Chapter 42: Drug Therapy for Hyperthyroidism and Hypothyroidism

A nurse is caring for a client with subacute lymphocytic thyroiditis. The health care provider prescribes thyroid hormones to the client. From which sign 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

a. Increased appetite 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 swollen neck, excessive sweating, or heat intolerance as signs of responding to therapy. Swollen neck, sore throat, and cough may occur after two to three days of administering radioactive iodine. Sweating and flushing are the adverse reactions to thyroid hormones.

Thyroid hormones are principally concerned with the increase in metabolic rate of tissues that can result in certain effects. What are some of these effects? Select all that apply. a. Increased heart rate b. Decreased respiratory rate c. Increased body temperature d. Increased cardiac output e. Decreased oxygen consumption

a. Increased heart rate c. Increased body temperature d. Increased cardiac output Thyroid hormones are principally concerned with the increase in metabolic rate of tissues, which results in increased heart and respiratory rate, body temperature, cardiac output, oxygen consumption, and the metabolism of fats, proteins, and carbohydrates.

Which of the following drug types is most likely to cause respiratory depression and myxedema coma in clients with thyroid disorders? a. Opioid analgesics b. Inderal c. Calcium channel blockers d. Methimazole

a. Opioid analgesics Clients with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs. These drugs should be avoided when possible.

A client is receiving a thyroid hormone to treat hypothyroidism. Which would indicate to the nurse that the client needs a reduced dosage of the drug? a. Tachycardia b. Slowed reflexes c. Pale dry skin d. Intolerance to cold

a. Tachycardia Tachycardia suggests hyperthyroidism due to excessive thyroid hormone; this would require a reduction in dosage. The other responses suggest hypothyroidism and drug ineffectiveness.

A client is diagnosed with Graves disease. Propylthiouracil (PTU) is prescribed. After 8 weeks of therapy, the client reports a fever and sore throat. The nurse is concerned that this symptoms may be early signs of: a. agranulocytosis. b. altered renal function. c. hepatotoxicity. d. hyperthyroidism.

a. agranulocytosis. Agranulocytosis is a serious but rare complication of PTU therapy. Agranulocytosis is characterized by an extreme reduction of white blood cells (neutropenia) and usually occurs in the first few months of PTU therapy. Altered renal function, hepatotoxicity, and hyperthyroidism are not identified adverse effects of PTU.

When describing thyroid function, the nurse would emphasize the need for intake of: a. iodine. b. calcium. c. sodium. d. vitamin B6.

a. iodine. Iodine intake is necessary for the production of thyroid hormones.

A nurse is teaching a client about a prescribed thyroid supplement and describes a drug that is relatively inexpensive, requires once-a-day dosing, and has a more uniform potency than do other thyroid hormone replacement drugs. Which drug is the nurse describing? a. levothyroxine b. propylthiouracil c. methimazole d. liotrix

a. levothyroxine Levothyroxine is the drug of choice for hypothyroidism because it is relatively inexpensive, requires once-a-day dosing, and has a more uniform potency than do other thyroid hormone replacement drugs. Propylthiouracil and methimazole are used to treat hyperthyroidism and are given in 8-hour intervals. Liotrix is used to treat hypothyroidism, given once a day, however, it is more expensive and does not have a more uniform potency.

A nurse is preparing to administer a scheduled dose of levothyroxine to an older adult client who is being treated in the hospital for a respiratory infection. Prior to administering the drug, the nurse should perform what assessment? a. measurement of blood pressure b. assessment of pupillary response c. chest auscultation for rales d. temperature measurement

a. measurement of blood pressure In older adults receiving levothyroxine, regular monitoring of blood pressure and pulse is essential. Temperature, pupillary response, and chest auscultation are not necessary before safe administration of this medication.

Based on the nurse's knowledge about thyroid hormone supplements, the nurse administers levothyroxine cautiously to a client who has recently had which condition or disorder? a. myocardial infarction b. cataract surgery c. seizure d. hypoglycemic episode

a. myocardial infarction A nurse should be cautious not to administer levothyroxine to a client who has recently had a myocardial infarction. Drug interactions with oral antidiabetics and insulin with hormone supplements can cause hyperglycemia. Seizure and cataract surgery are not contraindicated with the use of levothyroxine.

