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CHAPTER 12: MICROVASCULAR COMPLICATIONS OF DIABETES: PERIPHERAL NEUROPATHY

During triage, the nurse interviews AP to obtain a medication history. AP reports taking all of his medications every day in the morning with breakfast except for the medications he has to inject. He injects his insulin glargine in the evening every day and his dulaglutide every Monday. After completing a medication reconciliation using the medication history obtained from the triage nurse and the prescribed medication list in the EHR, you were able to identify which of the following medication-related problem(s)?

A. AP is taking atorvastatin incorrectly

B. AP is taking levothyroxine incorrectly

C. AP is taking dulaglutide incorrectly

D. All of the above

Correct answer: B

Rationale: Levothyroxine should be administered consistently in the morning on an empty stomach, at least 30 to 60 minutes before food and should not be administered within 4 hours of calcium- or iron-containing products (e.g., multivitamins). AP is taking atorvastatin as prescribed once daily (it can be taken at any time). AP is taking dulaglutide correctly once weekly (can be taken irrespective to meals or time of day).

Which of the following is NOT in the differential diagnosis for diabetic peripheral neuropathy?

A. Thyroid disorder

B. Vitamin B12 deficiency

C. Vitamin K deficiency

D. Chronic amiodarone use

Correct answer: C

Rationale: Thyroid dysfunction, B12 deficiency, and chronic amiodarone use are associated with neuropathy and need to be ruled out before determining if a patient has neuropathy of diabetic origin. Conversely, vitamin K does not need to be evaluated, as imbalances are not necessarily shown to have correlation to neuropathy.2

Which of the following is NOT a potential sign or symptom associated with cardiovascular autonomic neuropathy (CAN)?

A. Syncope

B. Anhidrosis

C. Resting tachycardia

D. Orthostatic hypotension

Correct answer: B

Rationale: CAN is associated with signs and symptoms of abnormal blood pressure control, resting tachycardia, and orthostatic hypotension. Answers A, C, and D (syncope, resting tachycardia, and orthostatic hypotension, respectively) fall within the criteria of CAN and are therefore incorrect. Answer B can be due to neuropathy but does not fall within the criteria of CAN specifically. Answer B, anhidrosis (abnormal sweating), is a sudomotor complication. Therefore, ...

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