Chapter 31 Thyroid and Antithyroid Drugs

8. When reviewing the laboratory values of a patient who is taking antithyroid drugs, the nurse will monitor for which adverse effect? a.Decreased glucose levels b.Decreased white blood cell count c.Increased red blood cell count d.Increased platelet count

ANS: B Antithyroid drugs may cause bone marrow suppression, resulting in agranulocytosis, leukopenia, thrombocytopenia, and other problems. The other options are incorrect

4. During a teaching session for a patient on antithyroid drugs, the nurse will discuss which dietary instructions a.Using iodized salt when cooking b.Avoiding foods containing iodine c.Restricting fluid intake to 2500 mL per day d.Increasing intake of sodium- and potassium-containing foods

ANS: B Patients on antithyroid therapy need to avoid iodine-containing foods. These foods may interfere with the effectiveness of the antithyroid drug. The other options are incorrect.

When monitoring a patient who is taking a thyroid replacement hormone, which adverse effect needs to be reported to the prescriber a.Weakness b.Palpitations c.Constipation d.Drowsiness

ANS: B The signs of excess dosages of thyroid replacement hormone mimic those of hyperthyroidism.Instruct the patient to report immediately any of the following to the prescriber: chest pain, weight loss, palpitations, tremors, sweating, nervousness, shortness of breath, or insomnia. The other options are incorrect.

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply. 1. Administer methimazole with food. 2. Place the client on a low-calorie, low-protein diet. 3. Assess the client for unexplained bruising or bleeding. 4. Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. 5. Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

ANS: 1, 3, 4 Rationale: Common side effects of methimazole include nausea, vomiting, and diarrhea. To address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high-calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis and the health care provider should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly, due to the risk of thyroid storm.

The nurse should tell the client, who is taking levothyroxine, to notify the health care provider (HCP) if which problem occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

ANS: 2 Rationale: Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

ANS: 3 Rationale: Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

7. A patient, newly diagnosed with hypothyroidism, has received a prescription for thyroid replacement therapy. The nurse will instruct the patient to take this medication at which time of day? a.In the morning b.With the noon meal c.With the evening meal d.At bedtime

ANS: A If possible, it is best to administer thyroid drugs taken once daily in the morning so as to decrease the likelihood of insomnia that may result from evening dosing

1. Levothyroxine (Synthroid) has been prescribed for a patient with hypothyroidism. The nurse reviews the patient's current medications for potential interactions. Which of these drugs or drug classes interact with levothyroxine? (Select all that apply.) a. Phenytoin (Dilantin) b. Estrogens c. Beta blockers d. Warfarin (Coumadin) e. Penicillins f. Iron supplements

ANS: A, B, D, F Drug interactions with thyroid preparations include phenytoin, cholestyramine, antacids, calcium salts, iron products, estrogens, and warfarin (see Table 31-3). The other options are not correct.

The nurse is teaching a patient who has a new prescription for the antithyroid drug propylthiouracil (PTU). Which statement by the nurse is correct? a. "There are no food restrictions while on this drug." b. "You need to avoid foods high in iodine, such as iodized salt, seafood, and soy products." c. "This drug is given to raise the thyroid hormone levels in your blood." d. "Take this drug in the morning on an empty stomach."

ANS: B

6. A 19-year-old student was diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 1 week, she called the clinic to report that she does not feel better. Which response from the nurse is correct? a."It will probably require surgery for a cure to happen." b."The full therapeutic effects may not occur for 3 to 4 weeks." c."Is it possible that you did not take your medication as instructed?" d."Let's review your diet; it may be causing absorption problems.

ANS: B Patients need to understand that it may take up to 3 to 4 weeks to see the full therapeutic effects of thyroid drugs. The other options are incorrect

5. A patient who is taking propylthiouracil (PTU) for hyperthyroidism wants to know how this medicine works. Which explanation by the nurse is accurate? a.It blocks the action of thyroid hormone. b.It slows down the formation of thyroid hormone. c.It destroys overactive cells in the thyroid gland. d.It inactivates already existing thyroid hormone in the bloodstream

ANS: B Propylthiouracil impedes the formation of thyroid hormone but has no effect on already existing thyroid hormone. The other options are incorrect

Levothyroxine (Synthroid) has been prescribed for a patient with hypothyroidism. The nurse provides information to the patient about the medication and tells the patient to contact the prescriber if which potential adverse effect occurs? (Select all that apply.) a.Fatigue b.Chest pains c.Palpitations d.Drowsiness e.Rapid heart rate f.Constipation

ANS: B, C, ESome of the more serious adverse effects of the thyroid drugs include tachycardia, palpitations, and chest pains. The other options are not adverse effects of thyroid replacement drugs

When monitoring the laboratory values for a patient who is taking antithyroid drugs, the nurse knows to watch for a. increased platelet counts. b. increased white blood cell counts. c. increased blood urea nitrogen level. d. increased blood glucose levels.

