NR 511 Week 8 Final Exam

3.  You should treat it very aggressively, preferably with angiotensin-converting enzyme (ACE) inhibitors. 4.  You should initiate therapy when the blood pressure is 5 to 10 mm Hg more than the conventional therapeutic guidelines. Rationales Option 1: Because hypertension is implicated in accelerating the microangiopathy of diabetes (especially retinopathy and nephropathy), according to the Eighth Joint National Committee (JNC 8) therapy should be initiated when the patient has a blood pressure at or above 140/90 mm Hg. Other organizations recommend the lower goal of 130/80 in clients with DM. Option 2: Owing to the beneficial effects of reducing albuminuria and glomerular pressure, angiotensin- converting enzyme (ACE) inhibitors are the drugs of choice in clients with DM with hypertension. Option 3: ACE inhibitors should be initiated in patients with diabetes and an elevated blood pressure and are recommended in normotensive patients with albuminuria. Option 4: Depending on the guidelines, therapy should be initiated when blood pressure reaches levels equal to or 10 mm Hg less than conventional therapeutic guidelines. [Page reference: 932] ● Course Topic: Endocrine and Metabolic Problems ● Area of Practice(s): Adult-Gerontology Primary Care; Family Practice ● APN Knowledge Area(s): Pharmacologic Therapy and Polypharmacy, Disease Management ● Testing Domain: Plan ● Cognitive Level: Analysis [Analyzing] Question 3. Dan, age 45, is obese and has type 2 diabetes. He has been having trouble getting his glycohemoglobin under control. He has heard that exenatide (Byetta) causes weight loss and wants to try it. What do you tell him? 1.  “Let’s adjust your oral antidiabetic agents instead.” 2.  “That’s a myth. People usually change their eating habits when taking this, and that’s what causes the weight loss.” 3.  “With type 2 diabetes, you never want to be on injectable insulin.” 4.  “Let’s try it. Your glycohemoglobin will be lowered and you may lose weight.” Rationales Option 1: Adjusting the client’s oral antidiabetic agents may not be as effective, but these drugs are less expensive. Option 2: Exenatide (Byetta) can cause weight loss in some individuals. Question 5. Which of the following is not a risk factor for diabetes mellitus type 2? 1.  Body mass index (BMI) greater than 25. 2.  History of gestational diabetes. 3.  Caucasian race. 4.  History of polycystic ovary syndrome (PCOS). Rationales Option 1: A BMI greater than 25 is a risk factor for diabetes mellitus type 2. Option 2: A history of gestational diabetes is associated with the development of diabetes mellitus type 2 later in life. Option 3: Caucasians are less likely than African Americans, Asian Americans, Latin Americans, and Native Americans to develop diabetes mellitus type 2. Option 4: Women diagnosed with PCOS are more likely to develop diabetes mellitus type 2. [Page reference: 923] ● Course Topic: Endocrine and Metabolic Problems ● Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Practice ● APN Knowledge Area(s): Disease Management ● Testing Domain: Assess ● Cognitive Level: Knowledge [Remembering] Question 6. Bill, age 43, appears with a tender, ulcerated, exudative, papular lesion on his penis. It