As the shift begins, you are assigned these patients. Which patient should you assess first?

Correct Answer: C

Rationale: In this scenario, the correct answer is option C) A 58-year-old patient with hypothyroidism and a heart rate of 48/minute. This patient should be assessed first because a heart rate of 48/minute is significantly outside the normal range (60-100 beats per minute) and may indicate bradycardia, which can be a life-threatening condition requiring immediate attention. Option A) A 38-year-old patient with Graves' disease and a heart rate of 94/minute may have tachycardia, which is common in Graves' disease but is not as critical as bradycardia. Option B) A 63-year-old patient with type 2 diabetes and a fingerstick glucose of 137 mg/dL is within the normal range and does not require immediate attention. Option D) A 49-year-old patient with Cushing's disease and +1 dependent edema is concerning for fluid retention but does not present an immediate threat to the patient's life. Educationally, this question highlights the importance of recognizing abnormal vital signs and prioritizing patient assessments based on the urgency of the situation. Understanding the significance of vital sign abnormalities in different endocrine disorders is crucial for providing safe and effective patient care.

Correct Answer: C

Rationale: Rationale for Correct Answer (C): Dextroamphetamine causes peripheral adrenergic effects by displacing, releasing, intraneuronal NE. Amphetamines disrupt the storage and release of NE from intraneuronal vesicles, leading to an increase in synaptic NE levels. This excess NE can stimulate adrenergic receptors in the periphery, causing adverse effects like hypertension, tachycardia, and potentially fatal outcomes. Summary of Incorrect Choices: A: Activating MAO would increase NE breakdown, not cause peripheral adrenergic effects. B: Blocking NE reuptake would increase NE levels in the synapse, not intraneuronally, leading to central effects. D: Enhancing NE synthesis would not directly lead to peripheral adrenergic effects, as it would require release and action at the synapse.

Correct Answer: B

Rationale: The correct answer is B: Inhibits ACh release from all cholinergic nerves. Botulinum toxin blocks the release of acetylcholine (ACh) from cholinergic nerve terminals, leading to muscle paralysis. This occurs through the cleavage of SNARE proteins, preventing vesicle fusion and neurotransmitter release. Choice A is incorrect because botulinum toxin does not directly activate receptors. Choice C is incorrect as botulinum toxin does not affect neuronal norepinephrine reuptake. Choice D is incorrect because botulinum toxin does not release norepinephrine via a nonexocytotic process.

Correct Answer: D

Rationale: Adrenaline is contraindicated in hypertension because it can worsen high blood pressure and increase the risk of cardiovascular events. Adrenaline's vasoconstrictive effects can further elevate blood pressure in individuals with hypertension, potentially leading to severe complications. Therefore, it is crucial to avoid administering adrenaline in patients with hypertension to prevent adverse cardiovascular outcomes. Summary: - A: Adrenaline is indicated in cardiac arrest to improve cardiac output. - B: Adrenaline is indicated in acute bronchial asthma to relax bronchial smooth muscles. - C: Adrenaline is indicated in anaphylactic shock to reverse severe allergic reactions. - D (Correct): Adrenaline is contraindicated in hypertension due to its vasoconstrictive effects.

Correct Answer: C

Rationale: Monoamine oxidase enzyme (MAO) is responsible for the degradation of neurotransmitters like adrenaline. MAO breaks down adrenaline into inactive metabolites, regulating its levels in the body. This process is crucial for maintaining neurotransmitter balance. Choice A is incorrect because MAO does not activate adrenaline. Choice B is incorrect as MAO is not involved in adrenaline synthesis. Choice D is incorrect as MAO does not degrade acetylcholine, but rather neurotransmitters like serotonin, dopamine, and adrenaline.