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NURS 5400 FINAL EXAM COMPLETE QUESTIONS &
CORRECT ANSWERS (WELL VERIFIED) BRAND NEW
VERSION
What are some risk factors for osteoporosis? - CORRECT ANSWER >>> female white/asian increase age low body weight smoking inactivity Excessive A alcohol calcium/vitamin D deficiencies CO morbidities Estrogen deficiency What is the gold standard for osteoporosis diagnosis? - CORRECT ANSWER >>> Dexa scan What is a normal T score? - CORRECT ANSWER >>> Normal T score is between - 1, 0, & + standard deviations What T score is indicative of osteoporosis? - CORRECT ANSWER >>> T score of - 2.5 or less What T score is osteopenia? - CORRECT ANSWER >>> between - 1 and - 2. Low bone mass What is the difference between z score and t score? - CORRECT ANSWER >>> T-scores compare bone density with that of a healthy person, whereas Z-scores use the average bone density of people of the same age, sex, and size as a comparator
Who is the z score usually used for? - CORRECT ANSWER >>> Children & young adults When should you screen for osteoporosis? - CORRECT ANSWER >>> Women 65 or older, men 70 or older If an adult older than 50 has a fracture and has risk for bone loss from meds or other diagnoses Recommended meds for very high fracture risk - CORRECT ANSWER >>> Osteoanabolics & human monoclonal antibody to sclerostin (romosozumab) Recommended meds for high fracture risk - CORRECT ANSWER >>> Biphosphonates & RANKL inhibitors (denosumab) What is the recommended dosage of vitamin D for for adults? - CORRECT ANSWER >>> > years: 50,000 IU Q week or 5000-6000 IU Q D x 8-12 weeks then maintenance 1000 IU QD What patients should avoid biphosphonates and why? - CORRECT ANSWER >>> Pt with GERD or Barrett's esophagus Causes esophageal inflammation What is the half life of biphosphonates? - CORRECT ANSWER >>> 1 - 10 years When should you repeat labs and BMD for patients on meds for osteoporosis? - CORRECT ANSWER >>> In 2 years, sooner if necessary When BMD is stable, how often should you repeat Dexa scan? - CORRECT ANSWER >>> Every 2- 3 years
What diabetes medications are best for CV disease & kidney disease? **- CORRECT ANSWER
** SGLT-2 ("Flozins") I.E. Jardiance What diabetes medications are the best for CV disease? - CORRECT ANSWER >>> SGLT- 2 ("FLOZINS") I.E. Jardiance GLP-1 agonist ("TIDES") I.E. Semeglutide (Ozempic) Who are SGLT-2 Inhibitors contraindicated in? - CORRECT ANSWER >>> Type 1 Diabetics What does medication does SGLT-2 Inhibitors mimic? - CORRECT ANSWER >>> diuretics - takes away water & sugar via urine Examples of GLP-1 agonists - CORRECT ANSWER >>> "tides" Exenatide (Byetta) Liraglutide (Victoza) Dulaglutide (Trulicity) Semaglutide (Ozempic) What are the benefits of GLP-1 agonists? - CORRECT ANSWER >>> Help with diabetes management, CV health, and weight loss How do GLP-1 agonists impact cardiovascular health? - CORRECT ANSWER >>> Significant decrease in cardiovascular disease risk, including heart attack, nonfatal stroke, and CV-related mortality
Which GLP-1 agonists are particularly notable for their benefits? **- CORRECT ANSWER
** Ozempic and Trulicity What do GLP-1 agonists do? - CORRECT ANSWER >>> Indirectly lowers the overproduction of glucagon Binds to receptors in the stomach, slows down the rapid emptying that is typical Binds to receptors in the satiety center of the brain Post prandial (after meal) elevation causes cardiovascular disease, these meds prevent that How does GLP-1 agonists affect A1C? - CORRECT ANSWER >>> Strong A1C reducer Which med causes more weight loss GLP-1 agonists or SGLT-2? - CORRECT ANSWER >>> GLP1 - up to or greater than 20 lb What illness should you use GLP-1 agonist with caution? - CORRECT ANSWER >>> Pancreatitis Only ok for gallstone associated pancreatitis What is an example of Glucose-dependent insulinotropic polypeptide (GIP) **- CORRECT ANSWER ** Tirzepatide (Mounjaro) What diabetes meds do you have to adjust with Tirzepatide (Mounjaro) **- CORRECT ANSWER ** Usually have to decrease basal insulin by 20-30% when this med is started Short acting (like humalog) is usually decrease by half What meds don't cause you hypoglycemic? - CORRECT ANSWER >>> GIP, SGLT-2 , Pioglitazone (actos) OR GLP- 1
What can Pioglitazone (actos) prevent? - CORRECT ANSWER >>> Prevention of diabetes in pre diabetic patients What are the disadvantages of Pioglitazone (actos)? - CORRECT ANSWER >>> Delayed onset of action Weight gain Can cause fluid retention Don't use in CHF patients Reversed upon discontinuation Not alleviated by loop diuretics Is alleviated by spironolactone Fluid retention Cardiovascular concerns Liver monitoring required What meds are the "fab 4" - CORRECT ANSWER >>> Metformin, Jardiance, GLP-1, TZD What lab do you have to check for Diabetic nephropathy and how often? **- CORRECT ANSWER
