Pharm Chapter 42 & 44
Alendronate (Fosamax) is prescribed for a patient. Which statement made by the patient will indicate to the nurse that further instruction is needed?
"I can go back to bed as soon as I take this drug." Explanation: The patient must remain upright (sitting or standing) for at least 30 minutes after taking alendronate with a full glass of water. Nothing should be taken by mouth for at least 30 minutes. Upper abdominal pain or heartburn may indicate that alendronate is causing esophageal irritation or damage.
A routine metabolic panel shows that an adult client has a low calcium level. After the nurse provides teaching about increasing dietary calcium, what statement made by the client indicates that further education is required?
"I will replace red meat with more lean meat in my diet." Explanation: Milk and other dairy products are high in calcium. Other dietary sources include some vegetables (e.g., broccoli, spinach, kale, mustard greens) and certain types of seafood (e.g., clams, oysters). Although meat is high in phosphorous, it is not a significant source of calcium.
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?
"It does not matter which brand of the drug I take, they are all the same." Explanation: 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.
The nurse in the newborn nursery is assessing an infant with suspected congenital hypothyroidism. What assessment findings support this diagnosis? (Select all that apply.) Elevated temperature Bradycardia Feeding difficulties Lethargy Diarrhea
-Bradycardia -Feeding difficulties -Lethargy Explanation: Symptoms that support a diagnosis of congenital hypothyroidism include subnormal temperature, low heart rate, feeding difficulties, lethargy, and constipation.
An adult client has been diagnosed with hypothyroidism and has been prescribed an initial dose of PO levothyroxine of 1.7 mcg/kg/day. The hospital nurse obtains a weight of 130 lb and would obtain levothyroxine in which available dose from the pharmacy?
100 mcg Explanation: The client's weight must first be converted to kilograms: 130/2.2 = 59.1 kg. The prescribed dose is 1.7 mcg/kg, and 1.7 X 59.1 = 100.5 mcg. The most appropriate delivery of the medication would consequently be 100 mcg.
A nurse is discussing nutrition with a group of older adults at a community senior center. The nurse informs the group that the recommended daily calcium intake is:
1000-1500 mg Explanation: For most adults, the calcium requirement is 1000 mg daily. For postmenopausal women do not take replacement estrogens, it is 1500 mg daily.
The nurse is caring for a client who is being monitored for hypercalcemia. The nurse understands that what calcium level is considered a medical emergency?
12 mg/dL Explanation: Calcium levels at 12 mg/dL or above are considered medical emergencies, and rehydration must be started immediately.
Older adult clients are at increased risk for adverse cardiovascular reactions when taking thyroid drugs; therefore, increases in dosage, if needed, are made in smaller increments during a period of how many weeks?
8 weeks Explanation: Older adult clients are at increased risk for adverse cardiovascular reactions when taking thyroid drugs; therefore, increases in dosage, if needed, are made in smaller increments during a period of 8 weeks. Due to the gradual increase the increment of 1 to 6 weeks is not enough time to increase slowly.
A 43-year-old male client takes prednisone 7.5 mg daily to treat his temporal arteritis. His dose varies from 7.5 to 10 mg based on symptoms and laboratory test analysis. His disease process has been managed successfully with this drug regimen for 7 years. To prevent osteoporosis, what would his health care provider order? (Select all that apply.) A calcium supplement Testosterone A bisphosphonate drug Regular weight-bearing exercise A soy supplement
A calcium supplement A bisphosphonate drug Regular weight-bearing exercise Explanation: Preventive measures are necessary for clients on chronic corticosteroid therapy (e.g., prednisone 7.5 mg daily; equivalent amounts of other systemic drugs; high doses of inhaled drugs). For both men and women, most of the guidelines for prevention of osteoporosis apply (e.g., calcium supplements, regular exercise, a bisphosphonate drug). In addition, low doses and nonsystemic routes help prevent osteoporosis and other adverse effects. For men, corticosteroids decrease testosterone levels by approximately one half, and replacement therapy may be needed.
A client with symptomatic hyperthyroidism is prescribed propranolol. Which clinical manifestation would the nurse identify that indicates the medication is having the desired effect?
