

A patient arrives in the emergency department with a heart rate of 128 beats/minute and a temperature of 105 $\degree$F. The patient's skin feels hot and moist. The free T₄ level is 4 ng/dL, the free T₃ level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The provider caring for this patient will give what intervention priority?

Accepted Answer

The patient's symptoms and lab results suggest thyrotoxicosis or thyroid storm, a life-threatening condition characterized by an extreme overproduction of thyroid hormones. Propylthiouracil (PTU) is preferred in this acute setting because it not only inhibits the synthesis of thyroid hormones (like methimazole) but also blocks the peripheral conversion of T4 to the more active T3, providing a quicker reduction in thyroid hormone levels. Additionally, PTU is preferred in thyroid storm management due to its rapid action.

Question 3

A patient is admitted to the hospital and is prescribed levothyroxine. Assessment data show that the patient also takes warfarin. The provider will make what medication dosage-related change?

Accepted Answer

Levothyroxine can increase the effects of warfarin by accelerating the metabolism of vitamin K-dependent clotting factors, potentially leading to an increased risk of bleeding. Therefore, it may be necessary to reduce the warfarin dosage to avoid excessive anticoagulation.

Question 4

Insulin glargine is prescribed by the provider for a hospitalized patient with type 1 diabetes. When will the provider order this medication to be administered?

Accepted Answer

Insulin glargine is a long-acting insulin with a duration of action that lasts up to 24 hours. It is typically administered once daily to maintain a baseline level of insulin, often at bedtime to mimic the body's natural release of insulin.

Question 5

What method will the provider consider the most reliable measure for assessing a patient's diabetes control over the preceding 3-month period?

Accepted Answer

Glycosylated hemoglobin level (HbA1c) is considered the most reliable measure for assessing a patient's diabetes control over the preceding 3-month period because it reflects the average blood glucose levels over this period.

Question 6

A pregnant patient recently began treatment for hypothyroidism. What response will the provider give when the patient shares that she does not want to take medications while she is pregnant?

Accepted Answer

Untreated hypothyroidism during pregnancy can lead to serious consequences for the baby, including permanent neuropsychological deficits. It is crucial to manage maternal thyroid levels to ensure the health and development of the fetus.

Question 7

A patient with type 1 diabetes reports taking propranolol for hypertension. What concern does this information present for the provider?

Accepted Answer

Propranolol, a beta-blocker, can mask the symptoms of hypoglycemia, such as tachycardia and tremors, making it harder for patients with diabetes to recognize when their blood sugar levels are dangerously low.

Question 8

An older adult patient with type 2 diabetes has a history of severe hypoglycemia. The patient's partner asks the provider what A_1c level they should strive to achieve. What guideline will the prescriber provide?

Accepted Answer

For older adults with a history of severe hypoglycemia, especially those with complex health issues, less stringent A1C goals such as below 8.0% are often recommended to reduce the risk of hypoglycemia while still managing blood glucose levels.

Question 9

A patient with type 1 diabetes recently became pregnant. What blood glucose testing schedule will the provider recommended during the pregnancy?

Accepted Answer

Pregnant patients with type 1 diabetes are recommended to monitor their blood glucose levels very closely to ensure both maternal and fetal health. This typically involves testing their blood glucose six or seven times a day, including before meals, before bedtime, and sometimes overnight. This frequent testing helps in making necessary adjustments to insulin therapy to maintain blood glucose levels within a target range.

Question 10

A patient who takes oral levothyroxine for hypothyroidism is admitted to the hospital. After the provider determines the patient has myxedema, what action will the provider take?

Accepted Answer

Myxedema is a severe form of hypothyroidism that can be life-threatening. In such cases, oral medications may not be absorbed well due to gastrointestinal edema. Switching to intravenous levothyroxine ensures the medication is delivered effectively into the bloodstream, providing a more immediate therapeutic effect.

Question 11

A provider teaches a patient who has been diagnosed with hypothyroidism about a new prescription for levothyroxine. Which statement by the patient indicates a need for further teaching?

Accepted Answer

The correct statement indicating a need for further teaching is D. Calcium supplements can interfere with the absorption of levothyroxine, not decrease the need for it. Patients may need to adjust the timing of calcium intake rather than the dose of levothyroxine.

Question 12

An adolescent had a serum glucose test at a health fair. The parent calls the clinic and says, "The level was 125 mg/dL. Does that mean my child has diabetes?" What is the provider's most accurate response?

Accepted Answer

A fasting blood glucose level of 125 mg/dL is not conclusive for diabetes unless the child was fasting for at least 8 hours. Further testing is needed to confirm a diagnosis.

Question 13

The provider is assessing a newly diagnosed patient for short-term complications of diabetes. What evaluation does this assessment include?

Accepted Answer

Short-term complications of diabetes primarily involve monitoring for hyperglycemia, which can lead to acute conditions like diabetic ketoacidosis or hyperosmolar hyperglycemic state.

Question 14

A patient has a free T₄ level of 0.6 ng/dL and a free T₃ level of 220 pg/dL. When asked by the patient what these laboratory values mean, how will the provider respond?

Accepted Answer

A TSH level is needed to better evaluate thyroid function and determine if the patient has hypothyroidism or hyperthyroidism, as free T4 and T3 levels alone are not sufficient for diagnosis.

Question 15

The provider working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient presents with needs that the provider should address first?

Accepted Answer

The patient with diabetes who has received insulin but is NPO (nothing by mouth) and has a blood glucose level of 80 mg/dl is at risk for hypoglycemia, which requires immediate intervention to prevent a potentially life-threatening situation.

Quiz 10: Drugs for Endocrine Disorders