A patient at the clinic says, "I always walk after dinner, but lately my leg cramps and hurts after just a few minutes. The pain goes away after I stop walking, though." Which focused assessment would the nurse make?

Choice A reason: Low T4 levels do not indicate hyperthyroidism. In fact, low levels of T4 are typically associated with hypothyroidism, a condition in which the thyroid gland does not produce enough thyroid hormones.
Choice B reason: High T4 levels are indicative of hyperthyroidism. In hyperthyroidism, the thyroid gland is overactive and produces excessive amounts of thyroid hormone (T4), leading to elevated T4 levels in the blood.
Choice C reason: Low TSH levels are also indicative of hyperthyroidism. The pituitary gland secretes TSH to regulate thyroid hormone production. When thyroid hormone levels are high, as in hyperthyroidism, the pituitary gland reduces TSH secretion, resulting in low TSH levels.
Choice D reason: High TSH levels are not associated with hyperthyroidism. Elevated TSH levels are more commonly seen in hypothyroidism, where the thyroid gland is underactive, and the pituitary gland compensates by increasing TSH production to stimulate the thyroid gland.

Choice A reason:
Administering furosemide in this scenario would further lower the serum potassium level, as furosemide is a loop diuretic known for causing potassium loss through urine. This action could worsen the patient’s hypokalemia, leading to severe complications such as cardiac arrhythmias. Therefore, administering furosemide in the presence of hypokalemia is inappropriate and could put the patient at significant risk.
Choice B reason:
Administering both spironolactone and furosemide together without addressing the hypokalemia would not be safe. While spironolactone is a potassium-sparing diuretic, combining it with furosemide could negate its potassium-sparing effects. Furthermore, administering furosemide when hypokalemia is present could cause further electrolyte imbalance. Proper evaluation of the patient's condition and selective administration of the medications are crucial in this case.
Choice C reason:
Withholding both medications and attributing the decision to contraindications with hyperkalemia is incorrect because the reported potassium level (3.2 mEq/L) reflects hypokalemia, not hyperkalemia. Misinterpreting the lab result could delay appropriate treatment, such as correcting the potassium level or safely administering a medication that would not exacerbate the hypokalemia. Proper communication with the healthcare provider is necessary for effective patient care.
Choice D reason:
Administering spironolactone is the best action in this scenario because it is a potassium-sparing diuretic. By administering spironolactone, the risk of worsening hypokalemia is minimized. Notifying the healthcare provider about the low potassium level ensures appropriate monitoring and any necessary interventions, such as potassium supplementation. This approach is both safe and effective in managing the patient’s current condition while adhering to standard nursing practices.