Question 1

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

Accepted Answer

Feeding gastrostomy tubes increase the risk of aspirational pneumonia in end-of-life Alzheimer's disease patients. Choosing not to provide artificial nutrition may be a more appropriate option in these patients.

Question 2

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

Accepted Answer

Exophthalmos, or bulging of the eyes, is a common sign of hyperthyroidism in younger populations, but is notably lacking in the elderly. Weight gain and constipation are actually signs of hypothyroidism, while bradycardia (slowed heart rate) is also not generally associated with hyperthyroidism, which typically causes tachycardia (increased heart rate).

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?

Accepted Answer

Loose stools are a common side effect of metformin and often resolve over time. The medication should not be discontinued unless the patient experiences severe gastrointestinal symptoms or develops lactic acidosis, which is rare but serious. Increasing the dosage at this point may increase the risk of adverse effects. Close monitoring and supportive care are recommended.

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?

Accepted Answer

The patient's TSH level is still elevated, indicating that the current dose of Synthroid is insufficient. Doubling the dose is a common approach to achieve better thyroid hormone balance and alleviate symptoms.

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?

Accepted Answer

Elderly patients with hypothyroidism are at an increased risk of developing cardiac issues such as angina and arrhythmias. Initiating levothyroxine sodium at a low dose helps prevent these untoward effects.

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?

Accepted Answer

Xanthelasma is a yellowish deposit of cholesterol under the skin, often seen in older people, especially around the eyes. It indicates abnormal lipid metabolism and may be associated with an increased risk of cardiovascular disease. Therefore, medical management is required, and the patient should undergo lipid profile testing and further evaluation.

Question 7

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

Accepted Answer

Acanthosis Nigricans is a common sign of insulin resistance in African American patients. It appears as dark and thickened patches of skin, especially in skin folds such as the armpits and neck. Psoriasis Nigricans, Seborrheic Nigricans, and Bullemic Nigricans are not recognized medical terms.

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?

Accepted Answer

The combination of atrial fibrillation with a rapid heart rate and fine tremors of both hands are classic presentations of hyperthyroidism. It is important for the nurse practitioner to order thyroid function tests and refer the patient to an endocrinologist for further evaluation and management.

Question 9

Which patient is most likely to have osteoporosis?

Accepted Answer

The risk factors for osteoporosis include advanced age, low body weight, smoking, chronic steroid use, and male gender. The patient described in option A has multiple risk factors for osteoporosis, making them the most likely to have the condition. The other options have either no or fewer risk factors.

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?

Accepted Answer

The answer of You are working as a nurse practitioner...

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?

Accepted Answer

Fluoroquinolones like ciprofloxacin are known to have decreased effectiveness when taken with antacids, iron supplements, or caffeine. Therefore, the nurse practitioner should advise the patient to avoid taking these substances while on this medication. The medication can be taken with or without food, so choice A is incorrect. Ciprofloxacin may cause gastrointestinal disturbances and central nervous system side effects, but metallic aftertaste is not a common symptom, so choice C is incorrect as well. Lastly, choice D is incorrect as the effectiveness of the medication can be affected by the aforementioned substances.

Question 12

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

Accepted Answer

The American Thyroid Association recommends assessing TSH levels in 4-6 weeks after initiation or dose adjustment of levothyroxine. This allows enough time for the medication to achieve steady-state levels and for the TSH to reflect any changes in thyroid hormone levels. Option A is too frequent for TSH assessment, and option C relies solely on patient-reported symptoms which may not reliably reflect thyroid function. Option D is not a typical management approach unless there are significant adverse effects or lab abnormalities.

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:

Accepted Answer

The patient has been on Synthroid for 10 years and is feeling well, however her heart rate is slightly elevated. Ordering a TSH will help determine if her current dose of Synthroid is appropriate or if it needs to be adjusted. Starting a beta-blocker or ordering a thyroid scan may not be necessary without first checking the TSH levels.

Question 14

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

Accepted Answer

Poor nutritional status is the cardinal feature of failure to thrive. It refers to inadequate weight gain or weight loss, decreased muscle mass, and decreased energy levels due to insufficient caloric and nutrient intake. Decline in toileting ability, gait disturbance, and spiritual distress are not specific features of failure to thrive.

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?

Accepted Answer

Charcot foot is a serious complication of diabetes that can lead to severe deformity and disability over time. Referral to an orthopedist is the best intervention in this case as they are specialized in treating conditions involving the bones, joints, and soft tissues of the foot. Warm soaks or pain management is not enough to manage this condition. A referral to a cardiologist, while important for ruling out peripheral vascular disease, is not necessary for the treatment of Charcot foot.

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:

Accepted Answer

The modifiable cardiac risk factors for this client include diabetes, obesity, and hyperlipidemia. While advanced age and male gender may increase the risk of cardiovascular disease, they are not modifiable risk factors. Smoking and family history of heart disease are also modifiable risk factors, but they are not present in this case. The answer D is not correct because it includes male gender with age greater than 45 as a modifiable risk factor, which is incorrect as gender and age are not modifiable.

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?

Accepted Answer

The patient's symptoms such as fatigue, lack of energy, constipation, weight gain, and dry skin are all characteristic of hypothyroidism. Hyperthyroidism (A) would present with opposite symptoms such as weight loss, palpitations, and heat intolerance. Hyperparathyroidism (C) would not typically present with fatigue and lack of energy. Grave's disease (D) is a type of hyperthyroidism and would present with symptoms opposite to those seen in this patient.

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?

Accepted Answer

Taking the bisphosphonate with a full glass of water in the morning, 30 minutes prior to other food and medications, is the correct way to take this medication. This ensures proper absorption and reduces the risk of gastrointestinal distress. Option A is incorrect because taking the medication at bedtime may increase the risk of esophageal irritation. Option C is incorrect because taking the medication with orange juice may reduce its effectiveness. Option D is incorrect because taking the medication with a meal may reduce absorption.

Question 19

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

Accepted Answer

A body mass index of 25 is within a healthy range and therefore not an indication of poor nutritional status. The other options suggest poor nutritional status, with albumin levels indicating protein depletion and low total cholesterol levels indicating malnourishment. Loss of 10% body weight in 180 days suggests inadequate caloric intake and may also be a sign of poor nutritional status.

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?

Accepted Answer

Mr. White's significant proteinuria and hypertensive urgency (BP of 188/90) suggest that he may have developed renal disease progression or renal artery stenosis. Changing his calcium channel blocker to an ACE-I is the best option in this case, as ACE-Is have been shown to have renal protective effects and can slow the progression of renal disease. Additionally, ACE-Is are preferred over calcium channel blockers for patients with proteinuria. Increasing the dose of the Crestor or calcium channel blocker would not address his current issue. Waiting 4 weeks for a re-check is not appropriate for his level of urgency.

Quiz 14: Endocrine, metabolic, and Nutritional Disorders