What drug type is most likely to cause respiratory depression and myxedema coma in clients with thyroid disorders? a. opioid analgesics b. thioamide antithyroids c. beta-adrenergic blockers d. calcium channel blockers

a. opioid analgesics Clients with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs. These drugs should be avoided when possible. None of the other options present with this contraindication.

A hospital client's current medication administration record specifies oral administration of propylthiouracil (PTU) every 8 hours. What sign or symptom may have originally prompted the care provider to prescribe this drug? a. persistent tachycardia b. orthostatic hypotension c. visual disturbances d. tinnitus

a. persistent tachycardia Propylthiouracil (PTU) is used for the treatment of hyperthyroidism; one of the characteristic symptoms of this disease is tachycardia. Tinnitus, visual disturbances, and hypotension are not associated with hyperthyroidism.

A health care provider has prescribed thyroid drugs to a client with euthyroid goiter. Which 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

b. Anxiety related to symptoms, adverse reactions, and treatment regimen The nurse should include anxiety related to symptoms, adverse reactions, and treatment regimen in the nursing diagnosis checklist on administering thyroid drugs to the client with euthyroid goiter. In the nursing diagnosis checklist for this client, the nurse need not include disturbed thought processes related to adverse drug reactions, risk for infection, or risk for impaired skin integrity related to adverse drug reactions. Risk for infection related to adverse drug reactions and risk for impaired skin integrity related to adverse reactions must be included in the nursing diagnosis checklist of a patient who is administered antithyroid drugs. The nursing diagnosis checklist of a client receiving ACTH must include disturbed thought processes related to adverse drug reactions.

The most common cause of subclinical hyperthyroidism is: a. Untreated osteoporosis. b. Excess thyroid hormone therapy. c. Previous neck radiation. d. Taking central nervous system depressants.

b. Excess thyroid hormone therapy. Clients should be monitored closely for hypothyroidism while taking antithyroid drugs, which usually develops within a year after receiving treatment for hyperthyroidism. The most common cause of subclinical hyperthyroidism is excess thyroid hormone therapy.

During a general health assessment, a client indicates taking thyroid medication to increase weight loss. What should the nurse teach the client about this use of the medication? a. Thyroid medication will increase weight loss, but the client needs to take a calcium supplement as well. b. Excessive or unnecessary antithyroid medication may produce serious or life-threatening manifestations of toxicity. c. Thyroid medication will increase weight loss, but the client will need to take supplementary iodine. d. Studies have shown that thyroid medication will not contribute to weight loss.

b. Excessive or unnecessary antithyroid medication may produce serious or life-threatening manifestations of toxicity. The FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of obesity or weight loss, either alone or with other therapeutic agents. Significant and serious complications may develop with normal thyroid function.

A nurse should recognize that a client taking antithyroid medication may be developing thyrotoxicosis if the client exhibits which of the following symptoms? a. Sore throat b. Extreme tachycardia c. Excessive fatigue d. Easy bruising

b. Extreme tachycardia Signs of thyrotoxicosis (increased hyperthyroidism) include high fever, extreme tachycardia, and altered mental status. A sore throat would alert the nurse to possible agranulocytosis. Fatigue is a sign of hypothyroidism. Bruising is a sign of increased bleeding tendency, not hyperthyroidism.

The pharmacology instructor is providing education regarding propylthiouracil to the nursing students. What would the instructor identify as the primary mode of action for this medication? a. Destruction of part of the thyroid gland b. Inhibition of production of thyroid hormone c. Suppression of the anterior pituitary gland's hormonal secretions d. Sedation of the central nervous system and suppression of cardiac function

b. Inhibition of production of thyroid hormone Propylthiouracil acts by inhibiting production of thyroid hormones and peripheral conversion of thyroxine (T4) to the more active triiodothyronine (T3).

