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?
A. Takes medication at bedtime with a full glass of water
B. Takes medication with a full glass of water when up in a.m. 30 minutes prior to other food and medications
C. Takes medication when up in a.m. with a glass of orange juice to increase absorption
D. Takes medication sitting up and with a meal to avoid gastrointestinal distress
Question 2The 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?
A. Angina and arrhythmia
B. Nausea and diarrhea
C. Confusion and delirium
D. Osteoporosis and muscle weakness
Question 3Six 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?
A. Assess further for a cause of fatigue
B. Double the dose of Synthroid
C. Discontinue the Synthroid
D. Prescribe Liotrix (T3 & T4 combination)
Question 4A 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?
A. Hyperthyroidism
B. Hypothyroidism
C. Hyperparathyroidism
D. Grave's disease
Question 5Mrs. 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
A. Increase the Synthroid
B. Order TSH
C. Start a beta-blocker
D. Order thyroid scan
Question 6Which patient is most likely to have osteoporosis?
A. An 80-year-old underweight male who smokes and has been on steroids for psoriasis
B. A 90-year-old female with no family history of osteoporosis who is on hormone replacement therapy
C. A 68-year-old overweight female who drinks 1-2 drinks alcohol/day
D. An 82-year-old female with a normal BMI takes calcium and performs weight-bearing exercise daily
Question 7An older male presents with incontinence, has a wide-based and irregular gait, and progressive dementia. Which of the following presents with these cardinal signs?
A. Parkinson's disease
B. Normal pressure hydrocephalus
C. Basilar artery CVA
D. Progressive supranuclear palsy
Question 8An 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?
A. Hypothyroidism
B. Hyperthyroidism
C. Congestive heart failure
D. Type 2 diabetes mellitus
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