Ms. Georgia is a 58-year-old African American female. She works full time as a high school math teacher. She is currently working on a specialist degree. taking night classes at one of the local colleges. Eugena has noticed that she is more sluggish than normal. She doesn't have the energy for girls nights out anymore, and for the past 4 months she has not attended her exercise classes. She has gained 25 pounds in the past 4 to 6 months. Her friends say she acts depressed and encouraged her to see her provider. Eugena made an appointment to see her provider. She followed up with her provider and was diagnosed with hypothyroidism and prescribed levothyroxine. She states she is not a fan of taking any medications.
Several days later, her husband brings her to the Emergency Department. Ms. Georgia is barely conscious, has significant swelling including facial swelling. Her husband states earlier she was complaining of being very cold and "she seems to have had a seizure. Her husband states she has been sick for the last couple of weeks.
Partial laboratory values results show: anemia, hyponatremia, hypoglycemia, hypercholesterolemia, and high serum creatine kinase concentrations. Low serum FT4 and high serum TSH.
SPO2-93%
HR-54
BP-90/56
What is going on with Ms. Georgia?
Thyrotoxicosis
Diabetic Ketoacidosis
Myxedema coma
Hyperosmolar hyperglycemic state
The Correct Answer is C
A. Thyrotoxicosis is caused by excess thyroid hormone and usually presents with tachycardia, weight loss, heat intolerance, tremors, and anxiety. Ms. Georgia’s hypothermia, bradycardia, lethargy, and generalized edema are opposite to these findings, making thyrotoxicosis unlikely.
B. DKA occurs in patients with type 1 or insulin-dependent diabetes and presents with hyperglycemia, ketonuria, metabolic acidosis, nausea, vomiting, and Kussmaul respirations. Ms. Georgia is hypoglycemic, not hyperglycemic, and there is no evidence of ketones, so DKA does not fit her presentation.
C. Myxedema coma is a life-threatening complication of severe hypothyroidism, most often seen in older women and precipitated by illness, cold exposure, or medication noncompliance. Ms. Georgia shows altered mental status, hypothermia, bradycardia, hypotension, hyponatremia, hypoglycemia, facial and generalized edema, and lab findings consistent with severe hypothyroidism including low FT4, high TSH, hypercholesterolemia, high creatine kinase, and anemia. Her recent illness and noncompliance with levothyroxine likely triggered this condition. Immediate treatment requires IV thyroid hormone replacement, supportive care for hypotension and hypothermia, correction of electrolytes, and management of precipitating factors.
D. HHS presents with extreme hyperglycemia, hyperosmolarity, dehydration, and altered mental status in type 2 diabetes. Ms. Georgia is hypoglycemic, not hyperglycemic, and her history and lab findings point toward severe hypothyroidism rather than HHS.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D","E"]
Explanation
A. Propofol itself can cause pain at the injection site, but the use of a local anesthetic prior to infusion is not routinely recommended. Pain can sometimes be minimized by using a larger vein, slower administration, or lidocaine mixed with the propofol, but prophylactic local anesthetic at the IV site is not standard practice.
B. Propofol is a lipid emulsionand is highly prone to bacterial contamination. Open vials should not be refrigerated for extended periods; they are generally discarded within 6 hours of openingto reduce the risk of infection, especially propofol-related sepsis.
C. Propofol dosing for continuous sedationis weight-based, typically administered as mg/kg/hr, to maintain appropriate sedation levels and minimize adverse effects such as hypotension or oversedation. Close monitoring of infusion rates is essential.
D. Extended propofol infusions can cause propofol infusion syndrome, a rare but life-threatening condition characterized by rhabdomyolysis, hyperkalemia, metabolic acidosis, and cardiac failure. A CPK >5000 units/Lmay indicate rhabdomyolysis, and the infusion should be discontinued immediatelyto prevent further complications.
E. Propofol can cause respiratory depression and hypotension, even at standard doses. Nurses must ensure airway management and resuscitation equipment are readily available, and continuous monitoring of respiratory status, oxygen saturation, and hemodynamicsis required during administration.
Correct Answer is C
Explanation
A. Methohexital is a short-acting barbiturateused for induction of anesthesia. It is not typically used as a premedication to prevent ketamine-related adverse reactions or to reduce preoperative anxiety. Its primary role is to induce sedation, not anxiolysis in the perioperative period.
B. Atropine is an anticholinergicused to reduce secretions (saliva, bronchial) or prevent bradycardia during anesthesia. While it can mitigate some cardiovascular effects of ketamine (e.g., bradycardia), it does not reduce ketamine-induced emergence reactionssuch as hallucinations or dysphoria, nor does it address anxiety.
C. Diazepam is a benzodiazepinethat provides anxiolytic, sedative, and amnestic effects. Administered as a premedication, it can minimize ketamine’s adverse psychological effectsin the post-anesthesia recovery period, such as hallucinations, agitation, or vivid dreams. It also helps reduce pre-surgical anxiety, making the patient more comfortable before induction. Benzodiazepines are commonly used as adjuncts when ketamine is planned, especially in adult patients sensitive to emergence reactions.
D. Sevoflurane is a volatile inhalation anestheticused for induction or maintenance of general anesthesia. While it provides sedation and hypnosis, it is not used as a premedicationto reduce ketamine-related adverse reactions or anxiety. Its use is limited to the intraoperative or induction period.
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