Ch 44 Thyroid and Antithyroid Drugs

A client is diagnosed with euthyroid goiter. The nurse would expect to administer which of the following? A) Levothyroxine B) Methimazole C) Propylthiouracil D) Sodium iodide

Ans: A Feedback: Euthyroid goiter is treated with thyroid hormones, such as levothyroxine. Methimazole, propylthiouracil, and sodium iodide are used to treat hyperthyroidism.

A client is diagnosed with thyroid cancer. Which drug would the nurse anticipate being prescribed for the client? A) Iodine-131 B) Methimazole C) Propylthiouracil D) Liothyronine

Ans: A Feedback: Radioactive iodine (131I) is used for the treatment of hyperthyroidism and cancer of the thyroid. Methimazole and propylthiouracil are used to manage hyperthyroidism. Liothyronine is used to treat hypothyroidism.

A client diagnosed with hyperthyroidism has been prescribed propylthiouracil. After administering the drug, the nurse would assess the client for which of the following? A) Skin rash B) Tachycardia C) Nervousness D) Constipation

Ans: A Feedback: The adverse reactions to propylthiouracil include paresthesias, numbness, headache, skin rash, nausea, vomiting, and agranulocytosis. The nurse need not observe for tachycardia, nervousness, and constipation as adverse reactions associated with propylthiouracil. Tachycardia, nervousness, and vomiting are the adverse reactions associated with the thyroid hormone levothyroxine sodium (T4).

A nurse is caring for a client with thyrotoxicosis. The physician prescribes liotrix for the client. The nurse would be alert for the development of which of the following? A) Tachycardia B) Agranulocytosis C) Loss of hair D) Skin rash

Ans: A Feedback: The nurse should monitor for tachycardia, palpitations, headache, nervousness, insomnia, diarrhea, vomiting, weight loss, fatigue, sweating, and flushing as adverse reactions after administering liotrix to a client with thyrotoxicosis. Agranulocytosis, loss of hair, and skin rash are not the adverse reactions to liotrix; they are adverse reactions found in a client receiving a methimazole drug.

A nurse is caring for a client who is prescribed thyroid hormone replacement. From which of the following signs during ongoing assessment should the nurse conclude that the client is responding to the therapy? A) Increased appetite B) Swollen neck C) Excessive sweating D) Flushing

Ans: A Feedback: The nurse should observe for signs of therapeutic responses, which include increased appetite, weight loss, mild diuresis, an increased pulse rate, and decreased puffiness of the face, hands, and feet. The nurse need not observe for swollen neck, excessive sweating, or heat intolerance as signs of responding to therapy. Swollen neck, sore throat, and cough may occur after 2 to 3 days of administering radioactive iodine. Sweating and flushing are the adverse reactions to thyroid hormones.

After teaching a client who is prescribed methimazole, the nurse determines that the teaching was effective when the client states which of the following? Select all that apply. A) ìI need to take the drug around the clock.î B) ìI should call my primary health care provider if I have a fever.î C) ìI can use any over-the-counter medications if I need to.î D) ìI might have some tenderness and swelling of my neck.î E) ìI don't need to monitor my weight like I did before.î

Ans: A, B Feedback: The client taking methimazole should take the drug as prescribed around the clock and call the primary health care provider if he develops fever, sore throat, cough, easy bleeding or bruising, headache, or a general feeling of malaise. The client also needs to check with the prescriber before using any nonprescription drugs and monitor his weight twice a week, notifying the primary health care provider if there is any sudden weight gain or loss. Tenderness and swelling would be noted if the client received radioactive iodine for a procedure.

The nurse should monitor a client receiving radioactive iodine (131I) for which of the following severe reactions? Select all that apply. A) Agranulocytosis B) Exfoliative dermatitis C) Hypoprothrombinemia D) Seizures E) Stroke

Ans: A, B, C Feedback: The nurse should monitor a client receiving radioactive iodine (131I) for severe reactions including agranulocytosis, exfoliative dermatitis, hypoprothrombinemia, and granulocytopenia.

During ongoing assessment the nurse should observe a client taking levothyroxine for which of the following indicating a therapeutic response? Select all that apply. A) Weight loss B) Mild diuresis C) Increased appetite D) Increased mental activity E) Decreased pulse rate

Ans: A, B, C, D Feedback: Signs of therapeutic response to levothyroxine include weight loss; mild diuresis; increased appetite; increased pulse rate; decreased puffiness of face, hands, and feet; and client report of increased mental activity and increased sense of well-being.

