18 Oct Which glucose level equates with a Hgb A1C of 8.1%?

I understand the value of doing my own work and learning this skill to support my future independent practice

 

as a nurse practitioner. I understand that while there may be opportunities beyond my faculty’s control to collaborate or share answers with peers, that it would not benefit my own personal and professional growth to do so. I agree to do my own work and take personal responsibility for my learning.

 

I do not.

 

I do.

 

Use the John Jones case study to answer the following question.

 

Which glucose level equates with a Hgb A1C of 8.1%?

 

~204 mg/dl

 

~160 mg/dl

 

~175 mg/dl

 

~183 mg/dl

 

Use the John Jones case study to answer the following question.

 

John calls the office and reports that he is scheduled for diagnostic testing that requires IV contrast for imaging. He inquires if there are concerns with undergoing this procedure while taking his medications. What instructions should be given to John regarding his metformin regimen?

 

Don’t take the metformin the day of the procedure and for 48 hours afterward.

 

 Take the metformin the morning of the procedure but don’t take it for 48 hours afterward.

 

Don’t take the metformin the day of the procedure but resume the following day.

 

Use the John Jones case study to answer the following question.

 

Which of the following lab test should be evaluated before prescribing metformin?

 

Complete blood count (CBC)

 

Complete metabolic profile (CMP)

 

Lipid Panel

 

Urinalysis

 

Use the John Jones case study to answer the following question.

 

Which behavior in John’s social history poses a potential concern with initiating metformin?

 

His diet largely consists of fast-food meals. He drinks sweet tea with every meal.

 

He reports drinking “a few beers on the weekend during football season”.

 

 He drinks 3-4 cups of coffee per day.

 

Use the John Jones case study to answer the following question.

 

Metformin works by decreasing               and        .

 

glucogenesis; incretin secretion

 

incretin secretion; insulin production

 

glucogenesis; insulin resistance

 

insulin resistance; incretin secretion

 

Use the John Jones case study to answer the following question.

 

Using the ADA Standards of Medical Care in Diabetes-2020, which of the following medications should be prescribed for John?

 

Canagliflozin

 

Glyburide

 

Dulaglutide

 

 Metformin

 

Use the John Jones case study to answer the following question.

 

Which of the following statements best describes John’s status?

 

He has diabetes and requires pharmacological intervention.

 

He does not have diabetes.

 

He has diabetes but does not require pharmacological intervention.

 

He has pre-diabetes.

 

Use the John Jones case study to answer the following question.

 

John’s triglycerides are 260 mg/dl and his HDL is 35mg/dl. Referring to the ADA Standards of Medical Care in Diabetes-2020, what is the correct action to take at this time?

 

Increase John’s atorvastatin to 20mg per day.

 

Leave John’s atorvastatin as is and re-check lipids when A1C is re-checked.

 

 Increase John’s atorvastatin to 40 mg per day.

 

Stop John’s atorvastatin since he is now being treated for diabetes.

 

Use the John Jones case study to answer the following question.

 

What is the recommended interval for monitoring John’s HgbA1C?

 

1-month

 

6-weeks

 

3-months

 

6-months

 

 

 

Use the John Jones case study to answer the following question.

 

Which of John’s behaviors should be addressed to encourage lifestyle changes and decrease A1C levels? Select all that apply.

 

He drinks 3-4 cups of coffee per day.

 

 Sits at a desk several hours a day.

 

Weight 235lbs

 

His diet largely consists of fast-food meals. He drinks sweet tea with every meal.

 

Family history is significant for diabetes.

 

BP 130/90

 

Use the Alfonso Giuliani case study to answer the following question.

 

Which lab test is necessary to evaluate before prescribing a sodium/glucose cotransporter-2 inhibitor (SGLT2i)?

 

CBC

 

LFTs

 

HgbA1C

 

CMP

 

Use the Alfonso Giuliani case study to answer the following question.

 

 Alfonso should be started on statin therapy to address his high total cholesterol and low HDL.

 

True

 

False

 

Identify SGLT2i agents in the list below. Select all that apply.

 

linagliptin

 

dapagliflozin

 

alogliptin

 

sitagliptin

 

saxagliptin

 

canagliflozin

 

empagliflozin

 

Question 15        Use the ASCVD Risk Estimator-Plus calculator (Links to an external site.) to estimate Alfonso’s ASCVD Risk score. Which of the following scores is his ASCVD Risk score?

 

 31.2%

 

37.6%

 

46.5%

 

52.1%

 

Alfonso’s ASCVD Risk score is 46.5% according to ASCVD Risk Estimator-Plus tool, which estimates risk based on age, gender, presence of diabetes, treatment for hypertension, cholesterol values, and systolic pressure.

