Endocrine Ch. 51 and 52

Which technique is most appropriate regarding mixing insulin when the patient must administer 30 units regular insulin and 70 units NPH insulin in the morning? A.) Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. B.) Draw the medication into two separate syringes but inject into the same spot. C.) Administer these insulins at least 10 minutes apart, so that you will know when they are working. D.) Use the Z-track method for administration.

A.) Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin. The medications do not have to be in separate syringes and can be administered together. Z-track is an IM technique.

A nurse is teaching a patient how to recognize symptoms of hypoglycemia. Which symptoms should be included in the teaching? (select all that apply). A.) Headache B.) Nervousness C.) Bradycardia D.) Sweating E.) Thirst F.) Sweet breath odor

A.) Headache B.) Nervousness D.) Sweating

The nurse is administering vasopressin (Pitressen) to a patient. The nurse realizes that nursing implications for this drug would include which implications? (Select all that apply). A.) Record urinary output B.) Observe patients weight, and note edema C.) monitor the patient for decreased BP D.) Closely monitor the patients blood glucose levels E.) Monitor the patient's pulse for increased heart rate F.) Record the patient's daily calcium levels

A.) Record urinary output B.) Observe patients weight, and note edema C.) monitor the patient for decreased BP E.) Monitor the patient's pulse for increased heart rate

A patient is taking levothyroxine (Synthroid). For which adverse effect would the nurse monitor this patient? A.) Tachycardia B.) Drowsiness C.) Constipation D.) Weight gain

A.) Tachycardia

The nurse is caring for several patients who will be receiving glucocorticoid therapy. Which patient should be assessed first? A.) The patient with uncontrolled diabetes mellitus B.) The patient with rheumatoid arthritis C.) The patient with septic shock D.) The patient experiencing an exacerbation of asthma

A.) The patient with uncontrolled diabetes mellitus A common side effect of steroid therapy is hyperglycemia. The patient with uncontrolled diabetes mellitus could suffer a severe hyperglycemic episode. The risks and benefits should be considered.

A patient is given corticotropin (Acthar). The nurse knows to monitor the patient for which condition? A.) Weight gain B.) Hyperkalemia C.) Hypoglycemia D.) Dehydration

A.) Weight gain

A nurse gives a patient NPH insulin at 8:00 am. At 2:00 pm the nurse finds the patient extremely lethargic but conscious. The patient is diaphoretic and slightly combative. The nurse should A.) call the health care provider. B.) ensure that the patient has a meal. C.) provide the patient with 4 ounces of orange juice. D.) administer the next dose of insulin.

Answer: C Rationale: NPH is an intermediate-acting insulin that peaks in 6 to 12 hours. Because the patient is conscious, it is most important for the nurse to provide the orange juice to prevent a possible hypoglycemic reaction (insulin shock).

The nurse will teach a patient taking levothyroxine (Synthroid) for hypothyroidism to notify the health care provider if he or she experiences A.) dizziness. B.) nausea. C.) palpitations. D.) abdominal cramps.

Answer: C Rationale: Patients taking this drug should report tachycardia or palpitations to the health care provider. The other options are considered to be not necessarily reportable.

A nurse has been teaching a patient about levothyroxine (Synthroid). Which side effect should the nurse teach the patient to observe for? A.) Somnolence B.) Bradycardia C.) Constipation D.) Nervousness

Answer: D Rationale: Side effects of levothyroxine include nervousness, tremors, diarrhea, and insomnia.

What nursing diagnosis is the highest priority for a patient receiving desmopressin (DDAVP)? A.) Risk for injury B.) Alteration in comfort C.) Fluid volume excess D.) Knowledge deficit

C.) Fluid volume excess Desmopressin (DDAVP) is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow's hierarchy of needs.

