A male patient who has a history of type 2 DM is admitted to the medical unit with a diagnosis of pneumonia.
The patient has many Questions regarding his care and asks the nurse why everyone keeps telling him about HbA1C.

What can the nurse inform the patient about the use of HbA1C in diabetes mellitus?

Choice A rationale

Chest pain and palpitations in a patient taking levothyroxine can be signs of thyroid hormone overdose or hyperthyroidism, which can induce cardiac side effects. The cardiovascular system is highly sensitive to thyroid hormones. These symptoms could be indicative of myocardial ischemia, tachycardia, or dysrhythmias, which are serious and require immediate medical evaluation. The nurse's priority is to notify the healthcare provider immediately for dose adjustment or further cardiac workup.

Choice B rationale

Advising the patient to rest and monitor symptoms is an insufficient and potentially dangerous action. While rest may temporarily alleviate some symptoms, it does not address the underlying cause, which could be an overdose of the medication. The nurse should not delay notifying the healthcare provider, as the cardiac symptoms could escalate and lead to a more serious event, such as a myocardial infarction.

Choice C rationale

Antacids containing calcium or aluminum can interfere with the absorption of levothyroxine, but they are not a treatment for chest pain or palpitations related to the medication. Administering an antacid would be inappropriate and would not address the patient's serious cardiac symptoms. The nurse's focus should be on addressing the potential cardiac side effects of the medication and reporting them to the healthcare provider.

Choice D rationale

Increasing the dose of levothyroxine would worsen the patient's symptoms. The chest pain and palpitations suggest that the patient may be receiving too high a dose of the thyroid hormone, leading to symptoms of hyperthyroidism. Increasing the dose would further elevate the circulating thyroid hormone levels, exacerbating the cardiac side effects and increasing the risk of a serious cardiac event.

Choice A rationale

While the chest is a common site for patch application, it is not mandatory to apply the patch directly over the heart. The patch can be applied to any hairless area of the body to allow for optimal absorption of the medication through the skin.

Choice B rationale

Transdermal nitroglycerin patches are designed to provide a continuous, sustained release of the medication. Applying two patches at a time can lead to an overdose, resulting in severe hypotension, headache, and dizziness. Patients should be instructed to apply a new patch each day and remove the old one.

Choice C rationale

Hair on the skin can interfere with the adherence of the patch and the absorption of the medication. Applying the patch to a hairless area ensures that the medication is in direct contact with the skin, allowing for proper transdermal delivery and therapeutic effect.

Choice D rationale

Applying petroleum jelly to the skin before applying a transdermal patch can create a barrier that prevents the medication from being absorbed. This would render the patch ineffective. The skin should be clean, dry, and free of any lotions or creams before patch application.