You are teaching a patient who will begin taking methimazole (Tapazole) for Graves' disease about the medication. Which statement by the patient indicates understanding of the teaching?

it is safe to get pregnant while taking this medication

Because of the risk for liver toxicity, I will need frequent liver function tests

I should report a sore throat or fever to my provider if either occurs

I will need a complete blood count every few months

Answer and Explanation

The Correct Answer is C

A. Methimazole crosses the placenta and is considered teratogenic, especially during the first trimester of pregnancy. It can cause congenital malformations such as choanal or esophageal atresia and aplasia cutis. Patients planning pregnancy should discuss alternatives with their provider. Often, propylthiouracil (PTU) is preferred during early pregnancy because it has a lower teratogenic risk, though it carries a higher risk of liver toxicity. After the first trimester, methimazole may be used if necessary. This statement shows a lack of understanding of safe pregnancy practices while on this medication.

B. Although methimazole can rarely cause hepatotoxicity, it is much less hepatotoxic than PTU. Routine liver function tests are not typically required unless the patient shows symptoms of liver dysfunction (e.g., jaundice, dark urine, abdominal pain). Overemphasis on routine LFTs may cause unnecessary anxiety or testing.

C. Methimazole carries a risk of agranulocytosis, a severe reduction in white blood cells that can increase susceptibility to infections. Early warning signs include sore throat, fever, malaise, or other signs of infection. Prompt reporting is critical because agranulocytosis can develop suddenly and requires immediate discontinuation of the drug and medical evaluation. This statement reflects correct understanding of patient safety and monitoring while on methimazole.

D. Routine CBC monitoring is not recommended unless the patient exhibits symptoms suggestive of infection. Frequent testing without clinical indication is unnecessary and does not improve safety outcomes. Symptom-driven monitoring is the current standard of care.

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Correct Answer is B

Explanation

A. Epinephrine is a vasoconstrictor, meaning it narrows blood vessels at the injection site. This leads to decreased blood flow rather than increased perfusion. Although this helps reduce bleeding, the statement is incorrect because it describes the opposite effect.

B. Epinephrine causes localized vasoconstriction, which slows the absorption of lidocaine into the bloodstream. This allows the anesthetic to remain at the site longer, thereby prolonging its effect. At the same time, reduced systemic absorption lowers the risk of toxicity, such as central nervous system or cardiovascular complications.

C. Epinephrine decreases, not increases, the rate of absorption of lidocaine. Slower absorption is essential for maintaining the drug’s local effect and preventing it from rapidly entering systemic circulation.

D. Increasing systemic absorption would raise blood levels of lidocaine and increase the risk of toxicity. The purpose of adding epinephrine is to limit systemic exposure, not enhance it.

A. Blood glucose level of 60 mg/dL B. Ketones in the urine C. Acidosis D. Blood glucose level of 600 mg/dL

Correct Answer is A

Explanation

A. A blood glucose level of 60 mg/dLindicates hypoglycemia, which is not consistent with diabetic ketoacidosis (DKA). DKA occurs due to insulin deficiency, which prevents glucose from entering cells. As a result, blood glucose levels rise, leading to hyperglycemia, rather than the low blood glucose seen in hypoglycemia. Patients with DKA typically present with blood glucose levels well above normal (often >250 mg/dL). Hypoglycemia is a completely opposite metabolic stateand would suggest insulin overdose or other causes unrelated to DKA.

B. Ketones in the urineare a hallmark of DKA. When the body cannot use glucose for energy due to lack of insulin, it breaks down fats, producing ketone bodies (acetone, acetoacetate, beta-hydroxybutyrate). The accumulation of ketones leads to ketonuria, which is a key diagnostic sign of DKA and contributes to the metabolic acidosis observed.

C. Acidosisis a defining characteristic of DKA. The ketone bodies are acidic, and their accumulation lowers blood pH, resulting in metabolic acidosis. Laboratory findings typically show low serum bicarbonate levelsand decreased pH. Acidosis is a core feature that differentiates DKA from hyperglycemia without ketoacidosis.

D. Blood glucose levels of 600 mg/dLare consistent with severe hyperglycemia in DKA. While glucose levels in DKA can vary, they are usually markedly elevated, often ranging from 250–600 mg/dL or higher. Such hyperglycemia contributes to osmotic diuresis, dehydration, and electrolyte imbalances, all common complications of DKA.

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You are teaching a patient who will begin taking methimazole (Tapazole) for Graves' disease about the medication. Which statement by the patient indicates understanding of the teaching?

Nursing Test Bank

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Explanation

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