Pharm201 CH44

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?

"Are you breastfeeding your child?"

What question is important for the nurse to ask a client who is scheduled to receive a first dose of radioactive iodine for hyperthyroidism?

"Do you have any trouble swallowing?"

The nurse is caring for a 55-year-old client with Hashimoto's thyroiditis. During discharge teaching, which statement by the client tells the nurse the client understands the teaching?

"I should take this medication on an empty stomach in the morning."

Which statement indicates a client understands the management of care after a thyroidectomy?

"I will have to take thyroid hormones for the rest of my life."

An older adult client has been using levothyroxine for several years on an outclient basis. Which client statement should the nurse attribute to the decreased effect of levothyroxine?

"I've been using a lot of antacids lately because of my indigestion."

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."

A female client with hyperthyroidism reports nervousness and "racing" heart one week after starting antithyroid medication. How should the nurse respond to the client's report?

"It may take three to four weeks for the effects of this medication to be seen."

The nurse is caring for a 57-year-old woman who is requesting a thyroid supplement to help lose weight through increased metabolism. What is the nurse's best response?

"The body compensates for the extra hormone by reducing its own production."

A pregnant client asks about the safety of taking thyroid hormone replacement drugs during her pregnancy. What is the nurse's best response?

"Thyroid hormones are pregnancy category A drugs and should be taken during pregnancy."

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

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

Elderly 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

A client is diagnosed with a simple goiter. The client asks the nurse what causes a goiter to occur. What would be the nurse's best response?

A goiter is the result of too much TSH.

Which finding is most characteristic of Paget's disease?

Abnormal bone remodeling

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?

Administer the drug early in the morning before breakfast.

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?

Agranulocytosis

The nurse should assess for an enlarged thyroid by palpating which area?

Anterior neck

A client taking methimazole develops a rash. What is the nurse's best recommendation to treat the rash?

Apply a soothing cream until the rash subsides.

The nurse knows that which assessment finding suggests hyperthyroidism?

Blood pressure 145/87

The treatment protocol for a client with hyperthyroidism includes antithyroid medication and propranolol. The purpose of propranolol is to do which of the following?

Decrease tachycardia

The nurse is caring for a client newly diagnosed with hypothyroidism. The client also takes theophylline to control asthma symptoms. What change may need to be made to the client's theophylline dose?

Decrease theophylline dosage immediately.

What would the nurse expect to assess if a client was receiving too much methimazole?

Decreased appetite

The nurse is caring for an older adult who will be beginning thyroid hormone replacement therapy. The nurse should be alert to which signs and symptoms of hypothyroidism that may be confused with other conditions associated with aging? (Select all that apply.)

Depression Unsteady gait Weight gain Confusion

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?

Elevated TSH, reduced T3 and T4 levels

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

After a client takes a radioactive iodine preparation, the nurse should teach the client to do which of the following? Select all that apply.

Flush twice after using the toilet facilities. Wash eating utensils and laundry separately. Avoid contact with pregnant women for two to four days. Remain in separate area of the house as much as possible.

A client presents at the clinic reporting weight loss despite an increased appetite. For which condition should this client be assessed?

Hyperthyroidism

A client prescribed levothyroxine asks the nurse to explain when the medication should be taken. Which would the nurse include in the response?

In tie morning on an empty stomach

What would expected findings during an assessment of a client with hyperthyroidism include? (Select all that apply.)

Increased appetite Tachycardia Goiter

A client with diabetes has started thyroid hormone replacement therapy. The nurse should monitor closely for which effects?

Increased thirst

The nurse is caring for a client who just received radioactive iodine. What should the nurse assess first when receiving the client into care after the procedure?

Infection

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

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?

It will block stimulation of the sympathetic nervous system.

While studying thyroid replacement therapy in pharmacology class, the nursing students learn that hypothyroidism is treated with what drug?

Levothyroxine

A group of students are reviewing information about thyroid and parathyroid hormones. The students demonstrate understanding of the information when they identify what as being stored in the follicular cells of the thyroid? (Select all that apply.)

