A nurse is teaching a client about the proper way to take levothyroxine. Which instruction should be included in the teaching plan? "Take levothyroxine:

A. Administer an oral potassium supplement is incorrect. Potassium imbalances can cause muscle weakness and cramps, but the client’s symptoms are more likely related to hypocalcemia rather than hypokalemia. Administering potassium without verifying the actual cause of the symptoms could be inappropriate.

B. Request prescription for a relaxant is incorrect. While muscle spasms can be painful, the first priority is to address the underlying cause of the spasms, which in this case is likely hypocalcemia. A muscle relaxant might not address the root cause and could delay appropriate treatment.

C. Check the pedal pulses is incorrect. While checking pedal pulses is important for assessing circulation, the client's symptoms of severe muscle spasms are more indicative of hypocalcemia rather than a circulation issue. The nurse's priority should be to address the electrolyte imbalance.

A. Deterioration in relationships with colleagues is correct. Substance abuse can impact a nurse's behavior, leading to mood swings, irritability, and interpersonal conflicts with colleagues. This can result in a breakdown in relationships and teamwork.
B. Changes in physical appearance, such as unkempt appearance is correct. Nurses struggling with substance abuse may exhibit poor hygiene, an unkempt appearance, and weight changes due to neglect of personal care. These changes are often visible signs of the physical and emotional toll of substance abuse.
C. Consistent improvement in work performance and productivity is incorrect. Substance abuse typically leads to decreased work performance and increased errors due to impairment in concentration, judgment, and decision-making. Improved performance is not a common indicator of substance abuse.
D. Increased incidents of medication errors is correct. Substance abuse can lead to impaired judgment and inattention to detail, which can contribute to an increase in medication errors. Nurses under the influence may struggle to follow protocols and maintain focus on patient safety.
E. Frequent unexplained absences from work is correct. Frequent absences, arriving late, or leaving early can be signs of substance abuse, as the individual may be seeking time to recover from the effects of substance use or to obtain substances.