A patient is diagnosed with type 2 diabetes mellitus. The nurse is aware that which statement is true about this patient? A.) Patient is most likely a teenager B.) Patient is most likely a child younger than 10 years C.) Heredity and obesity are major causative factors D.) Viral infections contribute most to disease development

C.) Heredity and obesity are major causative factors

The nurse administers NPH insulin at 8 AM. What intervention is essential for the nurse to perform? A.) Assess the patient for hyperglycemia by 10 AM. B.) Monitor fingerstick at 2 PM. C.) Make sure patient eats by 5 PM. D.) Administer the insulin via IV pump.

C.) Make sure patient eats by 5 PM. NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia. The patient needs to eat by 5 PM. The patient would not be at high risk for hypoglycemia at 10 AM. A fingerstick is not necessary at 2 PM. The insulin should not be routinely administered IV.

The patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine (Lantus). What information is essential for the nurse to teach this patient? A.) "This medication should be mixed with the regular insulin each morning." B.) "This medication is very short-acting. You must be sure you eat after injecting it." C.) "This medication is very expensive, but you will be receiving it only a short time." D.) "This medication has a duration of action of 24 hours."

D.) "This medication has a duration of action of 24 hours." Insulin glargine (Lantus) has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for a long time.

The nurse is teaching the patient how to administer insulin. What information is essential to include in the plan? A.) "For the most consistent absorption, inject the insulin into the abdomen." B.) "Avoid administering the insulin into your arm." C.) "Inject the insulin at a 30-degree angle between the fat and muscle." D.) "Do not mix any insulins in the same syringe."

A.) "For the most consistent absorption, inject the insulin into the abdomen." The abdomen has the most consistent absorption because the blood flow to the subcutaneous tissue typically is not as affected by muscular movements as it could be in the arm or thigh. Insulin can be administered in the arm. The patient should be instructed to inject insulin at a 45- to 90-degree angle, not a 30-degree angle. Most insulins can be mixed.

A patient asks the nurse to explain the action of glucocorticoids. Which statement is the nurse's best response? A.) "Glucocorticoids influence carbohydrate, lipid, and protein metabolism." B.) "Glucocorticoids are produced in decreased amounts during times of stress." C.) "Glucocorticoids decrease serum sodium and glucose levels." D.) "Glucocorticoids stimulate defense mechanisms to produce immunity."

A.) "Glucocorticoids influence carbohydrate, lipid, and protein metabolism." Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They are produced in increasing amounts during stress. They increase sodium and glucose levels and suppress the immune system.

Which patient statement demonstrates understanding of the nurse's teaching for levothyroxine (Synthroid)? A.) "I will take this medication first thing in the morning." B.) "I will double my dose if I gain more than 1 pound per day." C.) "It is best to take the medication with food to prevent gastrointestinal upset." D.) "I can expect to see relief of my symptoms within 1 week."

A.) "I will take this medication first thing in the morning." Levothyroxine (Synthroid) increases basal metabolism and thus wakefulness. It should be taken first thing in the morning. The patient should not increase the dose. The medication is absorbed best on an empty stomach. Depending on the symptoms, some symptoms may take weeks to improve.

The patient with type 1 diabetes mellitus asks, "Why can't I take a sulfonylurea like my friend who has diabetes?" What is the nurse's best response? A.) "Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you." B.) "You must be mistaken. If your friend has diabetes mellitus, she is taking insulin." C.) "Sulfonylurea will lower your blood sugar too much, and you will be hypoglycemic." D.) "You are unable to store glucose, because you do not have insulin, and sulfonylurea helps with glucose storage."

A.) "Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you." Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release, decreasing hepatic glucose production, and increasing insulin sensitivity. It is administered for type 2 diabetes mellitus but will not be effective in type 1.

The nurse is teaching a patient who has been prescribed repaglinide (Prandin). Which information will the nurse include in the teaching plan? A.) "You will need to be sure you eat as soon as you take this medication." B.) "This medication is compatible with all of your cardiac medications." C.) "This medication will not cause hypoglycemia." D.) "This medication has no side effects."

