A client who received a renal transplant three months ago is readmitted to the acute care unit with signs of graft rejection. While taking the client’s history, the nurse determines that the client has been self-administering St. John's Wort, an herbal preparation on the advice of a friend.

Which information is most significant about this finding?

Levothyroxine is a thyroid hormone replacement medication used to treat hypothyroidism. To ensure proper absorption and effectiveness of the medication, it should be taken on an empty stomach, preferably in the morning, and at least 30 minutes before eating. Therefore, when the client indicates that they understand the need to take the medication on an empty stomach, it indicates that the education was effective.

Option b, "Avoid the use of iron supplements," is also important education for clients taking levothyroxine because iron supplements can interfere with the absorption of the medication. However, it is not the best indicator of effective education because the question asks for the statement that indicates education was effective, and option a is a more direct and specific response to the medication.

Option c, "Administer levothyroxine at bedtime," is not accurate information because the medication should be taken in the morning on an empty stomach.

Option d, "Consume foods that are high in iodine," is not recommended for clients taking levothyroxine because high amounts of iodine can interfere with thyroid function. Therefore, this statement indicates a need for further education.

The correct answer is C. Instruct the client to request assistance when ambulating to the bathroom.

Choice A reason:

Advise the client that the medication should start to work in about 30 minutes.

While it is important to inform the client about the onset of action of the medication, this is not the highest priority. Codeine, an opioid, can cause dizziness and sedation, which increases the risk of falls. Therefore, safety measures take precedence over informing the client about the medication’s onset time.

Choice B reason:

Administer a stool softener/laxative at the same time as the analgesic.

Opioids like codeine can cause constipation, so administering a stool softener or laxative is a good practice. However, this action is not the highest priority when considering the immediate safety of the client. Ensuring the client’s safety from potential falls due to dizziness or sedation is more urgent.

Choice C reason:

Instruct the client to request assistance when ambulating to the bathroom.

This is the correct answer because codeine can cause dizziness, sedation, and orthostatic hypotension, increasing the risk of falls. Ensuring the client requests assistance when moving can prevent potential injuries, making it the highest priority nursing action.

Choice D reason:

Tell the client to notify the nurse if the pain is not relieved.

While it is important for the client to communicate about the effectiveness of pain relief, this is not the highest priority. The immediate concern is the client’s safety due to the sedative effects of codeine. Therefore, preventing falls and injuries takes precedence.