A client diagnosed with hyperthyroidism is unsure about the need for the prescribed propranolol, stating, "I looked this up online and it's for high blood pressure, not thyroid problems." What statement concerning beta-adrenergic blockers should the nurse use as a basis for the response? a. It will inhibit the release of hormones from the anterior pituitary gland. b. It will block stimulation of the sympathetic nervous system. c. It stimulates the parasympathetic nervous system. d. It limits the action potential involved in cardiac conduction.

b. It will block stimulation of the sympathetic nervous system. When given to clients with hyperthyroidism, propranolol blocks beta-adrenergic receptors in various organs and thereby controls symptoms of hyperthyroidism resulting from excessive stimulation of the sympathetic nervous system. None of the other options provide accurate information concerning the appropriate use of propranolol in the management of hyperthyroidism.

Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which assessment finding should prompt the nurse to withhold a scheduled dose of levothyroxine? a. The resident has not eaten breakfast because of a recent loss of appetite. b. The resident's apical heart rate is 112 beats/minute with a regular rhythm. c. The resident had a fall during the night while transferring from her bed to her bathroom. d. The resident received her annual influenza vaccination the previous day.

b. The resident's apical heart rate is 112 beats/minute with a regular rhythm. If the pulse rate is greater than 100 bpm, it is necessary to withhold a levothyroxine dose in an older adult. Anorexia, recent vaccination, and recent falls do not necessary indicate a need to withhold this medication.

Which hormone regulates the production and release of thyroid hormone? a. Thyrotropin-releasing hormone (TRH) b. Thyroid-stimulating hormone (TSH) c. Tetraiodothyronine d. Triiodothyronine

b. Thyroid-stimulating hormone (TSH) The anterior pituitary hormone called thyroid-stimulating hormone (TSH) regulates thyroid hormone production and release. The secretion of TSH is regulated by thyrotropin-releasing hormone (TRH), a hypothalamic regulating factor. Tetraiodothyronine and triiodothyronine are thyroid hormones produced by the thyroid gland using iodine that is found in the diet.

Knowing that thyroid hormones are principally concerned with the increase in metabolic rate of tissues, which symptoms would a nurse observe in a client with uncontrolled hypothyroidism? (Select all that apply.) a. Elevated body temperature b. Weight gain c. Bradycardia d. Hypertension e. Sleepiness

b. Weight gain c. Bradycardia e. Sleepiness 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 appears puffy, coarse hair, thick, hard nails, heavy menses, fertility problems, and low sperm count.

A female client with a six-month-old infant has been prescribed propylthiouracil (PTU). What is the most important question the nurse should ask this client? a. "Have you ever taken thyroid replacement medications in the past?" b. "Did your baby have hyperthyroidism in utero?" c. "Are you breastfeeding your child?" d. "How long have you had thyroid related symptoms?"

c. "Are you breastfeeding your child?" Mothers taking PTU should not breastfeed their children (pregnancy category D). For the safety of the infant, the nurse should ask the client if she's breastfeeding. Taking thyroid medications in the past does not have an immediate impact on safety for the client or infant. Using PTU during pregnancy can cause hypothyroidism in the fetus. The time frame in which the client has had thyroid-related symptoms does not have an immediate effect on safety of the client or infant.

A client is diagnosed with both hypothyroidism and adrenal insufficiency. If the adrenal insufficiency is not treated first, what may occur with the administration of thyroid hormone? a. Hypertensive crisis b. Acute congestive heart failure c. Acute adrenocortical insufficiency d. Life-threatening arrhythmias

c. Acute adrenocortical insufficiency When hypothyroidism and adrenal insufficiency coexist, the adrenal insufficiency should be treated with a corticosteroid drug before starting thyroid replacement. Thyroid hormones increase tissue metabolism and tissue demands for adrenocortical hormones. If adrenal insufficiency is not treated first, administration of thyroid hormone may cause acute adrenocortical insufficiency, a life-threatening condition.

A primary health care provider has prescribed levothyroxine to a client with hypothyroidism. Which information would the nurse include in the teaching plan to promote an optimal response to the drug therapy? a. Bring your recorded pulse rates to the primary health care provider. b. Offer suggestions about the dosage schedule. c. Administer the drug early in the morning before breakfast. d. Apply soothing creams or lubricants to prevent rashes.

c. Administer the drug early in the morning before breakfast. The nurse should instruct the client to administer the drug early in the morning before breakfast to promote an optimal response to the drug therapy since an empty stomach increases the absorption of the oral preparation. When methimazole and propylthiouracil are administered to the client, the nurse should recommend that the client record the pulse rates and bring the record to the primary health care provider. If the client expresses a concern about the dosage schedule, the nurse can offer suggestions to the client about the dosage schedule. If the client experiences a rash while taking methimazole or propylthiouracil, the nurse needs to inform the client to apply soothing creams or lubricants.

