A client taking propylthiouracil for hyperthyroidism reports a fever and sore throat. Which action should the nurse take?
1Withhold the next dose, notify the prescriber, and prepare for an urgent white blood cell count✓ Correct answer
2Administer the scheduled dose with food and reassess the throat after several hours at the clinic today
3Recommend an over-the-counter cold product and continue the current treatment plan
4Explain that these symptoms are expected as the thyroid hormone level decreases
Explanation
Fever and sore throat during propylthiouracil therapy can signal agranulocytosis. The medication is withheld while the prescriber is contacted and white blood cell evaluation is arranged because infection can become rapidly dangerous.
Quick answer Hold propylthiouracil and urgently evaluate fever and sore throat for agranulocytosis.
Why this is correct Propylthiouracil can rarely cause severe neutrophil depletion. Fever or throat pain may be the first infection signal, so continuing the medication or masking symptoms could delay recognition of a potentially life-threatening adverse reaction.
Easy analogy or mental picture White blood cells are like an infection-response crew; agranulocytosis can leave too few responders available. The analogy explains the danger but does not diagnose the condition without laboratory assessment.
Memory hook PTU plus fever or sore throat means hold, call, and count cells.
NCLEX decision rule For a medication linked to severe blood dyscrasia, treat new infection symptoms as a safety signal. Withhold further exposure as directed, notify the prescriber, and obtain the indicated blood count rather than offering symptomatic reassurance.
Why the other choices are wrong Food does not remove agranulocytosis risk. A cold product can mask progression, and infection symptoms are not an expected sign of successful thyroid treatment.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
DailyMed: Propylthiouracil Prescribing InformationU.S. National Library of Medicine, updated November 2025