Modulo 3
Which statement indicates that a patient understands the proper administration of levothyroxine (choose ALL that apply)?
"I need to take levothyroxine on an empty stomach with water, about 30 to 60 minutes before breakfast." The correct answer highlights the essential instructions for levothyroxine administration. Taking levothyroxine on an empty stomach with water and allowing 30 to 60 minutes before breakfast ensures optimal absorption of the medication. Choices A, B, and C provide incorrect instructions that may affect the absorption and effectiveness of levothyroxine.
A provider teaches a patient who has been diagnosed with hypothyroidism about a new proscription for levothyroxine. Which statement by the patient indicates a need for further teaching?
"If I take calcium supplements, I may need to decrease my dose of levothyroxine." Patients taking calcium supplements should take these either 4 hours before or after taking levothyroxine, because they interfere with levothyroxine absorption. Many heartburn medications contain calcium, so patients should consult their provider before taking them. Insomnia, tremors, and tachycardia are signs of levothyroxine toxicity and should be reported. Iron also interferes with levothyroxine absorption, so dosing should be 4 hours apart.
A patient taking an angiotension-converting enzyme (ACE) inhibitor to treat hypertension tells the provider that she wants to become pregnant. What response will the provider give to the patient?
"Let's discuss using methyldopa instead of the ACE inhibitor while you are pregnant." Methyldopa has limited effects on uteroplacental and fetal hemodynamics and does not adversely affect the fetus or neonate. Controlling blood pressure does not lower the risk of preeclampsia. ACE inhibitors and ARBs are specifically contraindicated during pregnancy.
An adolescent had a serum glucose test at a health fair. The parent calls the clinic and says, "The level was 125 mg/dL. Does that mean my child has diabetes?" What is the provider's most accurate response?
"Unless your child were fasting for longer than 8 hours, this does not necessarily indicate diabetes." If a person has not fasted for 8 hours, a blood sugar level of 125 mg/dL would be considered normal, because it is less than 200 mg/dL for a random sampling. Also, a person must have positive outcomes on two separate days to be diagnosed with diabetes. This patient does not need to have an oral glucose tolerance test, because the 125 mg/dL reading is so far below 200 mg/dL, which would require furter work-up. No conclusive evidence indicates that this patient has diabetes, because the random sample value is so low, and the patient has not had two separate tests on different days. However, this also is not conclusive evidence that the patient does not have diabetes.
A patient has a free T4 level of 0.6 ng/dL and a free T3 level of 220 pg/dL. When asked by the patient what these laboratory values mean, how will the provider respond?
"We will need to obtain a TSH level to better evaluate your diagnosis." A free T4 level of less than 0.9 ng/dL and a free T3 level of < 230 pg/dL are consistent with hypothyroidism, but measurement of the TSH level is necessary to distinguish primary hypothyroidism from secondary hypothyroidism. Total T3 and T4 levels are not as helpful as free T3 and T4 levels. These laboratory values indicate hypothyroidism, not hyperthyroid conditions like Graves disease.
A pregnant patient recently began treatment for hypothyroidism. What response will the provider give when the patient shares that she does not want to take medications while she is pregnant?
"Your baby will likely be born with permanent neuropsychologic deficits if the condition is not treated." Maternal hypothyroidism can result in permanent neuropsychologic deficits in the child. Hypothyroidism is not a normal effect of pregnancy and is a serious condition that can affect both mother and fetus. The greatest danger to the fetus occurs in the first trimester, because the thyroid does not fully develop until the second trimester. Early identification is essential. Symptoms often are vague. Treatment should begin as soon as possible, or intellectual disabilities and other developmental problems may occur.
To address the potential risk of hypoglycemia associated with insulin therapy, patients are advised to have a glucagon emergency kit readily available at home. Patient education should encompass the appropriate protocol for responding to a hypoglycemic emergency. In the event of such an emergency, the family should be aware that a glucagon dose can be administered every _______ minutes while awaiting emergency services.
15
The provider working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient presents with needs that the provider should address first?
A patient with diabetes who is NPO and has a blood glucose level of 80 mcg/dl needs a change in diet status after receiving 20 units of 70/30 Novolin Insulin. The NPO patient with hypoglycemia who just received 70/30 Novolin Insulin takes priority, because this patient needs to consume a good source of glucose immediately or perhaps the NPO status will be discontinued for this shift. The digoxin may be withheld for the patient with a pulse of 58 beats/min, but this is not a priority action. The patient with a headache needs to be followed up, and prescription for pain medication, but because the blood pressure is 136/92 mm Hg, the headache is probably not caused by hypertension. The patient with an allergy to penicillin will not have a reaction to the vancomycin.
