Pharm Endocrine - Thyroid (ch 31)

levothyroxine adverse effects: neurological (5)

-anxiety -irritability -tremors -insomnia -headache

antithyroid drug adverse effects: CNS (4)

-headache -drowsiness -vertigo -paresthesia

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? (Select all that apply) 1. administer methimazole with food 2. place the client on a low-calorie, low-protein diet 3. assess the client for unexplained bruising and bleeding 4. instruct the client to report side and adverse effects such as sore throat, fever, or headaches 5. use special radioactive precautions when handling the client's urine for the first 24 hrs after administration

1. administer methimazole with food 3. assess the client for unexplained bruising and bleeding 4. instruct the client to report side and adverse effects such as sore throat, fever, or headaches -common side effects include nausea, vomiting, and diarrhea, so the medication should be taken with food -sore throat, fever, headache, or bleeding may indicate agranulocytosis NCLEX

The nurse should tell the client, who is taking levothyroxine, to notify the health care provider (HCP) if which problem occurs? 1. fatigue 2. tremors 3. cold intolerance 4. excessively dry skin

2. tremors (excessive doses of levothyroxine can produce symptoms of hyperthyroidism - these include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, sweating) NCLEX

thyroid storm, symptoms (5)

exacerbation of the symptoms of hyperthyroidism, important to teach a pt who is on antithyroid medication to monitor for symptoms: -fever -flushed skin -confusion -tachycardia -dysrhythmias

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Hypothyroidism is diagnosed, and levothyroxine is prescribed. What is an expected outcome of the medication? 1. alleviate depression 2. increase energy levels 3. increase blood glucose levels 4. achieve normal thyroid hormone levels

4. achieve normal thyroid hormone levels (Although energy levels may increase and the client's mood may improve following effective treatment, these are not noted until normal thyroid hormone levels are achieved. An increase in the blood glucose is not associated with this condition.) NCLEX

The nurse is reviewing the adverse effects of antithyroid medications for a patient prescribed propylthiouracil (PTU). What potential serious adverse effects should the nurse discuss with the patient during discharge teaching? (Select all that apply.) a. Joint pain b. Liver toxicity c. Kidney damage d. Increased urination e. Bone marrow toxicity

a. Joint pain b. Liver toxicity e. Bone marrow toxicity (The most damaging or serious adverse effects of the antithyroid medications are liver and bone marrow toxicity. Myalgias and arthralgias (joint pain) may also occur with PTU.) Pharm

A nurse is caring for a client who is taking propylthiouracil. For which of the following adverse effects of this medication should the nurse monitor? a. bradycardia b. insomnia c. heat intolerance d. weight loss

a. bradycardia (symptom of hypothyroidism, indicates overmedication) ATI

When teaching a pt who has a new prescription for thyroid hormone, the nurse will instruct the pt to notify the prescriber if which adverse effects are noted? (Select all that apply) a. palpitations b. weight gain c. angina d. fatigue e. cold intolerance

a. palpitations c. angina (levothyroxine is associated with cardiac dysrhythmias) Pharm

levothyroxine

hormone replacement - hypothyroidism

antithyroid drug interactions

oral anticoagulants (warfarin) (antithyroid drugs enhance the effects of warfarin)

levothyroxine drug interactions

oral anticoagulants (warfarin) (levothyroxine enhances the effects of warfarin)

antithyroid drug contraindications (1)

pregnancy category D (PTU during the first trimester only, methimazole for the remainder of the pregnancy)

symptoms of hypothyroidism (7)

-drowsiness, fatigue -depression -weight gain -anorexia -edema -bradycardia -cold intolerance (overmedication of antithyroid drugs can cause hypothyroidism)

symptoms of leukopenia (4)

-fever -sore throat -lesions (mouth ulcers/sores, skin eruptions) -unusual bleeding or bruising

levothyroxine adverse effects: other (3)

-heat intolerance -sweating -fever

labs to monitor for a pt taking antithyroid drugs (2)

-liver function tests (liver toxicity) -CBC counts (leukopenia, agranulocytosis, thrombocytopenia)

antithyroid drug adverse effects: musculoskeletal (1)

-myalgia/arthralgia (joint pain)

levothyroxine adverse effects: GI (5)

