NRNP-6540 Endocrine, Metabolic and Nutritional Disorders
The NP recognizes that all of the following patients have an increased risk of developing adverse effects from metformin (Glucophage) except:
Metformin (Glucophage) often causes weight loss. Metformin may rarely cause a serious, life threatening condition called lactic acidosis. Patients with dehydration, renal disease, and alcoholism, especially binge drinking, increased their risk for developing lactic acidosis.
Stefanie is a 70 y/o female with 2 year history of Type II diabetes, presents to your office for her routine follow up visit. Which of the following would you recommend on an annual basis for an elderly patient with Type II Diabetes?
Patients with Type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist shortly after the diagnosis of diabetes. Subsequent examinations for Type 1 and Type 2 Diabetic patients should be repeated annually by an ophthalmologist. Examinations will be required more frequently if retinopathy is progressing.
A 66-year-old male patient who has hypothyroidism takes level thyroxine daily. Based on the following lab results, how should the nurse practitioner proceed?
|TSH||28.2 mIU/L||Normal Values:
|Free T4||0.05 ng/dL||Normal Values:
|Total Cholesterol||272 mg/dL||Normal Values:
|LDL Cholesterol||189 mg/dL||Normal Values:
|HDL Cholesterol||34 mg/dL||Normal Values:
|Triglycerides||142 mg/dL||Normal Values:
Dyslipidemia is a common finding when TSH values exceed 10 mIU/L. In patients who have hypothyroidism, there is decreased catabolism of LDL, primarily due to a reduction of cell surface receptors for LDL. This causes an accumulation of LDL cholesterol. The NP should first treat the TSH to 10 mIU/L or less. Lipids should be treated if they remain elevated after TSH is less than 10 mIU/L.
Patients with Type I Diabetes should be screened for renal nephropathy five years after diagnosis. Since nephropathy takes several years to develop, it is highly improbable that a newly diagnosed patient will have no properties secondary to diabetes. Diabetic nephropathy is usually diagnosed based on the presence of albuminuria and/or reduced eGFR in the absence of signs or symptoms of other primary causes of kidney damage.
Macular degeneration is typically characterized by loss of central vision. Early complaints and findings include patchy or blurry vision and the presence of retinal drusen, pale yellow deposits visible upon ophthalmic examination.
Miss Johnson’s symptoms are consistent with adult failure to thrive. It is important that the NP recognizes that this is not a normal part of aging and it should be assessed properly.