The nurse is planning discharge education for a client who was prescribed oxycodone. Which information should the nurse plan to include?

A. Occasional palpitations: Palpitations are a common sign of levothyroxine toxicity because excessive thyroid hormone increases cardiac output and sympathetic activity, leading to an elevated heart rate and irregular heart rhythms, which can be dangerous if untreated.

B. Seasonal allergies: Seasonal allergies are unrelated to levothyroxine therapy. They are a chronic, immune-mediated response to environmental allergens and do not indicate thyroid hormone toxicity.

C. Muscle pain: Muscle aches or weakness can occur with levothyroxine overdose due to hypermetabolism, increased protein catabolism, and overstimulation of muscle activity, making this a relevant symptom of toxicity.

D. Excessive sweating: Hyperthyroid-like symptoms, including diaphoresis, occur with levothyroxine toxicity as a result of increased basal metabolic rate and overstimulation of sympathetic nervous system activity.

E. Diarrhea: Increased gastrointestinal motility is a hallmark of levothyroxine overdose. Clients may experience frequent loose stools or diarrhea due to the hypermetabolic state induced by excess thyroid hormone.

A. The nurse injects air into the regular insulin vial first: Air should be injected into each vial before drawing insulin to prevent creating a vacuum, but the order of air injection does not override the critical rule regarding drawing up insulin. The sequence of drawing the insulins is more important to maintain correct dosing.

B. The nurse withdraws the NPH insulin first: When mixing insulins, rapid-acting or short-acting insulin (e.g., regular insulin) should be drawn up first to avoid contaminating it with NPH, which could alter the onset and peak of the short-acting insulin. Drawing NPH first is incorrect practice.

C. The nurse gently rotates the NPH insulin vial: NPH insulin is a suspension that must be gently rolled to mix the insulin evenly before drawing it into the syringe. This ensures accurate dosing and prevents inconsistent absorption and unpredictable blood glucose effects.

D. The nurse selects a 3 mL syringe to mix insulins: While syringe size should match the insulin dose for accuracy, selecting a 3 mL syringe is not specific to the proper technique of mixing insulins and is less critical than ensuring proper vial mixing and correct order of withdrawal.