A nurse caring for a client who is receiving warfarin (Coumadin) will monitor for signs of bleeding if which of the following thyroid hormoneñregulating drugs is initiated? Select all that apply. A) Propylthiouracil (PTU) B) Desiccated thyroid (Armour Thyroid) C) Liotrix (Thyrolar) D) Methimazole (Tapazole) E) Liothyronine (Triostat)

Ans: A, B, C, D, E Feedback: All of the thyroid hormone replacement drugs and methimazole (Tapazole) and propylthiouracil (PTU) can increase the risk for bleeding, especially in clients taking warfarin (Coumadin).

During initial therapy with levothyroxine, the most common reactions a nurse might observe in a client include which of the following? Select all that apply. A) Elevated body temperature B) Weight loss C) Tachycardia D) Hypotension E) Insomnia

Ans: A, B, C, E Feedback: During initial therapy with levothyroxine, the most common reactions a nurse would observe are signs of overdose and hyperthyroidism, which include increased metabolism; heat intolerance; elevated body temperature; weight loss; tachycardia; hypertension; nervousness; anxiety; insomnia; exophthalmos; flushed, warm, moist skin; thinning hair; goiter; and irregular or scant menses.

A physician has ordered an iodine procedure for a client with thyroid dysfunction. What should be included in the nurse's preadministration assessment for the client? Select all that apply. A) Allergy history B) Weight C) Pulse D) Blood glucose E) Temperature

Ans: A, B, C, E Feedback: The nurse's preadministration assessment for the client should include vital signs (blood pressure, respiratory rate, pulse, and temperature), allergy history, weight, and notation regarding the outward symptoms of the hyperthyroidism.

A nurse is describing the action of thyroid hormones to a client. The nurse would include information that thyroid hormones are principally concerned with the increase in the metabolic rate of tissues that can result in which of the following? Select all that apply. A) Increased heart rate B) Decreased respiratory rate C) Increased body temperature D) Increased cardiac output E) Decreased oxygen consumption

Ans: A, C, D Feedback: Thyroid hormones are principally concerned with the increase in the metabolic rate of tissues, which results in increases in the heart and respiratory rate, body temperature, cardiac output, oxygen consumption, and metabolism of fats, proteins, and carbohydrates.

A nurse educating a client and his family about levothyroxine for the treatment of hypothyroidism should include which of the following information? Select all that apply. A) Therapy is lifelong. B) Drug is taken in the evening. C) Therapy needs to be evaluated every week initially. D) Weekly weights are needed with significant changes reported. E) Changing brands of the drug is okay.

Ans: A, D Feedback: A nurse educating a client and his family about levothyroxine includes the following: therapy is lifelong, dose is taken in the morning before breakfast, therapy needs to be evaluated every 2 weeks initially, weekly weights are needed and significant changes are reported to the physician, and the client should not change brands of the drug without consulting the physician.

After teaching a group of nursing students about thyroid drugs, the instructor determines that the teaching was successful when the students identify which of the following as an antithyroid drug? Select all that apply. A) Propylthiouracil B) Levothyroxine C) Liotrix D) Desiccated thyroid E) Methimazole

Ans: A, E Feedback: Propylthiouracil and methimazole are antithyroid drugs. Levothyroxine, liotrix, and desiccated thyroid are thyroid hormone supplements.

. A physician has prescribed a thyroid supplement for a client with euthyroid goiter. Which of the following should the nurse include in the nursing diagnosis checklist? A) Disturbed Thought Processes related to adverse drug reactions B) Anxiety related to symptoms, adverse reactions, and treatment regimen C) Risk for Infection related to adverse drug reactions D) Risk for Impaired Skin Integrity related to adverse reactions

Ans: B Feedback: The nurse should include Anxiety related to symptoms, adverse reactions, and treatment regimen as a nursing diagnosis. Disturbed Thought Processes related to adverse drug reactions, Risk for Infection, and Risk for Impaired Skin Integrity related to adverse drug reactions are inappropriate. Risk for Infection related to adverse drug reactions and Risk for Impaired Skin Integrity related to adverse reactions would be appropriate for a client receiving antithyroid drugs. Disturbed Thought Processes may apply for a client receiving ACTH.

