Pharmacology Exam 3 Practice Questions

A patient has just walked into the clinic you work at and exhibits signs of brittle hair as well as hair loss. They also have a very puffy, expressionless face. Which of the following conditions would this patient be suspected of having? a. Hypothyroidism b. Grave's disease c. Cretinism d. Thyrotoxicosis

A

One month after your patient started taking levothyroxine for their hypothyroidism, a TSH test is ordered to test the function of the medication. Which of the following results would indicate that the thyroid hormone replacement is working? a. The TSH level is dropping or in normal range. b. The TSH level is elevating. c. The TSH level has remained the same. d. The TRH level is elevating.

A

What is the preferred drug of use for hyperthyroidism? a. Methimazole b. Propylthiouracil c. Levothyroxine d. Beta-blockers

A

Which of the following is NOT an adverse effect seen with benzodiazepines? a. Hypertension b. Daytime sedation b. Anterograde amnesia d. Anxiety, rage

A

Which of the following medications may need to be reduced when taking levothyroxine due to the increase of the chance of bleeding? a. Warfarin b. Omeprazole c. Cimetidine d. Questran

A

Which of these statements is the most important for a nurse to make to a patient who is taking propylthiouracil (PTU)? a. "You need to notify your doctor if you have a sore throat and fever." b. " Another medication can be given if you experience any nausea." c. " You may experience some muscle soreness with this medicine." d. " Headache and dizziness may occur but not very frequently."

A (Agranulocytosis (the absence of granulocytes to fight infection) is the most serious toxicity associated with propylthiouracil. Sore throat and fever may be the earliest signs. Nausea, muscle soreness, and headache and dizziness are other adverse effects of propylthiouracil that are not as serious as agranulocytosis.)

Which of these manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine (Synthroid)? a. Tachycardia b. Tremors c. Insomnia d. Irritability

A (High doses of levothyroxine may cause thyrotoxicosis, a condition of profound excess thyroid activity. Tachycardia is the priority assessment, because it can lead to severe cardiac dysfunction. Tremors, insomnia, and irritability are other symptoms of thyrotoxicosis and should be assessed after tachycardia.)

A patient has been given instructions about levothyroxine (Synthroid). Which of these statements, if made by the patient, would indicate that the patient understands the instructions? a. " I'll take this medication in the morning so as not to interfere with sleep." b. " I'll plan to double my dose if I gain more than 1 pound per day." c. " I'll be glad when I don't have to take this medication in a few months."

A (Levothyroxine is used to treat hypothyroidism by increasing basal metabolism and thus wakefulness. It is administered as a once-daily dose and a lifelong therapy and is best taken on an empty stomach to enhance absorption.)

Your patient's hypothyroidism is being treated with levothyroxine. What laboratory value would indicate that your patient needs a decreased dose? a. A TSH which is below the normal range. b. A TSH which is above the normal range. c. A T3 which is below the normal range. d. A T4 which is below the normal range.

A (TSH that is below the normal range indicates a decreased dose because the medication is lowering the TSH by too much.)

What is the MOA of Propylthiouracil (PTU) and methimazole?

Act by inhibiting the incorporation of iodine molecules into the amino acid tyrosine (this process converts T3 into T4) prevents the formation of thyroid hormone

When taking Iodine 131, what precautions the patient should take?

Avoid contact with others No sharing with others Increase fluid intact Flush twice

What education should the patient know before taking PTU/Methimazole?

Avoid the use of iodized salt or shellfish

A patient with thyroid cancer will most likely be prescribed which of the following medications? a. Low-dose Iodine b. High-dose Iodine c. Methimazole d. Levothyroxine

B

All thionamides have the following characteristics: a. Prevention of T4 to T3 conversion in the periphery. b. Inhibition of thyroid hormone synthesis by inhibiting peroxidase. c. Short-half lives. d. Immediate restoration of normalized thyroid hormone levels.

B

Benzodiazepines work by decreasing neuronal excitability by increasing: a. potassium influx into the cell. b. chloride influx into the cell. c. sodium influx into the cell. d. calcium influx into the cell.

B

Thyroid replacement is contraindicated in patients with what condition? a. Type II diabetes b. MI and thyrotoxicosis c. Hypothyroidism d. Pregnancy

B

What is the drug of choice to treat hypothyroidism? a. Methimazole b. Levothyroxine c. Liothyronine d. Propylthiouracil

B

What lab values are expected for a patient with Grave's disease? a. Decreased T3 and T4 b. Elevated T3 and T4 c. Elevated TSH

B

Which of the following adverse effects would you expect to see in a patient taking propylthiouracil? a. Severe kidney injury b. Agranulocytosis c. Hyperthyroidism d. Hypoglycemia

B

Which of the following antagonists is used for acute toxicity in patients taking benzodiazepines intravenously? a. Naloxone (Narcan) b. Flumazenil (Romazicon) c. Acetaminophen (Tylenol) d. Naproxin (Aleve)

