Voiceover: Welcome to NP certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Leading NP expert Dr. Margaret Fitzgerald shares her knowledge and experience to help you dissect the anatomy of a test question, so you can better understand how to arrive at the correct test answer.
So, if you're ready, let's jump right in.
Margaret Fitzgerald: A 77-year-old man is in for a routine follow-up visit. He has a 20-year history of type 2 diabetes and hypertension, as well as a 5-year history of stage 3B chronic kidney disease, or CKD. At this visit, his A1C is 8.4% and his estimated GFR is 42 mL per minute. His BP is 128/76.
He states he's feeling well and denies headache, visual changes, dizziness, and hypoglycemic episodes. His medications include metformin, amlodipine, lisinopril, and rosuvastatin. So, just to recap. Metformin, a biguanide, though nobody ever thinks of it that way.
Amlodipine, a calcium channel blocker. It's for his high blood pressure. Lisinopril, an ACE inhibitor and rosuvastatin, which is brand name Crestor®, for his dyslipidemia.
And reviewing his current medication, the NP considers which of the following options:
A: Prescribe glipizide.
B: Add pioglitazone.
C: Continue on his current medication without adjustment.
D: Initiate therapy with canagliflozin.
And the correct answer here is D: Initiate therapy with canagliflozin. So, where should we start with a question like this? First, let's determine what kind of a question it is.
Given the patient has been seen in the past, diagnosed and treated, and is now having ongoing care of how he's doing, this is an evaluation question where we're being asked to take a look at response to care. First, some background information. Type 2 diabetes is by far the most common endocrinopathy noted in North America, accounting for more than 95% of all people who have been diagnosed with diabetes.