A heart rate of 72 beats/min Explanation: Propranolol is recommended for use in all clients with symptomatic hyperthyroidism because it blocks beta-adrenergic receptors in various organs and thereby controls symptoms of hyperthyroidism resulting from excessive stimulation of the sympathetic nervous system. Since tachycardia is associated with hyperthyroidism, a heart rate of 72 beats/min indicates that the drug is having the desired effect. Profuse diaphoresis indicates that the medication is not effective or having the desired effect intended. The blood glucose is not affected by the propranolol use. The blood pressure of this client is not well controlled and still considered hypertensive.
The nurse is evaluating an electrocardiogram (ECG) of a client in the emergency department. What does the nurse analyze on the ECG that might indicate a serum calcium level greater than 10.5 mg/dL?
A shortened Q-T interval and inverted T wave Explanation: Electrocardiographic changes indicative of hypercalcemia include a shortened Q-T interval and an inverted T wave. Frequent premature atrial contractions may have many causes and may be benign but are not indicative of hypercalcemia. A peaked T-wave may be significant in elevated potassium levels but not calcium levels. A prolonged P-R interval and missing ventricular beats indicate a heart block but are generally not related to hypercalcemia.
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?
Acute adrenocortical insufficiency Explanation: 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 patient will take alendronate (Fosamax). The nurse knows that which of these statements regarding alendronate is correct?
Alendronate suppresses osteoclast activity. Explanation: Alendronate is poorly absorbed from the gastrointestinal tract; bioavailability is approximately 10%. Food or other beverages will decrease the absorption of alendronate. This drug is renally excreted. Alendronate decreases the activity of osteoclasts, which are cells that break down bone.
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?
Altered mental status Explanation: 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 to the emergency department with an apparent reaction to recently started thyroid therapy. Which assessment finding would lead the nurse to question that this client is experiencing a thyroid storm?
Altered mental status Explanation: Some clients will experience an increase in hyperthyroidism rather than decrease during therapy. When these symptoms occur rapidly, it is termed a thyrotoxic crisis or thyroid storm. It is characterized by high fever, extreme tachycardia, and altered mental status. Memory impairment, cold intolerance, and constipation are the manifestations of myxedema, which is a severe form of hypothyroidism.
The nurse is reviewing the client's medication history. The client is to receive ibandronate. Which supplements would the nurse identify as possibly interfering with the drug's absorption? (Select all that apply.) Antacids Iron Calcium Multiple vitamins Aspirin
Antacids Iron Calcium Multiple vitamins Explanation: Antacids decrease the absorption of oral bisphosphonates, such as ibandronate. Iron decreases the absorption of oral bisphosphonates, such as ibandronate. Calcium decreases the absorption of oral bisphosphonates, such as ibandronate. Multiple vitamins decrease the absorption of oral bisphosphonates, such as ibandronate. Aspirin increases the GI distress associated with bisphosphonates, but does not affect absorption.
A health care provider has prescribed thyroid drugs to a client with euthyroid goiter. Which should the nurse include in the nursing diagnosis checklist?
Anxiety related to symptoms, adverse reactions, and treatment regimen Explanation: 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 nurse elicits a positive Chvostek sign when tapping on the facial nerve. What action by the nurse is a priority after this assessment is complete?
Assess the client's calcium level for hypocalcemia. Explanation: Hypocalcemia is indicated by a positive Chvostek sign and the nurse should assess the calcium level for the deficit and prepare to administer calcium. Low levels of potassium, thyroid hormone, and sodium do not elicit the response of tetany.
A client has been diagnosed with hypothyroidism after laboratory testing and will soon begin taking levothyroxine. What education should the nurse provide to the client? Select all that apply. Take the medication at bedtime to prevent daytime drowsiness. Avoid using antacids during treatment. Report agitation or racing heartbeat. Avoid grapefruit juice for the duration of treatment. Expect to be able to tolerate cold temperatures better.
Avoid using antacids during treatment. Report agitation or racing heartbeat. Expect to be able to tolerate cold temperatures better. Explanation: Levothyroxine will address the cold intolerance associated with hypothyroidism. Tachycardia and agitation are potential adverse effects and should be reported. Antacids reduce absorption and should be avoided. In general, levothyroxine is taken in the morning so that it does not affect sleep quality. Levothyroxine is not metabolized by CYP3A4 enzymes so there is no need to avoid grapefruit juice.
