Ch 42: Drug Therapy for Hyper and Hypothyroidism

T/F: Graves' disease is the most common cause of hyperthyroidism.

True: Graves' disease, a poorly understood condition that is thought to be an autoimmune problem, is the most common cause of hyperthyroidism.

kg to lb

1 kg = 2.2 lb

Elderly patients 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 (not 4)

A child has been diagnosed with congenital hypothyroidism. What term should the nurse use when providing the parents with information regarding this condition? A) cretinism B) graves' disease C) myxedema D) Hashimoto's

A) cretinism

When providing care for a client who has been admitted with clinical hypothyroidism, the nurse should implement what intervention to address? Select all that apply. A) maintain a warm room temperature B) Provide a low-calorie diet C) monitor for constipation D) constant SpO2 monitoring E) implement fall risk precautions

A) maintain a warm room temperature C) monitor for constipation E) implement fall risk precautions

An infant has diminished growth and development with a very slow pulse and below normal temperature. Based on the symptoms, what disorder is suspected? A. cretinism B. Cushing's disease C. Addison's disease D. thyroid storm

A. cretinism A child with poor growth and development along with slow pulse and subnormal temperature should be assessed for cretinism.

A physician has ordered an iodine procedure. What should be included in the nurse's pre-administration assessment for the client? Select all that apply: Weight Allergy history Temperature Pulse

ALL A physician has ordered an iodine procedure. The nurse's pre-administration assessment for the client should include vital signs (blood pressure, respiratory rate, pulse, and temperature), weight, and allergy Hx.

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? Hypertensive crisis Acute congestive heart failure Acute adrenocortical insufficiency Life-threatening arrhythmias

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

A physician has prescribed thyroid drugs to a patient with euthyroid goiter. Which of the following should the nurse include in the nursing diagnosis checklist?

Anxiety related to symptoms, adverse reactions, and treatment

A client taking methimazole develops a rash. What is the nurse's best recommendation to treat the rash? Use an antibacterial soap when bathing. Decrease drug dose. Discontinue drug. Apply a soothing cream until the rash subsides.

Apply a soothing cream until the rash subsides. Explanation:If a client experiences a rash while taking methimazole, either soothing creams or lubricants may be applied; soap is used sparingly, if at all, until the rash subsides.

What medication will be a likely component of therapy for a client admitted with a diagnosis of thyroid storm? Select all that apply. A) levothyroxine B) propranolol C) Potassium Iodide (SSKI) D) digoxin E) propylthiouracil

B) propranolol E) propylthiouracil

A patient with a diagnosis of hyperthyroidism has a blood pressure of 170/98. Which of the following medications might a physician prescribe to treat hypertension? A. propylthiouracil B. propranolol C. furosemide D. hydrochlorothiazide with triamteren

B. propranolol Propranolol is administered as an adjuvant agent for the control of blood pressure in clients with hyperthyroidism.

How does propranolol control symptoms of hyperthyroidism? A. propranolol blocks the alpha-adrenergic receptor sites. B. propranolol stimulates the thyroid gland to decrease thyroid production. C. propranolol blocks the beta-adrenergic receptors in various organs. D. propranolol lowers blood pressure to decrease metabolism.

C. propranolol blocks the beta-adrenergic receptors in various organs.

Patients taking levothyroxine (synthroid) and warfarin (coumadin) concurrently would be monitored for which adverse effect?

Increased risk for bleeding

What is an essential element for the manufacturing of thyroxine and triiodothyronine?

Iodine

T/F: Thyroid hormones can be measured as protein-bound iodine.

True

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

iodine.

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: stored in the thyroid gland. stored in the parathyroid glands. released into the bloodstream. released into the lymphatic system.

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

What question is important for the nurse to ask a client who is scheduled to receive a first dose of radioactive iodine for hyperthyroidism? "Have you discussed your cancer treatment plan with your provider?" "Do you have any trouble swallowing?"

"Do you have any trouble swallowing?" Explanation:Radioactive iodine is given orally, either as a solution or in a gelatin capsule. Since it is not given intravenously, any questions regarding needles or veins is not necessary. Ra ... (more)

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

Low calorie, high fiber Hypothyroidism slows the metabolism and decreases gastrointestinal secretions and motility. Hypothyroid clinets, therefore, should be encouraged to eat a low-calorie, high-fiber diet

The nurse educates a client newly diagnosed with a euthyroid goiter that therapy usually continues until the goiter is resolved for how long? 3-6 months 6-12 months 2 years 4-8 months

6-12 months

A health care provider has prescribed thyroid drugs to a client with euthyroid goiter. Which should the nurse include in the nursing diagnosis checklist? Disturbed thought processes related to adverse drug reactions Anxiety related to symptoms, adverse reactions, and treatment regimen Risk for infection related to adverse drug reactions Risk for impaired skin integrity related to adverse reactions

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

The 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 Symptoms that support a diagnosis of congenital hypothyroidism include subnormal temperature, low heart rate, feeding difficulties, lethargy, and constipation.

