Which are effective ways to help prevent medication errors? (Select all that apply)

Choice A reason: Hyperthyroidism involves elevated T3 and T4 with low TSH due to excessive thyroid hormone production. The patient’s low T3/T4 and high TSH indicate reduced thyroid activity, not overactivity, as the pituitary increases TSH to stimulate the underactive thyroid, making this choice incorrect.

Choice B reason: Hypothyroidism is characterized by low T3 and T4 levels due to underactive thyroid function, prompting the pituitary to secrete more TSH to stimulate hormone production. This matches the patient’s lab results (low T3/T4, high TSH), often seen in primary hypothyroidism, making this the correct choice.

Choice C reason: Thyroid cancer may alter thyroid function but typically doesn’t present with consistently low T3/T4 and high TSH. It’s more likely to cause nodules or abnormal growths, not this specific hormonal pattern, which aligns with hypothyroidism, making this choice less likely.

Choice D reason: Pituitary adenoma causing secondary hypothyroidism would lower TSH, T3, and T4 due to impaired pituitary function. High TSH with low T3/T4 suggests primary thyroid failure, not pituitary dysfunction, making this choice incorrect for the patient’s hormonal profile.

Choice A reason: NPH insulin is not mixed with insulin glargine, as glargine’s pH and formulation cause precipitation or altered pharmacokinetics when combined. NPH can be mixed with regular insulin, as they are compatible, making this choice incorrect for the patient’s reported practice.

Choice B reason: NPH and regular insulin are compatible and routinely mixed in one syringe to provide both intermediate and short-acting coverage. They don’t react chemically or lose efficacy when combined properly, making this choice incorrect, as mixing is a standard practice in diabetes management.

Choice C reason: Mixing NPH and regular insulin does not increase potency; it combines their pharmacokinetics for basal and prandial glucose control. The mixture delivers the additive effects of each insulin’s profile without enhancing overall potency, making this choice inaccurate for their combined action.

Choice D reason: Mixing NPH (intermediate-acting) and regular insulin (short-acting) is an accepted practice to manage type 1 diabetes with one injection, covering basal and prandial needs. Proper technique (drawing regular insulin first) ensures stability, making this the correct choice for the patient’s reported insulin administration.