Nokea
Elderly patients who are started on levothyroxine for hypothyroidism may experience which of the following as a side effect that would require reevaluation of dosage?
- A. Excessive sedation
- B. Tachycardia and angina
- C. Weight gain
- D. Cold intolerance
Correct Answer: B
Rationale: Levothyroxine can cause tachycardia and angina in the elderly if overdosed; sedation or weight gain suggest underdosing.
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A nurse is reviewing laboratory findings and notes that a client's plasma Lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse?
- A. Perform immediate gastric lavage.
- B. Prepare the client for hemodialysis.
- C. Administrative and additional oral dose of lithium.
- D. Request a stat repeat of the laboratory test
Correct Answer: B
Rationale: A level of 2.1 mEq/L indicates toxicity (normal 0.6-1.2 mEq/L); hemodialysis is used for severe cases.
A 52-year-old overweight woman presents to the clinic for a diabetes management. She had not been doing well controlling her blood sugars with metformin. Her last hemoglobin A1c was 13.4%, despite her taking her medication every day. The physician decides to start her on a long-acting insulin that is injected only once a day for better glucose control. Also, he wants the insulin to have a minimal risk of hypoglycemia. What is the most likely medication given to this patient?
- A. Insulin aspart
- B. Insulin glargine
- C. Insulin lispro
- D. NPH insulin
Correct Answer: B
Rationale: Insulin glargine is a long-acting, peakless insulin administered once daily, with a lower risk of hypoglycemia compared to other insulins.
The choice of diuretic to use in treating hypertension is based on:
- A. Presence of diabetes with loop diuretics being used for these patients
- B. Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40 mL/min range
- C. Ethnicity with aldosterone antagonists best for African Americans and older adults
- D. Presence of hyperlipidemia with higher doses needed for patients with LDL above 130 mg/dL
Correct Answer: B
Rationale: Thiazides are effective with GFR >40-50 mL/min; loops are used for lower GFR.
A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to:
- A. Treat thyroid storm.
- B. Prevent cardiac irritability.
- C. Treat hypocalcemic tetany.
- D. Stimulate the release of parathyroid hormone.
Correct Answer: C
Rationale: Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes or muscle spasms or twitching, the health care provider is notified immediately. Calcium gluconate should be kept at the bedside.
Which of the following is a disadvantage of IM administration?
- A. Larger volumes can be used
- B. Can affect lab tests
- C. Painful
- D. B and C
Correct Answer: C
Rationale: Intramuscular (IM) administration is painful due to needle insertion, though larger volumes are an advantage; affecting lab tests is less specific, making C the primary disadvantage.