A nurse is caring for a client with hypothyroidism who is starting levothyroxine.
What should the nurse understand about the initial start of levothyroxine for hypothyroidism?

Choice A rationale

The statement "I can change who I designate as my health care proxy at any time" indicates a correct understanding. A health care proxy designation is a revocable document, meaning the individual can modify or revoke their chosen proxy at any point, provided they have the decisional capacity to do so, reflecting their evolving wishes.

Choice B rationale

The statement "The health care proxy does not go into effect until I am incapable of making decisions" indicates a correct understanding. A health care proxy's authority is activated only when the principal is deemed medically incapacitated and unable to communicate their own healthcare decisions, preserving patient autonomy while capable.

Choice C rationale

The statement "If I become incapacitated, end-of-life choices will be made by my proxy" indicates a correct understanding. The designated health care proxy is legally empowered to make medical decisions, including end-of-life choices, on behalf of the incapacitated individual, aligning with the patient's previously expressed wishes or acting in their best interest.

Choice D rationale

The statement "I have to choose a family member as my health care proxy" indicates a need for clarification. While many individuals choose a family member, the law does not restrict the choice of a health care proxy to family members only. A person can designate any trusted adult, such as a friend, as their proxy, as long as they are competent and willing to serve. .

Choice A rationale

Confronting bullying behavior directly establishes clear professional boundaries and expectations within the unit. This approach fosters a psychologically safe environment, which is crucial for team cohesion and optimal patient care. Addressing the issue promptly prevents escalation and demonstrates leadership commitment to a respectful workplace, promoting accountability and encouraging healthier communication patterns among staff.

Choice B rationale

Modeling bullying behavior is counterproductive and unethical, as it normalizes and perpetuates harmful actions within the workplace. Such actions undermine trust, decrease morale, and can lead to increased stress, burnout, and higher staff turnover rates. A nurse manager's role is to promote a positive and supportive work environment, not to emulate detrimental behaviors.

Choice C rationale

Ignoring horizontal violence, even if not physical, can have significant negative psychological and professional consequences for staff members and the unit. Verbal abuse and gossip erode trust, create a toxic work environment, and can lead to increased anxiety, depression, and decreased job satisfaction, ultimately impacting patient care quality.

Choice D rationale

While logging observed behavior is a useful documentation tool, waiting for an annual evaluation to address horizontal violence delays necessary intervention. Prompt and direct confrontation is essential to mitigate immediate harm and prevent further escalation. Addressing the issue in a timely manner demonstrates a commitment to a safe workplace and supports a healthy team dynamic.