A nurse is preparing to administer levothyroxine 50 mcg to a client. Available is levothyroxine 0.025 mg/tablet. How many tablets should the nurse administer per dose? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A. Refer the family to a chronic pain support group: While psychosocial support can be beneficial for children with chronic migraines, referral to a support group is not the priority initial action. The first step is to assess and understand the pattern and triggers of the headaches.

B. Request a change in medication from the provider: Medication adjustments may be necessary, but the nurse must first gather objective and subjective data on the child’s pain patterns, frequency, and triggers before advocating for changes in pharmacologic management.

C. Set up an appointment with the school nurse: Collaborating with the school nurse can help manage migraines during school hours, but this action is secondary to assessing the child’s headache history and current management at home.

D. Review the child's electronic pain diary: Reviewing the electronic pain diary provides detailed, chronological information about headache frequency, intensity, triggers, and response to interventions. This assessment is essential for guiding further interventions and is the first action in clinical decision-making according to the nursing process.

Rationale for correct choices

• Client reports lower back pain as 0 on a scale from 0 to 10: Resolution of back pain suggests that uterine contractions and associated discomfort have decreased, indicating reduced preterm labor activity and improved comfort. Pain control and labor suppression interventions appear effective.

• No further reports of burning with urination: The absence of dysuria indicates that a possible urinary tract infection is improving, either spontaneously or following interventions such as increased hydration or antibiotic therapy. Symptom resolution reflects clinical improvement.

• No uterine contractions noted: The absence of contractions indicates that preterm labor activity has decreased. This reflects effective management and a positive trend in preventing progression to preterm birth.

• Temperature 37.1° C (98.7° F): A normalized temperature reflects a reduction in maternal infection or inflammatory response. This indicates that the client’s fever is resolving, decreasing risk for maternal and fetal complications.

• No reports of vaginal discharge: The absence of abnormal vaginal discharge suggests that cervical or infection-related changes are resolving, reflecting decreased risk of preterm labor progression

• WBC count 12,000/mm³: The white blood cell count has decreased from the initial 16,000/mm³, showing a positive response to antibiotic therapy. A decrease from the previous elevated WBC count indicates that infection or inflammation is resolving, demonstrating laboratory improvement and decreased maternal risk.

Rationale for incorrect choices

• FHR baseline 138/min, minimal variability: A baseline fetal heart rate within normal limits is reassuring, but minimal variability persists, indicating continued need for monitoring. This alone does not indicate full clinical improvement.