Question

Question 1 2 / 2 points

When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research?

Question options:

Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia.

Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents.

Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.

Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime.

Question 2 2 / 2 points

Prior to prescribing metformin, the provider should:

Question options:

Draw a serum creatinine to assess renal function

Try the patient on insulin

Tell the patient to increase iodine intake

Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions

Question 3 2 / 2 points

Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset and duration of action?

Question options:

Lispro

Glulisine

Glargine

Detemir

Question 4 2 / 2 points

The drugs recommended for older adults with type 2 diabetes include:

Question options:

Second-generation sulfonylureas

Metformin

Pioglitazone

Third-generation sulfonylureas

Question 5 2 / 2 points

Women with an intact uterus should be treated with both estrogen and progestin due to:

Question options:

Increased risk for endometrial cancer if estrogen alone is used

Combination therapy provides the best relief of menopausal vasomotor symptoms

Reduced risk for colon cancer with combined therapy

Lower risk of developing blood clots with combined therapy

Question 6 2 / 2 points

Bisphosphonate administration education includes:

Question options:

Taking it on a full stomach

Requiring sitting erect for at least 30 minutes afterward

Drinking it with orange juice

Taking it with H2 blockers or proton pump inhibitors (PPI) to protect the stomach

Question 7 2 / 2 points

Long-term use of androgens requires specific laboratory monitoring of:

Question options:

Glucose, calcium, testosterone, and thyroid function

Calcium, testosterone, PSA, and liver function

Calcium, testosterone, PSA, liver function, glucose, and lipids

CBC, testosterone, PSA, and thyroid level

Question 8 2 / 2 points

Patients taking hormonal contraceptives and hormone replacement therapy need to take the drug daily at the same time to prevent:

Question options:

Nausea

Breakthrough bleeding

Breast tenderness

Pregnancy

Question 9 2 / 2 points

The mechanism of action of oral combined contraceptives that prevents pregnancy is:

Question options:

Estrogen prevents the luteinizing hormone surge necessary for ovulation.

Progestins thicken cervical mucus and slow tubal motility.

Estrogen thins the endometrium making implantation difficult.

Progestin suppresses follicle stimulating hormone release.

Question 10 2 / 2 points

When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include:

Question options:

They should feel symptomatic improvement in 1 to 2 weeks.

Drug adverse effects such as lethargy and dry skin may occur.

It may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory testing.

Because of its short half-life, levothyroxine doses should not be missed.

 

 

 

 

 

  I NEED A POSITIVE COMMENT BASEDIN THIS ARGUMENT..BETWEEN 100-120 WORDS

 

1. What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.

My recommendations for continued treatment would be:

• Start antibiotics “Patients with diabetes mellitus are at increased risk of invasive S. aureus infections.” (Hakeem, L., Laing, R. et al, 2013).
• Tylenol to reduce the fever.
• Pain medicine should be administered as needed.
• Order wound consult so that the wound can be assessed appropriately and recommendations for wound care can be made. The wound may require debridement in order to promote healing.
• Elevate the legs to promote venous blood return and apply compression stocking to the other extremity.
• Appropriate high protein diet to promote wound healing.
• Case management should be consulted to start discharge plan.

 

2)     Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”

Muscle groups affected by Ms.G condition are: flexor hallucis longus, flexor digitorum longus, and tibialis anterior.

3)       What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.

The subjective and objective data is vital in prevention of future worsening or recurring of infection. Information that MS. G presented with should be indication for future recommendations for her. With Ms. G’s young age and diabetes we know that she is more prone to have venous ulcers; therefore education and prevention will be crucial in her case. Understanding disease process, controlling her blood sugar level, proper diet with right amount of protein, weight loss and wearing compression stockings will be information that patient needs to be provided and followed up with.

4)      What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

The main factor present in this situation that could prevent wound healing is diabetes disease. “Healing problems are caused by the peripheral arterial diseases and peripheral neuropathy that can occur with diabetes”

Brem, H., Tomic-Canic, M, 2007). One of the characteristics of patients with diabetes is  poor circulation, especially to extremities. Reduced amount of oxygen and nutrients delays healing. Ms G. needs consistent blood sugar control along with medication available for her to decrease high blood sugar. Another risk factor is that MS G. lives alone and does not have help with meal preparation. Proper diet high in protein is crucial in wound healing. Education along with case management involvement will be priority to ensure right nutrition.

 

 References:

 

Brem, H., & Tomic-Canic, M. (2007). Cellular and molecular basis of wound healing in diabetes. Journal of Clinical Investigation, 117(5), 1219–1222. http://doi.org/10.1172/JCI32169

 

Hakeem, L., Laing, R. et al (August 21, 2013). Invasive Staphylococcus aureus infections in diabetes mellitus.Retrieved from http://journals.sagepub.com/doi/abs/10.1177/1474651413500830#articleCitationDownloadContainer