A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day, the client states, "I feel numbness and tingling around my mouth." What action should the nurse take?

Choice A rationale: Hyperglycemia results from a lack of insulin, leading to an inability of cells to uptake glucose. Glucagon functions as a hormone that stimulates the liver to convert stored glycogen into glucose, thereby raising blood glucose levels. Administering glucagon in an already hyperglycemic state would exacerbate the condition, potentially leading to a dangerous spike in blood sugar. It's used for low, not high, blood sugar.
Choice B rationale: Hypoglycemia, a dangerously low blood glucose level (typically below 70 mg/dL), can be caused by an overdose of insulin, which drives too much glucose into cells. Glucagon is a hormone that counteracts insulin's effects by stimulating glycogenolysis in the liver, releasing stored glucose into the bloodstream. This rapid increase in circulating glucose effectively treats the acute hypoglycemic episode, making it an essential emergency treatment.
Choice C rationale: Diabetic ketoacidosis (DKA) is a severe metabolic complication of diabetes characterized by hyperglycemia, ketosis, and metabolic acidosis. It is caused by an absolute or relative lack of insulin. Administering glucagon would increase blood glucose levels even further, worsening the hyperglycemia, which is a primary component of DKA. Insulin and fluid replacement are the mainstays of treatment for DKA.
Choice D rationale: Hyperglycemia during 'sick days' is a common phenomenon in people with diabetes due to increased stress hormones like cortisol and epinephrine, which raise blood glucose. Administering glucagon would further elevate blood sugar, intensifying the existing hyperglycemia. Therefore, glucagon is contraindicated in this scenario, as it would worsen the metabolic state rather than improving it.

Choice A rationale: Hypothyroidism is a chronic condition where the thyroid gland does not produce sufficient thyroid hormones. Symptoms improve because levothyroxine replaces the missing hormones, not because the underlying thyroid dysfunction has resolved. Stopping the medication will lead to a return of symptoms as the synthetic hormone is no longer present to regulate metabolism.
Choice B rationale: The duration of levothyroxine therapy is not determined by a specific time frame like one year. The need for the medication is based on the chronic nature of the disease itself. Stopping the medication prematurely will result in the return of hypothyroid symptoms. It is a chronic condition that requires consistent management.
Choice C rationale: Thyroid hormone levels are critical for fetal development, and a woman with hypothyroidism must continue her medication throughout pregnancy. In fact, the dose may need to be increased. Stopping the medication before pregnancy is medically inappropriate and dangerous for both the woman and a potential fetus, as it would cause a relapse of her hypothyroid state.
Choice D rationale: Hypothyroidism is a lifelong condition for most patients because the thyroid gland's ability to produce hormones is permanently impaired. Levothyroxine provides exogenous hormone replacement, and without it, the patient's body will return to a hypothyroid state. Therefore, continuous therapy is essential for maintaining normal metabolic function and preventing the recurrence of symptoms.