Author Question: A patient reports fatigue, weight loss, and dry skin. The primary care nurse practitioner (NP) ... (Read 43 times)

NguyenJ · **on:** Jul 24, 2018

A patient reports fatigue, weight loss, and dry skin. The primary care nurse practitioner (NP) orders thyroid function tests. The patient's thyroid stimulating hormone (TSH) is 40 microunits/mL, and T4 is 0.1 ng/mL.

The NP should refer the patient to an endocrinologist and prescribe: a. methimazole.
b. liothyronine.
c. levothyroxine.
d. propylthiouracil.

Question 2

A patient has been taking antibiotics to treat recurrent pneumonia. The patient is in the clinic after having diarrhea for 5 days with six to seven liquid stools each day. The primary care NP should:

a. obtain a stool specimen and order vancomycin.
b. order testing for Clostridium difficile and consider metronidazole therapy.
c. prescribe diphenoxylate (Lomotil) to provide symptomatic relief.
d. reassure the patient that diarrhea is a common side effect of antibiotic therapy.

jaykayy05 · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

C
This patient has hypothyroidism and should be treated with levothyroxine. Methimazole is a thyroid suppressant. Liothyronine is synthetic T3 . Propylthiouracil is a thyroid suppressant.

Answer to Question 2

B
The guidelines for treatment of diarrhea emphasize comprehensive evaluation before treatment begins. Antibiotic use points to C. difficile as a possible cause, and metronidazole is often used to treat mild to moderate infection. Vancomycin is used when C. difficile is severe. Diphenoxylate can worsen the infection because it slows transit time of the bacteria in the gut. Prolonged diarrhea during antibiotic therapy should be investigated.