Levothyroxine sodium is prescribed for a client with hypothyroidism.

The nurse should instruct the client to report which symptom because it indicates that the client is taking too much levothyroxine sodium?

Choice A reason: Denying having coughing spells indicates that the antitussive medication benzonatate is effective. Benzonatate works by numbing the throat and lungs, reducing the cough reflex. This means that if the client is no longer experiencing coughing spells, the medication is performing its intended function.

Choice B reason: Being able to sleep through the night can be an indirect indicator of the medication’s effectiveness, but it is not as specific as denying coughing spells. While improved sleep might result from reduced coughing, it could also be influenced by other factors such as overall improvement in the client’s condition or the use of other medications.

Choice C reason: Expectorating bronchial secretions is not a direct indicator of the effectiveness of benzonatate. Benzonatate is an antitussive, meaning it suppresses the cough reflex rather than promoting the expulsion of mucus. Therefore, expectorating bronchial secretions would not be a primary measure of this medication’s effectiveness.

Choice D reason: Reporting reduced nasal discharge is also not a direct indicator of the effectiveness of benzonatate. This medication specifically targets the cough reflex and does not have a significant impact on nasal discharge. Reduced nasal discharge could be due to other factors or treatments.

Choice A reason:

Insomnia is a known side effect of St. John’s wort. While it can be bothersome, it does not typically require further instruction beyond standard advice on managing insomnia. Patients should be advised to take the medication earlier in the day to minimize sleep disturbances.

Choice B reason:

St. John’s wort can interact with hormonal contraceptives, reducing their effectiveness and increasing the risk of unintended pregnancy. This interaction occurs because St. John’s wort induces the enzymes that metabolize contraceptive hormones, leading to lower levels of these hormones in the body. Therefore, it is crucial to instruct the client to use an additional form of contraception to prevent pregnancy.

Choice C reason:

Sensitivity to the sun, or photosensitivity, is a documented side effect of St. John’s wort. Patients should be advised to use sunscreen and wear protective clothing when exposed to sunlight. While this side effect requires caution, it does not necessitate further instruction beyond these preventive measures.

Choice D reason:

Using hard candy to alleviate dry mouth is a common and effective strategy. St. John’s wort can cause dry mouth, and sucking on sugar-free hard candy can help stimulate saliva production. This advice is appropriate and does not require further instruction.