A 62 yr old woman has a reduced thyroid-stimulating hormone level of 0.07 microunit/L and a normal T3 and T4. Which of the following symptoms is she at risk for developing? A. Sinus Bradycardia B. Premature ventricular contractions C. Atrial fibrillation D. Prolong QT interval

C. Atrial fibrillation Women older than 60 years of age with a thyroid-stimulating hormone level below 0.1 mcg/L and a normal T3 andT4 are at risk for developing atrial fibrillation.

Which of the following is true in regard to the thyroid hormone replacement drug levothyroxine (Synthroid)? Select all that apply: Levothryroxine (Synthroid) has a more uniform potency than other thyroid hormone replacement drugs Levothryroxine (Synthroid) requires less frequent lab monitoring. Levothryroxine (Synthroid) is relatively inexpensive.

Levothryroxine (Synthroid) has a more uniform potency than other thyroid hormone replacement drugs Levothryroxine (Synthroid) is relatively inexpensive. Explanation: The following are true of the thyroid replacement drug levothyroxine (Synthroid): it is relatively inexpensive, requires once daily dosing, and has a more uniform potency than do o ...

A nurse completing a pre-administration assessment on a 70-year-old client prior to the administration of levothyroxine (Synthroid) may confuse which of the following symptoms of hypothyroidism with which symptoms associated with the aging process? Select all that apply: Cold intolerance Decreased visual acuity Confusion Unsteady gait Weight loss Depression

Confusion Unsteady gait Cold intolerance Depression The symptoms of hypothyroidism may be confused with symptoms associated with aging, such as depression, cold intolerance, weight gain, confusion, or unsteady gait.

The nurse is assisting a client who has just begun medication therapy for hypothyroidism. Which nursing assessment is most important in this client? Vital signs Vision changes ....

Correct response: Vital signs Explanation:Vital signs would be the most important assessment because cardiac difficulties may occur early in treatment for hypothyroidism.

A client has been admitted to the ICU with myxedema coma. What predisposing factor is considered when diagnosing myxedema coma? A) serum sodium level of 112 mEq/L B) CNS stimulant abuse C) congenital heart disease D) Core body temperature of 94 F (34 C)

D) Core body temperature of 94 F (34 C)

A nurse is preparing to administer levothyroxine to a client who is also prescribed citalopram. The nurse predicts which assessment finding may occur in this client? Prolonged bleeding Decreased effectiveness of the thyroid drug Increased risk of paresthesias Increased risk of hypoglycemia

Decreased effectiveness of the thyroid drug The nurse should monitor for a decreased effectiveness of the thyroid drug as the result of the interaction with selective serotonin reuptake inhibitors (SSRIs) such as citalopram. When the client is receiving oral anticoagulants with thyroid hormones, the client is at risk of prolonged bleeding. Increased risk of hypoglycemia occurs when oral hypoglycemics and insulin are administered with thyroid hormones to the client. The nurse should observe for paresthesias as one of the adverse reactions in a client receiving antithyroid drugs.

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 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? "Have you ever taken thyroid replacement medications in the past?" "Did your baby have hyperthyroidism in utero?" "Are you breastfeeding your child?" "How long have you had thyroid related symptom

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

A 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."

A client with hyperthyroidism resulting from Graves' disease is admitted to the unit. Which is the recommended daily fluid intake for this client? 3000-4000 mL 2000-3000 mL 1000-2000 mL 400 - 1000 mL

3000-4000 mL Explanation: Clients with hyperthyroidism, such as that caused by Graves' disease, need large amounts of fluids (3000-4000 mL/day) unless contraindicated by cardiac or renal disease.

Levothyroxine is a synthetic form of T4. What must occur to convert this T4 to T3? Thyroid-binding Deiodination

Deiodination Explanation: Much of the levothyroxine is converted to liothyronine in peripheral tissues. This conversion (i.e., removal of an iodine atom, called deiodination) occurs at several locations, in ... (more)

Which of the following is potentially the most serious adverse reaction of the antithyroid drugs methimazole (Tapazole) and propylthiouracil (PTU)?