ANS: C

10. A patient has a diagnosis of primary hypothyroidism. Which statement accurately describes this problem? a.The hypothalamus is not secreting thyrotropin-releasing hormone (TRH), therefore thyroid-stimulating hormone (TSH) is not released from the pituitary gland b.The pituitary gland is dysfunctional and is not secreting TSH. c.The abnormality is in the thyroid gland itself. d.The abnormality is caused by an insufficient intake of iodine

ANS: C Primary hypothyroidism stems from an abnormality in the thyroid gland itself and occurs when the thyroid gland is not able to perform one of its many functions. Secondary hypothyroidism begins at the level of the pituitary gland and results from reduced secretion of TSH. TSH is needed to trigger the release of the T3and T4stored in the thyroid gland. Tertiaryhypothyroidism is caused by a reduced level of the TRH from the hypothalamus. This reducedlevel, in turn, reduces TSH and thyroid hormone levels

When reviewing the drugs taken by a patient who will be starting thyroid replacement preparations, the nurse notes that an interaction may occur with which of these drugs? a.Vitamin supplements b.Antibiotics c.Oral antidiabetic drugs d.Beta blockers

ANS: C Drug interactions with thyroid replacement preparations include oral antidiabetic drugs, anticoagulants, cholestyramine, and digitalis. See Table 31-3

9. A patient has been taking levothyroxine (Synthroid) for more than 1 decade for primary hypothyroidism. Today she calls because she has a cousin who can get her the same medication in a generic form from a pharmaceutical supply company. Which is the nurse's best advice? a."This would be a great way to save money." b."There's no difference in brands of this medication." c."This should never be done; once you start with a certain brand, you must stay withit." d."It's better not to switch brands unless we check with your doctor."

ANS: D Switching brands of levothyroxine during treatment can destabilize the course of treatment. Thyroid function test results need to be monitored more carefully when switching products

3. The order reads, "Give levothyroxine (Synthroid), 200 mg, PO once every morning." Which action by the nurse is correct? a. Give the medication as ordered. b. Change the dose to 200 mcg, because that is what the prescriber meant. c. Hold the drug until the prescriber returns to see the patient. d. Question the order because the dose is higher than 200 mcg

ANS: D Levothyroxine is dosed in micrograms. A common medication error is to write the intended dose in milligrams instead of micrograms. If not caught, this error would result in a thousandfold overdose. Doses higher than 200 mcg need to be questioned in case this error has occurred. The other options are incorrect

2. A patient with hypothyroidism is given a prescription for levothyroxine (Synthroid). When thenurse explains that this is a synthetic form of the thyroid hormone, he states that he prefers to receive more "natural" forms of drugs. What will the nurse explain to him about the advantages of levothyroxine? a.It has a stronger effect than the natural forms. b.Levothyroxine is less expensive than the natural forms. c.The synthetic form has fewer adverse effects on the gastrointestinal tract. d.The half-life of levothyroxine is long enough to permit once-daily dosing

ANS: D One advantage of levothyroxine over the natural forms is that it can be administered only once a day because of its long half-life. The other options are incorrect

11. A 19-year-old woman has been diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 6 months, she calls the nurse to saythat she feels better and wants to stop the medication. Which response by the nurse is correct? a."You can stop the medication if your symptoms have improved." b."You need to stay on the medication for at least 1 year before a decision about stopping it can be made." c."You need to stay on this medication until you become pregnant." d."Medication therapy for hypothyroidism is usually lifelong, and you should not stop taking the medication.

ANS: D These medications must never be abruptly discontinued, and lifelong therapy is usually the norm. The other options are incorrect

1. A patient, newly diagnosed with hypothyroidism, receives a prescription for a thyroid hormone replacement drug. The nurse assesses for which potential contraindication to this drug? a.Infection b.Diabetes mellitus c.Liver disease d.Recent myocardial infarction

ANS:D Contraindications to thyroid preparations include known drug allergy to a given drug product, recent myocardial infarction, adrenal insufficiency, and hyperthyroidism. The other options are incorrect