NUR 720 exam 2 set 4 (thyroid)

The mechanism of action of radioactive iodine in the tx of Graves' disease is to: A. destroy the overactive thyroid tissue B. reduce production of TSH C. alter thyroid metabolic rate D. relieve distress caused by increased thyroid size

A. destroy the overactive thyroid tissue

Which of the following medications is helpful tx option for relief of tremor and tachycardia seen with untreated hyperthyroidism? A. propranolol B. diazepam C. carbamazepine D. verapamil

A. propranolol

A 48-year-old woman with newly dx hypothyroidism asks about a "natural thyroid" medication she read about online and provides the drug's name: desiccated thyroid. As you counsel her about his medication , you consider all of the following except: A. this product contains a fixed dose of T3 and T4 B. the medication is a plan-based product C. its pharmacokinetics differ significantly when compared to levothyroxine. D. the majority of the study on tx for hypothyroidism has been done using levothyroxine.

B. the medication is a plant-based product

Periodic routine screening for hypothyroidism is indicated in the presence of which of the following clinical conditions? A. digoxin use B. male gender C. Down syndrome D. alcoholism

C. Down syndrome

A patient is admitted with complaints of palpations, excessive sweating, and unable to tolerate heat. In addition, the patient voices concern about how her appearance has changed over the past year. The patient presents with protruding eyeballs and pretibial myxedema on the legs and feet. Which of the following is the likely cause of the patient's signs and symptoms? A. Thyroiditis B. Deficiency of iodine consumption C. Grave's Disease D. Hypothyroidism

C. Grave's Disease

Hypothyroidism most often develops as a result of: A. primary pituitary failure B. thyroid neoplasia C. autoimmune thyroiditis D. radioactive iodine exposure

C. autoimmune thyroiditis

Physical examination findings in patients with Graves' disease include: A. muscle tenderness B. coarse, dry skin C. eyelid retraction D. delayed relaxation phase of the patellar reflex

C. eyelid retraction

Which of the following is the most cost-effective method of distinguishing a malignant from a benign thyroid nodule? A. ultrasound B. MRI C. fine-needle aspiration bx D. radioactive iodine scan

C. fine-needle aspiration bx

Increase risk of thyroid disorder is found in individuals who are: A. obese B. hypertensive C. tx with systemic corticosteroids D. elderly

D. elderly

The use of which of the following medications can induce thyroid dysfunction? A. sertraline B. venlafaxine C. bupropion D. lithium

D. lithium

In the report of a thyroid scan done on a 48-year-old woman with a thyroid mass, a "cold spot" is reported. This finding is most consistent with: A. autonomously functioning adenoma B. Graves' disease C. Hashimoto's disease D. thyroid cyst

D. thyroid cyst

The findings of a painless thyroid mass and TSH level of less than 0.1 IU/mL in a 35-year-old woman is most consistent with: A. autonomously functioning adenoma B. Graves' disease C. Hashimoto's disease D. thyroid malignancy

D. thyroid malignancy

Toxicity of Tapazole (an antithyroid medication) would include bradycardia, hypothermia, hypotension (signs and symptoms of ?) etc. This medication is not known to cause high blood glucose, and the patient should avoid foods high in iodine because this causes an increased production of thyroid hormones.

HYPOthyroidism

How is hypothyroidism dx: Measuring ? the most helpful thyroid test

Measuring TSH(thyrotropin). IF TSH is abnormal then check free T4

If a patient is taking synthroid a ? level should be checked every ?-? weeks

TSH, 6-8 weeks

Match the condition with the laboratory results: hypothyroidism, hyperthyroidism, or subclinical hypothyroidism: TSH =24mIU/L (0.4-4.0 mIU/L); free T4 = 3pmol/L (10 to 27 pool/L)

hypothyroidism

constipation is associated with hypothyroidism or hyperthyroidism?

hypothyroidism

With hyperthyroidism we will see (increased or decreased) levels of ? serum T4 ? free T4 ? TSH

increased serum T4 increased free T4 decreased TSH

What is the life threatening complication if hypOthyroid is not tx?

myxedema coma

A patient with hyperthyroid should avoid ? type medications and foods high in ?

salicylates, iodine

Match the condition with the laboratory results: hypothyroidism, hyperthyroidism, or subclinical hypothyroidism: TSH=8.9 mIU/L (0.4 to 4.0 mIU/L_; free T4 =15 pool/L (10 to 27 pmol/L)

subclinical hypothyroidism:

What it the tx for hypothyroid? The most popular tx is ? Medication to avoid with these patients are ?s and ?s

synthroid, sedatives and narcotics

In prescribing levothyroxine therapy for an elderly patient, which of the following statements is true? A. elderly persons require a rapid initiation of levothyroxine therapy B. THS should be checked about 2 days after dosage adjustment C. the levothyroxine dose needed by elderly persons is 75% of less of the needed by younger adults D. TSH should be suppressed to a non detectable level

C. the levothyroxine dose needed by elderly persons is 75% of less of the needed by younger adults

At minimum, at what interval should TSH be reassessed after a levothyroxine dosage is adjusted? A. 1-2 weeks B. 2-4 weeks C. 4-6 weeks D. 6-8 weeks

D. 6-8 weeks

TSH is release by the: A. thyroid follicles B. adrenal cortex C. hypothalalmus D. anterior lobe of the pituitary

D. anterior lobe of the pituitary

Coarse dry skin is associated with hypothyroidism or hyperthyroidism?

hypothyroidism

A patient with hypothyroidism is having pain 6 on 1-10 scale in the right hip due to recent hip surgery. Which of the following medications are NOT appropriate for this patient? Select all that apply: A. Fentanyl B. Tylenol C. Morphine D. Dilaudid

A, C, D

A patient is receiving radioactive iodine as treatment for Grave's Disease. Which of the following are common side effects of the treatment? Select all that apply: A. Nausea B. Taste changes C. Excessive saliva D. Swollen salivary glands

A,B,D

A patient is being educated on how to take their anti-thyroid medication. Which of the following statements are INCORRECT? A. "I will continue taking aspirin daily." B. "I will take this medication at the same time every day." C. "It may take a while before I notice that the medication is helping my condition." D. "I will avoid foods containing high levels of iodine."

A. "I will continue taking aspirin daily." The patient needs to be instructed NOT to take aspirin because it increases thyroid hormones. All the other statements are correct.

A patient is started on Tapazole (Methimazole) for treatment of Grave's Disease. Which statement by the patient indicates they understood your teaching about this medication? A. "If I experience fast heart, excessive sweating, or fever, I will notify the doctor immediately because I may be experiencing toxicity of the medication." B. "I know it may take a while before I feel relief of symptoms, therefore, I will never abruptly stop taking my medication." C. "This medication can cause high blood glucose." D. "I will make sure my diet is rich in foods containing iodine."

A. "If I experience fast heart, excessive sweating, or fever, I will notify the doctor immediately because I may be experiencing toxicity of the medication."

A patient who is in her first trimester of pregnancy is diagnosed with hyperthyroidism. Which medication do you suspect the patient will be started on? A. Propylthiouracil (PTU) B. Radioactive Iodine C. Tapazole D. Synthroid

A. Propylthiouracil (PTU)

Which of the following is the least helpful test for the assessment of thyroid disease? A. Total T4 B. TSH C. free T4 D. thyroid peroxidase (TPO) antibodies

A. Total T4

A patient was recently discharged home for treatment of hypothyroidism and was ordered to take Synthroid for treatment. The patient is re-admitted with signs and symptoms of the following: heart rate 42, blood pressure 70/56, blood glucose 55, and body temperature of 96.8 'F. The patient is very fatigued and drowsy. The family reports the patient has not been taking Synthroid since being discharged home from the hospital. Which of the following conditions is this patient most likely experiencing? A. Thryoid Storm B. Myxedema Coma C. Iodism D. Toxic Nodular Goiter

B. Myxedema Coma

As part of the evaluation of a 3 cm, round, mobile thyroid mass, you obtain a thyroid ultrasound scan revealing a fluid-fills structure. The dos likely dx is: A. adenoma B. thyroid cyst C. multi nodular goiter D. vascular lesion

B. thyroid cyst

You advise a 58-year-old woman with hypothyroidism about the correct use of levothyroxine. she also takes a calcium supplement. All of the following should be shared with the patient except which instruction? A. Take the medication on an empty stomach B. to help with adherence, take your calcium supplement at the same time as your thyroid medication C. You should take the medication oat approximately the same time every day D. Do not take your medication with soy milk

B. to help with adherence, take your calcium supplement at the same time as your thyroid medication

Change in mental status is associated with hypothyroidism or hyperthyroidism?

