A client taking methimazole reports anorexia, pruritus, and right-upper-quadrant pain. ALT and AST are more than 3 times the upper limit of normal. Which action is the priority?

1 Give the next dose with food and repeat laboratory tests in 6 months.
2 Double the dose because hyperthyroidism can affect liver tests.
3 Hold methimazole and notify the prescriber promptly for evaluation of clinically significant liver injury. ✓ Correct answer
4 Reassure the client that pruritus proves the drug is effective.

Explanation

Compatible symptoms and transaminases above 3 times the upper limit require prompt discontinuation and evaluation under the methimazole label.

Next question on this topicA nurse is reviewing the morning lab results for an adult client receiving warfarin for at…

In-depth explanation

Quick answer
Hold methimazole and escalate possible clinically significant hepatotoxicity.

Why this is correct
The label directs liver-function evaluation for anorexia, pruritus, or right-upper-quadrant pain and prompt discontinuation when clinically significant liver abnormality includes transaminases above 3 times normal.

Easy analogy or mental picture
When the organ-processing plant sounds an alarm, do not send another load through it.

Memory hook
Methimazole plus RUQ symptoms and marked enzymes: hold and evaluate.

NCLEX decision rule
Use symptom and laboratory thresholds together; do not normalize a trend that meets a labeled stop criterion.

Why the other choices are wrong
Food, dose escalation, and delayed review do not address the injury mechanism.

References

1DailyMed: MethimazoleAgranulocytosis warning and prompt discontinuation for clinically significant liver abnormality

Clinical scenario

Hepatic adverse-effect review
Assess symptoms, bilirubin, alkaline phosphatase, ALT, AST, current dose, and alternative causes before authorized rechallenge.

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For study reference only. Always follow current clinical guidelines and your institution’s protocols.

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A client taking methimazole reports anorexia, pruritus, and right-upper-quadrant pain. ALT and AST are more than 3 times the upper limit of normal. Which action is the priority?

In-depth explanation

Clinical scenario

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