A physician has prescribed desiccated thyroid USP for thyroid-stimulating hormone suppression. The client is also taking serotonin reuptake inhibitors to overcome depression. The nurse would be alert to the development of which of the following due to the interaction of the two drugs? A) Prolonged bleeding B) Decreased effectiveness of the thyroid drug C) Increased risk of paresthesias D) Increased risk of hypoglycemia

Ans: B Feedback: The nurse should monitor for a decreased effectiveness of the thyroid drug as the result of the interaction between desiccated thyroid USP and serotonin reuptake inhibitors. When the client is receiving desiccated thyroid USP with serotonin reuptake inhibitors, there is no increase in the risk of paresthesias, hypoglycemia, or prolonged bleeding. When the client is receiving oral anticoagulants with thyroid hormones, the client is at risk of prolonged bleeding. Increased risk of hypoglycemia occurs when oral hypoglycemics and insulin are administered with thyroid hormones to the client. The nurse should observe for paresthesias as one of the adverse reactions in a client receiving antithyroid drugs.

A group of nursing students are reviewing information about thyroid disorders. The students demonstrate understanding of the information when they identify which of the following as indicative of hyperthyroidism? Select all that apply. A) Low body temperature B) Weight loss C) Tachycardia D) Hypotension E) Sleepiness

Ans: B, C Feedback: The signs and symptoms of hyperthyroidism include increased metabolism; heat intolerance; elevated body temperature; weight loss; tachycardia; hypertension; nervousness; anxiety; insomnia; exophthalmos; flushed, warm, moist skin; thinning hair; goiter; and irregular or scant menses.

A nurse is assessing a client who is prescribed levothyroxine. The nurse understands that this drug is prescribed to treat the thyroid condition associated with which of the following symptoms? Select all that apply. A) Nervousness B) Anorexia C) Coarse hair D) Cold intolerance E) Tachycardia

Ans: B, C, D Feedback: Levothyroxine is used to treat hypothyroidism manifested by anorexia, coarse hair, cold intolerance, lethargy, and bradycardia.

A nurse is providing care to a client with hyperthyroidism. Which treatment modalities would the nurse anticipate being used? Select all that apply. A) Levothyroxine (Synthroid) B) Methimazole (Tapazole) C) Radioactive iodine (131I) D) Propylthiouracil (PTU) E) Subtotal thyroidectomy

Ans: B, C, D, E Feedback: Methimazole (Tapazole), propylthiouracil (PTU), radioactive iodine (131I), and subtotal thyroidectomy are treatment modalities used in the treatment of clients with hyperthyroidism.

When teaching a client about his prescribed levothyroxine therapy, the nurse determines that the teaching was successful when the client states that he will contact his primary health care provider if which of the following occur? Select all that apply. A) Constipation B) Palpitations C) Excessive diaphoresis D) Significant weight changes E) Chest pain

Ans: B, C, D, E Feedback: The client taking levothyroxine should contact his primary health care provider if any of the following occur: headache, nervousness, palpitations, diarrhea, excessive diaphoresis, heat intolerance, chest pain, increased pulse rate, significant weight changes, or any unusual physical change or event.

A client is diagnosed with hypothyroidism. Which of the following would the nurse expect to assess? Select all that apply. A) Elevated body temperature B) Weight gain C) Bradycardia D) Hypertension E) Sleepiness

Ans: B, C, E Feedback: The signs and symptoms of hypothyroidism include decreased metabolism; cold intolerance; low body temperature; weight gain; bradycardia; hypotension; lethargy; sleepiness; pale, cool, dry skin; face appearing puffy; coarse hair; thick, hard nails; heavy menses; fertility problems; and low sperm count.

A nurse completing a preadministration assessment on a 70-year-old client prior to the administration of levothyroxine may confuse which of the following symptoms of hypothyroidism with which symptoms associated with the aging process? Select all that apply. A) Constipation B) Confusion C) Unsteady gait D) Decreased visual acuity E) Cold intolerance

Ans: B, C, E Feedback: The symptoms of hypothyroidism may be confused with symptoms associated with aging, such as depression, cold intolerance, weight gain, confusion, or unsteady gait.

A client with a heart condition controlled on which of the following drugs must be monitored closely by the nurse for worsening atrial fibrillation if levothyroxine is initiated to treat hypothyroidism? Select all that apply. A) Lisinopril (Prinivil) B) Digoxin (Lanoxin) C) Diltiazem (Cardizem) D) Metoprolol (Toprol) E) Warfarin (Coumadin)

Ans: B, D Feedback: A client with a heart condition controlled on digoxin (Lanoxin) and metoprolol (Toprol) must be monitored closely by the nurse for worsening atrial fibrillation if levothyroxine is initiated to treat hypothyroidism because levothyroxine can decrease the effectiveness of digoxin and beta blockers (metoprolol).

