D118 Unit 7 Study Guide

D118 Unit 7 Study Guide

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Western Governors University

D118 Adult Primary Care for the Advanced Practice Nurse

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D118 Unit 7 Study Guide

Differentiation of Laboratory Findings in Anemia

Anemia is defined as a reduction in hemoglobin concentration, hematocrit, or red blood cell (RBC) count and may arise from multiple underlying mechanisms. The evaluation of anemia requires careful interpretation of laboratory data to identify the etiology. Priority differential diagnoses include acute or chronic blood loss, bone marrow disorders, malignancy, and renal insufficiency.

Acute blood loss, such as from hemorrhage or hemolysis, often presents with initially normal indices followed by declining hemoglobin and hematocrit. Reticulocyte counts are typically elevated due to compensatory marrow response. Chronic blood loss, frequently associated with gastrointestinal or gynecologic sources, commonly results in iron deficiency anemia, characterized by low ferritin, reduced serum iron, elevated total iron-binding capacity (TIBC), and microcytosis.

Bone marrow failure or disease, including aplastic anemia or myelodysplastic syndromes, is associated with pancytopenia, low reticulocyte counts, and abnormal marrow cellularity. Malignancy-related anemia may result from marrow infiltration, chronic inflammation, or chemotherapy effects and often demonstrates normocytic or mildly microcytic indices with elevated inflammatory markers. In renal failure, decreased erythropoietin production leads to normocytic, normochromic anemia.

Table 1
Key Laboratory Patterns in Common Types of Anemia

What Laboratory Values in Metabolic Syndrome Require Nephrology Referral and Why?

In patients with metabolic syndrome, early identification of renal impairment is critical to prevent progression to end-stage kidney disease. Referral to nephrology is warranted when the estimated glomerular filtration rate (eGFR) declines below 30 mL/min/1.73 m² or when albuminuria exceeds 300 mg/g of urinary creatinine.

An eGFR below this threshold indicates stage 4 chronic kidney disease, at which point specialized management is necessary to slow disease progression and prepare for renal replacement therapy if needed. Significant albuminuria reflects glomerular damage and is independently associated with increased cardiovascular and renal morbidity.

What Is the First-Line Treatment for Generalized Anxiety Disorder?

Antidepressant medications are considered the first-line pharmacologic treatment for generalized anxiety disorder (GAD). Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors have demonstrated consistent efficacy in reducing anxiety symptoms across multiple anxiety-related conditions.

SSRIs such as sertraline and escitalopram and SNRIs such as venlafaxine and duloxetine are preferred due to their favorable safety profile and long-term effectiveness. These agents address both psychological and somatic symptoms of anxiety and are suitable for chronic use. Psychotherapy, particularly cognitive behavioral therapy, is recommended concurrently to optimize outcomes.

Differentiation of the Types of Urinary Incontinence

Urinary incontinence encompasses several distinct subtypes, each with unique pathophysiologic mechanisms and clinical features.

Table 2
Types of Urinary Incontinence

Accurate differentiation is essential, as treatment strategies vary based on the underlying cause.

In Which Patients Should Oxybutynin Be Avoided?

Oxybutynin, an anticholinergic agent used for overactive bladder, should be avoided in patients with conditions that may be exacerbated by antimuscarinic effects. These include myasthenia gravis due to the risk of worsening muscle weakness, untreated narrow-angle glaucoma, urinary retention associated with benign prostatic hyperplasia, and inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease.

What Medications Are Appropriate for the Treatment of Graves Disease and Why?

Graves disease is an autoimmune disorder characterized by hyperthyroidism due to thyroid-stimulating immunoglobulins. Definitive therapy in the United States most commonly involves radioactive iodine ablation. This treatment destroys hyperfunctioning thyroid tissue, leading to long-term disease control.

Antithyroid medications such as methimazole may be used initially to control symptoms or in patients who are not candidates for radioactive iodine. Beta-blockers are often prescribed adjunctively to manage adrenergic symptoms.

Common Clinical Manifestations of Addison’s Disease

Addison’s disease, or primary adrenal insufficiency, results from inadequate production of cortisol and aldosterone. Chronic symptoms include fatigue, weight loss, hypotension, hyperpigmentation, and electrolyte imbalances such as hyponatremia and hyperkalemia.