The patient is advised to increase daily intake of vitamin D. The nurse will counsel the patient that this will improve intestinal absorption of which of the following?
Calcium Explanation: Vitamin D is essential for proper absorption of calcium from the small intestine. This vitamin does not affect absorption of magnesium, sodium, or potassium.
The nurse should review which lab result before advising a client about taking the first dose of ibandronate (Boniva)?
Calcium Explanation: When bisphosphonates are administered, serum calcium levels are monitored before, during, and after therapy.
A client who is taking tetracycline has been prescribed a calcium supplement. What guidance should the nurse include in medication teaching?
Calcium should be taken at least 2 hours before or after taking tetracycline. Explanation: Oral calcium preparations decrease the effects of oral tetracycline drugs by combining with the antibiotic and preventing its absorption. The two medications should be taken at least 2 hours apart.
A nurse is preparing to administer liothyronine to a client with chronic thyroiditis. The nurse determines the drug needs to be administered cautiously after noting which disorder in the client's medical history?
Cardiac disease Explanation: 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 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 patient with hypothyroidism. The nurse would know that the effects of hypothyroidism include:
Decreased cardiac output Explanation: 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.
A nurse should recognize that a client taking antithyroid medication may be developing thyrotoxicosis if the client exhibits which of the following symptoms?
Extreme tachycardia Explanation: 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 nurse is caring for a client who is receiving levothyroxine and educates the client to what adverse effects of this medication? (Select all that apply.) Lethargy Fever Weight gain Insomnia Intolerance to heat
Fever Insomnia Intolerance to heat Explanation: Adverse effects of levothyroxine include irritability, fever, weight loss, insomnia, and intolerance to heat.
Which would a nurse expect to assess in a client experiencing hyperthyroidism?
Flushed, warm skin Explanation: Clients with hyperthyroidism typically exhibit flushed, warm skin; hyperactive deep tendon reflexes; tachycardia; and intolerance to heat.
A female client presents to the health care provider's office for a routine physical examination. The nurse assesses her current over-the-counter drug history and discovers that she takes vitamin D 600 international units daily. The nurse recognizes that the client is at risk for what condition?
Hypercalcemia Explanation: Clients diagnosed with osteoporosis require adequate calcium and vitamin D (at least the recommended dietary allowance), whether obtained from the diet or from supplements. Calcium 600 mg and vitamin D 200 international units once or twice daily are often recommended for postmenopausal women with osteoporosis, and pharmacologic doses of vitamin D are sometimes used to treat clients with serious osteoporosis. If such doses are used, caution should be exercised, because excessive amounts of vitamin D can cause
A client presents at the clinic reporting weight loss despite an increased appetite. For which condition should this client be assessed?
Hyperthyroidism Explanation: 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 patient is diagnosed with hypocalcemia. The nurse knows that which statement regarding hypocalcemia is correct?
Hypocalcemia can be accompanied by hyperphosphatemia. Explanation: Normal blood levels of calcium are 8.5 to 10.5 mg/dL. Calcium blood levels below 8.5 mg/dL are hypocalcemia. This imbalance is characterized by increased muscle tone that can progress to tetany. Phosphorus levels are increased when calcium levels fall; thus, hypocalcemia is often accompanied by hyperphosphatemia. Several malignancies, including breast cancer and multiple myeloma, enhance decalcification of bone, leading to hypercalcemia.
The nurse is caring for a 77-year-old client and understands that calcium deficiency commonly occurs in the elderly because of what factors? (Select all that apply.) Impaired absorption of calcium from the intestine Excessive exposure to ultraviolet rays Lack of exposure to sunlight Impaired liver or kidney metabolism of vitamin D Excessive intake of sodium
Impaired absorption of calcium from the intestine Lack of exposure to sunlight Impaired liver or kidney metabolism of vitamin D Explanation: Calcium deficiency commonly occurs in the elderly because of long-term dietary deficiencies of calcium and vitamin D, impaired absorption of calcium from the intestine, lack of exposure to sunlight, and impaired liver or kidney metabolism of vitamin D to its active form. It is not connected to sodium intake.
The nurse administers teriparatide (Forteo) and evaluates the drug as effective in achieving desired effects when what is assessed?
