A nurse is caring for a client who has Graves' disease and is to start therapy with propylthiouracil. The nurse should expect which of the following outcomes?

Choice A rationale Increased blood pressure is not an expected outcome when initiating propylthiouracil therapy for Graves' disease. Graves' disease typically causes hyperthyroidism, which elevates metabolic rate and can increase blood pressure. Propylthiouracil aims to decrease thyroid hormone synthesis, which would lead to a reduction in blood pressure toward normal. Normal blood pressure is 120/80 mmHg. Choice B rationale A decreased WBC count, specifically agranulocytosis, is a serious and potential adverse effect of propylthiouracil, not an expected therapeutic outcome for Graves' disease. While nurses monitor for this, the therapeutic goal is to reduce thyroid hormone levels, not to suppress the immune system. Normal WBC count is 4,500-11,000 cells/mm³. Choice C rationale An increased Hct is not an expected outcome of propylthiouracil therapy. Hyperthyroidism in Graves' disease can sometimes lead to a slight decrease in red blood cell parameters due to increased metabolic turnover. Propylthiouracil aims to normalize thyroid function, which might indirectly normalize Hct, but not necessarily cause a significant increase. Normal Hct is 37-52%. Choice D rationale A decreased heart rate is an expected and desirable outcome of propylthiouracil therapy for Graves' disease. Hyperthyroidism characteristically causes tachycardia due to increased adrenergic stimulation. Propylthiouracil reduces thyroid hormone synthesis, thereby alleviating the hypermetabolic state and lowering the elevated heart rate toward normal ranges. Normal heart rate is 60-100 beats/min.