After receiving change-of-shift report about the following four patients, which patient should the nurse assess first?
a. A 31-year-old female with Cushing syndrome and a blood glucose level of 244 mg/dL
b. A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse of 134
c. A 53-year-old male who has Addison's disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef).
d. A 22-year-old male admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L
ANS: B
Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications.
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