The nurse is caring for a patient with Graves Disease and anemia who had a thyroidectomy two days ago.
Based on the laboratory results below, which medication will the nurse administer first? Creatinine 1.2 mg/dL. Calcium 8.5 mg/dL. Hemoglobin 12 g/dL. Hematocrit 36%.

Choice A rationale

Pain from mucositis and oral tissue injury is a significant concern for patients undergoing chemotherapy. However, it is not typically life-threatening and can be managed with appropriate pain relief measures and oral care.

Choice B rationale

Weakness and fatigue with activity are common side effects of chemotherapy and the disease process itself. While these symptoms impact the patient's quality of life, they do not usually require urgent intervention.

Choice C rationale

Blood pressure of 90/64 mmHg, pulse of 102 beats per minute, and oral temperature of 38.5 degrees Celsius suggest possible sepsis or severe infection. These vital signs indicate an urgent need for intervention to prevent further deterioration and potentially life-threatening complications.

Choice D rationale

Scattered ecchymosis and petechiae are signs of thrombocytopenia (low platelet count), which is a common complication of leukemia and its treatment. While important to monitor and manage, these findings are not typically as urgent as signs of sepsis or severe infection.

Choice A rationale

Levothyroxine is used for the replacement of thyroid hormone in patients with hypothyroidism. While it is essential for long-term management of thyroidectomy patients, it is not the immediate priority. The patient’s calcium levels are low, indicating the need for urgent correction to prevent complications such as tetany or cardiac issues.

Choice B rationale

Calcium gluconate is crucial to administer first in this scenario because the patient's calcium level is 8.5 mg/dL, which is on the lower end of the normal range. After a thyroidectomy, patients are at risk of hypocalcemia due to potential damage to the parathyroid glands, which regulate calcium levels. Intravenous calcium gluconate helps rapidly correct any deficiency and prevents severe symptoms like muscle cramps, tingling, or cardiac arrhythmias.

Choice C rationale

Epoetin alfa is used to stimulate red blood cell production in patients with anemia, particularly those with chronic kidney disease or undergoing chemotherapy. Although this patient has anemia, indicated by a hemoglobin level of 12 g/dL and hematocrit of 36%, the levels are not critically low. Addressing the low calcium level takes precedence to prevent immediate life-threatening complications.

Choice D rationale

Potassium chloride is used to treat or prevent potassium deficiency. The patient’s laboratory results do not indicate any abnormality in potassium levels, making this medication unnecessary at this time. Administering it without indication could lead to hyperkalemia, which poses risks such as cardiac dysrhythmias.