Levothyroxine Liothyronine

A child is diagnosed with hypothyroidism. The nurse knows that the drug of choice for this child will most likely be:

Levothyroxine (Synthroid)

An older adult has been prescribed a thyroid hormone replacement medication. The nurse should first clarify which prescription?

Levothyroxine (Synthroid) 150 mcg orally once per day

A client has a history of atrial fibrillation and is taking an oral anticoagulant. The client has been newly diagnosed with hypothyroidism and placed on levothyroxine (Synthroid). What assessment should the nurse prioritize?

Monitoring the client for increased bruising

A 32-year-old client who has been prescribed levothyroxine is being discharged. Which symptom should the nurse instruct this client to report to the health care provider?

Nervousness

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

A client who has taken an overdose of levothyroxine (Synthroid) is brought to the Emergency Department. In assessing this client, what side effect would the nurse expect to find?

Nervousness, tachycardia, tremors

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.

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.

The client is 8 weeks pregnant and requires an antithyroid medication. The nurse identifies what drug as the drug of choice for this client?

Propylthiouracil

The nurse has admitted an elderly client in thyroid crisis to the unit. Since surgery is not an option, the client requires an antithyroid drug. What would be the best choice of drug for this client?

Radioactive iodine (Generic)

A 25-year-old female client is diagnosed with hypothyroidism. The client is prescribed levothyroxine. Which instruction about the administration of this medication would be important?

She should take the medication in the morning before breakfast.

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?

TSH

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?

Tachycardia

The nurse should monitor a client for which effect of a drug interaction in a client taking thyroid hormones and a beta blocker?

Tachycardia

A client diagnosed with hypothyroidism is started on levothyroxine. What should the client be taught regarding medication administration in the home setting?

Take the medication on an empty stomach.

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?

Taking excessive or unnecessary thyroid medication may produce serious or life-threatening manifestations of toxicity.

What client will the nurse assess most closely for secondary hyperparathyroidism?

The 68-year-old client with chronic renal failure

A client is seen in the clinic and diagnosed with hyperthyroidism. Before administering the prescribed potassium iodide, the nurse reviews the client's health record. What finding would cause the nurse to alter the plan of care?

The client takes digoxin 0.125 mg daily.

A client asks the nurse if she's taking a standard dose of thyroid hormone medication. What is the nurse's best response?

The dose is based on your relief of symptoms from hypothyroidism.

Which hormone regulates the production and release of thyroid hormone?

Thyroid-stimulating hormone (TSH)

The pharmacology instructor is talking about the drug propylthiouracil (PTU). What would the instructor cite as the primary mode of action for propylthiouracil (PTU)?

To inhibit production of thyroid hormone

A 23-year-old client is prescribed a thyroid-hormone antagonistic drug. Which should a nurse determine during an ongoing assessment and evaluation of the drug therapy?

Whether the client has become intolerant to cold

The nurse assesses a client closely for which serious adverse reaction associated with methimazole and propylthiouracil?

agranulocytosis

A clent 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:

agranulocytosis.

Following the completion of diagnostic testing, an adult client has received a diagnosis of hyperthyroidism. What nursing diagnosis should the nurse prioritize in this client's care?

anxiety related to hyperthyroidism

A client is undergoing sodium iodine drug therapy for the treatment of hyperthyroidism. Which adverse reactions to the drug should the nurse monitor for in the client?

bone marrow depression

An increase in what specific physiological effect is an expected outcome of thyroid hormone therapy? Select all that apply.

carbohydrate metabolism cellular metabolism oxygen consumption cardiac output

Levothyroxine is classified in which pregnancy category?

category A

A group of nursing students demonstrate understanding about the antithyroid drugs methimazole and propylthiouracil when they identify these drugs as belonging to which pregnancy category?

category D

A client has been diagnosed with hypothyroidism and admits to the nurse that she has heard of her thyroid gland but does not know the function of thyroid hormone. The nurse should explain the fact that thyroid hormone is responsible for which action?

