A patient with Graves’ disease exhibits symptoms of tachycardia, heat intolerance, and exophthalmos. Which drug is used to alter thyroid hormone levels prior to surgery?

Choice A rationale:

Prednisolone is a corticosteroid that has anti-inflammatory and immunosuppressant effects. It does not have a direct effect on urine output.

While it may be used in some cases of head trauma to reduce inflammation, it would not be the first-line choice to address excessive urine output.

Prolonged use of prednisolone can have adverse effects such as fluid retention, weight gain, hypertension, and hyperglycemia.

Choice B rationale:

Corticotropin (ACTH) is a hormone that stimulates the adrenal glands to produce cortisol. Cortisol has a variety of effects, including increasing blood pressure and blood sugar levels.

It does not have a direct effect on urine output and would not be used to address this issue.

ACTH can have significant side effects, including fluid retention, electrolyte imbalances, and mood changes.

Choice C rationale:

Vasopressin is a hormone that regulates fluid balance in the body. It works by increasing water reabsorption in the kidneys, which can help to reduce urine output.

It is the most appropriate medication to administer to a client with excessive urine output following head trauma.

Vasopressin can be administered intravenously or subcutaneously. It is important to monitor the client's fluid intake and output closely when administering vasopressin, as it can lead to fluid overload if not used carefully.

Choice D rationale:

Calciferol is a form of vitamin D that helps to regulate calcium and phosphorus levels in the body. It does not have a direct effect on urine output.

It would not be used to address excessive urine output in a client with head trauma.

Excessive doses of calciferol can lead to hypercalcemia, which can cause kidney stones, bone pain, and other serious problems.

Choice A rationale:

Hypertension is not a primary contraindication for mannitol use. While it's important to monitor blood pressure during mannitol administration, it's not the most concerning factor in this scenario.

Mannitol can even be used cautiously in hypertensive patients with conditions like intracranial hypertension or acute renal failure, where its benefits may outweigh the potential risks of exacerbating hypertension.

Choice B rationale:

Mannitol is actually indicated for the treatment of increased intracranial pressure (ICP). It works by drawing fluid from the brain tissues into the bloodstream, thereby reducing pressure within the skull.

Therefore, a patient with ICP would not be a concern for mannitol administration; rather, they would be a potential candidate for its use.

Choice D rationale:

While fluid volume overload can be a concern with mannitol use, it's typically managed with careful monitoring and fluid restriction.

The more significant concern in this scenario is congestive heart failure (CHF).

Choice C rationale:

Mannitol is contraindicated in patients with congestive heart failure (CHF). Here's why:

Increased Circulating Volume: Mannitol is an osmotic diuretic, meaning it draws fluid from the tissues into the bloodstream, increasing circulating blood volume. This can overload the already compromised heart in CHF patients, leading to worsening heart failure and pulmonary edema.

Elevated Blood Pressure: Mannitol can also cause a transient increase in blood pressure due to its osmotic effects. This can further strain the heart and worsen CHF symptoms.

Renal Impairment: CHF patients often have impaired renal function, which can reduce their ability to excrete mannitol effectively. This can lead to fluid retention and electrolyte imbalances, further complicating CHF management.

In summary, administering mannitol to a patient with CHF could potentially lead to:

Exacerbation of heart failure symptoms Pulmonary edema

Worsening renal function Electrolyte imbalances Increased risk of mortality

Therefore, it's crucial to avoid mannitol use in patients with CHF and to closely monitor fluid status and electrolytes in those who must receive it for other indications.