# A client with suspected thyroid storm has authorized prescriptions for propranolol, propylthiouracil, potassium iodide, and hydrocortisone. Place the medication actions in the safest sequence.

> source: MyMerci (mymerci.kr)  
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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client with suspected thyroid storm has authorized prescriptions for propranolol, propylthiouracil, potassium iodide, and hydrocortisone. Place the medication actions in the safest sequence.

Confirm hemodynamic status, continuous monitoring, IV access, and emergency support.

Administer potassium iodide at least 1 hour after the thionamide.

Administer the prescribed glucocorticoid and continue temperature, rhythm, perfusion, and neurologic reassessment.

Administer the authorized beta blocker while monitoring for contraindications and instability.

Administer propylthiouracil to block new hormone synthesis and reduce T4-to-T3 conversion.

## Explanation

Emergency readiness comes first, followed by adrenergic control, thionamide therapy, iodine only after at least 1 hour, and glucocorticoid with continuous reassessment.

## In-depth explanation

Quick answer
Remember block effects, block synthesis, then block release.

Why this is correct
Iodine is delayed until after the antithyroid drug so it does not provide substrate before organification is blocked; glucocorticoid supports adrenal needs and reduces conversion.

Easy analogy or mental picture
Think of medication safety as a control panel: identify the dangerous signal, change the correct control, and verify the response.

Memory hook
Cue, action, response, reassessment.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving the continuing indication.

Why the other choices are wrong
Options that delay escalation, ignore a contraindication, or change therapy without authorization do not close the safety loop.References
1ATA/AACE Guideline: Hyperthyroidism and ThyrotoxicosisThyroid-storm treatment sequence including thionamide before iodine and glucocorticoid therapy

## Clinical scenario

Medication safety review
Verify the indication, current assessment, laboratory trend, timing, interactions, authorized action, and measurable follow-up.

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