controlling the rate of cell metabolism throughout the body

A nurse is preparing an ordered dose of sodium iodide 131I. The nurse should proceed knowing that this drug will help to resolve hyperthyroidism by what means?

destroying thyroid tissue

A nurse must be aware that thyroid hormone can worsen control of which disease or condition necessitating close client observation?

diabetes

Which condition will warrant the tapering or possible discontinuation of propranolol?

euthyroid state

What is the most common cause of subclinical hyperthyroidism?

excess thyroid hormone therapy

While the nurse is talking with a client, the client informs the nurse that the client has been under treatment for weight loss management. The client indicates taking antithyroid medication to increase weight loss. Included in client education about antithyroid medication is that taking:

excessive or unnecessary antithyroid medication may produce serious or life-threatening manifestations of toxicity.

What assessment should the nurse perform prior to administration of a scheduled dose of levothyroxine?

heart rate

What assessment findings would suggest to the nurse that a client may be experiencing an adverse effect to levothyroxine?

hyperactivity and insomnia

What is a common cause of primary hypothyroidism? Select all that apply.

hyperthyroidism medication therapy Hashimoto's thyroiditis radiation to the neck

A client presents at the clinic with weight loss despite an increased appetite. The nurse knows this client should be assessed for:

hyperthyroidism.

A nurse is caring for a client undergoing thyroid hormone therapy for the treatment of multinodular goiter. The client informs the nurse that he is also taking an oral hypoglycemic drug. The nurse would be alert for which possible interaction?

increased risk of hypoglycemia

What information should the nurse provide a client newly prescribed propylthiouracil about its primary mode of action?

inhibits production of thyroid hormone

A newborn is diagnosed with hypothyroidism. What will the client likely develop if the condition is left untreated?

intellectual disability

With regard to the functioning of the thyroid gland, which is an essential element for the manufacturing of thyroxine and triiodothyronine?

iodine

When describing thyroid function, the nurse would emphasize the need for intake of:

iodine.

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?

levothyroxine

A nurse is preparing to administer a scheduled dose of levothyroxine to an elderly client who is being treated in the hospital for a respiratory infection. Prior to administering the drug, the nurse should perform what assessment?

measurement of blood pressure

When providing care for a client who has been admitted with clinical hypothyroidism, the nurse should implement what intervention to address common characteristics of the disorder? Select all that apply.

monitor for constipation implement falls risk precautions maintain a warm room temperature

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?

myocardial infarction

A client, diagnosed with hypothyroidism, is currently taking an opioid for knee pain. This client is at increased risk for developing which adverse reaction?

myxedema coma

The nurse should teach clients who are taking thyroid hormones to take the medication:

on an empty stomach.

What drug type is most likely to cause respiratory depression and myxedema coma in clients with thyroid disorders?

opioid analgesics

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

What medication will be a likely component of therapy for a client admitted with a diagnosis of thyroid storm? Select all that apply.

propranolol

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:

released into the bloodstream.

Prior to administering propylthiouracil, the nurse has reviewed the relevant black box warning and should teach the client about the need for what form of follow-up?

routine liver function testing

What expectorant is sometimes prescribed for the treatment of hyperthyroidism?

saturated solution of potassium iodide

A client, diagnosed with hyperthyroidism, is scheduled to receive a medication to destroy the thyroid gland. Which medication will be administered?

sodium iodide131I

Symptoms such as severe tachycardia, fever, dehydration, heart failure, and coma are consistent with what thyroid-associated health condition?

thyroid storm

An older adult client is diagnosed with hypothyroidism, and before therapy starts, the nurse conducts a preadministration assessment. Which symptoms should be thoroughly evaluated and documented in the preadministration assessment and periodically throughout therapy by the nurse?

unsteady gait

The nurse should advise a client who is taking levothyroxine for the first time that resolution of hypothyroid symptoms may not occur for how long after therapy is started?

weeks