A.) "You will need to be sure you eat as soon as you take this medication." Repaglinide (Prandin) is short-acting. The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal. Prandin interacts with beta-adrenergic blockers as well as other medications. Hypoglycemia is a side effect of this medication, and there are many other possible side effects of this medication.

Which patient is most likely to be treated with somatrem (Protropin)? A.) A 7-year-old diagnosed with growth hormone deficiency B.) A 10-year-old of short stature who has severe asthma C.) An 8-year-old with Prader-Willi syndrome D.) A 17-year-old who is 5 feet tall

A.) A 7-year-old diagnosed with growth hormone deficiency For this medication to be used, the patient has to be diagnosed with a growth hormone deficiency, and the epiphyses must not be fused, so the child needs to be young. Severe respiratory conditions, Prader-Willi syndrome, and age of 17 years are contraindications to this medication.

Antidiabetic drugs are designed to control signs and symptoms of diabetes mellitus. The nurse primarily expects a decrease in which? A.) Blood glucose B.) Fat metabolism C.) Glycogen storage D.) Protein mobilization

A.) Blood glucose

A patient with type 1 diabetes mellitus is ordered insulin therapy once daily to be administered at bedtime. What is the type of insulin the patient is most likely receiving? A.) Insulin glargine (Lantus) B.) Lente insulin C.) Lispro insulin D.) Regular insulin

Answer: A Rationale: Insulin glargine (Lantus) is long-acting insulin with an onset of 1 hour. It is evenly distributed over a 24-hour duration of action; thus, it is administered once a day, usually at bedtime. Intermediate-acting insulins include neutral-protamine-Hagedorn (NPH), Lente, and Humulin N. Rapid-acting insulins include insulin lispro. Regular insulin is short acting.

A patient received regular insulin at 7:30 am. At 9:30 am the patient feels slightly hungry and has a dull headache. The nurse A.) tests the patient's blood glucose level. B.) ensures that the patient has a meal. C.) provides the patient with 4 ounces of orange juice. D.) administers the next dose of insulin.

Answer: A Rationale: The peak time for regular insulin is 2 to 4 hours. It is most important for the nurse to check the patient's blood glucose level to prevent a possible hypoglycemic reaction (insulin shock).

Which time frame would be most appropriate for administering sliding-scale lispro insulin? A.) Within 30 minutes of consuming breakfast B.) When the breakfast tray is served and ready to eat C.) Within 1 hour of obtaining blood glucose measurement D.) Within 15 minutes of obtaining blood glucose measurement

Answer: B Rationale: Lispro should be given 5 minutes before eating because the onset of action is 5 to 15 minutes.

A patient has adrenocortical insufficiency and was taking hydrocortisone (Solu-Cortef) 240 mg every 12 hours IV. Before discharge the drug was switched to prednisone (Deltasone). Which is appropriate teaching for discharging a patient with oral prednisone? A.) Stop the drug when feeling better. B.) Prednisone is always given by injection. C.)The dose needs to be tapered off over 1 to 2 weeks. D.) Hyperkalemia is common.

Answer: C Rationale: Glucocorticoids must be tapered off gradually to avoid adrenal crisis. Never stop the drug abruptly. Prednisone is an oral preparation. Prednisone promotes potassium loss and hypokalemia.

A patient is prescribed metformin (Glucophage). Which is a side effect/adverse effect common to metformin? A.) Seizures B.) Constipation C.) Bitter or metallic taste D.) Polyuria and polydipsia

Answer: C Rationale: Metformin has a bitter or metallic taste. Seizures, constipation, polyuria, and polydipsia are not side effects/adverse effects of metformin.

A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help relieve symptoms. Which statement is the nurse's best response? A.) "Propylthiouracil inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism." B.) "This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." C.) "Propylthiouracil helps the thyroid gland use iodine and synthesize hormones better." D.) "This medication stimulates the pituitary gland to secrete thyroid-stimulating hormone, which inhibits the production of hormones by the thyroid gland."

B.) "This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." Propylthiouracil (PTU) is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate hormone already present.

Discharge teaching for a patient receiving glucocorticoids will include the preferred use of which medication for pain management? A.) Aspirin B.) Acetaminophen (Tylenol) C.) Ibuprofen (Motrin) D.) Naproxen sodium (Naprosyn)

B.) Acetaminophen (Tylenol) Acetaminophen (Tylenol) does not cause gastric distress as do aspirin, ibuprofen, naproxen sodium, and glucocorticoids.

The nurse would question an order for aminoglutethimide (Cytadren) for a patient who has been diagnosed with which condition? A.) Adrenal malignancy B.) Addison's disease C.) Cushing's syndrome D.) Metastatic breast cancer

B.) Addison's disease Aminoglutethimide (Cytadren) suppresses the adrenal cortex. Addison's disease presents with decreased adrenal secretion; thus, the nurse would not want to exacerbate this by administering aminoglutethimide.

What assessment finding indicates to the nurse that vasopressin (Pitressin) has been effective? A.) Increased serum albumin levels B.) Increased urine specific gravity C.) Decreased adrenocorticotropic hormone levels D.) Relief of pain

B.) Increased urine specific gravity Vasopressin (Pitressin) causes decreased water excretion in the renal tubule, thus increasing urine specific gravity. It is used to treat diabetes insipidus, which presents with a low urine specific gravity. This medication does not affect serum albumin, decrease adrenocorticotropic hormone levels, or decrease pain.

Which is the most appropriate action for the nurse who is told that a patient typically takes his glipizide (Glucotrol) with food? A.) Immediately check the patient's blood glucose level. B.) Inform the patient that it is better to take the medication 30 minutes before a meal. C.) Inform the patient that the medication must be taken 15 minutes after a meal. D.) Immediately call the health care provider.

B.) Inform the patient that it is better to take the medication 30 minutes before a meal. Food inhibits the absorption of glipizide (Glucotrol), the only sulfonylurea agent that should be given 30 minutes before a meal. The blood glucose level does not have to be taken right away. The medication is not to be taken after a meal. The health care provider does not have to be called; the nurse should intervene.

A patient is newly diagnosed with type 1 diabetes mellitus and requires daily insulin injections. Which instruction should the nurse include in the teaching of insulin administration? A.) Teach family members how to administer glucagon by injection when the patient has a hyper glycemic rxn. B.) Instruct the patient about the necessity for compliance with prescribed insulin therapy C.) Teach the patient that hypoglycemic rxns are more likely to occur at the onset of action time. D.) Instruct the patient in the care and handling of the insulin container and syringe

B.) Instruct the patient about the necessity for compliance with prescribed insulin therapy

A patient has just begun taking calcitrol (Rocaltrol). Which is a nursing implication of this drug? A.) Monitor the patient's weight B.) Monitor serum calcium levels C.) Teach side effects of alepecia and petechiae D.) Instruct the patient to avoid persons with respiratory infections

B.) Monitor serum calcium levels

The nurse is caring for a patient who is taking levothyroxine (Synthroid) and warfarin (Coumadin). Which intervention is a priority for the nurse? A.) Monitor the patient for cardiac dysrhythmias. B.) Monitor the patient for increased risk of bleeding. C.) Weigh patient daily for excessive weight loss. D.) Assess peripheral pulses and Homan's sign daily.

B.) Monitor the patient for increased risk of bleeding. Levothyroxine (Synthroid) can compete with protein-binding sites of warfarin (Coumadin), allowing more warfarin (Coumadin) to be unbound or free, thus increasing the effects of warfarin and the risk of bleeding. This combination does not place the patient at increased risk of dysrhythmias, weight loss, or deep vein thrombosis.

