A client has a history of atrial fibrillation and is taking an oral anticoagulant. The client has been newly diagnosed with hypothyroidism and placed on levothyroxine.
What assessment should the nurse prioritize?

Monitoring the client for increased bruising.

Assessing for signs and symptoms of infection.

Assessing the client’s level of consciousness.

Monitoring the client’s electrolyte levels.

Answer and Explanation

The Correct Answer is A

This is because levothyroxine can increase the anticoagulant effect of oral anticoagulants and increase the risk of bleeding. The nurse should check the client’s prothrombin time and international normalized ratio (INR) regularly and report any abnormal values to the prescriber.

Choice B is wrong because hypothyroidism does not increase the risk of infection.

Choice C is wrong because hypothyroidism does not affect the level of consciousness unless it is severe and causes myxedema coma.

Choice D is wrong because hypothyroidism does not cause electrolyte imbalances.

Normal ranges for prothrombin time are 11 to 13.5 seconds and for INR are 0.8 to 1.22.

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Correct Answer is D

Explanation

This is because prednisolone can cause insomnia if taken later in the day, and it mimics the natural secretion of cortisol by the adrenal glands, which peaks in the morning.

Choice A is wrong because splitting the dose into two equal doses can increase the risk of adrenal suppression and reduce the efficacy of alternate-day therapy (ADT), which is used to minimize adverse effects of corticosteroids.

Choice B is wrong because taking prednisolone before bedtime can interfere with sleep and cause nocturnal cortisol secretion, which can lead to Cushing syndrome.

Choice C is wrong because taking prednisolone 1 hour before meals can cause gastric irritation and ulceration, and it is recommended to take it with food or milk.

A. tetraiodothyronine. B. thyroid-stimulating hormone (TSH). C. triiodothyronine.

Correct Answer is B

Explanation

Thyroid-stimulating hormone - Wikipedia Thyroid-stimulating hormone (TSH) is a hormone produced by the anterior pituitary gland that stimulates the thyroid gland to release its own hormones, triiodothyronine (T) and thyroxine (T).12 If the anterior pituitary gland is dysfunctional, it will not produce enough TSH, leading to low levels of T and T. This condition is called secondary or pituitary hypothyroidism.123

Choice A is wrong because tetraiodothyronine is another name for thyroxine (T), which is a hormone produced by the thyroid gland, not the anterior pituitary gland.14

Choice C is wrong because triiodothyronine (T) is also a hormone produced by the thyroid gland, not the anterior pituitary gland.14

Normal ranges for TSH are 0.4 to 4.0 mIU/L, for T are 100 to 200 ng/dL, and for T are 4.5 to 11.2 mcg/dL.1

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A client has a history of atrial fibrillation and is taking an oral anticoagulant. The client has been newly diagnosed with hypothyroidism and placed on levothyroxine. What assessment should the nurse prioritize?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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A client has a history of atrial fibrillation and is taking an oral anticoagulant. The client has been newly diagnosed with hypothyroidism and placed on levothyroxine.
What assessment should the nurse prioritize?