# A 38-year-old client with newly diagnosed Graves disease is starting methimazole 10 mg PO three times daily. Which client statement indicates the most important safety teaching has been understood?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375114&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 38-year-old client with newly diagnosed Graves disease is starting methimazole 10 mg PO three times daily. Which client statement indicates the most important safety teaching has been understood?

## Option

1. I will stop the medication after one week if my symptoms feel better.
2. I can drink large amounts of seaweed soup to enhance the medication effect.
3. I will avoid getting a TSH or free T4 lab drawn while taking this medicine.
4. I will report any sore throat, fever, mouth ulcers, or unusual fatigue immediately because the medicine can lower my white blood cells. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Methimazole (Tapazole) is the first-line thionamide antithyroid for Graves disease in non-pregnant adults. It blocks thyroid hormone synthesis by inhibiting thyroid peroxidase. Onset of clinical improvement is gradual (2 to 8 weeks). Key safety teaching: (1) the most important serious adverse effect is agranulocytosis (severe neutropenia), which presents as sudden sore throat, fever, mouth ulcers, or persistent infection; the patient must stop the drug and obtain a CBC immediately, (2) hepatotoxicity is also possible — report jaundice, dark urine, RUQ pain, and obtain baseline and periodic LFTs, (3) other adverse effects include rash, arthralgia, and rare vasculitis, (4) take with food to limit GI upset, (5) effect takes weeks; do not stop when symptoms improve because hyperthyroidism returns and storm risk increases, (6) periodic TSH and free T4 monitoring guides dosing — labs are essential, not avoided, (7) avoid iodine-rich food (seaweed, kelp, iodized salt overload) because they oppose the action, (8) PTU (propylthiouracil) is preferred over methimazole in the first trimester of pregnancy and during thyroid storm; methimazole crosses placenta and is associated with aplasia cutis and embryopathy when used in early pregnancy. Stopping early, ignoring labs, and high-iodine intake are direct contraindications.

## In-depth explanation

The defining safety message for any thionamide is the agranulocytosis warning: sore throat plus fever equals stop and CBC. Pair with hepatotoxicity surveillance and the no-stop rule.

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