A nurse is caring for a patient with hypothyroidism. The nurse would know that the effects of hypothyroidism include: a. Nervousness and restlessness b. Fever c. Decreased cardiac output d. Increased blood pressure

c. Decreased cardiac output Decreased cardiac output is an effect of hypothyroidism. Low-grade fever, nervousness and restlessness, and increased systolic blood pressure are among the effects of hyperthyroidism.

The client with hypothyroidism takes levothyroxine daily and has triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) levels drawn in the laboratory to check appropriateness of prescribed dosage. What results would the nurse analyze as indicating the need for a higher dosage of medication? a. Elevated TSH, elevated T3, and reduced T4 levels b. Reduced TSH, elevated T3 and T4 levels c. Elevated TSH, reduced T3 and T4 levels d. Reduced TSH, T3, and T4 levels

c. Elevated TSH, reduced T3 and T4 levels TSH levels would be elevated to stimulate increased thyroid hormone secretion, whereas T4 and T3 will be low, which indicates the need for a higher dosage of medication. If TSH level is low, it would indicate a reduction in dosage would be needed, particularly if T3 and T4 levels are elevated.

Which would a nurse expect to assess in a client experiencing hyperthyroidism? a. Slow and deep tendon reflexes b. Bradycardia c. Flushed, warm skin d. Intolerance to cold

c. Flushed, warm skin Clients with hyperthyroidism typically exhibit flushed, warm skin; hyperactive deep tendon reflexes; tachycardia; and intolerance to heat.

The nurse is preparing to administer levothyroxine to a client. Which assessment finding would cause the nurse to hold the medication? a. Respiratory rate of 16 b. Temperature of 99.3°F c. Heart rate of 110 beats per minute d. Blood pressure of 107/64

c. Heart rate of 110 beats per minute Levothyroxine should be held if the client's heart rate is over 100 beats per minute.

Predisposing factors for myxedema coma include all of the following EXCEPT: a. Exposure to cold. b. Respiratory disease. c. History of Lupus. d. Taking central nervous system depressants.

c. History of Lupus. Myxedema coma is severe, life-threatening hypothyroidism characterized by coma, hypothermia, cardiovascular collapse, hypoventilation, and severe metabolic disorders such as hyponatremia, hypoglycemia, and lactic acidosis. Predisposing factors include exposure to cold, infection, trauma, respiratory disease, and administration of central nervous system depressants.

A client is diagnosed with liver disease. How would this affect the metabolism of the drugs used to treat the client's hypothyroidism? a. It would be unaffected. b. It would be rapid. c. It would be prolonged. d. It would be short-lived.

c. It would be prolonged. Drug metabolism in the liver is delayed in clients with hypothyroidism and liver disease, so most drugs given to these clients have a prolonged effect.

A patient with hypothyroidism is at increased risk for respiratory depression and myxedema coma if given what category of drugs? a. Antibiotics b. Corticosteroids c. Opioid analgesics d. Nonsteroidal anti-inflammatory drugs

c. Opioid analgesics Most drugs given to patients with hypothyroidism have a prolonged effect, because drug metabolism in the liver is delayed and the glomerular filtration rate of the kidneys is decreased. People with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs. These drugs should be avoided when possible.

A 25-year-old female client is diagnosed with hypothyroidism. She is admitted to the hospital for acute gallbladder disease and subsequent surgical intervention. When planning postoperative opioid pain management, the nurse must take into account the fact that the client is at greater risk for what condition, secondary to the client's hypothyroidism diagnosis? a. Hypotension b. Hypertension c. Respiratory depression d. Atrial fibrillation

c. Respiratory depression People with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs.

