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?
1Give the next dose with food, document the symptoms as expected effects, and repeat liver tests in 6 months.
2Double the methimazole dose because uncontrolled hyperthyroidism can elevate liver enzymes and cause pruritus.
3Hold methimazole and notify the prescriber promptly for evaluation of clinically significant liver injury.✓ Correct answer
4Reassure the client that pruritus and right-upper-quadrant pain indicate an effective medication response.
Explanation
Compatible symptoms and transaminases above 3 times the upper limit require prompt discontinuation and evaluation under the methimazole label.
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
Hepatic adverse-effect reviewAssess symptoms, bilirubin, alkaline phosphatase, ALT, AST, current dose, and alternative causes before authorized rechallenge.