wn to determine TSH and T<sub>4</sub> levels. Which of the following
would support the diagnosis?
lt;sub>4</sub>) despite being stimulated by the pituitary gland (TSH, t
hyroid-stimulating hormone) to do so. Elevated TSH and T<sub>4</sub>
levels are seen with secondary hyperthyroidism caused by excessive TSH producti
on by the pituitary. A decreased TSH and elevated T<sub>4</sub> are
seen with primary hyperthyroidism. Decreased TSH and T<sub>4</sub> l
evels are seen in hypothyroidism secondary to insufficient pituitary secretions.
ctions. Recall the negative feedback loop of the endocrine system. Eliminate opt
ions 1 and 4 because there is an increased T<sub>4</sub> level, whic
h would not be seen with primary hypothyroidism.
+++++++
Q: Your patient is receiving heparin to treat thromboembolism. Which statement would you include in your teaching about heparin?
A) Heparin inactivates prothrombin
B) heparin crosses into the placenta
C) heparin's antidote is protamin zinc
D) heparin may be given with warfarin
Heparin and warfarin may be used together because they inhibit two different pathways to fibrin formation. Heparin is usually given in acute situations and prophylactically to prevent clot formatin, but it can only be given parenterally. Warfarin inhibits the hepatic synthesis of vitamin K-dependent clotting factors, taking longer to reach the therapeutic leve, so it's used primariy for long-term therapy. Heparin blocks the conversion of prothrombin to thrombin and fibrinogen to fibrin but doesn't inactivate prothrombin. Because it's a large polar molecule, it can't cross the plancenta. The antidote for heparin is protamin sulfate; protamine zinc is used in the preparation of NPH insulin.
