# An 84-year-old client with coronary artery disease has a new prescription for liothyronine 25 mcg daily. Which action should the nurse take?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=514126&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

An 84-year-old client with coronary artery disease has a new prescription for liothyronine 25 mcg daily. Which action should the nurse take?

## Option

1. Administer 50 mcg because older adults metabolize thyroid hormone faster.
2. Hold the dose and clarify the prescription because the labeled starting dose is 5 mcg daily in an older adult or client with cardiac disease. **✔ Correct answer**
3. Administer the dose and assess for angina only at the next annual visit.
4. Crush the medication into an enteral feeding without checking the route or timing.

**Correct answer: 2**

## Explanation

Older adults and clients with underlying cardiac disease should start liothyronine at 5 mcg daily and increase in 5-mcg increments to reduce cardiac adverse-reaction risk.

## In-depth explanation

Quick answer
Clarify the 25-mcg starting dose.

Why this is correct
Liothyronine can increase heart rate and contractility and precipitate angina or arrhythmia. The label specifies a 5-mcg daily start for older adults or clients with cardiac disease.

Easy analogy or mental picture
A sensitive engine starts at idle, not at highway speed.

Memory hook
Older heart: start T3 low and increase slowly.

NCLEX decision rule
Apply age and cardiovascular status before accepting the usual adult starting dose.

Why the other choices are wrong
Dose escalation and delayed monitoring increase cardiac risk, while an unverified route change does not solve the dose problem.References
1DailyMed: Liothyronine SodiumFive-microgram start in older adults or cardiac disease

## Clinical scenario

Thyroid replacement safety
Check age, coronary disease, baseline pulse and rhythm, starting dose, titration interval, and symptoms of overtreatment.

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