A client is prescribed levothyroxine. The nurse understands that this drug contains: a. T3. b. iodine. c. T4. d. vitamin D.

c. T4. Levothyroxine is a synthetic salt of T4; desiccated thyroid contains both T3 and T4. Liothyronine contains T3. Iodine is an antithyroid agent. Calcitriol is a form of vitamin D.

When learning about thyroid hormones in pharmacology, the nursing students learn that when the thyroid gland is stimulated by thyroid-stimulating hormone (thyrotropin or TSH) from the anterior pituitary gland, thyroid hormones are: a. stored in the thyroid gland. b. stored in the parathyroid glands. c. released into the bloodstream. d. released into the lymphatic system.

c. released into the bloodstream. Thyroid hormones are released into the circulation when the thyroid gland is stimulated by thyroid-stimulating hormone (thyrotropin or TSH) from the anterior pituitary gland.

A female client's diagnoses include hyperthyroidism, congestive heart failure, and type 2 diabetes mellitus. What effect will the treatment of hyperthyroidism have on her routine medications? a. Metabolism will be slower than normal, and the dose will be increased. b. Metabolism will be slower than normal, and the dose will be decreased. c. Metabolism will be faster than normal, and the dose will be decreased. d. Metabolism will be faster than normal, and the dose will be increased.

d. Metabolism will be faster than normal, and the dose will be increased. Treatment of hyperthyroidism changes the rate of body metabolism, including the rate of metabolism of many drugs. In the hyperthyroid state, drug metabolism may be very rapid, and higher doses of most drugs may be necessary to achieve therapeutic results. When the client becomes euthyroid, the rate of drug metabolism is decreased. Consequently, doses of all medications should be evaluated and probably reduced to avoid severe adverse effects.

During a general health assessment, a client indicates taking thyroid medication to increase weight loss. What statement should be the basis of the nurse's response? a. While taking thyroid medication, the client needs to take a calcium supplement as well. b. While taking thyroid medication, the client needs to take additional dietary supplements of iodine as well. c. Taking thyroid medication will not contribute to weight loss but only result in a redistribution of fat deposits. d. Taking excessive or unnecessary thyroid medication may produce serious or life-threatening manifestations of toxicity.

d. Taking excessive or unnecessary thyroid medication may produce serious or life-threatening manifestations of toxicity. The FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of obesity or weight loss, either alone or with other therapeutic agents. Significant and serious complications may develop in euthyroid clients talking thyroid hormones.

Levothyroxine (Synthroid) 88 mcg is prescribed for a client. How many mg of Synthroid will the nurse administer? Do NOT round the answer.

0.088 1 mg = 1000 mcg. 88 mcg = 0.088 mg

Methimazole (Tapazole) 30 mg /day orally divided in 3 doses is prescribed for a client diagnosed with Graves' disease. The pharmacy has 5 mg tablets available. How many tablets should the nurse administer with each dose?

2 30 mg/day divided in 3 doses = 10 mg/dose; 10 mg / 5 mg tablets = 2 tablets per dose

The nurse is caring for a client who has a possible thyroid disorder and is aware that what medication will be used in diagnostic testing? a. PTU b. Levothyroxine c. Sodium iodide-131 d. Propranolol

c. Sodium iodide-131 Sodium iodide-131 is used in the diagnosis of thyroid disease and also in the treatment of hyperthyroidism.

The nurse educates a client newly diagnosed with hypothyroidism that replacement therapy usually continues until the client is euthyroid for how long? a. 6 to 12 months b. 18 to 24 months c. 3 to 6 months d. 8 to 12 months

a. 6 to 12 months Thyroid replacement therapy in the client with hypothyroidism is lifelong; no clear cut guidelines exist regarding duration of antithyroid drug therapy because of exacerbations and remissions. Replacement therapy usually continues until the client has been euthyroid for 6 to 12 months.

