Author Question: A patient with Graves' disease is taking methimazole. After 6 months of therapy, the primary care NP ... (Read 29 times)

fbq8i · **on:** Jul 24, 2018

A patient with Graves' disease is taking methimazole. After 6 months of therapy, the primary care NP notes normal T3 and T4 and elevated TSH. The NP should:

a. order a complete blood count (CBC) with differential.
b. order aspartate aminotransferase, AGT, and LDH tests.
c. decrease the dose of the medication.
d. add levothyroxine to the patient's regimen.

Question 2

A primary care NP sees a patient 2 days after an outpatient surgical procedure. The patient reports using ondansetron for nausea. The NP notes a blood pressure of 88/56 mm Hg, and the patient reports feeling faint. The NP should suspect:

a. hemorrhage.
b. dehydration.
c. drug toxicity.
d. drug interaction.

cuttiesgirl16 · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

C
Once clinical levels of thyrotoxicosis have been resolved, elevated TSH indicates a need to reduce the dosage. A CBC with differential is performed at the beginning of treatment and when signs of infection are present. Liver function tests may be monitored periodically but are not indicated by the current laboratory results. Levothyroxine is not indicated.

Answer to Question 2

C
Hypotension and faintness are signs of overdose of ondansetron, and drug toxicity is the more likely cause of this patient's decrease in blood pressure.