A patient who has diabetes mellitus and congestive heart failure ...

[nevelica]

A patient who has diabetes mellitus and congestive heart failure takes insulin and warfarin. The patient will begin taking exogenous testosterone to treat secondary hypogonadism. The primary care NP should recommend:
 
  a. increasing the dose of warfarin.
  b. more frequent blood glucose monitoring.
  c. a higher than usual dose of testosterone.
  d. increasing insulin doses to prevent hypoglycemia.

Question 2

A patient is identified as having stage 2 Alzheimer's disease and elects to take donepezil (Aricept). The patient asks the primary care nurse practitioner (NP) how long the medication will be needed.
 
  The NP should tell the patient that donepezil must be taken: a. until symptoms improve.
  b. indefinitely because it is not curative.
  c. for 24 weeks, which is when cognitive function improves in most patients.
  d. until symptoms worsen, when a switch to memantine (Namenda) will be needed.

[Zack0mack0101@yahoo.com]

Answer to Question 1

B
Patients with diabetes may require a decrease in insulin dose because of the metabolic effects of androgens. More frequent blood glucose monitoring should be performed. Warfarin doses may need to be decreased because androgens increase sensitivity to anticoagulants.

Answer to Question 2

B
Cholinesterase (ChE) inhibitor drugs such as donepezil diminish symptoms; when the drug is stopped, the symptoms return. Cognitive function will show improvement at about 24 weeks, but the drug must be continued indefinitely.