The nurse is preparing to administer methimazole to an 11-year-old client newly diagnosed with hyperthyroidism. What are the potential risks for the use of methimazole in children? (Select all that apply.) a. Cancer caused by radioactive iodine b. Chromosome damage c. Chronic hypertension d. Chronic hypotension e. Chronic hypothyroidism

a. Cancer caused by radioactive iodine b. Chromosome damage e. Chronic hypothyroidism For hyperthyroidism, PTU or methimazole is used. Potential risks for adverse effects are similar to those in adults. Radioactive iodine may cause cancer and chromosome damage in children; therefore, this agent should be used only for hyperthyroidism that cannot be controlled by other antithyroid drugs or surgery. It also may lead to the development of hypothyroidism

The treatment protocol for a client with hyperthyroidism includes antithyroid medication and propranolol. The purpose of propranolol is to do which of the following? a. Decrease tachycardia b. Promote weight loss c. Decrease the risk of infection d. Relieve coughing

a. Decrease tachycardia Propranolol is an adrenergic blocking agent. It is prescribed as adjunctive treatment for several weeks during antithyroid treatment, until the therapeutic effects of the antithyroid drug are obtained. Propranolol decreases tachycardia and palpitations, but it does not decrease the risk of infection or relieve coughing. People with hyperthyroidism tend to have difficulty with keeping weight on, a medication to enhance this effect would not be prescribed as part of the client's treatment.

The nurse is caring for a client with severe hypothyroidism and knows to contact the health care provider if which symptoms of myxedema coma occur? (Select all that apply.) a. Decreased level of consciousness b. Fever c. Decreased respirations d. High blood glucose level e. Decreased blood pressure

a. Decreased level of consciousness c. Decreased respirations e. Decreased blood pressure Symptoms of myxedema coma include coma, hypothermia, cardiovascular collapse, hypoventilation, hypoglycemia, and lactic acidosis.

The nurse cares for a client who was admitted for multiple bone fractures resulting from a fall. The client has a comorbidity of hypothyroidism. Which diet is the most appropriate for this client? a. Low calorie, high fiber b. Low calorie, low fiber c. High calorie, low fiber d. High calorie, high fiber

a. Low calorie, high fiber Hypothyroidism slows the metabolism and decreases gastrointestinal secretions and motility. Hypothyroid clients, therefore, should be encouraged to eat a low-calorie, high-fiber diets to combat weight gain and constipation.

The nurse is caring for a client who is seeking care for a chronic condition. The nurse is aware that the FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of what condition? a. Obesity b. Hypotension c. Diabetes mellitus type 1 d. GERD

a. Obesity The FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of obesity or for weight loss, either alone or with other therapeutic agents. Significant and serious complications may develop in euthyroid people taking thyroid hormones.

The nurse educates a client recently diagnosed with hypothyroidism about using the prescribed levothyroxine. The client has a history of diabetes. Which client statement establishes the need for further clarification? a. "I will take the drug thirty minutes before breakfast the same time each day." b. "It does not matter which brand of the drug I take, they are all the same." c. "The levothyroxine can increase my glucose, so I need to report hyperglycemia." d. "Thyroid replacement is lifelong; dosage changes must come from my provider."

b. "It does not matter which brand of the drug I take, they are all the same." The nurse needs to clarify with further teaching the client's statement that it does not matter what brand of levothyroxine is taken. The client needs to keep taking the same brand because switching brands can lead to changes in the hormone level and affect the treatment. The other statements made by the client support an adequate understanding of various teaching points. Taking the drug before breakfast allows the medication to dissolve and be absorbed on an empty stomach. Taking the medication at the same time of day helps to maintain a steady state of the drug. Thyroid replacement may cause symptoms of diabetes to increase, so monitoring for hyperglycemia is warranted since the client has a history of diabetes. Thyroid replacement in this case is lifelong, and the client should not intentionally change a dose by increasing, decreasing, or skipping a dose.

Knowing that thyroid hormones are principally concerned with the increase in metabolic rate of tissues, which symptom would a nurse observe in a client with uncontrolled hyperthyroidism? (Select all that apply.) a. Low body temperature b. Weight loss c. Tachycardia d. Hypotension e. Sleepiness

b. Weight loss c. Tachycardia 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, red) skin, thinning hair, goiter, and irregular or scant menses.

