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 C

Explanation

The correct answer is Choice C.

Choice A rationale

Facial swelling and jugular vein distension (JVD) are indicative of superior vena cava syndrome (SVCS), not tumor lysis syndrome (TLS). SVCS occurs when the superior vena cava, which carries blood from the head, neck, upper chest, and arms to the heart, is obstructed. This can lead to facial swelling, cyanosis, and distended neck veins due to increased venous pressure.

Choice B rationale

Muscle weakness, confusion, polyuria, and polydipsia are symptoms of hypercalcemia. Hypercalcemia is characterized by elevated levels of calcium in the blood, which can cause neuromuscular and cognitive symptoms, excessive urination, and increased thirst.

Choice C rationale

Tumor lysis syndrome (TLS) is characterized by rapid destruction of tumor cells, leading to elevated levels of uric acid, potassium, and phosphate. Symptoms include flank pain due to uric acid crystallization in the kidneys, and abnormal heart rhythms due to hyperkalemia.

Choice D rationale

Elevated liver function tests, jaundice, and blistering skin rash are symptoms of liver toxicity or hepatic dysfunction, possibly due to drug-induced liver injury. These symptoms are not related to tumor lysis syndrome (TLS).

A. "You will monitor me for flu-like symptoms during my immunotherapy infusions.” B. "I do not have to worry about losing my hair after this treatment.” C. "Immunotherapy uses my own immune system to help fight the cancer.” D. "This therapy will prevent me from getting hospital-acquired infections.”

Correct Answer is D

Explanation

The correct answer is Choice D.

Choice A rationale

Monitoring for flu-like symptoms during immunotherapy infusions is crucial because these medications can cause cytokine release syndrome. Symptoms like fever, chills, fatigue, and muscle aches are common side effects of immunotherapy and require close monitoring to manage and mitigate adverse reactions.

Choice B rationale

Immunotherapy generally does not cause hair loss, unlike traditional chemotherapy. Hair loss occurs because chemotherapy targets rapidly dividing cells, including hair follicle cells. Immunotherapy works by enhancing the body's immune response to cancer cells without targeting hair follicles.

Choice C rationale

Immunotherapy leverages the patient's immune system to recognize and attack cancer cells. It enhances the body's natural defenses by boosting immune system activity or by counteracting signals produced by cancer cells that suppress immune responses.

Choice D rationale

Immunotherapy does not prevent hospital-acquired infections. While it strengthens the immune system against cancer, it does not provide general protection against pathogens causing nosocomial infections. Patients undergoing immunotherapy should still follow standard precautions to avoid infections.

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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

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Explanation

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Correct Answer is D

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%.