A nurse is caring for a client who is at 10 weeks of gestation and reports nausea and vomiting on most days.
Which of the following recommendations should the nurse make?

This is because the client has hypothyroidism, which means their thyroid gland does not produce enough thyroid hormone. Levothyroxine is a synthetic form of thyroid hormone that can replace the missing hormone and normalize the TSH level. The client’s TSH level is 8.9 mIU/L, which is above the normal range of 0.4 to 4.0 mIU/L. This indicates that the client’s current dosage of levothyroxine is insufficient and needs to be increased.

Choice A is wrong because thyroid ablation therapy is a treatment for hyperthyroidism, not hypothyroidism.

Thyroid ablation therapy involves destroying part or all of the thyroid gland with radioactive iodine or surgery, which reduces the production of thyroid hormone.

This would worsen the client’s condition and symptoms.

Choice C is wrong because lovastatin is a statin drug that lowers cholesterol levels. Hypothyroidism can cause high cholesterol levels, but this is usually corrected by levothyroxine therapy. Replacing lovastatin with cholestyramine, a bile acid sequestrant that also lowers cholesterol levels, would not address the underlying cause of hypothyroidism and would not improve the client’s TSH level.

Choice D is wrong because restricting the intake of iodized salt would not help the client with hypothyroidism. Iodine is an essential element for the synthesis of thyroid hormone, but most people in developed countries get enough iodine from their diet.

Hypothyroidism is usually caused by autoimmune disease, not iodine deficiency.

The nurse should determine if the client has prepared their advance directives, which are legal documents that specify the client’s wishes regarding medical care in case they become incapacitated. Advance directives can include a living will, a durable power of attorney for health care, or a do-not-resuscitate order. The nurse should respect the client’s autonomy and right to self-determination by asking about their advance directives and ensuring that they are documented and followed.

Choice A is wrong because the nurse should not delay the admission while the client fills out the facility’s advance directives form.

The client has the right to refuse or accept any treatment, including filling out an advance directives form.

The nurse should inform the client about the benefits of having advance directives, but should not coerce or pressure them to complete one.

Choice B is wrong because the nurse should not confirm with the client’s family that the consent form has been signed.

The consent form is a legal document that indicates that the client has given informed consent for the surgery, which means that they have received adequate information about the procedure, its risks and benefits, and alternative options.

The consent form should be signed by the client, unless they are a minor, mentally incompetent, or unable to communicate.

The nurse should verify that the consent form has been signed by the client or their legal representative before the surgery.

Choice C is wrong because the nurse should not explain to the client that signing the facility’s consent form means they cannot refuse care.

Signing the consent form does not waive the client’s right to withdraw consent at any time before or during the surgery.

The nurse should inform the client that they can change their mind and refuse care at any point, and that their decision will be respected and honored.