A patient diagnosed with hyperthyroidism is about to start antithyroid medication therapy. Which food should the patient avoid as advised by the nurse?
Fava beans
Shellfish
Foods high in purine
Grapefruit
The Correct Answer is D
Choice A rationale:
Fava beans do not interact with antithyroid medications and do not need to be avoided specifically for this reason. However, it's important to note that fava beans can cause a condition called favism in individuals with a certain genetic predisposition. Favism is characterized by hemolytic anemia, which is the breakdown of red blood cells. If a patient has a history of favism or is unsure of their risk, it's best to avoid fava beans while on antithyroid medication and consult with their healthcare provider.
Choice B rationale:
Shellfish does not typically interact with antithyroid medications. However, some individuals with hyperthyroidism may have co-existing allergies to shellfish. In those cases, it's important to avoid shellfish to prevent allergic reactions, but this is not due to a direct interaction with antithyroid medications.
Choice C rationale:
Foods high in purine, such as organ meats, red meat, and certain seafood, are often restricted in individuals with gout. Gout is a form of arthritis caused by the buildup of uric acid crystals in the joints. While hyperthyroidism can sometimes increase uric acid levels, there's no specific interaction between antithyroid medications and purine-rich foods. Therefore, avoiding purine- rich foods is not necessary for those on antithyroid therapy unless they have gout or a predisposition to it.
Choice D rationale:
Grapefruit and grapefruit juice can significantly interact with antithyroid medications, particularly methimazole and propylthiouracil. These medications are broken down by an enzyme called CYP3A4 in the liver. Grapefruit juice inhibits the activity of CYP3A4, which can lead to increased levels of antithyroid medications in the bloodstream. This can increase the risk of side effects from the medication, such as liver damage, bone marrow suppression, and skin reactions. Therefore, it's crucial for patients on antithyroid therapy to avoid grapefruit and grapefruit juice.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Dopamine is a catecholamine that acts on both alpha- and beta-adrenergic receptors. It has inotropic (increases heart contractility), chronotropic (increases heart rate), and vasopressor (constricts blood vessels) effects.
It was previously used as a first-line agent for cardiogenic shock, but it has fallen out of favor due to concerns about its potential to increase heart rate and arrhythmias, which can worsen myocardial oxygen demand and ischemia.
Additionally, dopamine's effects on renal blood flow can be unpredictable, and it may not be as effective as norepinephrine in increasing blood pressure in patients with severe shock.
Choice B rationale:
Norepinephrine is a potent alpha-adrenergic agonist that causes vasoconstriction, leading to an increase in blood pressure. It has minimal beta-adrenergic effects, so it does not significantly increase heart rate.
Norepinephrine is the preferred first-line vasopressor for cardiogenic shock because it effectively raises blood pressure without significantly increasing heart rate or myocardial oxygen demand.
It also has beneficial effects on renal blood flow and may improve organ perfusion.
Choice C rationale:
Epinephrine is a potent alpha- and beta-adrenergic agonist. It has strong inotropic, chronotropic, and vasopressor effects.
It can be used in cardiogenic shock, but it is typically reserved for patients who do not respond adequately to norepinephrine or who have severe bradycardia.
Epinephrine's potent beta-adrenergic effects can increase heart rate and myocardial oxygen demand, which can be detrimental in patients with cardiogenic shock.
Choice D rationale:
Vasopressin (Pitressin) is a hormone that acts on V1 receptors in vascular smooth muscle to cause vasoconstriction. It is not a first-line agent for cardiogenic shock, but it can be used as an adjunct to norepinephrine in patients who are refractory to other vasopressors.
Vasopressin may be particularly useful in patients with septic shock, as it has been shown to improve outcomes in this population.
Correct Answer is ["A","C"]
Explanation
Choice A rationale:
Insulin glargine (Lantus) is a long-acting insulin analog that is designed to provide a steady, basal level of insulin throughout the day.
It has a duration of action of approximately 24 hours, so it is typically administered once daily at bedtime.
This helps to control blood glucose levels overnight and during the early morning hours, when the risk of hypoglycemia is highest.
Key characteristics of Insulin Glargine (Lantus):
Onset: 1-2 hours
Peak: No pronounced peak Duration: Approximately 24 hours
Administration: Once daily at bedtime
Choice B rationale:
Lispro (Humalog) is a rapid-acting insulin analog that is designed to be taken with meals to help control blood glucose spikes after eating.
It has a onset of action of approximately 15 minutes and a duration of action of 2-4 hours.
Because of its rapid onset and short duration of action, lispro is not typically used as a basal insulin. Key characteristics of Lispro (Humalog):
Onset: 15 minutes
Peak: 30-90 minutes
Duration: 2-4 hours
Administration: With meals
Choice C rationale:
Insulin detemir (Levemir) is another long-acting insulin analog that is similar to insulin glargine in terms of its duration of action.
It is typically administered once daily at bedtime to provide basal insulin coverage. Key characteristics of Insulin Detemir (Levemir):
Onset: 1-2 hours
Peak: No pronounced peak
Duration: Approximately 18-24 hours Administration: Once daily at bedtime Question 23.
The nurse receives an order for insulin: NPH (Humulin NPH) 10 units to be administered intravenously daily at 7:00am.
What action should the nurse take?
A. Administer the dose but ensure that if mixed with another Humulin-R insulin, to draw the regular insulin up first.
B. Give the drug subcutaneously rather than IV
C. Review the insulin order with the prescriber and pharmacy.
D. Administer the insulin ordered mixed in 50 ML of 0.9%NS IV Piggyback (not to infuse faster than 1/2 hour or 30 minutes).
The correct answer is C. Review the insulin order with the prescriber and pharmacy.
Rationale for Choice A:
Intravenous administration of NPH insulin is not recommended. It is an intermediate-acting insulin that is designed to be absorbed slowly from the subcutaneous tissue. IV administration can lead to rapid and unpredictable changes in blood glucose levels, which can be dangerous.
Mixing NPH insulin with regular insulin does not change the route of administration. Both insulins should still be given subcutaneously.
Rationale for Choice B:
Subcutaneous administration of NPH insulin is the correct route. This allows for slow and steady absorption of the insulin, which helps to prevent blood glucose fluctuations.
However, the nurse should still clarify the order with the prescriber and pharmacy. This is because IV insulin orders are unusual and may be a mistake.
Rationale for Choice D:
Adding NPH insulin to a 50 mL IV piggyback is not a safe practice. This would dilute the insulin and make it even more difficult to control the rate of infusion.
IV insulin infusions are typically administered using a dedicated insulin pump. This allows for precise control of the infusion rate and helps to prevent hypoglycemia.
Rationale for Choice C:
Reviewing the insulin order with the prescriber and pharmacy is the safest course of action. This will help to ensure that the order is correct and that the insulin is administered safely.
The prescriber may have meant to order regular insulin instead of NPH insulin. Regular insulin can be given intravenously, but it requires careful monitoring of blood glucose levels.
The pharmacy can also double-check the order and ensure that the correct insulin is dispensed.
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