Increase in serum calcium and decrease in serum phosphorous Explanation: With once-daily administration, teriparatide stimulates new bone formation, leading to an increase in skeletal mass. It increases serum calcium and decreases serum phosphorous.
A nurse has administered levothyroxine to a client for hypothyroidism. The nurse determines the client is responding appropriately to the therapy based on which assessment finding?
Increased appetite Explanation: The nurse should assess 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. Swollen neck, sore throat, and cough may occur after 2-3 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. Increased heart rate Decreased respiratory rate Increased body temperature Increased cardiac output Decreased oxygen consumption
Increased heart rate Increased body temperature Increased cardiac output Explanation: 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.
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?
Inhibition of production of thyroid hormone Explanation: Propylthiouracil acts by inhibiting production of thyroid hormones and peripheral conversion of thyroxine (T4) to the more active triiodothyronine (T3).
Calcium preparations can be given by two different routes. Which of the following are those routes? Intravenous Oral Intradermal Subcutaneous Intramuscular
Intravenous Oral Explanation: An intravenous (IV) calcium salt (usually calcium gluconate) is given for acute, symptomatic hypocalcemia. An oral preparation (e.g., calcium carbonate, citrate) is given for asymptomatic, less severe, or chronic hypocalcemia.
A client is diagnosed with liver disease. How would this affect the metabolism of the drugs used to treat the client's hypothyroidism?
It would be prolonged. Explanation: 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.
The nurse knows that phosphates should be given only when hypercalcemia is accompanied by hypophosphatemia. Hypophosphatemia is assumed when the serum phosphorus is less than what level?
Less than 3 mg/dL Explanation: Phosphates should be given only when hypercalcemia is accompanied by hypophosphatemia (serum phosphorus less than 3 mg/dL) and renal function is normal, to minimize the risk of soft tissue calcification.
A nurse is performing patient education for a woman who has just been prescribed a bisphosphonate. Which diagnostic and history findings would have prompted the woman's care provider to prescribe a bisphosphonate?
Low bone density and a family history of osteoporosis Explanation: Bisphosphonate drugs are recommended for long-term management of hypercalcemia to increase bone resorption of calcium, in treating and preventing osteoporosis in postmenopausal women, and in managing Paget disease. Low bone density and a family history of osteoporosis would consequently indicate a potential benefit. Impaired growth, cold intolerance, and cognitive deficits are not indications for the use of bisphosphonates.
A nurse is preparing to teach a client about levothyroxine. The nurse will point out which factor(s) about this drug to the client during the teaching session? Select all that apply. Equivalent to all other thyroid hormone replacement drugs More uniform potency than other thyroid hormone replacement drugs Twice-daily dosing necessary Relatively inexpensive Less frequent laboratory monitoring required
More uniform potency than other thyroid hormone Relatively inexpensive Explanation: Levothyroxine is the drug of choice for : hypothyroidism. It is relatively inexpensive, requires once-daily dosing, and has a more uniform potency than do other thyroid hormone replacement drugs. Laboratory monitoring will remain the same for all thyroid therapies to ensure adequate response to therapy.
A client is brought to the emergency department after taking an overdose of levothyroxine. When assessing this client, what adverse effects would the nurse expect to find?
Nervousness and tachycardia Explanation: Excessive doses of levothyroxine, a thyroid drug, can cause the same signs and symptoms that occur with hyperthyroidism. These include nervousness and tachycardia.
A client with a history of cardiovascular disease, who is taking a thyroid hormone, reports chest pain. What is the nurse's best action?
Notify the health care provider. Explanation: The development of chest pain or worsening of cardiovascular disease should be reported to the primary health care provider immediately because the client may require a reduction in the dosage of the thyroid hormone.
A client admitted to the hospital with hyperthyroidism treated with propylthiouracil suddenly develops a skin rash. Which action would the nurse implement first?
Notify the primary health care provider. Explanation: Whenever a client develops a skin rash after taking propylthiouracil, the nurse must notify the primary health care provider immediately because it may be an adverse reaction. The other measures are important to protect the skin integrity: avoid soap and apply soothing cream to affected areas. Recording the weight and reporting weight gain or loss are also important.
