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1. Question
A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially?
Correct
Option 2 (Maintain a patent airway) is the right answer.
Rationale: Myxedema coma is a rare but serious disorder that results from persistently low thyroid production. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opioid analgesics. In myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen should be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.
Test-Taking Strategy: Note the strategic word, initially. All the options are appropriate interventions, but use the ABCs—airway, breathing, and circulation— in selecting the correct option.
Incorrect
Option 2 (Maintain a patent airway) is the right answer.
Rationale: Myxedema coma is a rare but serious disorder that results from persistently low thyroid production. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opioid analgesics. In myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen should be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.
Test-Taking Strategy: Note the strategic word, initially. All the options are appropriate interventions, but use the ABCs—airway, breathing, and circulation— in selecting the correct option.
Myxedema Coma:
▪ This rare but serious disorder results from persistently low thyroid production.
▪ Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, or the use of sedatives and opioid analgesics.