A patient presents to the emergency department after accidentally taking too much prescribed warfarin. The patient's heart rate is 78 beats/min and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not report any pain. What will the provider order initially to address the patient's current condition?
A prothrombin time (PT) and an international normalized ratio (INR) The patient does not exhibit any signs of bleeding from a warfarin overdose. The vital signs are stable, there are no hematoma or petechiae, and the patient does not have pain. A PT and INR should be drawn to evaluate the anticoagulant effects. Vitamin K may be given if laboratory values indicate overdose. Protamine sulfate is given for heparin overdose. PTT evaluation is used to monitor heparin therapy.
A patient had a blood pressure of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. This is consistent with a blood pressure of 145/92 taken in an ambulatory setting. The patient's diagnostic tests are all normal. What will the patient's provider order to best manage the patient's hypertension?
A thiazide diuretic The patient has primary, or essential, hypertension as evidenced by systolic pressures greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics are first-line drugs for hypertension. Beta blockers are effective but are most often used to counter reflex tachycardia associated with reduced blood pressure caused by therapeutic agents. Loop diuretics cause greater diuresis than is usually needed and so are not first-line drugs, alpha blockers are not drugs of first choice.
Verapamil is prescribed for the client who takes digoxin. The provider will monitor closely for which adverse reaction?
AV blockade Verapamil and digoxin both suppress impulse conduction through the AV node; when the two drugs are used concurrently, the risk of AV blockade is increased. Gingival hyperplasia can occur in rare cases with verapamil, but it is not an acute symptom. Verapamil can be used to prevent migraine, although its use for this purpose is under investigation. Verapamil and digoxin both suppress the heart rate, so tachycardia is not anticipated. The calcium channel blocker nifedipine, not verapamil, causes reflex tachycardia.
Which of the following conditions is a contraindication for starting metformin therapy in a patient with Type 2 diabetes?
Acute Congestive Heart Failure. Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g. carbonic anhydrase inhibitors like topiramate), ≥ 65 years, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g. acute congestive heart failure), excessive alcohol intake, and hepatic impairment.
A patient with a recent onset of nephrosclerosis has been taking an angiotensin-converting enzyme (ACE) inhibitor and a thiazide diuretic. The patient's initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient's blood pressure is 130/90 mm Hg. What action will the provider take to address the patient's blood pressure?
Add a calcium channel blocker to this patient's drug regimen. In patient's with renal disease, the goal of antihypertensive therapy is to lower the blood pressure to 130/80 mm Hg or less. Adding a third medication is often indicated. Lowering the dose of the medications is not indicated because the patient's blood pressure is not in the target range. Adding potassium to the diet and using a potassium-sparing diuretic are contraindicated.
A patient diagnosed with heart failure and taking an ACE inhibitor, has developed fibrotic changes in the heart and vessels. Which type of medication will the provider order to counter this development?
Aldosterone antagonist Aldosterone antagonists are added to therapy for patients with worsening symptoms of HF. Aldosterone promotes myocardial remodeling and myocardial fibrosis, so aldosterone antagonists can help with this symptoms. ARBs are given for patients who do not tolerate ACE inhibitors. Beta blockers do not prevent fibrotic changes. DRIs (direct renin inhibitor) are not widely used.
Which conditions will the provider consider as a therapeutic use for verapamil? SATA
Angina of effort, Cardiac dysrhythmias, Essential hypertension Verapamil is used to treat both vasospastic angina and angina of effort. It slows the ventricular rate in patients with atrial flutter, atrial fibrillation, and paroxysmal supraventricular tachycardia. It is a first-line drug for the treatment of essential hypertension. It is contraindicated in patients with sick sinus syndrome. Nifedipine has investigational uses in suppressing preterm labor.
A patient with diabetes develops hypertension. Which type of medication will the provider prescribe to treat hypertension in this patient?
Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors slow the progression of KIDNEY injury in diabetic patients with renal damage. Beta blockers can mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are thired-line drugs for chronic hypertension. Thiazide diuretics promote hyperglycemia.
