A breastfeeding infant, screened for congenital hypothyroidism, is found to have low levels of thyroxine (T4) and high levels of thyroid stimulating hormone (TSH). Which is the best explanation for this finding?
The TSH is high because of the low production of T4 by the thyroid.
The thyroxine level is low because the TSH level is high.
The thyroid gland does not produce normal levels of thyroxine for several weeks after birth.
High thyroxine levels normally occur in breastfeeding infants.
The Correct Answer is A
In a normal infant, T4 levels increase after birth due to stimulation by TSH from the pituitary gland. In this case, the T4 level is low and the TSH level is high, indicating that the thyroid gland is not producing enough T4 in response to TSH stimulation. This suggests that the infant may have congenital hypothyroidism, which requires prompt treatment to prevent developmental delays and other complications.
The low T4 level is not a direct cause of the high TSH level; rather, the high TSH level is a compensatory mechanism to increase T4 production. It is not normal for a breastfeeding infant to have high thyroxine levels. While the thyroid gland may take a few weeks to reach normal function after birth, the persistent low T4 and high TSH levels in this infant suggest a more serious issue.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D","F"]
Explanation
Answer: B, D, F
Rationale:
A) Understanding that nonstimulant medications show little benefit in treatment: This is inaccurate, as nonstimulant medications like atomoxetine can be effective for ADHD, especially in children who may not tolerate stimulants. Nonstimulants are often considered a viable alternative or adjunctive treatment.
B) Designating an established area for study: Creating a dedicated study space can help a child with ADHD focus on tasks and minimize distractions, which is beneficial for completing homework and improving concentration in a structured environment.
C) Anticipating being automatically entered into a specialized education plan: An Individualized Education Plan (IEP) or 504 Plan for ADHD is not automatic and typically requires evaluation and recommendation from school staff. The plan is individualized based on the child’s specific needs.
D) Knowing that medication is not always the best approach to treatment: Recognizing that treatment can involve behavioral interventions, counseling, and environmental adjustments, in addition to or instead of medication, reflects a balanced understanding of ADHD management.
F) Maintaining a consistent home schedule: Consistent routines help children with ADHD manage expectations and reduce stress, enhancing their ability to focus and transition smoothly between activities.
Correct Answer is B
Explanation
Answer: (B) Counsel the client about the risks and benefits of using oral contraceptives.
Rationale:
(A) Encourage the client to discuss her need for contraceptives with her parents: Encouraging open communication with parents is important, but this action might not be the most appropriate in this context. The client has expressed a desire for confidentiality, and respecting her autonomy is essential, particularly when it comes to sensitive topics like sexual health.
(B) Counsel the client about the risks and benefits of using oral contraceptives: Providing counseling about the risks and benefits of oral contraceptives is the most appropriate action. It ensures the client is informed and able to make a decision that is right for her health and circumstances. The nurse can also discuss other contraceptive options and provide education on safe sex practices. This approach respects the client's autonomy and privacy while ensuring she receives the necessary information to make an informed choice.
(C) Explain that she needs parental approval to receive contraceptives: In many areas, adolescents have the right to obtain contraceptives without parental consent. Requiring parental approval might not only be legally incorrect but could also discourage the client from seeking necessary healthcare, potentially putting her at risk.
(D) Tell the client how to receive a variety of free oral contraceptives from the clinic: While providing information about accessing contraceptives is helpful, this option alone does not address the need for thorough counseling about the risks and benefits. It's important to ensure that the client understands the implications of using oral contraceptives and has the opportunity to ask questions and receive guidance tailored to her individual needs.
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