Which information will the nurse include when teaching a patient about thyroid replacement therapy?

Choice A rationale

Administering a medication when there is a strong possibility the patient has already received it could lead to an overdose. The automated dispensing machine's record indicates removal of the dose, and the patient's statement, despite her confusion, suggests she might have taken it. The nurse's primary responsibility is patient safety and preventing medication errors, which this action would violate.

Choice B rationale

This is the safest course of action. The medication was removed from the machine, and the patient states she thinks she took it. The night shift nurse's failure to sign the MAR is a documentation error, but the potential for a double dose is a serious safety concern. The nurse should hold the dose and investigate further before administering anything to prevent an iatrogenic event.

Choice C rationale

Notifying the provider for a new order is an unnecessary and premature step. The issue is not that the medication is unavailable or the order is incorrect. The immediate concern is whether the patient has already received the dose. Holding the medication and verifying the administration is the correct first step, and the provider would not be contacted unless there was a clinical reason to do so, such as if the blood glucose became dangerously high.

Choice D rationale

Giving the insulin and then monitoring the patient is dangerous. Administering an additional dose of insulin could cause a severe hypoglycemic event, especially in a confused patient. The blood glucose of 142 mg/dL is not critically high, so there is no immediate need for the insulin, and the risk of a medication error outweighs any perceived benefit of administering the medication immediately.

Choice A rationale

A patient reporting an increase in suicidal ideation after starting an antidepressant requires immediate and careful assessment. Encouraging them to continue the medication without evaluation could be dangerous and goes against the principle of patient safety. The patient's report is a critical red flag that must be addressed.

Choice B rationale

The black box warning for many antidepressants highlights the risk of increased suicidal thoughts and behaviors in some patients, particularly children, adolescents, and young adults. Documenting the patient's report and notifying the healthcare provider immediately is the appropriate and safest course of action to ensure proper management.

Choice C rationale

Discontinuing an antidepressant abruptly can lead to withdrawal symptoms and rebound depression, potentially worsening the patient's condition. It is not within the nurse's scope of practice to unilaterally discontinue a prescription medication. The healthcare provider must be consulted for a new treatment plan.

Choice D rationale

Increasing the dose of an antidepressant in a patient who reports increased suicidal ideation is contraindicated. This action could potentially exacerbate the side effects and the patient's symptoms, increasing the risk of self-harm. The provider must evaluate the patient's response and adjust the treatment plan accordingly.