** Once a year you have to get a microalbumin creatinine ratio This is best to catch early rather than regular creatinine which is shown in later stages What should you do if you have abnormal microalbumin? - CORRECT ANSWER >>> If there is some microalbumin noted, recheck every 3 months If there are 2 that are abnormal, refer to nephrology
What med is known to decrease the progression of kidney disease from diabetic neuropathy? - CORRECT ANSWER >>> Low dose ACE inhibitors have proven to decrease the progression of kidney disease from diabetic nephropathy Which is lost first with diabetic neuropathy? Vibration or sensation? **- CORRECT ANSWER
** Vibration is lost before sensation - tuning fork test What is the ADA guidelines for fasting glucose in diabetics? - CORRECT ANSWER >>> 70 - 130 What is the ADA guidelines goal for post prandial glucose in diabetics? **- CORRECT ANSWER ** < What is the A1C guideline goal for A1C in diabetics? - CORRECT ANSWER >>> <7% When first starting prandial insulin, when should it be given? - CORRECT ANSWER >>> Before largest meal. If still not at goal, progress to before 2-3 meals When does gestational diabetes occur? - CORRECT ANSWER >>> third trimester What is it called if the A1C is elevated in the 1st trimester? - CORRECT ANSWER >>> Diabetes in ** Once a year you have to get a microalbumin creatinine ratio This is best to catch early rather than regular creatinine which is shown in later stages What should you do if you have abnormal microalbumin? - CORRECT ANSWER >>> If there is some microalbumin noted, recheck every 3 months If there are 2 that are abnormal, refer to nephrology What med is known to decrease the progression of kidney disease from diabetic neuropathy? - CORRECT ANSWER >>> Low dose ACE inhibitors have proven to decrease the progression of kidney disease from diabetic nephropathy Which is lost first with diabetic neuropathy? Vibration or sensation? - CORRECT ANSWER >>> Vibration is lost before sensation - tuning fork test What is the ADA guidelines for fasting glucose in diabetics? - CORRECT ANSWER >>> 70 - 130 What is the ADA guidelines goal for post prandial glucose in diabetics? - CORRECT ANSWER >>> < What is the A1C guideline goal for A1C in diabetics? - CORRECT ANSWER >>> <7% When first starting prandial insulin, when should it be given? - CORRECT ANSWER >>> Before largest meal. If still not at goal, progress to before 2-3 meals When does gestational diabetes occur? - CORRECT ANSWER >>> third trimester What is it called if the A1C is elevated in the 1st trimester? - CORRECT ANSWER >>> Diabetes in pregnancy What lab do you check to see if a patient is making their own insulin? **- CORRECT ANSWER ** Check C peptide level to assess if pt is making their own insulin Do you check C reactive peptide to assess for type 1 DM? - CORRECT ANSWER >>> No
How often should you check urinary albumin and neuropathy in a type 1 diabetic? - CORRECT ANSWER >>> Every 5 years What medications are recommended for nephropathy or retinopathy? **- CORRECT ANSWER
** ACE or ARB What is recommended as initial treatment for diabetic neuropathy? **- CORRECT ANSWER ** Pregabalin or duloxetine Why is glucose dropped in the 1st trimester of pregnancy? - CORRECT ANSWER >>> Glucose needs to be dropped quickly in the 1st trimester due to the risk of bleeding in the eyes. What precaution should be taken in the 1st trimester regarding eye health? **- CORRECT ANSWER ** An eye MD should be on standby in the 1st trimester of pregnancy due to the risk of bleeding in the eyes. What is a potential concern when dropping glucose in the 1st trimester? **- CORRECT ANSWER ** There is a risk of pain associated with dropping glucose in the 1st trimester of pregnancy. What shoe should diabetic never wear? - CORRECT ANSWER >>> Never wear flip flops. Shouldn't have anything between the toes What effect does insulin have on weight? - CORRECT ANSWER >>> Causes weight gain What can you when just starting out insulin if the glucose is still higher than goal? - CORRECT ANSWER >>> if glucose is still higher than goal range, after 3 days you can increase the insulin by 2 units
What is basal insulin? - CORRECT ANSWER >>> long acting insulin Should you hold basal insulin if NPO or going for a procedure? - CORRECT ANSWER >>> NO! You can decrease it by 50% What basal insulins are given BID? - CORRECT ANSWER >>> Levemir and NPH only What type of patient shouldn't you use lantus with? - CORRECT ANSWER >>> Don't want to use lantus insulin on a pt with significant renal disease They hold on to insulin much longer and can cause dose stacking When is the best time to give Lantus? - CORRECT ANSWER >>> Best time to give lantus is the most consistent time of day for the pt. Doesn't have to be AM or PM Which basal insulin is good for patients with renal disease? - CORRECT ANSWER >>> Levemir What basal insulin is safe for pt in gestational diabetes? - CORRECT ANSWER >>> NPH Who is it a good idea to give NPH to? - CORRECT ANSWER >>> Outside of pregnancy, only should be used for patients with set routines I.E. pt eats same amount of carbs every meal, lives in a nursing home "Fixed dose insulin" When should rapid insulin be given? - CORRECT ANSWER >>> Within 5-15 minutes of starting a meal When should bolus insulin be administered? - CORRECT ANSWER >>> Only when eating carbs, otherwise pt will be hypoglycemic
