The nurse is caring for a client with hypothyroidism who has a history of myocardial infarction and heart failure.
What thyroid replacement drug would the nurse expect to be ordered?

Levothyroxine is a synthetic thyroid hormone that is used to treat hypothyroidism. It should be taken on an empty stomach, preferably in the morning, with a full glass of water to facilitate absorption and prevent choking. Taking the medication with food or other substances may interfere with its effectiveness.

Choice A is wrong because levothyroxine does not need to be taken after breakfast.

In fact, taking it after breakfast may reduce its absorption and efficacy.

Choice C is wrong because levothyroxine does not require the patient to remain in the upright position for 30 minutes after administering.

This instruction is more applicable to bisphosphonates, which are drugs used to treat osteoporosis.

Choice D is wrong because levothyroxine should not be taken at night.

Taking it at night may cause insomnia, as well as reduced absorption and efficacy.

The correct answer is c. The importance of consuming adequate amounts of water.

Rationale for Choice A:

• Statement:The need to monitor for systemic side effects.
• Rationale:It's not accurate to prioritize monitoring for systemic side effects when teaching a patient about psyllium (Metamucil).Psyllium is a bulk-forming laxative that primarily acts within the gastrointestinal tract,and systemic side effects are rare.While it's essential to be aware of potential side effects,focusing on them during initial teaching might cause unnecessary anxiety.

Rationale for Choice B:

• Statement:The need to use the dry form of Metamucil to prevent cramping.
• Rationale:This statement is incorrect.It's generally recommended to mix psyllium with water or another liquid before ingestion.Consuming the dry form can increase the risk of choking and might not adequately hydrate stool.

Rationale for Choice C:

• Statement:The importance of consuming adequate amounts of water.
• Rationale:This is the most crucial information to emphasize when teaching about psyllium.Psyllium works by absorbing water and forming a bulky gel that softens stool and promotes bowel movements.Without sufficient water intake,psyllium can cause constipation to worsen or lead to intestinal obstruction.

Rationale for Choice D:

• Statement:The onset of action of 30 to 60 minutes after administration.
• Rationale:This statement is inaccurate.Psyllium is not a fast-acting laxative.It typically takes 12-72 hours to produce a bowel movement.Informing patients about the expected time frame for results is essential to manage expectations and prevent unnecessary medication overuse.