A prescriber considers ordering propranolol for a patient with recurrent ventricular tachycardia. What information in the patient's medical history will be of greatest concern to the prescriber?
Asthma Propranolol is to be used cautiously in patients with asthma because it is a nonselective beta-adrenergic antagonist and can cause bronchoconstriction and exacerbate asthma. It is used to treat tachyarrhythmias and paroxysmal atrial tachycardia evoked by emotion, so it is not contraindicated for patients with these conditions. It lowers blood pressure, so it would be helpful in patients with hypertension.
An older adult patient with type 2 diabetes has a history of severe hypoglycemia. The patient's partner asks the provider what A1c level they should strive to achieve. What guideline will the prescriber provide?
Below 8.0. For patients with a history of severe hypoglycemia and those with a limited life-expectancy or advanced microvascular and macrovascular complications, the target A1c level should be below 8.0. For most other patients with diabetes, the target is 7.0 and below.
A patient who takes oral levothyroxine for hypothyroidism is admitted to the hospital. After the provider determines the patient has myxedema, what action will the provider take?
Change to IV levothyroxine. This patient is showing signs of severe hypothyroidism or myxedema. IV administration of levothyroxine is used for myxedema coma. A betal blocker is useful in patients who show signs of hyperthyroidism to minimize cardiac effects. Because the half-life of oral levothyroxine is so long, increasing the PO dose will not provide immediate relief of this patient's symptoms. Methimazole is used to treat hyperthyroidism.
Amiodarone is prescribed for a patient. Which baseline tests will the prescriber order before this medication is started? SATA
Chest radiograph, ophthalmologic examination, pulmonary function tests, thyroid function tests. Amiodarone has many potential toxic side effects, including pulmonary toxicity, ophthalmic effects, and thyroid toxicity, so these systems should be evaluated at baseline and periodically while the patient is taking the drug. A complete blood count is not indicated.
A 55-yearl old patient with Type 2 diabetes presents with an A1c level of 10.2%. No other significant past medical history such as kidney, heart, or liver disease. What is the most appropriate initial therapy for this patient?
Combine insulin and metformin. Combining insulin and metformin helps address both insulin resistance and impaired insulin secretion commonly seen in Type 2 diabetes patients with high A1C levels. This combination offers a synergistic effect to achieve better glucose control. Starting metformin alone may not provide optimal results, and sulfonylureas may cause hypoglycemia. Short -acting insulin alone will not provide adequate coverage.
Which effect will the provider expect when prescribing a cardiac glycoside?
Decreased heart rate. Digoxin slows the heart rate and increases the force of contraction. It does not decrease cardiac output or result in positive intoropic effects.
A patient taking a thiazide diuretic for hypertension and quinidine to treat a dysrhythmia, is now prescribed digoxin 0.125 mg to improve cardiac output. Which action will the provider take to best assure the patient's safety?
Discontinue the quinidine. Quinidine can cause plasma levels of digoxin to rise; concurrent use of quinidine and digoxin is contraindicated. There is no indication for adding spironolactone in this scenario. The dose of digoxin ordered is a low dose. Potassium supplements are contraindicated with digoxin.
What is the primary mechanism of action of glucagon-like peptide-1 (GLP-1) receptor agonists in the management of Type 2 diabetes? SATA
Enhancement of glucose-dependent insulin secretion; Slowed gastric emptying; Reduction of postprandial glucagon and food intake
A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats/min, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. What will the provider order in response to this assessment data?
Furosemide This patient shows signs of fluid volume overload and needs a diuretic. Furosemide is a loop diuretic, which can produce profound diuresis very quickly even when the glomerular filtration rate (GFR) is low. An ACE inhibitor will not reduce fluid volume overload. Digoxin has a positive inotropic effect on the heart, which may improve renal perfusion, but this is not its primary effect. Spironolactone is a potassium-sparing diuretic with weak diuresis efffects; it is used in conjunction with other diuretics to improve electrolyte balance.
A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths/min intercostal retractions, and frothy, pink sputum. After the patient's provider renders a diagnosis of heart failure, which diuretic will be prescribed to address these assessment findings?
Furosemide. Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient shows s/s of severe heart failure and needs immediate reduction of fluid overload. Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because they are less efficacious, and diuresis is less rapid. Mannitol is indicated for patients with increased intracranial pressure and must be discontinued immediately if s/s of pulmonary congestion or heart failure occur.