A patient with hypothyroidism is at increased risk for respiratory depression and myxedema coma if given what category of drugs?
Opioid analgesics Explanation: 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.
The nurse is discussing the use of corticosteroids with a group of nursing students and tells that students that both men and women who take corticosteroids are at risk for what side effect?
Osteoporosis Explanation: Both men and women who take corticosteroids are at risk for osteoporosis.
When teaching a client about the prescribed levothyroxine therapy, the nurse determines that the teaching was successful when the client states that they will contact the primary health care provider if which symptom(s) occurs? Select all that apply. Constipation Palpitations Excessive diaphoresis Significant weight changes Chest pain
Palpitations Excessive diaphoresis Significant weight changes Chest pain Explanation: The client taking levothyroxine should contact the primary health care provider if any of the following occur: headache, nervousness, palpitations, diarrhea (not constipation), excessive diaphoresis, heat intolerance, chest pain, increased pulse rate, significant weight changes, or any unusual physical change or event.
After teaching a group of students about bisphosphonates, the students demonstrate understanding of the information when they identify which drug as an example?
Pamidronate Explanation: Pamidronate is an example of a bisphosphonate. Teriparatide and dihydrotachysterol are antihypocalcemic agents. Calcitonin-salmon is a calcitonin used to treat hypercalcemia.
A female client presents to the emergency department with symptoms and laboratory values indicative of hypercalcemia. What IV solutions would the health care provider order to treat the hypercalcemia?
Sodium chloride (0.9%) Explanation: Sodium chloride (0.9%) injection (normal saline) is an IV solution that contains water, sodium, and chloride. It is included here because it is the treatment of choice for hypercalcemia and is usually effective. The sodium contained in the solution inhibits the reabsorption of calcium in renal tubules and thereby increases urinary excretion of calcium.
A client is prescribed calcitonin. The nurse would teach the client to administer the drug by which route?
Subcutaneous Explanation: Calcitonin is administered subcutaneously, intramuscularly, or intranasally.
A client with thyrotoxicosis is prescribed levothyroxine. The nurse would prioritize which finding on assessment?
Tachycardia Explanation: The nurse should monitor for tachycardia, palpitations, headache, nervousness, insomnia, diarrhea, vomiting, weight loss, fatigue, sweating, and flushing as adverse reactions after administering levothyroxine to a client with thyrotoxicosis. Agranulocytosis, loss of hair, and skin rash are not the adverse reactions to levothyroxine; they are adverse reactions found in a client receiving methimazole.
One of your female patients, age 45, is prescribed calcitonin to treat high calcium levels. However, at the onset of therapy, she experiences Paget's disease bone pain. What advice can the nurse give to such a patient to help her relieve her bone pain?
Teach the patient to manage pain with nonpharmacologic methods. Explanation: A patient who is experiencing Paget's disease bone pain may be taught to manage pain by applying heat, massaging, relaxation techniques, and meditation. The patient need not be asked to stop taking the drug, and the pain is not due to cold, so the patient need not be told to cover up well. However, the patient may be advised to camouflage bone-related deformities by wearing outfits cleverly. Using nasal drops and using the pump incorrectly are not reasons for the patient's bone pain.
The nurse is caring for four clients. Which client is at the highest risk for osteoporosis?
The female client aged 76 Explanation: Postmenopausal women are at high risk for osteoporosis.
Which of the following are appropriate goals to set with your patient who is suffering from an alteration in calcium levels? Choose all that apply. The patient will achieve and maintain normal serum levels of calcium. The patient will comply with instructions for safe drug use. The patient will decrease dietary intake of calcium-containing foods to prevent or treat osteoporosis. The patient will be monitored closely for therapeutic and adverse effects of drugs used to treat hypercalcemia.
The patient will achieve and maintain normal serum levels of calcium. The patient will comply with instructions for safe drug use. The patient will be monitored closely for therapeutic and adverse effects of drugs used to treat hypercalcemia. Explanation: All are correct except the patient will want to increase dietary intake of calcium-containing foods to prevent and treat osteoporosis.
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?
The resident's apical heart rate is 112 beats/minute with a regular rhythm. Explanation: 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?
Thyroid-stimulating hormone (TSH) Explanation: 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.
Which statement reflects the relationship between calcium and phosphate?
