A patient with Graves’ disease exhibits symptoms of tachycardia, heat intolerance, and exophthalmos. Which drug is used to alter thyroid hormone levels prior to surgery?

Choice A rationale:

Incorrect. Insulin pumps should be removed before bathing or swimming to prevent damage to the device. Water can enter the pump through the infusion set or through the battery compartment, causing it to malfunction. This can lead to inaccurate insulin delivery, which can result in hyperglycemia or hypoglycemia.

Additionally, the adhesive that holds the infusion set in place may not stick well to wet skin, which can increase the risk of the infusion set falling out.

It is important to note that some insulin pumps are now waterproof and can be worn while bathing or swimming. However, it is still important to check the manufacturer's instructions before doing so.

Choice B rationale:

Correct. Even though insulin pumps deliver insulin continuously, people who use them still need to monitor their blood glucose levels regularly. This is because many factors can affect blood glucose levels, such as food intake, exercise, stress, and illness.

Monitoring blood glucose levels allows people to adjust their insulin doses as needed to keep their blood glucose levels within a target range.

Recommended frequency of blood glucose monitoring:

Before meals and snacks Two hours after meals At bedtime

Before and after exercise During times of illness or stress

Whenever they feel symptoms of hypoglycemia or hyperglycemia

Choice C rationale:

Incorrect. People who use insulin pumps still need to count carbohydrates. This is because the amount of insulin that is needed to cover a meal depends on the amount of carbohydrates in the meal.

The insulin pump can be programmed to deliver different amounts of insulin for different meals, snacks, and corrections based on carbohydrate intake. This allows for more precise insulin dosing and better blood glucose control.

Choice D rationale:

Incorrect. Insulin pumps are not designed to help people lose weight. They are designed to help people manage their blood glucose levels.

While some people may lose weight when they start using an insulin pump, this is usually due to improved blood glucose control rather than the pump itself.

Choice A rationale:

Calcitonin (Fortical) is a hormone that lowers blood calcium levels. It is not indicated for the treatment of hypocalcemia caused by parathyroid hormone deficiency. In fact, it could worsen the condition by further reducing calcium levels.

Calcitonin is primarily used to treat hypercalcemia (high calcium levels) and osteoporosis.

It works by inhibiting osteoclast activity, which reduces bone resorption and calcium release into the bloodstream.

Choice B rationale:

Calcium is the essential mineral for treating hypocalcemia. It directly replenishes calcium levels in the blood.

Calcium can be administered orally (PO) or intravenously (IVPB), depending on the severity of the hypocalcemia and the patient's condition.

Oral calcium is often preferred for mild to moderate hypocalcemia, while IV calcium is typically used for severe hypocalcemia or when rapid correction is necessary.

Calcium supplements are available in various forms, including calcium carbonate, calcium citrate, and calcium gluconate. The dosage of calcium will be individualized based on the patient's serum calcium levels and clinical response.

Choice C rationale:

Vitamin B12 is not directly involved in calcium regulation. It is essential for red blood cell production and nerve function. While vitamin B12 deficiency can sometimes be associated with hypocalcemia, it is not a primary treatment for this condition. Choice D rationale:

Vitamin D3 (Calcitriol) is a hormone that aids in calcium absorption from the intestines. It is often used in conjunction with calcium supplements to treat hypocalcemia.

However, vitamin D3 alone is not sufficient to treat hypocalcemia caused by parathyroid hormone deficiency. Parathyroid hormone is essential for activating vitamin D3 in the kidneys, so its deficiency limits the effectiveness of vitamin D3.