The nurse is caring for a patient with Graves Disease and anemia who had a thyroidectomy two days ago.
Based on the laboratory results below, which medication will the nurse administer first? Creatinine 1.2 mg/dL. Calcium 8.5 mg/dL. Hemoglobin 12 g/dL. Hematocrit 36%.

Levothyroxine 50 mcg orally.

Calcium gluconate 45 mg intravenously.

Epoetin alfa 300 units per kilogram subcutaneously.

Potassium chloride 40 mEq orally.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Levothyroxine is used for the replacement of thyroid hormone in patients with hypothyroidism. While it is essential for long-term management of thyroidectomy patients, it is not the immediate priority. The patient’s calcium levels are low, indicating the need for urgent correction to prevent complications such as tetany or cardiac issues.

Choice B rationale

Calcium gluconate is crucial to administer first in this scenario because the patient's calcium level is 8.5 mg/dL, which is on the lower end of the normal range. After a thyroidectomy, patients are at risk of hypocalcemia due to potential damage to the parathyroid glands, which regulate calcium levels. Intravenous calcium gluconate helps rapidly correct any deficiency and prevents severe symptoms like muscle cramps, tingling, or cardiac arrhythmias.

Choice C rationale

Epoetin alfa is used to stimulate red blood cell production in patients with anemia, particularly those with chronic kidney disease or undergoing chemotherapy. Although this patient has anemia, indicated by a hemoglobin level of 12 g/dL and hematocrit of 36%, the levels are not critically low. Addressing the low calcium level takes precedence to prevent immediate life-threatening complications.

Choice D rationale

Potassium chloride is used to treat or prevent potassium deficiency. The patient’s laboratory results do not indicate any abnormality in potassium levels, making this medication unnecessary at this time. Administering it without indication could lead to hyperkalemia, which poses risks such as cardiac dysrhythmias.

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Correct Answer is A

Explanation

Choice A rationale

Notifying the healthcare provider is the appropriate first action when significant ecchymosis is observed in a patient with Cushing's syndrome, as it may indicate a need for medical intervention.

Choice B rationale

Administering insulin is not relevant as the primary concern here is the ecchymosis, not hyperglycemia.

Choice C rationale

While providing skin care is important, it does not address the potential underlying cause of the ecchymosis, necessitating provider notification first.

Choice D rationale

Monitoring intake and output and daily weight is a general care measure but does not address the immediate concern of ecchymosis observed.

A. Administer intravenous fluids with glucose. B. Administer 1000 mg of acetaminophen orally. C. Educate the patient about ordered hydrocortisone. D. Explore options to minimize stress.

Correct Answer is A

Explanation

Choice A rationale

Administering intravenous fluids with glucose is essential for a patient with Addison's disease who has been exposed to stressors like prolonged sun exposure. Patients with Addison's disease may experience an adrenal crisis, characterized by low blood pressure, dehydration, and hypoglycemia. Intravenous fluids with glucose help to rehydrate the patient and restore blood sugar levels, which are critical in preventing shock and other severe complications.

Choice B rationale

Administering 1000 mg of acetaminophen orally is not the priority intervention for this patient. While it may help reduce fever, it does not address the underlying issues of Addison's disease, such as hypoglycemia and dehydration, which are more urgent. The primary concern should be stabilizing the patient's vital signs and electrolyte balance.

Choice C rationale

Educating the patient about ordered hydrocortisone is important for long-term management of Addison's disease, but it is not the immediate priority in an emergency situation. The patient requires prompt medical intervention to address the acute symptoms of adrenal insufficiency, such as lethargy and hypoglycemia.

Choice D rationale

Exploring options to minimize stress is relevant for managing Addison's disease in general, as stress can trigger an adrenal crisis. However, in the emergency department, the nurse's priority should be to stabilize the patient and manage acute symptoms. Stress management can be addressed once the patient's condition is stabilized.

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The nurse is caring for a patient with Graves Disease and anemia who had a thyroidectomy two days ago.Based on the laboratory results below, which medication will the nurse administer first? Creatinine 1.2 mg/dL. Calcium 8.5 mg/dL. Hemoglobin 12 g/dL. Hematocrit 36%.

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Naxlex Comprehensive Predictor Exams

The nurse has received SBAR report on a patient with Cush and ecchymoses on the upper extremity.What action should the nurse implement first?

Correct Answer is A

Explanation

The nurse is caring for a patient with Addison's disease in the emergency department.The patient states that they were out in the sun gardening all day and is now lethargic, forgetful, and has a temperature of 101.5°F. What intervention will the nurse prioritize when caring for this patient?

Correct Answer is A

Explanation

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The nurse is caring for a patient with Graves Disease and anemia who had a thyroidectomy two days ago.
Based on the laboratory results below, which medication will the nurse administer first? Creatinine 1.2 mg/dL. Calcium 8.5 mg/dL. Hemoglobin 12 g/dL. Hematocrit 36%.