pharm EAQ wk 5

Levothyroxine (Synthroid) 12.5 mcg orally each day is prescribed for a client with hypothyroidism. Six weeks later, the health care provider increases the client's dose to 25 mcg daily and gives the client a prescription to be filled at the pharmacy. The client asks the nurse whether the original pill prescription can be completed before starting the new dose. How many of the original pills should the nurse instruct the client to take daily? Record your answer using a whole number. __________ tablets

2 rationale: Compute the dose by using ratio and proportion. Desire 25 mcg x tablets ------------- = --------- Have 12.5 mcg 1 tablet 12.5x = 25 x = 25 ÷ 12.5 x = 2 tablets

A client with rheumatoid arthritis does not want the prescribed cortisone and informs the nurse. Later, the nurse attempts to administer cortisone. When the client asks what the medication is, the nurse gives an evasive answer. The client takes the medication and later discovers that it was cortisone. The client states an intent to sue. What factors in this situation must be considered in a legal action? (Select all that apply.) 1 Clients have a right to refuse treatment. 2 Nurses are required to answer clients truthfully. 3 The health care provider should have been notified. 4 The client had insufficient knowledge to make such a decision. 5 Legally prescribed medications are administered despite a client's objections.

Clients have a right to refuse treatment. Nurses are required to answer clients truthfully. The health care provider should have been notified. rationale: Clients who are mentally competent have the right to refuse treatment; the nurse must respect this right. Client's questions must always be answered truthfully. The health care provider should be notified when a client refuses an intervention so that an alternate treatment plan can be formulated. This is done after the nurse explores the client's reasons for refusal. The client had a discussion with the nurse that indicated that the client had sufficient information to make the decision to refuse the medication. The client has a right to refuse treatment; this right takes precedence over the health care provider's prescription.

A client who had a subtotal thyroidectomy asks how hypothyroidism may develop when the problem was hyperthyroidism. What should the nurse consider when formulating a response? 1 Hypothyroidism is a gradual slowing of the body's function. 2 A decrease in pituitary thyroid-stimulating hormone (TSH) will occur. 3 Less thyroid tissue is available to supply thyroid hormone after surgery. 4 Atrophy of tissue remaining after surgery reduces secretion of thyroid hormones.

Less thyroid tissue is available to supply thyroid hormone after surgery. Rationale: After a thyroidectomy, thyroxine output usually is inadequate to maintain an appropriate metabolic rate. Hypothyroidism is decreased thyroid functioning, not a slowing of functions of the entire body. With hypothyroidism, the level of TSH from the pituitary usually is increased. Thyroid tissue remaining after surgery does not atrophy.

After receiving levothyroxine (Synthroid) for 3 months for congenital hypothyroidism an infant is brought to the pediatric clinic for a checkup. What does the mother tell the nurse about her baby that indicates that the drug is effective? 1 The infant's stools are soft. 2 The skin is cool to the touch. 3 The baby's fine tremor has ceased. 4 The baby's activity level has decreased.

The infant's stools are soft

A female client receiving cortisone therapy for adrenal insufficiency expresses concern about why she is developing facial hair. How should the nurse respond? 1 "It is just another sign of the illness." 2 "Do not worry because it will disappear with therapy." 3 "This is not important as long as you are feeling better," 4 "The drug contains a hormone that causes male characteristics."

This drug contains a hormone that causes male characteristics rationale: Some cortisol derivatives possess 17-keto-steroid (androgenic) properties, which result in hirsutism. Facial hair is not a sign of the illness; it results from androgens that are present in cortisol. The response "Do not worry because it will disappear with therapy" denies the client's concerns; hirsutism results from therapy, which is provided on a long-term basis. The response "This is not important as long as you are feeling better" denies the client's feelings.

A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? (Select all that apply.) Tremors Bradycardia Somnolence Heat intolerance Decreased blood pressure

Tremors Heat intolerance rationale: Excessive levothyroxine produces adaptations similar to hyperthyroidism, including tremors, tachycardia, hypertension, heat intolerance, and insomnia. These adaptations are related to the increase in the metabolic rate associated with hyperthyroidism. Bradycardia is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Somnolence is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Hypotension is a sign of hypothyroidism and a need to increase the dose of levothyroxine.

What response should a nurse be particularly alert for when assessing a client for side effects of long-term cortisone therapy? 1 Hypoglycemia 2 Severe anorexia 3 Anaphylactic shock 4 Behavioral changes

behavioral changes rationale: Development of mood swings and psychosis is possible during long-term therapy with glucocorticoids because of fluid and electrolyte alterations. Hypoglycemia, severe anorexia, and anaphylactic shock are not responses to long-term glucocorticoid therapy.

