A 55-year-old patient with type 2 diabetes is admitted to the hospital and is on NPH insulin. The patient experiences symptoms of hypoglycemia. At what time after administration of NPH insulin should the nurse be most vigilant for signs of hypoglycemia due to the peak action of the insulin?

Choice A Reason:

Administering IV levothyroxine is the priority intervention for a patient with myxedema coma. Myxedema coma is a severe form of hypothyroidism that requires immediate thyroid hormone replacement to correct the deficiency and stabilize the patient’s condition. Intravenous levothyroxine is preferred because it provides a rapid increase in thyroid hormone levels, which is crucial for reversing the life-threatening symptoms of myxedema coma, such as hypothermia, bradycardia, and altered mental status.

Choice B Reason:

Starting broad-spectrum antibiotics is not the primary intervention for myxedema coma. While infections can precipitate myxedema coma and should be treated if present, the immediate priority is to address the severe hypothyroidism with thyroid hormone replacement. Antibiotics may be administered if an infection is suspected or confirmed, but they do not directly address the underlying thyroid hormone deficiency.

Choice C Reason:

Administering corticosteroids immediately is important but not the highest priority. Corticosteroids are often given to patients with myxedema coma to treat potential adrenal insufficiency, which can coexist with severe hypothyroidism. However, the primary intervention remains the administration of thyroid hormone replacement to correct the hypothyroid state.

Choice D Reason:

Initiating fluid restriction is not appropriate for managing myxedema coma. Patients with myxedema coma often require careful fluid management to address potential hyponatremia and maintain hemodynamic stability. Fluid restriction is not a standard intervention for this condition and does not address the critical need for thyroid hormone replacement.

Choice A Reason:

Primary hyperparathyroidism is characterized by elevated PTH levels, which lead to increased serum calcium levels and decreased serum phosphate levels. The patient’s lab results show low PTH and low serum calcium, which are not consistent with primary hyperparathyroidism.

Choice B Reason:

Chronic kidney disease (CKD) can cause disturbances in calcium and phosphate metabolism, but it typically presents with elevated PTH levels due to secondary hyperparathyroidism. The patient’s low PTH levels make CKD an unlikely diagnosis in this context.

Choice C Reason:

Vitamin D deficiency can lead to low serum calcium levels, but it usually results in elevated PTH levels as the body attempts to compensate for the low calcium. The patient’s low PTH levels do not align with a diagnosis of vitamin D deficiency.

Choice D Reason:

Hypoparathyroidism is characterized by low serum calcium, low PTH levels, and elevated serum phosphate levels. This condition occurs when the parathyroid glands do not produce enough PTH, leading to the observed lab results and symptoms such as tingling, muscle cramps, and fatigue. The patient’s lab results are consistent with hypoparathyroidism.