During periods of stress, trauma, illness, or intense physical exertion, patients may develop an adrenal crisis. This life-threatening condition presents with acute vomiting, profound hypotension, dehydration, and shock, even in individuals previously stable on glucocorticoid therapy.

Educational Plan for a Patient With Type 2 Diabetes

Patient education is a cornerstone of type 2 diabetes management. Key components include lifestyle modification, medication adherence, glucose monitoring, and complication prevention.

Exercise plays a critical role by reducing insulin resistance and enhancing glucose uptake. Increased insulin sensitivity may persist for up to 48 hours after physical activity, requiring adjustments in medication dosing, particularly insulin. In patients with type 2 diabetes, reducing pharmacologic therapy rather than increasing caloric intake is preferred to support weight loss goals.

Education should also address nutritional planning, recognition of hypoglycemia, sick-day management, and the importance of regular follow-up. Exercise has been shown to prevent or delay progression from prediabetes to diabetes, reinforcing its long-term value.

Which Laboratory Test Is Most Important for Monitoring Kidney Function in Diabetes?

Microalbuminuria is the most critical early marker for diabetic nephropathy. It is often asymptomatic yet predicts both renal failure and cardiovascular disease. Microalbuminuria is defined as urinary albumin excretion greater than 30 mg per 24 hours.

Assessment can be performed using an albumin-to-creatinine ratio, random urine sample, timed collection, or 24-hour urine test. Diagnosis requires two out of three abnormal results over a 3–6 month period. Continued monitoring is essential to evaluate treatment response and disease progression.

What Is the Clinical Significance of the Philadelphia Chromosome?

The Philadelphia chromosome is a hallmark genetic abnormality in chronic myelogenous leukemia (CML). It results from a translocation between chromosomes 9 and 22, creating the BCR-ABL fusion gene. This gene encodes a constitutively active tyrosine kinase that drives uncontrolled white blood cell proliferation.

CML was the first malignancy linked to a specific chromosomal abnormality, and identification of the Philadelphia chromosome has led to targeted therapies that significantly improve prognosis.

Clinical Practice Guidelines for Type 1 and Type 2 Diabetes

The distinction between type 1 and type 2 diabetes is essential for diagnostic and therapeutic decision-making. Type 1 diabetes requires lifelong exogenous insulin due to absolute insulin deficiency. Type 2 diabetes management includes lifestyle modification, oral medications, and insulin when necessary.

In pregnancy, insulin has traditionally been the treatment of choice; however, oral agents such as glyburide and metformin are now considered equally effective and safe in selected patients. C-peptide testing may assist in distinguishing between diabetes types when clinical presentation is unclear.

Diagnosis, Laboratory Findings, and Treatment of Hypothyroidism

Hypothyroidism is diagnosed through elevated thyroid-stimulating hormone (TSH) levels and low free thyroxine (T4). Treatment involves thyroid hormone replacement to restore euthyroidism and suppress excessive TSH stimulation.

In patients with thyroid cancer, TSH suppression is critical. Intermediate- and high-risk patients require TSH levels below 0.3 mIU/L, while low-risk patients have a target range of 0.3 to 2.0 mIU/L.

Medications Used in the Treatment of Depression

Depression is treated with several classes of antidepressants, selected based on symptom profile, comorbidities, and tolerability.

Table 3
Common Antidepressant Classes and Typical Dosages

SSRIs and SNRIs are preferred first-line agents due to safety and efficacy.

Which Anemia Presents With a Beefy Red Tongue?

Vitamin B12 deficiency anemia, a form of megaloblastic anemia, is classically associated with a smooth, beefy red tongue (glossitis). Patients may also exhibit neurologic manifestations such as peripheral neuropathy and cognitive changes, making early diagnosis and treatment essential.

References

American Diabetes Association. (2024). Standards of medical care in diabetes—2024. Diabetes Care, 47(Suppl. 1), S1–S350.

Jameson, J. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Longo, D. L., & Loscalzo, J. (2022). Harrison’s principles of internal medicine (21st ed.). McGraw-Hill.

Katzung, B. G., & Trevor, A. J. (2023). Basic and clinical pharmacology (15th ed.). McGraw-Hill.

Melmed, S., Polonsky, K. S., Larsen, P. R., & Kronenberg, H. M. (2020). Williams textbook of endocrinology (14th ed.). Elsevier.

National Kidney Foundation. (2023). KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International Supplements.

World Health Organization. (2022). Nutritional anaemias: Tools for effective prevention and control. WHO Press.