Which of the following are potential side effects associated with metformin? SATA
Gastrointestinal discomfort, including diarrhea; vitamin B12 deficiency. Gastrointestinal discomfort, including diarrhea: Gastrointestinal side effects such as nausea, vomiting, and diarrhea are commonly reported with metformin use, especially when starting the medication. These symptoms often improve over time. Hypertension: Hypertension is not a common side effect of metformin. In fact, metformin is often used to manage blood glucose levels in patients with Type 2 diabetes who have hypertension. Vitamin B12 deficiency: Long-term use has been associated with reduced vitamin B12 absorption, which can lead to deficiency over time. Monitoring B12 levels and considering supplementation may be necessary. Hyperkalemia: Hyperkalemia is not a commonly reported side effect of metformin use. It is important to differentiate between potential side effects when considering metformin therapy. Hypoglycemia: While metformin itself does not cause hypoglycemia, it may increase the risk of hypoglycemia when used in combination with antidiabetic medications.
What method will the provider consider the most reliable measure for assessing a patient's diabetes control over the preceding 3-month period?
Glycosylated hemoglobin level (A1c) The glycosylated hemoglobin A1c level tells much about what the plasma glucose concentration has been, on average, over the previous 2 to 3 months as it measures the average amount of glucose "stuck" to the red blood cell, which has a lifespan of approximately 3 months. Fructosamine or glycated albumen tests can be used in people with red blood cell disorders that may render an A1C test inaccurate, but are not as standardized or reliable as the A1C test in most situations and offer a snapshot of glucose control over an approximately 2 or 3 week window rather than several months. Random blood sugar levels are not as sensitive or informative about ____ as the glycosylated hemoglobin level. One fasting blood glucose level indicates the patient's blood sugar level for that one time when it was obtained but is not reflective of a 3-month period.
A patient has been receiving iron replacement therapy for 2 days after hip replacement surgery. The provider is alerted to the following assessment data: Patient's stools appear black Patient is pale and reports feeling tired Patient's heart rate is 98 beats/min, respirations are 20 breaths/min, and the blood pressure is 100/50 mm Hg. What order will the provider take initially to best assure appropriate care for this patient?
Hemoglobin and hematocrit The patient is showing signs of iron deficiency anemia, as manifested by tachycardia and pallor. Because this patient's blood pressure is low, the anemia probably has occurred secondary to blood loss, a common occurrence with hip replacement surgery. The first response should be to obtain an H&H to compare baseline and posttreatment levels. This should be done before an intervention is ordered. A stool guaiac is not indicated because black stools are an expected effect of oral iron administration. If the patient has blood loss that is causing hypotension, an isotonic fluid bolus and packed red blodd cells (PRBCs) are indicated to treat this.
An admission history on an adult patient notes that the patient has a heart rate of 62 beats/min, a blood pressure of 105/62 mm Hg, and a temperature of 96.2F. The patient appears pale and reports always feeling cold and tired. The provider and patient will discuss tests to rule out what possible cause of these s/s?
Hypothyroidism. This patient is showing signs of hypothyroidism: a low heart rate, low temperature, pale skin, and feeling COLD and tired. In adults, thyroid deficiency is called hypothyroidism. In children, thyroid deficiency is calld cretinism. Graves disease and Plummer disease are rare conditions caused by thyroid excess.
A patient is admitted to the hospital with a diagnosis of vitamin B12 deficiency, hypoxia, and anemia. In addition to oxygen therapy, what will the provider order to address these problems?
IM cyanocobalamin and folic acid. The patient has anemia with associated hypoxia secondary to vitamin B12 deficiency; therefore, cyanocobalamin should be given parenterally along with folic acid. Antibiotics are indicated only when signs of infection are present. Oral cyanocobalamin is not recommended.
A patient with new-onset exertional angina has taken three nigrogylycerin sublingual tablets as 5-minute intervals, but the pain has intensified. The patient has a heart rate of 76 beats/minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient's lips and nail beds are pink, and there is no respiratory distress. The provider will prescribe what intervention?
IV nitroglycerin and a beta blocker This patient has unstable angina, and the next step, when the pain is unrelieved by sublingual nitroglycerin, is to give IV nitrogycerin and a beta blocker. ACE inhibitors should be given to patients with persistent hypertension if they have left ventricular dysfunction or heart failue. Ranolazine is a first-line angina drug, but it should not be given with quinidine because of the risk of increasing the QT interval. Supplemental oxygen is indicated if cyanosis or respiratory distress is present. IV morphine may be given if the pain is unrelieved by nitroglycerin.