B

Which of the following is NOT a principal action of thyroid hormones? a. Stimulation of energy use by increasing basal metabolism rate b. Delivers oxygen to peripheral tissues c. Stimulate the heart and increase heart rate and force of contraction d. Promotion of growth and development

B

Which of the following patient's would be most likely to have a developed tolerance for benzodiazepines? a. A patient who was given morphine once for extraction of a tooth b. A patient who has four drinks of alcohol per day and has been drinking for 20 years c. A patient who takes benzodiazepines for anti-anxiety effects d. A patient who takes Benadryl to help them sleep when they have a cold

B

You may see all of the following in an infant with congenital hypothyroidism EXCEPT: a. Mental retardation b. Exophthalmus c. Large tongue and pot belly d. Dwarfish stature and derangement of growth

B

Which of these findings, if noted in a patient who is taking levothyroxine (Synthroid) and warfarin (Coumadin), would require follow-up by a nurse? a. Cardiac dysrhythmias b. Excessive bruising c. Weight loss of 5 kg d. Shortness of breath

B (Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding, by degrading vitamin K-dependent clotting factors more quickly. The warfarin dose may need to be decreased. Bruising, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.)

You are implementing patient education for a client who has just started taking levothyroxine (Synthroid) for their hypothyroidism. Which of the following statements made by the client requires further instruction? a. "I should only use one brand and use the same one every time when taking this medication because not every brand has the identical effect." b. "This medication should only take a week for an effect to take place." c. "I should recheck my thyroid hormone levels one month after beginning levothyroxine." d. "I should take this medication 30-60 minutes before breakfast."

B (Levothyroxine takes 1 month to reach plateau)

A patient has been admitted to the emergency room with myxedema crisis, or severe life-threatening hypothyroidism, and is non-responsive. Which of the following medications would you anticipate the physician to order to treat this condition? a. Levothyroxine b. Liothyronine c. Methimazole d. Propylthiouracil

B (Liothyronine has a rapid onset of action in myxedema coma.)

A TSH test is ordered on your patient to screen for hyperthyroidism. Which of the following results would you anticipate if the patient did have this condition? a. High TSH levels b. Low TSH levels c. Normal TSH levels d. High TRH levels

B (Low TSH levels=hyperthyroidism, High=hypothyroidism)

What are a few sign affects of Iodine 131?

Bone marrow suppression GI upset Radiation sickness

All of the following indicate improvement of hyperthyroidism when taking thionamides EXCEPT: a. Decreased HR b. Weight gain c. Weight loss d. Decreased T3 and T4

C

Liothyronine is synthetic: a. TRH b. TSH c. T3 d. T4

C

Low-dose Iodine is used to: a. Treat thyroid cancer b. Treat hypothyroidism c. Destroy thyroid tissue d. Prevent Grave's disease

C

To test for a thyroid disorder, which of the following tests would MOST likely be ordered? a. Serum T3 b. Serum T4 c. TSH d. Creatinine

C

What is the interaction between catecholamines and levothyroxine? a. Levothyroxine has no effect on the bodies response to catecholamines. b. Lexothyroxine decreases the bodies response to catecholamines. c. Lexothyroxine increases the bodies response to catecholamines.

C

When educating your patient about taking levothyroxine with drugs that reduce absorption in the stomach, which of the following statements would you tell them? a. "You can take levothyroxine and proton pump inhibitors at the same time during breakfast." b. "You should wait two hours between taking levothyroxine and drugs that reduce absorption in the stomach." c. "You should wait at least four hours between taking levothyroxine and drugs that reduce absorption in the stomach." d. "Never take levothyroxine and drugs that reduce absorption in the stomach less than 24 hours apart."

C

You are teaching a patient information to know about benzodiazepines. Which of the following statements made by the patient requires further instruction? a. "I will monitor my respirations, blood pressure and pulse. If my pulse is slowing down or speeding up, I will call the physician." b. "I will not use this medication for minor stressors of everyday life, and only for acute situations." c. "I am safe to drive while under the influence of this medication." d. "I should not take this medication with, alcohol, opioids, and other central nervous system depressants as well as antihistamines." e. "I will make sure not to crush my sustained-release formulations."

C

Your patient has received low dose radioactive Iodine (131). You counsel your patient by stating that the drug: a. prevents the synthesis and release of thyroid hormone. b. completely destroys the thyroid gland. c. may cause hypothyroidism over time.

C

A patient with Graves' disease is treated with iodine-131 (Iodope) therapy. Which of these statements, if made by the patient, would indicate that the patient has the correct understanding of the treatment's effects? a. " I'll have to isolate myself from my family so I don't expose them to radiation." b. " I'm looking forward to feeling better immediately after this treatment." c. "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." d. " I'll need to take this drug on a daily basis for at least 1 year."

C (Iodine-131 is usually given as a single treatment to produce remission of Graves' disease. Fatigue, hair loss, and cold intolerance are signs of hypothyroidism, which is a complication from the treatment. Iodine-131 has a quick radioactive decay and half-life, so isolation is not needed, but it can take up to 2 months for the patient to have the desired response.)

