The practical nurse (PN) is providing discharge instructions to a client who had a partial thyroidectomy. When explaining the actions of the prescribed thyroid supplement levothyroxine sodium, which parameter should the PN tell the client is most important to monitor for potential side effects?

Choice A reason: Ibuprofen, a nonsteroidal anti-inflammatory drug, inhibits prostaglandins, reducing gastric mucosal protection and increasing GI bleeding risk. Symptoms like melena or hematemesis may occur, especially with prolonged use. Monitoring for bleeding is critical to detect early complications, ensuring timely intervention to prevent severe outcomes.

Choice B reason: While ibuprofen can elevate blood pressure by affecting renal prostaglandins and sodium retention, this is less immediate than GI bleeding risk. Frequent blood pressure monitoring is relevant for long-term use but not the primary concern compared to the acute danger of GI hemorrhage.

Choice C reason: Giving ibuprofen on an empty stomach increases GI irritation, as food buffers gastric acid, reducing ulcer risk. This choice is incorrect, as it contradicts best practice, which recommends taking ibuprofen with food to minimize mucosal damage and bleeding risk.

Choice D reason: Sunblock is irrelevant to ibuprofen’s effects, as it does not cause photosensitivity. This action applies to drugs like tetracyclines, not NSAIDs. Monitoring for GI bleeding is far more critical, as ibuprofen’s primary adverse effect involves the gastrointestinal tract, not skin.

Choice A reason: Keratolytic agents, like salicylic acid, break down keratin in psoriatic plaques, softening scaly skin and reducing peeling. This promotes shedding of thickened, dead skin cells, improving skin texture. Softer, less scaly skin directly indicates the medication’s effect on hyperkeratotic lesions, confirming therapeutic success.

Choice B reason: Absence of purulent drainage indicates no infection but is not the primary goal of keratolytics. These agents target scale reduction, not infection. Psoriasis lesions are typically not purulent, so this finding is unrelated to the medication’s intended effect on skin texture.

Choice C reason: Reduced redness and swelling suggest decreased inflammation, which is not the primary action of keratolytics. Anti-inflammatory agents, like corticosteroids, target these symptoms, while keratolytics focus on scale removal. This finding is irrelevant to the medication’s specific role in psoriasis management.

Choice D reason: Full range of motion without pain relates to joint function, possibly in psoriatic arthritis, but is unrelated to keratolytics, which treat skin lesions. Keratolytics do not affect joint inflammation or mobility, making this choice incorrect for assessing the medication’s skin-specific effects.