A patient who has taken warfarin for a year has now been prescribed carbamazepine. What additional action will the provider take to assure the patient's safety?
Increase the dose of warfarin. Carbamazepine (anticonvulsant) is a powerful inducer of hepatic drug-metabolizing enzymes and can accelerate warfarin degradation. The warfarin dose should be increased if the patient begins taking carbamazepine. Decreasing the dose of carbamazepine is not indicated. It is not necessary to perform more frequent aPTT monitoring or to add extra vitamin K.
Insulin glargine is prescribed by the provider for a hospitalized patient with type 1 diabetes. When will the provider order this medication to be administered?
Once daily at bedtime. Glargine insulin is indicated for once daily subcutaneous administration to treat adults and children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be given more than once a day, although some patients require bid dosing to achieve a full 24 hours of basal coverage.
The provider orders furosemide for a patient who takes digoxin and is admitted to the hospital for treatment of heart failure. The morning assessment identifies an irregular heart rate of 86 beats/minute, a respiratory rate of 22 breaths/min, and a blood pressure of 130/82 mm Hg. Crackles are heard in both lungs. Which laboratory result will be of greatest concern to the provider?
Potassium level of 3.4 mEq/L This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This patient's serum potassium level is low, which can trigger fatal dysrhythmias, especially in patients taking digoxin. Furosemide contributes to loss of potassium through its effects on the distal nephron. Potassium-sparing diuretics often are used in conjunction with furosemide to prevent this complication. This patient's serum glucose and sodium levels are normal and of no concern at this point, although they can be affected by furosemide. The oxygen saturation is somewhat low and needs to be monitored, although it will likely improve with diuresis.
A patient who uses transdermal nitroglycerin for angina reports occasional periods of tachycardia. What intervention will the prescriber order?
Prescribe verapamil as an adjunct to nitroglycerin therapy Nitroglycerin lowers blood pressure by reducing venous return and dilating the arterioles. The lowered blood pressure activates the baroreceptor reflex, causing reflex tachycardia, which can increase the cardiac demand and negate the therapeutic effects of nitroglycerin. Treatment with a beta blocker or verapamil suppresses the heart to slow the rate. Digoxin is not recommended. Discontinuation of the nitroglycerin is not indicated. Resting does not slow the heart when the baroreceptor reflex is the cause of the tachycardia.
A patient arrives in the emergency department with a heart rate of 128 beats/min and a temperature of 105F. The patient's skin feels hot and moist. The free T4 levels is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The provider caring for this patient will give what intervention priority? BEST/PREFERRED answer
Propylthioiracil (PTU). Propylthyuracil is used for patients experiencing thyroid storm, and this patient is showing signs of that condition. Levothyroxine is given IV for hypothyroidism. 131 Iodine is used in patients over 30 years of age who have not responded to other therapies for hyperthyroidism. Methimazole is used long term to treat hyperthyroidism but, PTU is more useful for emergency treatment.
A patient receiving heparin postoperatively to prevent deep vein thrombosis has a blood pressure of 90/50 mm Hg and a heart rate of 110 beats/minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The provider will order what interventions initially? SATA
Protamine sulfate, discontinue heparin. Heparin overdose may cause hemorrhage, which can be characterized by low blood pressure, tachycardia, and lumbar pain. Protamine sulfate should be given and the heparin should be discontinued. An aPTT may be drawn later to monitor the effectiveness of protamine sulfate. Analgesics are not indicated because lumbar pain is likely caused by adrenal hemorrhage. No only will aspirin increase the risk of hemorrhage, but antiplatelet drugs may be used to prevent excessive arterial clotting while anticoagulants are used to prevent excessive venous clotting; therefore they are not used interchangeably.
Match the type of insulin with its corresponding approximate peak time:
Rapid-acting insulin: 30 min to 1 hr Short-acting insulin: About 1 - 2 hrs Intermediate-Acting insulin: Approximately 4 to 12 hrs Long-Acting insulin: Minimal to no distinct
A patient i admitted to the hospital and is prescribed levothyroxine. Assessment data show that the patients also takes warfarin. The provider will make what medication dosage-related change?