 

Use the Alfonso Giuliani case study to answer the following question.

 

Which of the following benefits from GLP-1 therapy are helpful to Alfonso? Select all that apply.

 

appetite suppression

 

weight loss

 

low risk for hypoglycemia

 

blood pressure control

 

Question 17        Which statin agents and dosages are consistent with the statin therapy intensity Alfonso needs? Select all that apply.

 

 Atorvastatin 10-20 mg Correct Answer Rosuvastatin 20-40 mg

 

Atorvastatin 40–80 mg

 

Pravastatin 40-80 mg

 

Use the Alfonso Giuliani case study to answer the following question.

 

Which of the following lab values are important to monitor while taking GLP-1 agents?

 

hemoglobin and hematocrit

 

amylase and lipase

 

aspartate transaminase & alkaline phosphatase

 

magnesium and calcium

 

Question 19        Identify GLP-1 agents in the list below. Select all that apply.

 

 exenatide

 

semaglutide

 

dulaglutide

 

lixisenatide

 

liraglutide

 

rosiglitazone

 

pioglitazone

 

albiglutide

 

.

 

Which of the following complications may be caused by GLP-1 agents?

 

diverticulitis

 

cholecystitis

 

pancreatitis

 

cellulitis

 

Use the Alfonso Giuliani case study to answer the following question.

 

Considering Alfonso’s ASCVD risk score, which of the following diabetic drug classes should be considered in addition to metformin?

 

TZD

 

SGLT2i

 

GLP-1

 

Sulfonylurea

 

Question 22        Use the Alfonso Giuliani case study to answer the following question. Which of the following types of statin therapy should be started for Alonso?

 

High-intensity statin therapy

 

Low-intensity statin therapy

 

Moderate-intensity statin therapy

 

Use the Helen Smith case study to answer the following question.

 

Helen’s has abnormal thyroid values:

 

TSH 24 mU/L

 

Free T4 0.2 ng/dl

 

What condition do these tests indicate?

 

Hashimoto’s thyroiditis

 

Hypothyroidism

 

Grave’s Disease

 

Hyperthyroidism

 

 What are the Black Box Warnings associated with NSAIDs? Select all that apply.

 

Increases risk for GI bleeding, ulceration, and perforation

 

Increases risk for cardiovascular thrombotic event

 

Increases all-cause mortality

 

Increases risk for serious skin reactions Black Box warning on NSAIDs:

 

Use the Helen Smith case study to answer the following question.

 

Which of the following criteria support’s Helen’s diagnosis of DM? (Select all that apply)

 

Glucose: 189 mg/dL

 

T. Cholesterol 240 mg/dl

 

Triglycerides 260 mg/dl

 

HgbA1C: 9.2%

 

nocturia

 

Use the Helen Smith case study to answer the following question.

 

If the standard starting dose of levothyroxine 1.6 mcg/kg/dose is prescribed for Helen, what is the correct dose?

 

200mcg

 

175mcg

 

300mcg

 

150mcg

 

Use the Helen Smith case study to answer the following question.

 

 Because metformin is contraindicated with her age.

 

Because only diabetic medication should be prescribed.

 

Because heart failure can predispose patients to lactic acidosis.

 

Because metformin interacts with her Irbesartan.

 

Use the Helen Smith case study to answer the following question.

 

Which of the following lab values require consideration for possible treatment?

 

Hgb 15.3 g/dL

 

Alkaline phosphatase: 50 U/L

 

Triglycerides 260 mg/dl

 

TSH 24 mU/L

 

Total Cholesterol 240 mg/dl

 

HDL 35 mg/dl

 

 LDL 120mg/dl

 

AST (aspartate aminotransferase): 20

 

Hct 48%

 

Free T4 0.2 ng/dl

 

Use the Helen Smith case study to answer the following question.

 

What is the daily maximum dose of levothyroxine?

 

700mcg/day

 

500mcg/day

 

300mcg/day

 

1000mcg/day

 

 Use the Helen Smith case study to answer the following question.

 

Which of the following medical conditions will determine Helen’s diabetes treatment regimen?

 

Obesity

 

Osteoarthritis

 

Dyslipidemia

 

Heart Failure

 

Use the Helen Smith case study to answer the following question.

 

Which DM drug class is contraindicated in patients with heart failure?

 

Sulfonylurea

 

Biguanide

 

GLP-1

 

TZD

 

Use the Helen Smith case study to answer the following question.

 

There is still one important issue to address with Helen today. Which of the following concerns requires addressing?

 

Heart failure

 

Fatigue

 

Weight

 

Cholesterol

 

Use the Helen Smith case study to answer the following question.

 

Which medication should be prescribed for Helen to address her thyroid levels?