When there is an increase in calcium, the phosphate is decreased. Explanation: An inverse relationship exists between calcium and phosphate. When serum calcium levels increase, serum phosphate levels decrease. When the serum calcium level decreases, serum phosphate levels increase. Calcium and phosphorus are learned together as they are closely related. These mineral nutrients occur in the same food, and absorbed together.
The nurse is providing education to a client who has been newly diagnosed with osteoporosis. How should the nurse describe the role of the parathyroid on the development of the disorder?
When there is too much parathyroid hormone, the bones release their calcium into the blood at a rate that is too high, resulting in bones which have too little calcium. Explanation: Osteoporosis associated with hyperparathyroidism is caused by the high parathyroid hormone that is secreted by the overactive parathyroid gland(s). This excess parathyroid hormone acts directly on the bones to remove calcium from the bones.
The nurse is providing education to a client who is taking calcium for the treatment of osteopenia. What is the rationale for the nurse suggesting that the client limit whole grains in the diet?
Whole grains are known to interfere with calcium absorption. Explanation: Clients should be taught to avoid whole grain cereals in the meal before taking calcium because they interfere with calcium absorption. The restriction is not related to serum phosphate levels, adverse effects, or the nutritional content of the grain products.
A patient is receiving calcitonin by IM injection. The nurse would expect the drug's effects to last how long?
approximately 6 to 8 hours Explanation: Calcitonin by IM injection decreases serum calcium levels in approximately 2 hours; its effects last approximately 6 to 8 hours.
The nurse is caring for a client with osteoporosis. Which electrolyte will the nurse assess to determine the action of exogenous calcitonin in this client?
calcium Explanation: Calcitonin is a hormone from the thyroid gland whose secretion is controlled by the concentration of ionized calcium in the blood flowing through the thyroid gland. When the serum level of ionized calcium increases, secretion of calcitonin increases. The function of calcitonin is to lower serum calcium in the presence of hypercalcemia, which it does by decreasing movement of calcium from bone to serum and increasing urinary excretion of calcium. The action of exogenous calcitonin is rapid, but short in duration. This hormone has little effect on long-term calcium metabolism. Sodium, magnesium, and potassium are not used to monitor the action of calcitonin.
A patient with osteoporosis has bones that become progressively porous, brittle, and especially prone to fracture. This increased susceptibility to fracture manifests most commonly as:
compression fracture of the vertebrae. Explanation: Although all bones in the affected patient are more prone to fracture, common fracture sites are the vertebrae of the lower dorsal and lumbar spines, wrists, and hips.
The client diagnosed 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?
elevated TSH, reduced T3 and T4 levels Explanation: 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.
What is the most common cause of subclinical hyperthyroidism?
excess thyroid hormone therapy Explanation: The most common cause of subclinical hyperthyroidism is 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. Common causes of primary hypothyroidism include treatment of hyperthyroidism with radiation therapy or surgery. Predisposing factors for myxedema coma include administration of central nervous system depressants. Untreated osteoporosis is not relevant to subclinical hyperthyroidism.
The community health nurse is preparing to administer a prescribed dose of levothyroxine to a client. What is the nurse's priority assessment?
heart rate and rhythm Explanation: The effects of hypothyroidism and thyroid medications are varied, due to the broad effects of thyroid hormones. However, cardiac function is among the most frequent and serious. For this reason, cardiac assessment is a priority. Hypothyroidism may cause drowsiness or decreased LOC, but this poses a lower risk to safety than cardiac issues. Blood glucose is less commonly affected and respiratory function is only affected as a consequence of cardiac dysfunction, as in cases of heart failure.
A nurse is caring for a client undergoing thyroid hormone therapy for the treatment of multinodular goiter. The client informs the nurse that they are also taking an oral hypoglycemic drug. The nurse would be alert for which possible interaction?
increased risk of hypoglycemia Explanation: The nurse should inform the client that there will be an increased risk of hypoglycemia as the effect of interaction between the thyroid hormone and hypoglycemics. The interaction between these two drugs does not decrease the effectiveness of the thyroid drug, decrease the number of white blood cells, or increase the risk of prolonged bleeding. Selective serotonin reuptake inhibitors (SSRIs) or antidepressants interact with thyroid hormones to cause decreased effectiveness of the thyroid drug. When methimazole is administered to the client, the nurse should monitor for a decrease in the number of white blood cells as an adverse reaction to the drug. When the client is administered thyroid hormones with oral anticoagulants, there will be an increased risk of prolonged bleeding.
