A nurse is caring for a client who has thrombocytopenia due to chemotherapy treatment. Which of the following actions should the nurse take?

Choice A reason: Raising the drainage bag above the abdomen reverses gravity flow, stopping dialysate outflow and worsening the issue in peritoneal dialysis. Fluid drains downward naturally, so elevating the bag traps it, potentially causing discomfort or infection risk from stagnation. This action opposes dialysis mechanics, where the bag must stay low, making it contraindicated and detrimental to treatment efficacy.

Choice B reason: High-Fowler’s position (upright) may shift abdominal contents, but it doesn’t directly resolve catheter blockages or flow issues in peritoneal dialysis. It’s used during infusion to aid breathing, not drainage. Without evidence of respiratory distress, this adjustment lacks priority over actions addressing flow directly, like repositioning, rendering it less effective here.

Choice C reason: Measuring dialysate outflow quantifies the flow reduction, identifying if less fluid returns than infused, signaling obstruction or leakage. This data guides interventions, like catheter checks or flushes, ensuring dialysis removes toxins effectively. It’s a critical step in troubleshooting, providing objective evidence of the problem’s scope, essential for maintaining treatment goals.

Choice D reason: Monitoring the access site for drainage detects leaks or infection—common flow rate culprits—as fluid escaping reduces outflow. Peritonitis risk rises with poor site integrity, necessitating early intervention. This action ensures catheter function and patient safety, directly addressing potential causes of the observed decrease, making it vital.

Choice E reason: Repositioning to the other side relieves catheter kinks or omental wrapping, frequent causes of slow flow in peritoneal dialysis. Shifting position adjusts intra-abdominal pressure, freeing the catheter tip to drain properly. This non-invasive fix restores dialysis efficacy, a standard first-line response, directly tackling mechanical flow issues effectively.

Choice A reason: Hypothyroidism requires lifelong levothyroxine because the thyroid gland doesn’t regain function in most cases, such as Hashimoto’s disease. Stating several months misleads the client, implying a temporary treatment, which is inaccurate. This chronic condition demands continuous hormone replacement to maintain metabolism, energy, and organ function. Temporary therapy applies to transient conditions, not primary hypothyroidism, so this statement fails to reflect the long-term nature of management needed.

Choice B reason: Hypothyroidism slows metabolism due to low thyroid hormone levels, reducing basal metabolic rate and calorie burning. This leads to weight gain as energy expenditure drops, even with unchanged diet, a common symptom. Educating clients about this helps them understand and manage expectations, linking it to the condition’s physiology. It’s a key teaching point, as weight gain often prompts diagnosis and motivates adherence to levothyroxine therapy.

Choice C reason: Laboratory tests like TSH and free T4 are essential to monitor levothyroxine’s effectiveness in hypothyroidism, ensuring the dose restores euthyroid status. These tests, typically done every 6-12 weeks initially then annually, guide adjustments to prevent under- or over-treatment. Including this in teaching empowers clients to participate in their care, understanding why follow-ups matter. It reflects standard practice for managing this endocrine disorder accurately.

Choice D reason: Increased perspiration is a hyperthyroidism symptom, where excess thyroid hormone accelerates metabolism, raising body heat. Hypothyroidism, conversely, causes cold intolerance and dry skin due to slowed metabolism, reducing sweat production. This statement contradicts hypothyroidism’s physiology, misinforming the client about expected symptoms. Correct teaching would highlight cold sensitivity instead, aligning with the condition’s impact on thermoregulation and skin.

Choice E reason: Hypothyroidism slows gastrointestinal motility due to decreased thyroid hormone, often causing constipation as a complication. A high-fiber diet increases bulk and promotes bowel movements, preventing this issue. Teaching this dietary adjustment addresses a common, manageable symptom, improving quality of life. It’s a scientifically supported recommendation, as fiber counteracts the sluggish digestion typical in hypothyroid states, making it vital education.