A patient who is taking levothyroxine (Synthroid) texts a home care nurse and states "I feel very anxious and I have been having palpitations." Which of these responses should the nurse make to the patient?

A. "This is an expected side effect of the medicine.": Anxiety and palpitations can indicate excessive thyroid hormone levels rather than a normal response to therapy. Reassuring the patient may delay identification of overreplacement, which can increase the risk of arrhythmias. B. "Cut back on your daily caffeine intake.": While caffeine can worsen palpitations, the sudden onset of these symptoms in a patient on levothyroxine raises concern for elevated dosing. Reducing caffeine does not address the potential for thyrotoxicosis caused by medication excess. C. "Make sure you change positions slowly.": Changing positions slowly helps prevent dizziness from orthostatic hypotension but does not address tachycardia or heightened anxiety. These symptoms relate more to metabolic overstimulation than positional changes. D. "Do not take the medication and call your HCP.": Anxiety and palpitations are early signs of levothyroxine overreplacement, which can escalate into serious cardiac effects if the medication continues. Holding the dose prevents further elevation of thyroid levels while the patient seeks evaluation.