A nurse is administering prednisone (Deltasone) to a newly admitted patient who is taking multiple other drugs. The nurse should consider which drug interactions with prednisone? (select all that apply). A.) Cardiac and CNS actions are increased when taken with an adrenergic agent. B.) Potassium wasting diuretics increase potassium loss, resulting in hypokalemia C.) Risk for GI bleeding and ulceration increases when taken with aspirin or other NSAIDS D.) Action of prednisone is decreased when taken with phenytoin (Dilantin) because phenytoin increases glucocorticoid metabolism. E.) Risk for dysrhythmias and digitalis toxicity increases when taken with cardiac glycosides F.) Dosage of antidiabetic agents may need to be increased when taken concurrently with glucocorticoids

B.) Potassium wasting diuretics increase potassium loss, resulting in hypokalemia C.) Risk for GI bleeding and ulceration increases when taken with aspirin or other NSAIDS D.) Action of prednisone is decreased when taken with phenytoin (Dilantin) because phenytoin increases glucocorticoid metabolism. E.) Risk for dysrhythmias and digitalis toxicity increases when taken with cardiac glycosides F.) Dosage of antidiabetic agents may need to be increased when taken concurrently with glucocorticoids

A patient is prescribed glipizide (Glucotrol). The nurse knows that which side effects and adverse effects may be expected? (select all that apply). A.) Tachypnea B.) Tachycardia C.) Increased alertness D.) Increased weight gain E.) Visual disturbances F.) Hunger

B.) Tachycardia E.) Visual disturbances F.) Hunger

A patient is to receive insulin before breakfast, and the time the breakfast tray arrives varies. The nurse knows that which insulin should not be administered until the breakfast tray has arrived, and the patient is ready to eat? A.) Humulin N B.) lispro (Humalog) C.) glargine (Lantus) D.) Humulin R

B.) lispro (Humalog)

What is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? A.) Administer subcutaneous regular insulin immediately. B.)Administer glucagon. C.) Start an insulin drip. D.) Draw blood glucose level and send to the laboratory.

B.)Administer glucagon. Glucagon stimulates glycogenolysis, raising serum glucose levels. The patient is showing signs of hypoglycemia.

Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents? A.) "I will limit my alcohol consumption." B.) "I will report symptoms of fatigue and loss of appetite." C.) "I will take the medication only when I need it." D.) "I will monitor my blood sugar daily."

C.) "I will take the medication only when I need it." Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the health care provider. The patient needs to closely monitor blood sugar.

What information will the nurse teach the patient who has been prescribed an alpha glucosidase inhibitor? A.) "This medication will stimulate pancreatic insulin release." B.) "This medication will increase the sensitivity of insulin receptor sites." C.) "This medication will delay the absorption of carbohydrates from the intestines." D.) "This medication cannot be used in combination with other antidiabetic agents."

C.) "This medication will delay the absorption of carbohydrates from the intestines." Alpha glucosidase is an enzyme necessary for the absorption of glucose from the GI tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.

A patient is receiving a daily dose of Humulin N insulin at 7:30am. The nurse expects the peak effect of this drug to occur at which time? A.) 8:15am B.) 10:30 C.) 5:00pm D.) 11:00pm

C.) 5:00pm

After administering corticotropin, what assessments are priorities for the nurse? (Select all that apply.) A.) Acid and alkaline phosphatase levels B.) C-reactive protein levels C.) Changes in vision D.) Glucose levels E.) Intake and output F.) Serum sodium levels

C.) Changes in vision D.) Glucose levels E.) Intake and output F.) Serum sodium levels Corticotropin (Acthar, ACTH) can cause cataracts and glaucoma, so the nurse needs to monitor for changes in vision. Corticotropin stimulates the release of adrenal hormones, which can lead to sodium and fluid retention as well as hyperglycemia. Corticotropin can cause sodium and fluid retention, so that intake and output should be monitored. Serum sodium levels should be monitored, as sodium retention can be a result of corticotropin administration.

