A nurse is a long-term care facility is caring for a client who has methicillin-resistant Staphylococcus aureus (MRSA). Which of the following actions should the nurse take?

A) Arterial blood gases: Arterial blood gas (ABG) tests are typically used to assess respiratory and metabolic function, including the balance of oxygen and carbon dioxide in the blood. While important in many clinical situations, ABGs are not specifically relevant for monitoring a client on levothyroxine, as it does not directly affect gas exchange or acid-base balance.

B) Thyroid stimulating hormone (TSH): TSH is the most important laboratory test to monitor in a client taking levothyroxine, as this medication is used to replace or supplement thyroid hormone levels. Levothyroxine directly affects thyroid hormone levels in the body, so monitoring TSH levels is essential for determining whether the medication dosage needs to be adjusted. Elevated TSH levels may indicate that the dose is too low, while low levels may suggest an overdose.

C) Prothrombin time: Prothrombin time (PT) is used to assess blood clotting and coagulation status. While certain thyroid conditions can influence coagulation, PT is not a routine test to monitor in clients on levothyroxine therapy unless there are specific concerns related to bleeding or clotting. It is not the most relevant test for monitoring thyroid function in this context.

D) Blood urea nitrogen (BUN): Blood urea nitrogen (BUN) levels reflect kidney function and hydration status. While kidney function is always important to monitor, BUN is not specifically used to assess the effects of levothyroxine therapy. It would not provide direct information regarding the effectiveness of the medication or the thyroid status of the client.

A) Patient care technician: While a patient care technician (PCT) is an important part of the healthcare team, their role generally focuses on providing direct patient care tasks such as monitoring vital signs, assisting with activities of daily living, and supporting the nursing staff. They do not have the expertise to address complex medication interactions, so they are not the appropriate referral in this scenario.

B) Psychologist: A psychologist focuses on providing mental health support, including therapy and counseling. While medication interactions may be of concern in patients receiving psychiatric medications, a psychologist does not typically have the medical knowledge to assess or manage pharmacological interactions. The nurse would not make a referral to a psychologist for this issue.

C) Social worker: Social workers are important for addressing the social and emotional needs of patients, including helping with care coordination, support, and resources. However, they are not trained to evaluate or address medication interactions. This issue would be outside of their scope of practice.

D) Advanced practice nurse: An advanced practice nurse (APN), such as a nurse practitioner or clinical nurse specialist, has advanced training in diagnosing, managing, and prescribing medications. They are the most appropriate team member to assess the potential interactions of the client’s medications and make any necessary adjustments to their medication regimen. The nurse should refer the client to an APN for expertise in this area.