A nurse is preparing to administer the thyroid hormone replacement drug levothyroxine to a client. The nurse understands which of the following about this drug? Select all that apply. A) Equivalent to all other thyroid hormone replacement drugs B) More uniform potency than other thyroid hormone replacement drugs C) Twice-daily dosing necessary D) Relatively inexpensive E) Less frequent lab monitoring required

Ans: B, D Feedback: The following is true of the thyroid hormone replacement drug levothyroxine: it is relatively inexpensive, requires once-daily dosing, and has a more uniform potency than do other thyroid hormone replacement drugs.

. A nurse is caring for a client with hyperthyroidism. The physician prescribes methimazole to the client. The nurse observes that the client has developed skin rashes after the drug is administered. Which of the following interventions should the nurse perform while caring for the client? A) Offer suggestions to alter the drug schedule. B) Instruct the client to avoid applying lubricants. C) Instruct the client to use soap sparingly. D) Check if discoloration of the hair occurs.

Ans: C Feedback: The nurse should instruct the client to use soap sparingly and apply soothing creams or lubricants until the rash subsides. The nurse need not offer suggestions to alter the drug schedule, instruct the client to avoid applying lubricants, or check if discoloration of hair occurs.

A client presents to the physician's office with complaints of worsening hypothyroidism symptoms. When questioned about medication changes, the client tells the nurse that she has recently started taking an antidepressant prescribed by another physician. Which of the following antidepressants can decrease the effectiveness of levothyroxine? A) Amitriptyline (Elavil) B) Quetiapine (Seroquel) C) Sertraline (Zoloft) D) Fluoxetine (Prozac) E) Topiramate (Topamax)

Ans: C, D Feedback: Selective serotonin reuptake inhibitors (SSRIs), like sertraline (Zoloft) and fluoxetine (Prozac), can decrease the effectiveness of levothyroxine, leading to the reappearance of hypothyroidism symptoms in clients previously controlled on a dose of levothyroxine.

When describing the thyroid gland, the nursing instructor would include which hormones as being secreted by the thyroid gland? Select all that apply. A) Thyroid-stimulating hormone B) Adrenocorticotropic hormone C) Thyroxine D) Prolactin E) Tri-iodothyronine

Ans: C, E Feedback: Thyroxine and tri-iodothyronine are hormones secreted by the thyroid gland. The anterior pituitary secretes thyroid-stimulating hormone. Prolactin and adrenocorticotropic hormone are secreted by the pituitary gland.

A nurse is caring for a client with thyroid storm. Which of the following would the nurse expect to assess? A) Memory impairment B) Cold intolerance C) Constipation D) Altered mental status

Ans: D Feedback: A severe form of hyperthyroidism called thyroid storm is characterized by high fever, extreme tachycardia, and altered mental status. The nurse need not observe for memory impairment, cold intolerance, or constipation as characteristics of thyroid storm. Memory impairment, cold intolerance, and constipation are the manifestations of myxedema, which is a severe form of hypothyroidism.

A nurse is caring for a client with chronic lymphocytic thyroiditis. The physician has prescribed liothyronine to the client. The nurse understands that the drug is administered cautiously to clients with which of the following? A) Upper respiratory tract infection B) Diabetes C) Elevated body temperature D) Cardiac disease

Ans: D Feedback: The nurse should be cautious about existing conditions such as cardiac disease and also cautious about lactating clients before administering liothyronine to clients with chronic lymphocytic thyroiditis. The nurse need not be cautious about administering liothyronine to clients with an upper respiratory tract infection, diabetes, or elevated body temperature. The nurse should be cautious about clients contracting an upper respiratory tract infection on administrating antithyroid drugs. A client with diabetes may experience an increase in diabetes while undergoing thyroid hormone replacement therapy. The nurse should observe for elevated body temperature while managing the needs of a client administered thyroid hormones.

. A nurse is caring for a client undergoing thyroid hormone replacement therapy. The nurse instructs the client to take the drug at which time? A) Before bedtime B) Just before dinner C) After lunch D) Before breakfast

Ans: D Feedback: The nurse should inform the client undergoing thyroid hormone replacement therapy to take the drug in the morning, preferably before breakfast. The nurse should not ask the client to take the drug before bedtime, just before dinner, or after lunch as that is not generally recommended by the health care provider.