Both

atypical presentation in an elderly person is associated with hypothyroidism or hyperthyroidism?

Both

goiter is associated with hypothyroidism or hyperthyroidism?

Both

A patient is being treated for Grave's Disease. They have a health history of type 1 diabetes, breast cancer, eczema, and hypertension. The physician orders Inderal. What important information will you include in their discharge teaching about this medication? A. Importance of taking the medication only as needed for symptoms. B. Avoid aged cheeses and wines while taking this medication. C. Monitor blood glucose levels closely because this medication can mask the signs and symptoms of hypoglycemia. D. Monitor heart rate regularly because this medication will increase the heart rate.

C. Monitor blood glucose levels closely because this medication can mask the signs and symptoms of hypoglycemia. -Inderal is a beta-blocker which can cause masking of hypoglycemia in diabetic patients. Therefore, the patient must monitor blood glucose levels closely while taking this medication to treat Grave's Disease.

A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT present with this condition? A. Weight loss B. Intolerance to heat C. Smooth skin D. Hair loss

D. Hair loss

A patient is 6 hours post-opt from a thyroidectomy. The surgical site is clean, dry and intact with no excessive swelling noted. What position is best for this patient to be in? A. Fowler's B. Prone C. Trendelenburg D. Semi-Fowler's

D. Semi-Fowler's

TX for hyperthyroid includes antithyroid agents such as: ?/methamazole(inhibits incorporation of iodide into thyroglobulin reducing thyroid hormone production), ?/propothiouracil (inhibits conversion of iodide to iodine) ? solution/Lugal's solution (increases uptake of iodine which increase production of T3/T4 telling the feedback loop that it's all good) and also radioactive ? therapy and of course thyroidectomy (kills the thyroid).

Tapazole/methamazole, PTU/propothiouracil, Iodide solution/ Lugal's solution, radioactive iodine therapy

Possible consequences of excessive levothyroxine use include: a. bone thinning b. fatigue C. renal impairment d. constipation

a. bone thinning

Hashimoto's thyroiditis is ? thyroiditis and is the ? common type

autoimmune most common type

What medication can be rx for symptoms of hyperthyroidism?

beta-blockers

With hypothyroidism we will see (increased or decreased) levels of ? serum T4 ? free T4 ? TSH

decreased serum T4, decrease Free T4, increased TSH

The most helpful test if there is an abnormal TSH level is to check ?

free T4

hyporeflexia with a characteristic slow relaxation phase, the "hung-up" reflex is associated with hypothyroidism or hyperthyroidism?

hypOthryroidism

Is Hashimoto's thyroiditis a (hypOthyroid or hyperthyroid) disease? caused by a ? condition and it is also a ? disease like Grave's

hypOthyroid, autoimmune

coarse hair with tendency to break easily is associated with hypothyroidism or hyperthyroidism?

hypOthyroidism

menorrhagia is associated with hypothyroidism or hyperthyroidism?

hypOthyroidism

secondary hypertigliceridemia is associated with hypothyroidism or hyperthyroidism?

hypOthyroidism

thick, dry nails is associated with hypothyroidism or hyperthyroidism?

hypOthyroidism

Is Grave's disease a (hypOthyroid or hyperthyroid disease)II? and Grave's is caused by a ? problem

hyperthyroid, autoimmune

Amenorrhea or oligomenorrhea is associated with hypothyroidism or hyperthyroidism?

hyperthyroidism

IF a patient is taking to much synthroid what complication can happen? hyperthyroidism or hypothyroidism

hyperthyroidism

Match the condition with the laboratory results: hypothyroidism, hyperthyroidism, or subclinical hypothyroidism: TSH less than 0.15 mIU/L (0.4 to 4.0 mIU/L); free T4= 70pmol/L (10 to 27 pmol/L)

hyperthyroidism

Proximal muscle weakness is associated with hypothyroidism or hyperthyroidism?

hyperthyroidism

frequent low volume loose stools is associated with hypothyroidism or hyperthyroidism?

hyperthyroidism

heat intolerance is associated with hypothyroidism or hyperthyroidism?

hyperthyroidism

hyperreflexia with a characteristic "quick out-quick back" action at the patellar reflex is associated with hypothyroidism or hyperthyroidism?

hyperthyroidism

smooth silky skin is associated with hypothyroidism or hyperthyroidism?

hyperthyroidism

tachycardia with HTN is associated with hypothyroidism or hyperthyroidism?

hyperthyroidism