-nausea -diarrhea -cramps -menstrual irregularities -weight loss

antithyroid drug adverse effects: GI (3)

-nausea -vomiting -diarrhea

levothyroxine contraindications (2)

-recent MI -adrenal insufficiency

levothyroxine adverse effects: cardiovascular (5)

-tachycardia -palpitations -angina -dysrhythmias -hypertension

pt teaching: taking levothyroxine (4)

-take at the same time each day (to maintain constant blood levels) -take in the morning (to avoid sleeplessness) -take without food/before breakfast (to enhance absorption) -it must not be stopped abruptly

pt teaching: taking antithyroid drugs (3)

-take with food (to minimize GI upset) -take at the same time each day (to maintain constant blood levels) -they must not be stopped abruptly (can cause thyroid storm)

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? (Select all that apply) 1. insomnia 2. weight loss 3. bradycardia 4. constipation 5. mild heat intolerance

1. insomnia 2. weight loss 5. mild heat intolerance NCLEX

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care should the nurse review with the client's health care provider? 1. a decreased dosage of levothyroxine 2. an increased dosage of levothyroxine 3. a decreased dosage of warfarin sodium 4. an increased dosage of warfarin sodium

3. a decreased dosage of warfarin sodium (levothyroxine enhances the effects of warfarin) NCLEX

The nurse provides instructions for a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? 1. with food 2. at lunchtime 3. on an empty stomach 4. at bedtime with a snack

3. on an empty stomach (should be taken on an empty stomach to enhance absorption and in the morning before breakfast) NCELX

Which information needs to be included in the nurse's teaching of pts taking thyroid medicatons? (Select all that apply) a. keep a log or journal of individual responses and a graph of pulse rate, weight, and mood would be helpful b. the medication will be discontinued if the adverse effects become too strong c. the medication needs to be taken at the same time every day d. nervousness, irritability, and insomnia may be a result of a dosage that is too high e. take thyroid replacement drugs after meals

a. keep a log or journal of individual responses and a graph of pulse rate, weight, and mood would be helpful c. the medication needs to be taken at the same time every day d. nervousness, irritability, and insomnia may be a result of a dosage that is too high Pharm workbook

The nurse knows what which laboratory tests are used to monitor thyroid hormone replacement therapy? (Select all that apply) a. serum TSH b. BUN c. CBC d. free thyroid hormone levels e. serum iodine levels

a. serum TSH d. free thyroid hormone levels Pharm

Pt teaching for antithyroid medication will include the need to avoid which foods? a. soy products and seafood b. bananas and oranges c. dairy products d. processed meats and cheese

a. soy products and seafood (avoid foods high in iodine) Pharm

methimazole

antithyroid drug - hyperthyroidism

propylthiouracil

antithyroid drug - hyperthyroidism

why monitor liver function?

antithyroid drugs can cause liver toxicity (increased BUN and creatinine)

why monitor CBC counts? (2)

antithyroid drugs can cause: -leukopenia/agranulocytosis (decreased WBC) -thrombocytopenia (decreased platelet count)

pt teaching: antithyroid drugs, dietary teaching

avoid foods high in iodine (iodized salt, soy products, high-iodine seafood, some breads)

A patient receiving propylthiouracil (PTU) asks the nurse, "How does this medication relieve symptoms?" What is the nurse's best response? a. "PTU helps your thyroid gland synthesize and use iodine, which produces hormones better." b. "PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal." c. "PTU causes the pituitary gland to secrete thyroid-stimulating hormone, which blocks the production of hormones by the thyroid gland." d. "PTU removes thyroid hormones that are already circulating in your bloodstream, thus decreasing the adverse effects of this medication."

b. "PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal." Pharm

The nurse has been providing education regarding thyroid hormone replacement therapy. Which statement by the pt reflects a need for further teaching? a. "I will take this pill in the morning." b. "Sometimes this medicine can make my heart skip beats, but that's a normal side effect." c. "I need to take this pill on an empty stomach and wait about 30-60 min before eating." d. "I will be sure to go to the clinic and have my thyroid levels tested regularly."

