A nurse is reviewing a client’s laboratory results and sees that their hemoglobin A1C is 9. Which of the following statements from the nurse is appropriate?

Choice A reason: Lower Extremities Edematous with Decreased Pulses and Cool to the Touch

Lower extremities that are edematous with decreased pulses and cool to the touch can indicate severe peripheral artery disease (PAD) and poor blood circulation1. While this is a serious condition that requires medical attention, it is not necessarily an immediate emergency unless there are signs of acute limb ischemia, such as sudden pain or loss of function. Chronic symptoms like these often require ongoing management and monitoring rather than immediate intervention.

Choice B reason: Pain, Pallor, and Paresthesia in the Foot

Pain, pallor, and paresthesia (the three Ps) in the foot are classic signs of acute limb ischemia, a medical emergency that requires immediate intervention. Acute limb ischemia occurs when there is a sudden decrease in blood flow to a limb, leading to tissue damage and potential loss of the limb if not treated promptly4. The presence of these symptoms indicates that the limb is not receiving adequate blood supply, necessitating urgent medical attention to restore circulation and prevent permanent damage.

Choice C reason: Presence of an Open Wound Near the Ankle with Serous Drainage and Pruritus

An open wound near the ankle with serous drainage and pruritus (itching) suggests a chronic wound or ulcer, which is common in patients with PAD5. While this condition requires medical treatment to prevent infection and promote healing, it does not typically constitute an immediate emergency unless there are signs of severe infection, such as increased redness, warmth, or purulent drainage. Chronic wounds need regular care and monitoring but are not usually life-threatening.

Choice D reason: Murmur Auscultated at the Left Sternal Border, Slight Dyspnea, and Lower Extremity Edema

A murmur auscultated at the left sternal border, slight dyspnea (shortness of breath), and lower extremity edema can indicate heart valve disease or heart failure. These symptoms are concerning and require medical evaluation, but they do not typically represent an immediate emergency unless the patient is experiencing severe symptoms such as acute heart failure or cardiogenic shock. These conditions require prompt but not necessarily emergent intervention.

Choice A Reason:

Taking levothyroxine with high-protein foods can interfere with the absorption of the medication. High-protein foods can bind to the medication, reducing its effectiveness. Therefore, it is not recommended to take levothyroxine with high-protein foods.

Choice B Reason:

While it is important to take levothyroxine with a full glass of water to ensure the tablet is swallowed properly and to aid in its absorption, taking it with fruit juice is not recommended. Certain juices, like grapefruit juice, can interfere with the absorption of levothyroxine.

Choice C Reason:

Levothyroxine should be taken on an empty stomach, ideally 30 to 60 minutes before breakfast or at least 3 to 4 hours after the last meal. This timing helps ensure optimal absorption of the medication. Food can significantly reduce the absorption of levothyroxine, making it less effective.

Choice D Reason:

Taking levothyroxine during a meal is not recommended because food can interfere with the absorption of the medication. It is best to take it on an empty stomach to ensure maximum absorption and effectiveness.