Chapter 58: Drugs for Thyroid Disorders

A patient has been given instructions about levothyroxine [Synthroid]. Which statement by the patient indicates understanding of these instructions? a. "I'll take this medication in the morning so as not to interfere with sleep." b. "I'll plan to double my dose if I gain more than 1 pound per day." c. "It is best to take the medication with food so I don't have any nausea." d. "I'll be glad when I don't have to take this medication in a few months."

a

The patient reports that she had to switch pharmacies to save money. She noticed that her "thyroid pill" looks different. The nurse anticipates that the healthcare provider will order what? a. Thyroid stimulating hormone (TSH) b. Electrocardiogram (ECG) c. Beta human chorionic gonadotropin (hCG) test d. Creatinine level

a

Which statement is the most important for a nurse to make to a patient who is taking methimazole? a. "You need to notify your doctor if you have a sore throat and fever." "b. Another medication can be given if you experience any nausea." c. "You may experience some muscle soreness with this medicine." d. "Headache and dizziness may occur but not very frequently."

a

Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? a. Tachycardia b. Tremors c. Insomnia d. Irritability

a Rationale: Tachycardia is the primary concern because it can lead to cardiac dysfunction, tremor, insomnia, irritability etc.

A nurse is teaching a patient who will begin taking methimazole (Tapazole) for Graves' disease about the medication. Which statement by the patient indicates understanding of the teaching? a. "Because of the risk for liver toxicity, I will need frequent liver function tests." b. "I should report a sore throat or fever to my provider if either occurs." c. "I will need a complete blood count every few months." d. "It is safe to get pregnant while taking this medication."

b

A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats per minute, a blood pressure of 105/62 mm Hg, and a temperature of 96.2 F. The patient appears pale and complains of always feeling cold and tired. The nurse will contact the provider to discuss tests for which condition? a. Cretinism b. Graves' disease c. Hypothyroidism d. Plummer's disease

c

A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what? a. Thyrotoxicosis b. Hypothyroidism c. Hyperthyroidism d. Graves' disease

B

Thyrotoxic Crisis (Thyroid Storm)

Can occur in pts with severe thyrotoxicosis when they undergo major surgery or develop an illness -Profound hyperthermia -Severe tachycardia -Restlessness, agitation, tremor -Severe: Unconsciousness, coma, hypotension, heart failure

What symptom does graves disease have that toxic nodular goiter not have?

Exophthalamos

Treatment of thyroid storm

High doses of potassium or iodine or strong iodine solution are given to suppress thyroid hormone release -Methimazole: Suppresses thyroid hormone synthesis -Beta blocker: Reduce HR -Additional: Sedation, cooling, glucocorticoids and IV fluid

Prototype drug for HYPOTHYROIDISM

Levothyroxine (T4)

Prototype drug for HYPERTHYROIDISM

Methimazole

A patient has been taking levothyroxine for several years and reports that "for the past 2 weeks, the drug doesn't seem to work as well as before." What will the nurse do? a. Ask the patient when the prescription was last refilled. b. Expect the patient to have an elevated temperature and tachycardia. c. Suggest that the patient begin taking calcium supplements. d. Tell the patient to try taking the medication with food.

a

A nurse caring for a patient notes that the patient has a temperature of 104° F and a heart rate of 110 beats per minute. The patient's skin is warm and moist, and the patient complains that the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will contact the provider to discuss: a. cretinism. b. Graves' disease. c. myxedema. d. Plummer's disease.

b

The nurse prepares a patient with Graves' disease for radioactive iodine (131I) therapy. Which statement made by the patient best demonstrates understanding of 131I therapy? a. "I will have to isolate myself from my family for 1 week so that I don't expose them to radiation." b. "This drug will be taken up by the thyroid gland and will destroy the cells to reduce my hyperthyroidism." c. "This drug will help reduce my cold intolerance and weight gain." d. "I will need to take this drug on a daily basis for at least 1 year."

b

Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? a. Cardiac dysrhythmias b. Excessive bruising c. Weight loss of 5 kg d. Shortness of breath

b

A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131? a. White blood cell (WBC) count b. Electrocardiogram (ECG) c. Beta human chorionic gonadotropin (hCG) test d. Creatinine level

c

A patient in her twenties with Graves' disease who takes methimazole (Tapazole) tells a nurse that she is trying to conceive and asks about disease management during pregnancy. What will the nurse tell her? a. Methimazole is safe to take throughout pregnancy. b. Propylthiouracil (PTU) should be taken throughout her pregnancy. c. The patient should discuss changing to propylthiouracil (PTU) from now until her second trimester with her provider. d. The patient should discuss therapy with iodine-131 instead of medications with her provider.

c

A patient with hypothyroidism begins taking PO levothyroxine (Synthroid). The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature of 97.2° F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request an order for which drug? a. Beta blocker b. Increased dose of PO levothyroxine c. Intravenous levothyroxine d. Methimazole (Tapazole)

c

A nurse is teaching a patient who has been diagnosed with hypothyroidism about levothyroxine (Synthroid). Which statement by the patient indicates a need for further teaching? a. "I should not take heartburn medication without consulting my provider." b. "I should report insomnia, tremors, and an increased heart rate to my provider." c. "If I take a multivitamin with iron, I should take it 4 hours after the Synthroid." d. "If I take calcium supplements, I may need to decrease my dose of Synthroid."

d

A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105 F. The patient's skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer: a. intravenous levothyroxine. b. iodine-131 (131I). c. methimazole (Tapazole). d. propylthiouracil (PTU).

d

Thyroid hormones have 3 principal actions

1. Stimulation of energy use 2. Stimulation of the heart 3. Promotion of growth and development

The nurse instructs a patient about taking levothyroxine [Synthroid]. Which statement by the patient indicates the teaching has been effective? A."To prevent an upset stomach, I will take the drug with food." B."If I have chest pain or insomnia, I should call my doctor." C."This medication can be taken with an antacid." D."The drug should be taken before I go to bed at night."

B Rationale: Drug is not taken with food. Antacids will decrease levothyroxine absorption. The drug should be taken first thing in the morning 30-60 minutes before breakfast

A patient takes levothyroxine [Synthroid] 0.75 mcg every day. It is most appropriate for the nurse to monitor which laboratory test to determine whether a dose adjustment is needed? A. Thyrotropin-releasing hormone (TRH) B.Thyroid-stimulating hormone (TSH) C.Serum free T4 test D.Serum iodine level

B Rationale: Serum TSH is the most sensitive method for diagnosis hypothyroidism. A small rise in TSH indicates hypothyroidism

The nurse instructs a patient in the administration of Lugol's solution. The nurse determines that teaching has been effective if the patient makes which statement? A."I'll need to take this solution for the rest of my life." B."The medication should be diluted in fruit juice." C."To prevent stains on my teeth, I'll use a straw." D."The solution should be placed under my tongue."

B Rationale: When mixed with juice it can mask the brassy taste

A patient with Graves' disease is treated with iodine-131 therapy. Which statement by the patient would indicate understanding of the treatment's effects? a. "I'll have to isolate myself from my family so I don't expose them to radiation." b. "I'm looking forward to feeling better immediately after this treatment." c. "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." d. "I'll need to take this drug on a daily basis for at least 1 year."

C Rationale: these are signs and symptoms of hypothyroidism

A patient with hyperthyroidism is taking propylthiouracil (PTU). It is most important for the nurse to assess the patient for which adverse effects? A.Gingival hyperplasia and dysphagia B.Dyspnea and a dry cough C.Blurred vision and nystagmus D.Fever and sore throat

D Rationale: these are adverse effects of agranulocytosis

A patient is admitted to the hospital and will begin taking levothyroxine (Synthroid). The nurse learns that the patient also takes warfarin (Coumadin). The nurse will notify the provider to discuss _____ the _____ dose. a. reducing; levothyroxine b. reducing; warfarin c. increasing; levothyroxine d. increasing; warfarin

b

The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient? a. Hypothyroidism is a normal effect of pregnancy and usually is of no consequence. b. Neuropsychologic deficits in the fetus can occur if the condition is not treated. c. No danger to the fetus exists until the third trimester. d. Treatment is required only if the patient is experiencing symptoms.

b

Which statements about levothyroxine [Synthroid] are correct? (Select all that apply.) a. Levothyroxine should be taken with food. b. Levothyroxine can be given by IV but is usually taken orally. c. Levothyroxine brands should not be changed if possible. d. Levothyroxine should be taken at night to avoid adverse effects. e. Levothyroxine can affect the metabolism of other medications.

b c e