The nurse observes that a client has become lethargic 30 minutes after receiving an opioid injection for pain. Which vital sign should the nurse obtain first?

A. Give parental dose once every 24 hours: Propylthiouracil (PTU) and Lugol's solution are not typically administered via parenteral routes for hyperthyroidism; they are usually given orally. Additionally, the dosing schedule does not typically involve administering both drugs once every 24 hours but rather involves more frequent dosing.
B. Offer both drugs together with a meal: While it may be appropriate to take some medications with food to reduce gastrointestinal irritation, propylthiouracil (PTU) and Lugol's solution have specific administration guidelines. PTU is often taken multiple times a day, and Lugol's solution is usually taken in divided doses. There is no specific requirement to take both with a meal.
C. Schedule both medications at bedtime: Scheduling both medications at bedtime does not align with the administration guidelines for these drugs. PTU usually requires multiple daily doses, and Lugol's solution is typically divided throughout the day. Proper timing is essential for their effectiveness and minimizing side effects.
D. Administer iodine one hour before PTU: This is the correct approach because Lugol’s solution (iodine) is typically administered first to rapidly decrease thyroid hormone production, while PTU is used to inhibit the synthesis of thyroid hormones. Administering iodine first helps prepare the thyroid gland for the PTU, optimizing the effectiveness of the treatment regimen.

A. Have a chest x-ray prior to your first dose: While certain medications for rheumatoid arthritis, particularly disease-modifying antirheumatic drugs (DMARDs) like methotrexate, might require baseline assessments such as a chest x-ray to evaluate lung health, adalimumab (a tumor necrosis factor-alpha inhibitor) does not specifically require a chest x-ray before starting treatment. It is important to monitor for infections but not specifically for a chest x-ray before administration.
B. Obtain routine vaccinations as scheduled: Clients receiving adalimumab are often advised to avoid live vaccines due to the risk of infections, as the medication suppresses the immune system. However, routine vaccinations should be updated before starting the medication, rather than during treatment. This instruction might be relevant before starting adalimumab but not specifically as a current instruction.
C. Undergo annual eye examinations: Regular eye examinations are not a specific requirement for clients on adalimumab. While eye health is important, annual eye exams are not directly linked to the use of adalimumab. The primary concern with adalimumab is monitoring for infections and other specific side effects.
D. Avoid crowds and people who are sick: Adalimumab, being an immunosuppressive agent, increases the risk of infections. Therefore, clients should avoid crowded places and individuals who are sick to minimize the risk of infection. This precaution is crucial for clients on adalimumab to protect their compromised immune system from potential infections.