A client is ordered to receive insulin lispro (Humalog) at mealtimes. When should the nurse instruct the client to administer the medication?

Choice A rationale:

Fava beans do not interact with antithyroid medications and do not need to be avoided specifically for this reason. However, it's important to note that fava beans can cause a condition called favism in individuals with a certain genetic predisposition. Favism is characterized by hemolytic anemia, which is the breakdown of red blood cells. If a patient has a history of favism or is unsure of their risk, it's best to avoid fava beans while on antithyroid medication and consult with their healthcare provider.

Choice B rationale:

Shellfish does not typically interact with antithyroid medications. However, some individuals with hyperthyroidism may have co-existing allergies to shellfish. In those cases, it's important to avoid shellfish to prevent allergic reactions, but this is not due to a direct interaction with antithyroid medications.

Choice C rationale:

Foods high in purine, such as organ meats, red meat, and certain seafood, are often restricted in individuals with gout. Gout is a form of arthritis caused by the buildup of uric acid crystals in the joints. While hyperthyroidism can sometimes increase uric acid levels, there's no specific interaction between antithyroid medications and purine-rich foods. Therefore, avoiding purine- rich foods is not necessary for those on antithyroid therapy unless they have gout or a predisposition to it.

Choice D rationale:

Grapefruit and grapefruit juice can significantly interact with antithyroid medications, particularly methimazole and propylthiouracil. These medications are broken down by an enzyme called CYP3A4 in the liver. Grapefruit juice inhibits the activity of CYP3A4, which can lead to increased levels of antithyroid medications in the bloodstream. This can increase the risk of side effects from the medication, such as liver damage, bone marrow suppression, and skin reactions. Therefore, it's crucial for patients on antithyroid therapy to avoid grapefruit and grapefruit juice.

Choice A rationale:

Calcitonin (Fortical) is a hormone that lowers blood calcium levels. It is not indicated for the treatment of hypocalcemia caused by parathyroid hormone deficiency. In fact, it could worsen the condition by further reducing calcium levels.

Calcitonin is primarily used to treat hypercalcemia (high calcium levels) and osteoporosis.

It works by inhibiting osteoclast activity, which reduces bone resorption and calcium release into the bloodstream.

Choice B rationale:

Calcium is the essential mineral for treating hypocalcemia. It directly replenishes calcium levels in the blood.

Calcium can be administered orally (PO) or intravenously (IVPB), depending on the severity of the hypocalcemia and the patient's condition.

Oral calcium is often preferred for mild to moderate hypocalcemia, while IV calcium is typically used for severe hypocalcemia or when rapid correction is necessary.

Calcium supplements are available in various forms, including calcium carbonate, calcium citrate, and calcium gluconate. The dosage of calcium will be individualized based on the patient's serum calcium levels and clinical response.

Choice C rationale:

Vitamin B12 is not directly involved in calcium regulation. It is essential for red blood cell production and nerve function. While vitamin B12 deficiency can sometimes be associated with hypocalcemia, it is not a primary treatment for this condition. Choice D rationale:

Vitamin D3 (Calcitriol) is a hormone that aids in calcium absorption from the intestines. It is often used in conjunction with calcium supplements to treat hypocalcemia.

However, vitamin D3 alone is not sufficient to treat hypocalcemia caused by parathyroid hormone deficiency. Parathyroid hormone is essential for activating vitamin D3 in the kidneys, so its deficiency limits the effectiveness of vitamin D3.