The nurse is working with a client who is newly diagnosed with hypothyroidism. Diagnostic testing has indicated that the client’s health problem is caused by anterior pituitary dysfunction.
This client’s hypothyroidism is rooted in a deficiency of:

Choice A reason:

Injury sustained to the perineum during birth is not a perinatal injury, but a perineal injury. The perineum is the area between the anus and the genitals, and it can be torn or cut during vaginal delivery. This is a common complication that affects the mother, not the fetus or newborn.

Choice B reason:

Traumatic injury to the mother during pregnancy is not a perinatal injury, but a maternal injury. This can occur due to accidents, violence, or complications of pregnancy such as preeclampsia or placental abruption. This can affect the mother's health and well-being, and may also have consequences for the fetus or newborn.

Choice C reason:

Traumatic injury to a fetus is not a perinatal injury, but a fetal injury. This can occur due to external forces such as blunt trauma, penetrating trauma, or radiation exposure that affect the fetus in utero. This can cause fetal distress, bleeding, fractures, or organ damage.

Choice D reason:

Injury sustained surrounding birth is a perinatal injury. This occurs in the period shortly before, during, or after delivery. This can be a critical time when the baby has to transition from surviving off oxygen, blood, and nutrients from the mother to separating from the womb and breathing oxygen from the air. Perinatal injuries can include head injuries, nerve injuries, hemorrhages, fractures, or soft-tissue injuries that result from the forces of labor and delivery or medical interventions such as forceps or vacuum extraction. Perinatal injuries can lead to long-term neurodevelopmental challenges for the newborn.

This is because levothyroxine can increase the anticoagulant effect of oral anticoagulants and increase the risk of bleeding. The nurse should check the client’s prothrombin time and international normalized ratio (INR) regularly and report any abnormal values to the prescriber.

Choice B is wrong because hypothyroidism does not increase the risk of infection.

Choice C is wrong because hypothyroidism does not affect the level of consciousness unless it is severe and causes myxedema coma.

Choice D is wrong because hypothyroidism does not cause electrolyte imbalances.

Normal ranges for prothrombin time are 11 to 13.5 seconds and for INR are 0.8 to 1.22.