The home health nurse is monitoring an 8-month-old child with hypothyroidism taking levothyroxine (Synthroid). Which symptoms does the nurse recognize as signs of overdose? (Select all that apply)

Choice A reason: Urine specific gravity of 1.025 indicates concentrated urine, reflecting dehydration as kidneys conserve water. While this confirms fluid deficit, it is not immediately life-threatening. Hypokalemia (2.5 mEq/L) poses a greater risk, as it can cause cardiac arrhythmias, requiring urgent correction to prevent life-threatening complications in a dehydrated child.

Choice B reason: Blood glucose of 110 mg/dL is within normal range (70-140 mg/dL) and does not indicate a priority issue in dehydration. Dehydration may elevate glucose due to hemoconcentration, but this value is normal. Hypokalemia is more critical, as low potassium disrupts cardiac and muscle function, necessitating immediate intervention.

Choice C reason: Potassium of 2.5 mEq/L indicates hypokalemia, a life-threatening condition in dehydration due to urinary potassium loss. Low potassium disrupts cardiac membrane potential, risking arrhythmias like ventricular tachycardia. In a 4-year-old, this is the priority finding, requiring immediate potassium replacement to stabilize cardiac function and prevent sudden death.

Choice D reason: Sodium of 142 mEq/L is within normal range (135-145 mEq/L) and does not indicate an immediate threat in dehydration. Mild hypernatremia may occur due to water loss, but this value is normal. Hypokalemia is more urgent, as it causes cardiac instability, making sodium a lower priority for intervention.

Choice A reason: Long-acting insulins, like glargine, provide basal coverage over 24 hours with no peak. Regular insulin has a shorter duration (6-8 hours) and peak (2-4 hours), making it unsuitable for basal control. Its rapid onset classifies it as short-acting, not long-acting, for managing postprandial glucose spikes in diabetes.

Choice B reason: Rapid-acting insulins, like aspart, have an onset of 10-15 minutes and peak at 1-2 hours. Regular insulin has a slower onset (30-60 minutes) and longer duration (6-8 hours), making it short-acting, not rapid-acting. This distinction is critical for timing insulin administration in diabetes management.

Choice C reason: Intermediate-acting insulins, like NPH, have an onset of 1-2 hours and duration of 12-18 hours. Regular insulin’s shorter duration (6-8 hours) and peak (2-4 hours) classify it as short-acting, used for prandial coverage, not intermediate basal control, making this an incorrect classification.

Choice D reason: Regular insulin is short-acting, with an onset of 30-60 minutes, peak at 2-4 hours, and duration of 6-8 hours. It effectively controls postprandial glucose spikes in diabetes by mimicking physiological insulin release. This classification guides its use in meal-time dosing, making it the correct choice.