A patient is given desmopressin acetate. The nurse knows that this drug is used to treat which condition? A.) Gigantism B.) Diabetes mellitus C.) Diabetes insipidus D.) Adrenal insufficiency

C.) Diabetes insipidus

A patient with type 1 diabetes mellitus has been ordered insulin aspart (Novolog) 10 units at 7:00 AM. What nursing intervention will the nurse perform after administering this medication? A.) Perform a fingerstick blood sugar test. B.) Have the patient void and dipstick the urine. C.) Make sure the patient eats breakfast immediately. D.) Flush the IV.

C.) Make sure the patient eats breakfast immediately. Insulin aspart (Novolog) is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as it starts to work. The patient should have had a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine. This medication is given subcutaneously.

When assessing for potential side effects of fludrocortisone (Florinef), what is a priority for the nurse to monitor? A.) Serum sodium levels for potential hyponatremia B.) Serum calcium levels for hypercalcemia C.) Serum potassium levels for hypokalemia D.) Intake and output for potential fluid volume deficit

C.) Serum potassium levels for hypokalemia Fludrocortisone (Florinef) has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion.

What plan is best for the patient beginning prednisone therapy? A.) Administer the medication early evening to coincide with the natural secretion pattern of the adrenal cortex. B.) Plan to keep a strict, unchanging schedule to prevent adverse reactions. C.) Take the medication with food to diminish the risk of gastric irritation. D.) Take the medication only every other day to decrease the risk of adrenal hyperplasia.

C.) Take the medication with food to diminish the risk of gastric irritation. Glucocorticoids can cause gastric distress and should be administered with food. The normal circadian secretion of the adrenal cortex is early morning to wake the person up, not early evening. These medications should be tapered off slowly to prevent adrenal crisis. The patient takes the medication daily.

A patient is receiving the drug somatotropin (Genotropin). The nurse understands that the action of this drug is to do what? A.) Act as an antiinflammatory agent B.) Increase metabolic rate and oxygen consumption C.) stimulate growth in long bones at epiphyseal plates D.) Promote water reabsorption from the renal tubules

C.) stimulate growth in long bones at epiphyseal plates

The nurse would include which statement when teaching a patient about insulin glargine (Lantus)? A.) "You should inject this insulin just before meals because it is very fast-acting." B.) "The duration of action for this insulin is approximately 8 to 10 hours, so you will need to take it twice a day." C.) "You can mix this insulin with Lente insulin to enhance its effects." D.) "You cannot mix this insulin with any other insulin in the same syringe."

D.) "You cannot mix this insulin with any other insulin in the same syringe." Insulin glargine (Lantus) is a long-acting insulin with a duration of action up to 24 hours. It should not be mixed with any other insulins. The insulin is not fast-acting.

The nurse is caring for a patient who has just started taking levothyroxine (Synthroid). What assessment finding is a priority for the nurse to address? A.) Heart rate 55 beats per minute B.) Intolerance to cold C.) Weight gain of 3 pounds in the last week D.) Irritability

D.) Irritability Irritability is a symptom of hyperthyroidism. This could be a sign that the medication dose is too high. A lowered heart rate, weight gain, and intolerance to cold could be symptoms of hypothyroidism and are expected in this patient who just began medication therapy.

The nurse admitting a patient with acromegaly anticipates administering which medication? A.) Desmopressin (DDAVP) B.) Corticotropin (Acthar) C.) Somatropin (Nutropin) D.) Octreotide (Sandostatin)

D.) Octreotide (Sandostatin) Octreotide (Sandostatin) suppresses growth hormone that causes acromegaly.

The patient is taking an antithyroid medication. Which foods will the nurse teach the patient to avoid eating? A.) Chicken salad sandwich with mayonnaise, vegetable soup, milk B.) Ham and cheese omelet, rye toast with butter, orange juice C.) Hamburger on sesame roll, salad with French dressing, milk D.) Shrimp cocktail, boiled lobster, spinach salad without dressing, water

D.) Shrimp cocktail, boiled lobster, spinach salad without dressing, water Seafood contains high amounts of iodine. The other choices do not. The nurse instructs a patient taking an antithyroid medication to avoid foods high in iodine.