Parathyroid hormone, vitamin D, and calcitonin all play a role in regulating serum calcium levels. When the level is low, these hormones increase it through what action?
increasing absorption in the intestines Explanation: When serum calcium is low, secretion of parathyroid hormone and activation of vitamin D increase. The hormones act to increase absorption of dietary calcium in the intestines, increase the movement of stored calcium from bone to serum, and reduce excretion of calcium through the kidneys.
When describing thyroid function, the nurse would emphasize the need for intake of:
iodine. Explanation: Iodine intake is necessary for the production of thyroid hormones.
In addition to calcium, what electrolyte affects parathyroid hormone (PTH) secretion?
magnesium Explanation: Another electrolyte—magnesium—also affects PTH secretion by mobilizing calcium and inhibiting the release of PTH when concentrations rise above or fall below normal. Sodium, potassium, and zinc do not affect PTH function
The nurse should teach clients who are taking thyroid hormones to take the medication:
on an empty stomach. Explanation: Thyroid hormones are administered once per day, early in the morning and preferably before breakfast. An empty stomach increases the absorption of the drug.
A client diagnosed with excessive parathyroid production is prone to develop:
osteopenia. Explanation: Most of the symptoms of parathyroid disease are "neurological" in origin. The most common symptoms are fatigue and tiredness. Other very common symptoms are lack of energy, memory problems, depression, problems with concentration, and problems sleeping. However, these symptoms are improved after intervention. Thus, although it may contribute to an existing diagnosis of Alzheimer's, it is not the cause. Hypertension is not commonly associated with this disorder. Excess parathyroid hormone acts directly on the bones to remove calcium from the bones. The calcium levels may cause abnormalities in heart function, but they do not cause heart disease.
What organ provides the control over the amount of calcium in the blood?
parathyroid glands Explanation: Parathyroid chief cells are cells in the parathyroid glands that produce parathyroid hormone. The end result of increased secretion by the chief cells of a parathyroid gland is an increase in the serum level of calcium. Parathyroid chief cells constitute one of the few cell types of the body that regulate intracellular calcium levels as a consequence of extracellular (or serum) changes in calcium concentration. The thyroid controls how quickly the body burns energy and makes proteins, and how sensitive the body should be to other hormones. The pituitary releases ACTH (adrenocorticotropic hormone), which in turn tells the adrenal cortex to release cortisol and aldosterone into the blood. The kidneys are complicated organs that have numerous biological roles. Their primary role is to maintain the homeostatic balance of bodily fluids by filtering and secreting metabolites (such as urea) and minerals from the blood and excreting them, along with water, as urine.
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?
persistent tachycardia Explanation: 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.
The nurse is caring for a client who takes alendronate. What laboratory result best demonstrates successful treatment?
serum calcium 2.45 mmol/L (9.8 mg/dL) Explanation: Alendronate and risedronate are commonly used drugs for osteoporosis and calcium lowering. All of the listed components are within their respective reference ranges, but calcium levels are the focus of this client's treatment
The nurse is preparing a teaching tool on the action of calcium preparations. The nurse will identify that calcium is absorbed through which body area?
small intestine Explanation: The absorption of calcium occurs in the small intestines. Approximately one third of the amount of calcium consumed is actually absorbed. Calcium is not absorbed through the mouth, the stomach, or the large intestines.
Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to:
stand or sit upright for at least 30 minutes after taking alendronate. Explanation: To decrease gastrointestinal distress, the patient should stand or sit upright for at least 30 minutes after taking the drug. Drinking at least 6 to 8 oz of water with the drug helps maximize the therapeutic effect of the drug. The patient should also take calcium and vitamin D supplements along with lifting weights to improve the success of therapy, but these interventions would not directly serve to decrease gastrointestinal distress.
A client exhibits severe tachycardia, fever, dehydration, and heart failure. The nurse recognizes that these signs are consistent with what thyroid-associated health condition?
thyroid storm Explanation: 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.