Increases in what specific physiologic effects are expected outcomes of thyroid hormone therapy? Select all that apply. a. pituitary secretion of TSH b. carbohydrate metabolism c. cellular metabolism d. oxygen consumption e. cardiac output

b. carbohydrate metabolism c. cellular metabolism d. oxygen consumption e. cardiac output Some specific physiologic effects of thyroid hormones include increased rate of cellular metabolism and oxygen consumption, with a resultant increase in heat production; increased heart rate, force of contraction, and cardiac output; increased carbohydrate metabolism; increased fat metabolism, including increased lipolytic effects of other hormones and metabolism of cholesterol to bile acids; and inhibition of pituitary secretion of thyroid-stimulating hormone (TSH).

What is a common cause of primary hypothyroidism? Select all that apply. a. insufficient release of thyrotropin-releasing hormone (TRH) b. dysfunctional anterior pituitary secretion c. hyperthyroidism medication therapy d. Hashimoto's thyroiditis e. radiation to the neck

c. hyperthyroidism medication therapy d. Hashimoto's thyroiditis e. radiation to the neck Common causes of primary hypothyroidism include chronic (Hashimoto's) thyroiditis, an autoimmune disorder characterized by inflammation of the thyroid gland, and treatment of hyperthyroidism with antithyroid drugs, radiation therapy, or surgery. Secondary hypothyroidism occurs when there is decreased TSH from the anterior pituitary gland or decreased thyrotropin-releasing hormone (TRH) secreted from the hypothalamus, which disrupts the negative feedback mechanism.

A client is prescribed methimazole for the treatment of hyperthyroidism. Which is a rare adverse effect or set of effects related to the administration of methimazole? a. Joint swelling with fever b. Immune-mediated hyperthyroidism c. Arthralgia d. Agranulocytosis

d. Agranulocytosis The rare but fatal adverse effects of methimazole are agranulocytosis, which affects only 0.2% to 0.5% of all people taking antithyroid medication; aplastic anemia; liver damage; and vasculitis. On the other hand, arthralgia, joint swelling, itching, rash, fever, hives, headaches, nausea, and vomiting are common, minor adverse effects of the drug. However, methimazole is used to treat immune-mediated hyperthyroidism of Graves disease, and it is not an adverse effect of the drug.

A nurse is caring for a client suffering from a severe form of hyperthyroidism called thyrotoxicosis or thyroid storm. What would the nurse observe for in the client as a characteristic of thyroid storm? a. Memory impairment b. Cold intolerance c. Constipation d. Altered mental status

d. Altered mental status A severe form of hyperthyroidism called thyrotoxicosis or thyroid storm is characterized by high fever, extreme tachycardia, and altered mental status (e.g., coma). The nurse need not observe 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 hypothyroidism.

A client presents at the clinic reporting weight loss despite an increased appetite. For which condition should this client be assessed? a. Chronic thyroiditis b. Hyperglycemia c. Hypothyroidism d. Hyperthyroidism

d. Hyperthyroidism Hyperthyroidism is manifested by increased appetite and metabolism. Without treatment, it may be difficult for hyperthyroid individuals to consume enough calories to prevent weight loss. Hypothyroidism, which may be caused by thyroiditis, causes decreased appetite and metabolism, and hypothyroid patients frequently experience weight gain.

A client diagnosed with hypothyroidism is to start thyroid hormone replacement therapy. Which lab value should the nurse review to assist the health care provider in determining the dosage? a. Platelets b. Glucose c. CBC d. TSH

d. TSH Lab work to determine thyroid hormone dosages includes TSH (thyroid-stimulating hormone), T3 and T4 levels, and possibly thyroid antibodies.

A client exhibits severe tachycardia, fever, dehydration, and heart failure. The nurse recognizes that these signs are consistent with what thyroid-associated health condition? a. subclinical hyperthyroidism b. Hashimoto's disease c. myxedema d. thyroid storm

d. thyroid storm Thyroid storm is a crisis or life-threatening condition characterized by an exaggeration of the usual physiologic response seen in hyperthyroidism. Whereas hyperthyroidism can cause symptoms such as sweating, feeling hot, palpitations, and weight loss, the symptoms of thyroid storm are more severe, resulting in complications such as fever, rapid heart rate, nausea/vomiting, diarrhea, irregular heartbeat, weakness, heart failure, confusion/disorientation, and coma. Myxedema and Hashimoto's disease are forms of hypothyroidism, so they would not manifest similarly.