A nurse is teaching a client who has hypothyroidism. Which of the following information should the nurse include in the teaching? (Select all that apply)

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.

Choice A reason: Infusing 0.9% sodium chloride at 150 mL/hr through an arterial line is excessive and dangerous, risking fluid overload or vessel damage. Arterial lines use a slow flush (1-3 mL/hr) to maintain patency, not high-volume infusion. This rate suits IV hydration, not arterial monitoring, making it an incorrect and harmful action for this setup.

Choice B reason: Having the client bear down (Valsalva maneuver) increases intrathoracic pressure, falsely elevating arterial readings, distorting accuracy. Arterial lines provide continuous, real-time pressure via transducers, not manual checks requiring such actions. This technique applies to venous lines or respiratory tests, not arterial monitoring, rendering it inappropriate and misleading here.

Choice C reason: Maintaining the pressure bag at 300 mm Hg ensures a continuous flush (1-3 mL/hr) of saline, preventing clot formation in the arterial line, which could block it. This pressure exceeds arterial systolic values, keeping the system patent and readings accurate. It’s a standard practice, critical for reliable monitoring, making it the correct action in this scenario.

Choice D reason: Aligning the transducer to the radial artery level is incorrect; it should be at the phlebostatic axis (heart level) for accurate pressure readings. Radial alignment overestimates pressure due to gravitational effects, skewing data. Proper calibration at the heart ensures true arterial values, so this action fails to meet monitoring standards.