Which patient would be a concern for the nurse when administering mannitol (Osmitrol)?

Rationale for Choice A:

It is not recommended to always consume levothyroxine with food. In fact, food can interfere with the absorption of levothyroxine, leading to decreased efficacy of the medication.

Consuming levothyroxine with food can decrease its absorption by up to 30%, which can significantly impact its ability to manage hypothyroidism symptoms.

Certain foods, such as those high in fiber, calcium, or iron, can be particularly problematic, as they can bind to levothyroxine in the gut and further reduce its absorption.

While taking levothyroxine with a small amount of food may be necessary for some individuals who experience gastrointestinal side effects, it's generally recommended to take it on an empty stomach for optimal absorption.

Rationale for Choice B:

Milk is not an ideal beverage to take with levothyroxine, as it can also interfere with absorption. Milk contains calcium, which can bind to levothyroxine and reduce its absorption.

It's best to avoid consuming milk or other calcium-rich beverages within a few hours of taking levothyroxine.

Rationale for Choice C:

Similar to milk, juice and crackers are not ideal choices to take with levothyroxine.

Juice, especially those high in acidity, can affect the absorption of levothyroxine in the gut.

Crackers, often made with refined grains, can be high in fiber, which can also interfere with absorption.

Rationale for Choice D:

Taking levothyroxine on an empty stomach, typically 30-60 minutes before breakfast, is generally recommended to ensure optimal absorption.

This allows the medication to be absorbed more efficiently in the small intestine without being affected by the presence of food.

By taking levothyroxine on an empty stomach, patients can maximize its effectiveness in treating hypothyroidism.

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.