 

Triiodothyronine

 

Methimazole

 

Levothyroxine

 

Propylthiouracil

 

Use the Helen Smith case study to answer the following question.

 

Medication lists should always be reviewed for evidence-based prescribing practices. Helen is taking Naproxen 500 mg PO every 12 hours.

 

What is the maximum dose of Naproxen per day (for 6 months)?

 

2000mg per day

 

1000mg per day

 

2500mg per day

 

1500mg per day

 

Use the Helen Smith case study to answer the following question.

 

Which of the following agents should be prescribed for Helen? (Independent searching may be required to find the answer to this question)

 

Glipizide

 

Dapagliflozin

 

Glimepiride

 

Pioglitazone

 

Use the Helen Smith case study to answer the following question.

 

Which of the following drug classes should be prescribed for Helen?

 

GLP-1

 

Biguanide

 

SGLTi

 

DPP-4i

 

Use the Helen Smith case study to answer the following question.

 

Which of the following is the recommended initial dose of levothyroxine for the general population?

 

1.2mcg/kg/dose daily

 

1.8 mcg/kg/dose daily

 

2.0 mcg/kg/dose daily

 

 1.6 mcg/kg/dose daily

 

In youth who are overweight or obese and have a new onset of diabetes with an A1C>8.5%, how much basal

 

insulin is recommended?

 

0.1 units/kg/da

 

0.8 units/kg/day

 

0.5 units/kg/day

 

1 unit/kg/day

 

When considering older adults in the treatment and management of diabetes, what special considerations

 

apply? Select all that apply.

 

Screening for geriatric syndromes

 

Current quality of life

 

Self-management abilities

 

A diabetic construction worker is seen for follow-up care. He has been taking metformin 1000mg PO twice daily for the last 3 months and his A1C is 8.7. Which section of the Standards of Medical Care in Diabetes—2020 best describes his treatment plan?

 

Cost is a major issue

 

Compelling need to minimize weight gain or promote weight loss

 

Compelling need to minimize hypoglycemia

 

ASCVD Predominates

 

Which of the following diabetic drug classes should be prescribed with metformin for a patient with a BMI of 52?

 

Select all that apply.

 

Insulin

 

TZD

 

 SGLT2i

 

GLP-1

 

Which of the following agents are recommended when hypoglycemia is a concern? Select all that apply,

 

Insulin

 

SGLT2i

 

DPP-4i

 

GLP-1

 

TZD

 

Sulfonylurea

 

 Which of the following hypertension drug classes are NOT recommended for the primary prevention of chronic

 

kidney disease in patients who have diabetes with normal blood pressure and GFR? (Select all that apply)

 

Angiotensin converting enzyme inhibitors

 

Calcium channel blockers

 

Angiotensin II receptor blockers

 

Thiazide diuretics 11.9

 

According to the ADA Standards of Medical Care in Diabetes-2020, what are the goals of care for diabetes?

 

Select all that apply.

 

Empower patients to manage their own disease process

 

Maintain constant control of blood sugar

 

Optimize quality of life

 

Exercise is recommended for all youth with type 1 diabetes with the goal of        min of moderate-to-vigorous

 

intensity aerobic activity daily, with vigorous muscle-strengthening and bone-strengthening activities at least   

 

days per week.

 

60;3

 

30;3

 

50;5

 

45;5

 

Which of the following is the preferred medication for treating hyperglycemia in gestational diabetes?

 

 Insulin

 

DPP-4i

 

GLP-1

 

Metformin

 

TZD

 

Glyburide

 

SGLT2i

 

Which classes of oral diabetic drugs carry a higher risk for hypoglycemia? (Select all that apply)

 

SGLT-2 inhibitors

 

Sulfonylureas

 

Biguanides

 

α-glucosidase inhibitors

 

Glinides

 

Which of the following DM drug class has a warning that it can cause severe and disabling joint pain at any

 

point in time during treatment?

 

Metformin

 

SGLT2i

 

DPP-4i

 

Insulin

 

Glyburide

 

TZD

 

GLP-1

 

Which of the following exams is important for diabetics and requires a referral?

 

 Eye exam

 

Foot exam

 

Gait evaluation

 

A single mom who makes minimum wage and struggles financially needs an additional diabetic medication

 

after experiencing minimal A1C improvement with metformin. Which of the following DM drugs is appropriate? Select all that apply.

 

Dulaglutide

 

Sitagliptin

 

Canagliflozin

 

Glyburide

 

Pioglitazone

 

Glucophage

 

NPH

 

Match the A1C testing recommendations to the correct patient.

 

Perform the A1C test at least two times a year

 

Perform the A1C test quarterly

 

A1C Testing Recommendations

 

                Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). E

 

                Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. E

 

                Point-of-care testing for A1C provides the opportunity for more timely treatment changes. E