A nurse is caring for a 3-month-old infant with congenital hypothyroidism. What should the parents be taught about the probable effect of the condition on the infant's future if treatment is not begun immediately? 1 Myxedema 2 Thyrotoxicosis 3 Spastic paralysis 4 Cognitive impairment

cognitive impairment Rationale: Congenital hypothyroidism is the result of insufficient secretion by the thyroid gland because of an embryonic defect. A decreased level of thyroid hormone affects the fetus before birth during cerebral development, so it is likely that there will be some cognitive impairments at birth. Treatment before 3 months will prevent further damage. Congenital hypothyroidism does not become myxedema. Thyrotoxicosis is another term for hyperthyroidism. Although it is not expected, it may occur with an overdose of exogenous thyroid hormone, but it is too soon to discuss this possibility with the parents. Spastic paralysis occurs only if the infant has cerebral palsy.

A nurse is assessing a client with hypothyroidism. Which clinical manifestations should the nurse expect the client to exhibit? (Select all that apply.) 1 Cool skin 2 Photophobia 3 Constipation 4 Periorbital edema 5 Decreased appetite

cool skin periorbital edema decreased appetite constipation Rationale: Cool skin is related to the decreased metabolic rate associated with insufficient thyroid hormone. Constipation results from a decrease in peristalsis related to the reduction in the metabolic rate associated with hypothyroidism. Periorbital and facial edema are caused by changes that cause myxedema and third-space fluid effusion seen in hypothyroidism. Decreased appetite is related to metabolic and gastrointestinal manifestations of the hypothyroidism. Photophobia is associated with exophthalmos that occurs with hyperthyroidism.

A client has a history of hypothyroidism. Which skin condition should the nurse expect when performing a physical assessment? 1 Dry 2 Moist 3 Flushed 4 Smooth

dry Rationale: Dry skin is caused by decreased function of sebaceous glands; a paucity of thyroid hormones T3 and T4, which control the basal metabolic rate, can alter the function of almost every body system. The skin will not be flushed; the client will appear pale. Moist and smooth skin occur with hyperfunction of the thyroidand an increase in the basal metabolic rate.

Before a client's discharge after a thyroidectomy, the nurse teaches the client to observe for signs of surgically induced hypothyroidism. What clinical indicators identified by the client provide evidence that the nurse's instructions are understood? (Select all that apply.) 1 Fatigue 2 Dry skin 3 Insomnia 4 Intolerance to heat 5 Progressive weight loss

fatigue dry skin Rationale: Fatigue is caused by a decreased metabolic rate. Dry skin is caused by decreased glandular function associated with a decreased metabolic rate. Insomnia is caused by an increased metabolic rate associated with hyperthyroidism, not hypothyroidism. Intolerance to heat is associated with hyperthyroidism. Intolerance to cold is associated with hypothyroidism. Progressive weight loss is associated with hyperthyroidism. Progressive weight gain is associated with hypothyroidism because of the reduced metabolic rate.

A client with rheumatoid arthritis asks the nurse why it is necessary to inject hydrocortisone into the knee joint. What reason should the nurse include in a response to this question? 1 Lubricate the joint 2 Reduce inflammation 3 Provide physiotherapy 4 Prevent ankylosis of the joint

reduce inflammation rationale: Steroids have an anti-inflammatory effect that can reduce arthritic pannus formation. Lubricating the joint does not provide lubrication. Injection of a drug into a joint is not physiotherapy. Ankylosis refers to fusion of joints. It is only indirectly influenced by steroids, which exert their major effect on the inflammatory process.

Hydrocortisone (Cortef) is prescribed for a client with Addison disease. Before discharge, the nurse teaches the client about this medication. What did the nurse include as a therapeutic effect of the drug? 1 Supports a better response to stress 2 Promotes a decrease in blood pressure 3 Decreases episodes of shortness of breath 4 Controls an excessive loss of potassium from the body

supports a better response to stress Rationale: Hydrocortisone is a glucocorticoid that has anti-inflammatory action and aids in metabolism of carbohydrates, fats, and proteins, causing elevation of the blood glucose level. Thus, it enables the body to adapt to stress. It may promote fluid retention that results in hypertension and edema. Shortness of breath (dyspnea) is caused by hypovolemia and decreased oxygen supply; neither is affected by hydrocortisone. It may cause potassium depletion.

A client with Addison's disease is receiving cortisone therapy. The nurse expects what clinical indicators if the client abruptly stops the medication? (Select all that apply.) 1 Diplopia 2 Dysphagia 3 Tachypnea 4 Bradycardia 5 Hypotension

tachypnea hypotension rationale: