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Zorluk: ZorPharmacological Therapies

During morning rounds, a client receiving daily oral levothyroxine 150 mcg150\text{ mcg} for primary hypothyroidism reports feeling restless and unusually warm. The practical nurse notes a heart rate of 112 bpm112\text{ bpm} and a blood pressure of 142/88 mmHg142/88\text{ mmHg}. A review of the morning laboratory results reveals a thyroid-stimulating hormone (TSH) level of 0.1 mU/L0.1\text{ mU/L} (normal: 0.4 to 4.0 mU/L0.4\text{ to }4.0\text{ mU/L}). Which action should the practical nurse take first?

  1. A
    Administer the levothyroxine as prescribed because the low TSH level indicates worsening hypothyroidism.
  2. B
    Verify the client's identity using two identifiers and administer the medication with a prescribed PRN antipyretic.
  3. Withhold the scheduled dose of levothyroxine and report the assessment findings to the registered nurse.Cevap
  4. D
    Independently reduce the levothyroxine dose by half to safely manage the client's elevated heart rate.

Cevap

The practical nurse should withhold the scheduled dose of levothyroxine and notify the registered nurse.
The client is exhibiting clinical signs of hyperthyroidism (tachycardia, heat intolerance, restlessness, elevated blood pressure) alongside a suppressed TSH level. These findings indicate levothyroxine toxicity. The safest and most appropriate action within the practical nurse's scope of practice is to withhold the scheduled dose to prevent further physiological harm and immediately escalate the critical findings to the registered nurse or healthcare provider for medical re-evaluation.

Adım Adım Çözüm

1
Analyze the client's physical symptoms and vital signs.
Restlessness, feeling warm, and tachycardia (112 bpm112\text{ bpm}) are identified as classic signs of a hypermetabolic state.
Identifying abnormal assessment findings is the critical first step in evaluating medication safety prior to administration.
2
Interpret the laboratory results in the context of the medication.
A TSH level of 0.1 mU/L0.1\text{ mU/L} is significantly below the normal range, indicating excessive circulating thyroid hormone.
TSH has an inverse relationship with thyroid hormone levels; a suppressed TSH confirms hyperthyroidism or levothyroxine toxicity.
3
Determine the appropriate nursing action within the practical nurse scope of practice.
The medication must be withheld and the clinical findings immediately escalated to the registered nurse or provider.
Administering the medication would exacerbate the toxicity, and altering the prescribed dose independently is strictly outside the practical nurse's scope.

Anahtar Kavram

Recognizing medication toxicity, understanding lab value relationships, and adhering to the practical nurse scope of practice.
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Pharmacological Therapies

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