Reduce warfarin. Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors, which enhances the effects of warfarin. Patients taking warfarin who start taking levothyroxine may need to have their warfarin dose reduced. It is not correct to increase or decrease the levothyroxine dose or to increase the warfarin dose.
The provider is assessing a newly diagnosed patient for short-term complications of diabetes. What evaluation does this assessment include?
Serum blood sugar results for hyperglycemia. High blood sugar, low blood sugar, and ketoacidosis are short-term complications of diabetes. Microvascular and macrovascular complications, such as peripheral neurophathy, are long-term complications, of diabetes. Arterial insufficiency and atherosclerosis also are long-term complications of diabetes.
A patient with heart failure who takes on ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the provider will focus on which evaluation?
Serum electrolyte levels Patients taking thiazide diuretics can develop hypokalemia, which can increase the risk for dysrhythmias; therefore, the serum electrolyte levels should be monitored closely. A complete blood count is not recommended. This patient is taking the drugs recommended for patients with stage C heart failure; although the patient's quality of life and ability to participate in activities should be monitored, routine measurement of the ejection fraction and maximal exercise capacity is not warranted at this time.
A patient with type 1 diabetes recently became pregnant. What blood glucose testing schedule will the provider recommend during pregnancy?
Six or seven times a day. A pregnant patient with type 1 diabetes mus have frequent blood sugar monitoring (e.g. six or seven times a day) to manage the patient's glucose levels and to ensure that no harm occurs to the fetus. Monitoring the blood sugar level before meals and at bedtime is not significant enough to provide the necessary glycemic control. Morning and 4:00 pm monitoring is not enough to provide glycemic control. Urine glucose testing is not sensitive enough to aid glycemic control, and monitoring three times a day is not enough.
Which medication will the provider prescribe for a patient admitted with severe hypertensive crisis?
Sodium nitroprusside IV Sodium nitroprusside, the drug of choice for hypertensive emergencies, is given intravenously. ACE inhibitors, such as captopril, are not used. Hydralazine may be used but should be given IV not PO. Minoxidil is effective, but its severe side effects make a second-line drug.
Azithromycin is prescribed for a patient who develops an infection. The patient's only other medication is simvastatin. Which patient symptom will create the greatest concern for the provider?
Statins can injure muscle tissue, causing muscle aches and pain known as myopathy/rhabdomyolysis. Azitrhomycin also can cause myopathy and thererfore should be used with caution in patients concurrently taking simvastatin. Nausea, tiredness, and headache would not cause the provider as much concern as the likelihood of myopathy.
A patient reports a family history of hypertension and cardiovascular disease but has no other risk factors. Current blood pressure is 126/82 mm Hg and the patient has a normal weight and body mass index for height and age. What will be the provider's focus when providing patient education?
The DASH diet, sodium restriction, and exercise. This patient has elevated hypertension without other risk factors. Lifestyle changes are indicated at this point. If blood pressure rises to hypertensive levels, other measures, including drug therapy, will be initiated. Calcium and potassium supplements are not indicated.
A patient with type 1 diabetes reports taking propranolol for hypertension. What concern does this information present for the provider?
The beta blocker can mask the symptoms of hypoglycemia. Beta blockers can delay awareness of and response to hypoglycemia by masking signs associated with stimulation of the sympathetic nervous system (e.g. tachycardia, palpitations) that hypoglycemia normally causes. Furthermore, beta blockade impairs glycogenolysis, which is one means by which the body can counteract a fall in blood glucose; beta blockers, therefore can worsen insulin-induced hypoglycemia. Propranolol does not cause insulin resistance. The incidence of DKA is not increased by concurrent use of propranolol and insulin. Insulin requirements are not increased because of receptor blocking by propranolol.
Levothyroxine is commonly prescribed to replace which hormone in patients with thyroid dysfunction? SATA
Triiodothyronine (T3) and Thyroxine (T4). Levothyroxine is a synthetic form of the thyroid hormone (T4). T4 is a prohormone that is converted into the active triiodothyronine (T3) within the body's tissues. By providing exogenous T4, levothyroxine aims to restore thyroid hormone levels and support normal metabolic functions in patients with hypothyroidism. Thyroid-stimulating hormone (TSH) is a pituitary hormone that stimulates the thyroid gland to produce and release thyroid hormones. Thyroxine-binding globulin (TBG) is a protein that binds and transports thyroid hormones in the blood.