b. "Sometimes this medicine can make my heart skip beats, but that's a normal side effect." (medication can cause dysrhythmias, must contact provider immediately) Pharm workbook

For a patient taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently, the nurse would closely monitor for which possible serious adverse effect? a. Acute confusion b. Increased bruising c. Cardiac dysrhythmias d. Orthostatic hypotension

b. Increased bruising (levothyroxine enhances the effects of warfarin, bruising can indicate bleeding) Pharm

The nurse would suspect a patient is taking too much levothyroxine (Synthroid) when the patient exhibits which adverse effect? a. Lethargy b. Irritability c. Feeling cold d. Weight gain

b. Irritability Pharm

When assessing for potential serious adverse effects to propylthiouracil (PTU), the nurse will monitor which laboratory test? a. Kidney function b. Serum electrolytes c. Complete blood count (CBC) d. Brain natriuretic peptide

c. Complete blood count (CBC) (With antithyroid medications, the nurse should monitor for possible serious adverse reactions such as agranulocytosis, leukopenia, and thrombocytopenia. An abnormal CBC result would indicate bone marrow dysfunction.) Pharm

When monitoring laboratory values for a pt who is taking antithyroid drugs, the nurse knows to watch for: a. increased platelet counts b. increased white blood cell counts c. increased blood urea nitrogen d. increased blood glucose levels

c. increased blood urea nitrogen -can cause liver toxicity -can cause thrombocytopenia, not increased platelet counts -can cause leukopenia, not increased WBC count Pharm

A nurse is reviewing laboratory values for a pt who reports fatigue and cold intolerance. Pt has increased thyroid stimulating hormone (TSH) and decreased total T3 and T4 level. The nurse should anticipate a prescription for which of the following medications? a. methimazole b. somatropin c. levothyroxine d. propylthiouracil

c. levothyroxine (symptoms of hypothyroidism) ATI

To help with the insomnia associated with thyroid hormone replacement therapy, the nurse will teach the pt to: a. take half the dose at lunchtime and the other half 2 hrs later b. use a sedative to assist with falling asleep c. take the dose upon awakening in the morning d. reduce the dosage as needed if sleep is impaired

c. take the dose upon awakening in the morning Pharm

A pt who is beginning therapy with levothyroxine (Synthyroid) asks the nurse when the medication will start working. What is the nurse's best answer? a. immediately b. within a few days c. within a few weeks d. within a few months

c. within a few weeks Pharm workbook

Which statement by the patient indicates an understanding of discharge instructions given by the nurse about the newly prescribed medication levothyroxine (Synthroid)? a. "I will take a double dose to make up for the missed one." b. "I can expect improvement of my symptoms within 1 week." c. "I will stop the medication immediately if I feel pain or weakness in my muscles." d. "I will take this medication in the morning so it does not affect my sleep at night."

d. "I will take this medication in the morning so it does not affect my sleep at night." Pharm

The pharmacy has called a pt to notify her that the current brand of thyroid replacement hormone is on back order. The pt calls the clinic to ask what to do. Which is the best response by the nurse? a. "Go ahead and take the other brand that the pharmacy has available for now." b. "You can stop the medication until your current brand is available." c. "You can split the thyroid pills that you have left so that they will last longer." d. "Let me ask your prescriber what needs to be done; we will need to watch how you do if you switch brands."

d. "Let me ask your prescriber what needs to be done; we will need to watch how you do if you switch brands." (brands of thyroid replacement drugs aren't interchangeable) Pharm

The nurse is teaching a patient taking an antithyroid medication to avoid food items high in iodine. Which food item should the nurse instruct the patient to avoid? a. Milk b. Eggs c. Chicken d. Seafood

d. Seafood (pts taking antithyroid medication shouldn't eat foods with iodine) Pharm

A nurse is caring for an older adult client in a long-term care facility who has hypothyroidism and a new prescription for levothyroxine. Which of the following dosage schedules should the nurse expect for this client? a. the client will start at a high dose, and the dose will be tapered down as needed b. the client will remain on the initial dosage during the course of treatment c. the client's dosage will be adjusted daily based on blood levels d. the client will start on a low dose, which will be gradually increased

d. the client will start on a low dose, which will be gradually increased (to prevent toxicity in older pts) ATI