A nurse is collecting a health history from a patient that is taking Levothyroxine for hypothyroidism. Over the past 12 months, the dose of the medication has been increased twice. Which of the following statements made by the patient could be the reason the medication is not effective:

A. Gives small continuous doses of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage to coordinate with meals: The insulin pump delivers a basal dose of regular insulin continuously and allows the client to administer bolus doses of insulin during meals to manage blood glucose levels.

B. It is surgically attached to the pancreas and infuses with regular insulin into the pancreas, which in turn releases insulin into the bloodstream: The insulin pump is not surgically attached to the pancreas. It delivers insulin subcutaneously, not directly into the pancreas.

C. Is time-released programmed doses of regular or NPH insulin into the bloodstream at specific intervals: The pump delivers continuous regular insulin, not NPH. NPH insulin is not used in insulin pumps due to its longer action.

D. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels: NPH insulin is not used in insulin pumps due to its variable absorption rate. The pump typically uses regular insulin or rapid-acting insulins. Blood glucose is monitored separately, often by the client or with a continuous glucose monitor.

A. Instruct her to take an antacid: Difficulty swallowing could be a sign of a more serious problem, such as esophageal irritationor a reaction to treatment. Taking an antacid may mask underlying issues, and it is not appropriate without further assessment.

B. Notify the healthcare provider immediately: Difficulty swallowing after treatment may indicate a serious side effector complication, such as esophageal damage, allergic reaction, or a swallowing disorder. Immediate evaluation by the healthcare provider is necessary to determine the cause and prevent further complications.

C. Reassure her that this is expected: Difficulty swallowing after treatment should not be considered normal without investigation. It may indicate an issue that needs prompt attention to prevent further harm or discomfort.

D. Encourage warm fluids: Encouraging fluids could be helpful in some cases of mild throat irritation, but it is not the first appropriate action. The nurse should prioritize notifying the healthcare provider to evaluate the cause of difficulty swallowing.