Invokana (canagliflozin), Jardiance (empagliflozin), Farxiga (dapagliflozin), and Steglaro (ertugliflozin If a pt is on a sulfonyurea what shouldn't they be on? - CORRECT ANSWER >>> Insulin What age is AAA screening recommended for? - CORRECT ANSWER >>> 65 - 75 years old who has ever smoked What age should you start colorectal CA screening? - CORRECT ANSWER >>> 45 years old Per the American cancer society, when should you stop colorectal screening? - CORRECT ANSWER >>> At age 85 What diseases requires colorectal screening 8 years after diagnosed with the disease? - CORRECT ANSWER >>> starting at least 8 years after they are diagnosed with inflammatory bowel disease. Follow-up colonoscopies should be done every 1 to 3 years, depending on the person's risk factors for colorectal cancer and the findings on the previous colonoscopy. What screening tests for colon cancer can you do every 5 years? - CORRECT ANSWER >>> CT colonography & flexible sigmoidoscopy Which test done every 5 years for colon cancer is best? - CORRECT ANSWER >>> CT colonography CT colonography every 5 years have greater estimated life-years gained than flexible sigmoidoscopy every 5 years What age is DM screening recommended? - CORRECT ANSWER >>> 35 - 70 years old
How often should you do DM screening for low risk patients? - CORRECT ANSWER >>> Every 3- 5 years What age should BP screen start? - CORRECT ANSWER >>> Start at 18 then every 3- 5 years if not at increased risk for HTN When should BP screening be annually? - CORRECT ANSWER >>> Age 40 and older for adults at increased risk for HTN What are the tests for TB? - CORRECT ANSWER >>> TST (skin test) & IGRA (serum) Age for screening lung CA - CORRECT ANSWER >>> 50 - 80 years old who have 20 pack year smoking history What is the lung CA screening method? - CORRECT ANSWER >>> Yearly Low dose CT scan (LDCT) Hep B screening recommendation for pregnant women - CORRECT ANSWER >>> At first prenatal visit Hep B screening for the general public - CORRECT ANSWER >>> The USPSTF recommends screening for hepatitis B virus (HBV) infection in adolescents and adults at increased risk for infection. What is the recommended screening test for hepatitis B? - CORRECT ANSWER >>> Screening for hepatitis B should be performed with HBsAg tests approved by the US Food and Drug Administration. What should be done for initially reactive HBsAg test results? - CORRECT ANSWER >>> A confirmatory test should be performed for initially reactive HBsAg test results.
women with risk factors for HIV acquisition and in women living or receiving care in highincidence settings What gender should be screened for chlamydia? - CORRECT ANSWER >>> Women When should screening be done for chlamydia and for who? - CORRECT ANSWER >>> The USPSTF recommends screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. What age group has the highest rate of infection for chlamydia and gonorrhea? - CORRECT ANSWER >>> Ages 15-24 years old Screening test for chlamydia and gonorrhea? - CORRECT ANSWER >>> Nucleic acid amplification tests (NAATs) = high sensitivity and specificity Recommendation for routine testing for herpes - CORRECT ANSWER >>> The USPSTF recommends against routine serologic screening for genital herpes simplex virus infection in asymptomatic adolescents and adults, including pregnant persons Recommendation for syphilis screening in pregnant women - CORRECT ANSWER >>> The USPSTF recommends early screening for syphilis infection in all pregnant women. Recommendation for syphilis screening in non pregnant person? - CORRECT ANSWER >>> The USPSTF recommends screening for syphilis infection in persons who are at increased risk for infection. What gender is the pravelance of syphilis higher in? - CORRECT ANSWER >>> Men
Screening test for syphilis? - CORRECT ANSWER >>> Current syphilis screening tests rely on detection of antibodies rather than direct detection of the organism that causes syphilis, 2 - step process involving an initial nontreponemal test (eg, Venereal Disease Research Laboratory [VDRL] or rapid plasma reagin [RPR] test) followed by a confirmatory treponemal antibody detection test (eg, T pallidum particle agglutination [TP-PA] test). What are the 5 M's of geriatrics? - CORRECT ANSWER >>> mind mobility medications multicomplexity mind matters most What does a positive lachman test and lateral pivot test mean? - CORRECT ANSWER >>> ACL tear What are the long term effects of hyperthyroidism if untreated? - CORRECT ANSWER >>> Long term effects if inadequately treated: heart disease, osteoporosis (in post menopausal women), mental illness, & infertility What is L.A.C.E? - CORRECT ANSWER >>> Licensure Accreditation Certification Education
