A client has a history of atrial fibrillation and is taking an oral anticoagulant. The client has been newly diagnosed with hypothyroidism and placed on levothyroxine.
What assessment should the nurse prioritize?
Monitoring the client for increased bruising.
Assessing for signs and symptoms of infection.
Assessing the client’s level of consciousness.
Monitoring the client’s electrolyte levels.
The Correct Answer is A
This is because levothyroxine can increase the anticoagulant effect of oral anticoagulants and increase the risk of bleeding. The nurse should check the client’s prothrombin time and international normalized ratio (INR) regularly and report any abnormal values to the prescriber.
Choice B is wrong because hypothyroidism does not increase the risk of infection.
Choice C is wrong because hypothyroidism does not affect the level of consciousness unless it is severe and causes myxedema coma.
Choice D is wrong because hypothyroidism does not cause electrolyte imbalances.
Normal ranges for prothrombin time are 11 to 13.5 seconds and for INR are 0.8 to 1.22.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
This is an antithyroid medication that can be used safely during pregnancy, as it has a lower risk of causing birth defects or fetal hypothyroidism than other drugs. Propylthiouracil inhibits the synthesis of thyroid hormones and also blocks their conversion to the more active form.
Choice A is wrong because radioactive iodine is contraindicated during pregnancy, as it can cross the placenta and damage the fetal thyroid gland.
Radioactive iodine is used to destroy overactive thyroid cells and treat hyperthyroidism.
Choice B is wrong because alendronate is not an antithyroid medication, but a bisphosphonate that is used to treat osteoporosis and prevent bone loss.
Alendronate should not be used during pregnancy, as it may affect fetal bone development and mineralization.
Choice D is wrong because methimazole is another antithyroid medication, but it is not the drug of choice for pregnant women, as it has a higher risk of causing birth defects or fetal hypothyroidism than propylthiouracil.
Methimazole also inhibits the synthesis of thyroid hormones, but does not block their conversion to the more active form.
Correct Answer is C
Explanation
This is because cortisol exhibits a proper 24-h circadian rhythm that affects the cardiovascular system and other organs. Cortisol levels are normally low at the beginning of sleep and high at the moment of awakening. Taking corticosteroids at this time mimics the natural cortisol rhythm and may reduce side effects such as adrenal suppression, sleep disturbances and cardiovascular complications.
Choice A is wrong because taking corticosteroids at 08:00 may not coincide with the client’s natural cortisol peak and may cause insomnia or unpleasant dreams.
Choice B is wrong because taking corticosteroids at 22:00 may disrupt the client’s sleep quality and increase the risk of nocturnal hypertension.
Choice D is wrong because taking corticosteroids at 16:00 may interfere with the client’s natural cortisol decline and cause hyperglycemia or dyslipidemia.
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