Which of the following is the correct order steps for thyroid hormone regulation? a. The TRH is released from the hypothalamus and stimulates the release of T3 and T4 from the anterior pituitary, which stimulates TSH from the thyroid to produce biologic effects b. TSH is released from the hypothalamus and stimulates the release of TRH from the anterior pituitary which stimulates T3 and T4 from the thyroid to produce biologic effects c. TRH is released from the hypothalamus and stimulates the release of TSH from the anterior pituitary, which stimulates T3 and T4 from the thyroid to produce biologic effects d. T3 and T4 are released from the hypothalamus to stimulate the release of TRH from the anterior pituitary, which stimulates TSH from the thyroid to produce biologic effects

C (TRH from hypothalamus. TSH from anterior pituitary. T3 & T4 from thyroid inhibit TSH from anterior pituitary)

A 37-year old female patient has just been admitted to your clinic for a chief complaint of diarrhea. Your client states, "I have trouble concentrating, I feel hot and sweaty all the time, and I'm eating ALL the time but losing weight! Also, for some reason my eyes look like they're bulging out of my head." Which of the following disease's do you suspect your patient of having based on these symptoms? a. Hashimoto's disease b. Type II diabetes c. Menopause d. Grave's disease

D

A patient is admitted to the ER with a pulse of 180, temperature of 105.7, blood pressure of 78/40, and is unconscious. Upon assessment, their muscles have atrophied and the patient looks underweight. Upon reviewing their medical history, you learn that they have hyperthyroidism and just recently had a major open heart surgery. Which of the following conditions do you suspect has occurred because of their hyperthyroidism and symptoms? a. Hypoglycemia b. Drug overdose c. Congestive heart failure d. Thyrotoxic crisis

D

Levothyroxine is synthetic: a. TRH b. TSH c. T3 d. T4

D

The time it takes methimazole (Tapazole) to induce lower T4 levels to normal is: a. 3 to 6 minutes b. 24 hours c. 1 to 2 days d. 3 to 12 weeks

D

Which of the following would NOT interact with levothyroxine? a. H2 receptor blockers and proton pump inhibitors b. Bile-acid sequetrants c. Vitamins d. An empty stomach

D

Your 68-year-old patient is being treated with levothyroxine 50 mcg/day. She states that the room's thermostat is set too high. She is sweating and has a noticeable fine tremor as she lifts a glass. You suspect that she is showing signs of: a. myxedema. b. Graves' disease. c. cretinism. d. thyrotoxicosis.

D

Your patient is a 27-year-old female patient with hypothyroidism taking levothyroxine that is newly married. Which of the following statements would you say to your patient regarding pregnancy and her medication? a. "You should be careful about getting pregnant because levothyroxine is toxic to a fetus." b. "You should decrease your dosage by 50% once your pregnancy is confirmed." c. "Once your pregnancy is confirmed, increase your dosage of the medication by 50% percent." d. "Because fetuses are unable to produce thyroid hormones during the first trimester, make sure to increase your dosage by 30% as soon as your pregnancy is confirmed to reduce the risk of decreased IQ and neuropsychological function in the fetus."

D

Which of the following medications would be considered safe to take with a benzodiazepine? a. Alcohol b. Benadryl c. Morphine d. Omeprazole

D (Alcohol, benadryl, and morphine are all CNS depressants that interact with benzodiazepines. Taking these medications with benzodiazepine may lead to respiratory depression, altered LOC and coma, and possibly death. Omeprazole is a proton pump inhibitor that is not a CNS depressant and is used for issues with gastric acid.)

Which of the following may indicate a potentially dangerous, rare adverse effect of thionamides? a. Headache b. Paresthesias c. Rash d. Sore throat

D (Sore throat indicates agranulocytosis)

What are several side effects of PTU?

Decrease WBC; agranulocytosis Prone to infection Rash Hepatotoxicity Hypothyroidism

In PTU, what adverse effects can a patient experience?

Fever, Sore Throat, Mouth ulcer, skin eruptions, unusual bleeding/bruising because this could be a sign of liver/bone marrow toxicity even leukopenia

What are several sides of to much Levothyroxine?

Hyperthyroidism Anxiety GI upset Weight loss Heat intolerance Sweaty

What is cretinism?

Hypothyroidism in neonates and infants

When administering thyroid hormones what's important to know?

It's important to give every day at the same time preferably 6 am, before breakfast, on an empty stomach, and with a full glass of water.

The most common used thyroid replacement drugs are?

Levothryroxine Liotrix

Which Thyroid hormone replacement is preferred?

Levothyroxine

What is the MOA of Iodine 131?

Radioactive iodine works by destroying the thyroid gland, in a process know ablation

Which labs should you assess before, during and after Thyroid replacement therapy?

T3, T4, TSH

When taking PTU what should the patient know?

Take the medication with food to reduce GI upset

What medicatioins are DIs for Levothryroxine?

Warfarin Digoxin