The nurse is caring for a client with hypothyroidism who has a history of myocardial infarction and heart failure.
What thyroid replacement drug would the nurse expect to be ordered?

The nurse would assess these factors to determine the need for therapy. Some possible explanations for the other choices are:

Choice A. Number of times client’s family reports the client is nauseated.

This is not a reliable indicator of the severity or cause of nausea and vomiting.

The nurse should assess the client directly and not rely on the family’s reports.

Choice B. How well the client is eating.

This is not a specific or objective measure of nausea and vomiting.

The client may have other reasons for not eating well, such as loss of appetite, taste changes, or pain.

The nurse should also monitor the client’s weight, hydration status, and electrolyte levels.

Choice D. Client’s nutritional status and fluid balance.

These are important aspects of the client’s overall health, but they are not directly related to nausea and vomiting.

The nurse should assess these factors as part of the comprehensive care plan, but they are not sufficient to determine the need for therapy.

This is because cortisol exhibits a proper 24-h circadian rhythm that affects the cardiovascular system and other organs. Cortisol levels are normally low at the beginning of sleep and high at the moment of awakening. Taking corticosteroids at this time mimics the natural cortisol rhythm and may reduce side effects such as adrenal suppression, sleep disturbances and cardiovascular complications.

Choice A is wrong because taking corticosteroids at 08:00 may not coincide with the client’s natural cortisol peak and may cause insomnia or unpleasant dreams.

Choice B is wrong because taking corticosteroids at 22:00 may disrupt the client’s sleep quality and increase the risk of nocturnal hypertension.

Choice D is wrong because taking corticosteroids at 16:00 may interfere with the client’s natural cortisol decline and cause hyperglycemia or dyslipidemia.