# A 52-year-old client with newly diagnosed primary hypothyroidism is starting levothyroxine 50 mcg PO daily. Which client statement indicates correct understanding of the new prescription?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375093&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 52-year-old client with newly diagnosed primary hypothyroidism is starting levothyroxine 50 mcg PO daily. Which client statement indicates correct understanding of the new prescription?

## Option

1. Once my symptoms improve after a few weeks, I will stop taking the medication since the thyroid gland will heal.
2. I can switch between the brand name and generic versions each time I refill to reduce my medication costs.
3. I will take it with my morning calcium and vitamin D supplement because it is convenient to take everything together.
4. I will take it on an empty stomach with water, 30 to 60 minutes before breakfast, at the same time every day. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Levothyroxine (Synthroid, Levoxyl) is a thyroid hormone replacement that requires precise, consistent absorption. Teaching: (1) take orally on an empty stomach 30 to 60 minutes before breakfast (or 4 hours after the evening meal at bedtime) with a full glass of water at the same time daily, (2) separate from calcium, iron, magnesium, antacids, sucralfate, and bile-acid binders by at least 4 hours because they impair absorption, (3) coffee within 1 hour reduces absorption — wait at least 1 hour, (4) hypothyroidism is usually lifelong; the medication is not stopped when symptoms improve, (5) bioavailability differs between brand and generic — keep the same product to maintain stable TSH; if the brand or generic must change, recheck TSH in 6 weeks, (6) report palpitations, tremor, heat intolerance, weight loss, or insomnia (over-replacement) and persistent fatigue, cold intolerance, weight gain, or constipation (under-replacement). Pregnancy requires a 25 to 30 percent dose increase.

## In-depth explanation

Choice 2 captures the four core absorption rules: empty stomach, full water, fixed time, and consistency. Calcium and iron pair-binding is the most commonly tested interaction.

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