Agranulocytosis

The nurse is caring for a client who was administered radioactive iodine (131I). Which assessment finding(s) should the nurse prioritize on the ongoing assessment? Select all that apply. Agranulocytosis Exfoliative dermatitis Hypoprothrombinemia Seizures Stroke

Agranulocytosis Exfoliative dermatitis Hypoprothrombinemia The nurse should monitor a client receiving radioactive iodine (131I) for severe reactions including agranulocytosis, exfoliative dermatitis, hypoprothrombinemia, granulocytopenia, and drug-induced hepatitis. Seizures and stroke are not recognized as a severe reaction to radioactive iodine.

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? Memory impairment Cold intolerance Constipation Altered mental status

Altered mental status A severe form of hyperthyroidism called thyrotoxicosis or thyroid storm is characterized by high fever, extreme tachycardia, and altered mental status (e.g., coma). The nurse need not observe memory impairment, cold intolerance, or constipation as characteristics of thyroid storm. Memory impairment, cold intolerance, and constipation are the manifestations of myxedema, which is a severe hypothyroidism.

A patient has been treated for ventricular dysrhythmias with amiodarone. What is the patient at risk for developing? A. Graves' disease B. thyroiditis C. thyroid storm D. cretinism

B. thyroiditis A client treated with amiodarone has the potential of developing thyroiditis.

A client with atrial fibrillation controlled on which of the following drugs must be monitored closely by the nurse for worsening atrial fibrillation if levothyroxine (Synthroid) is initiated to treat hypothyroidism? Select all that apply. Warfarin (Coumadin) Metoprolol (Toprol) Digoxin (Lanoxin)

Digoxin (Lanoxin) Metoprolol (Toprol)

A patient is undergoing sodium iodine drug therapy for the treatment of hyperthyroidism. Which of the following adverse reactions to the drug should the nurse monitor for in the patient? Agranulocytosis Bone marrow depression

Bone marrow depression The nurse should monitor for bone marrow depression, nausea, vomiting, tachycardia, itching, rash, and hives as the adverse reactions to the sodium iodine drug in the patient.

A client, diagnosed with hypothyroidism began treatment with levothyroxine several weeks ago, telephones the clinic to report missing yesterday's dose. The nurse should base his/her response on what understanding concerning the length of the half-life of this medication? A) 5-7 days B) 2-3 days C) 9-10 days D) 24-36 hours

C) 9-10 days

A physician has recommended that a patient undergo thyroid diagnostic testing. During the course of therapy, the patient experiences myxedema due to the administration of an inadequate dose. Which of the following symptoms should the nurse monitor for in the patient? High fever Cold intolerance

Cold intolerance The nurse should monitor for cold intolerance, lethargy, apathy, memory impairment, emotional changes, slow speech, deep coarse voice, thick dry skin, slow pulse, constipation ...

A nurse is preparing an ordered dose of sodium iodide (#131). The nurse should proceed knowing that this drug will help to resolve hyperthyroidism by what means? A) antagonizing T3 and T4 receptors in cells B) inducing a reduction in cellular metabolism C) suppressing pituitary release of TSH D) destroying thyroid tissue

D) destroying thyroid tissue

A patient who has taken an overdose of levothyroxine (Synthroid) is brought to the Emergency Department. In assessing this patient, what side effects would the nurse expect to find? Nervousness tachycardia tremors somnolence bradycardia paresthesia.

Nervousness tachycardia tremors Explanation:Excess thyroid hormone will produce symptoms similar to hyperthyroidism, which are nervousness, tachycardia, and tremors. It does not produce somnolence, bradycardia, or paresthesia.

A 21 year old woman is taking levothyroxine for hypothyroidism. She has recently become sexually active and would like to take an oral contraceptive. Which of the following aspects of patient teaching is most accurate? A. A low dose oral contraceptive agent is permissible with levothyroxine. B. Oral contraceptive agents increase the amount of thyroid hormone. C. For protection from pregnancy, it is necessary to use an oral contraceptive and an alternative form of birth control. D. Oral contraceptive agents results in diminished levothryroxine due to inactivation.

D. Oral contraceptive agents results in diminished levothryroxine due to inactivation. Oral contraceptives combined with levothyroxine cause estrogens to increase thyroxine-binding globulin, thereby increasing the amount of bound, inactive levothyroxine in clients with hypothyroidism

A woman taking propylthiouracil develops a sore throat and fever. What does the nurse suspect is wrong with this woman? A. She has developed a goiter. B. She has an elevated liver function. C. She has developed a hypersensitivity reaction. D. She has agranulocytosis.

D. She has agranulocytosis. A client taking propylthiouracil (PTU) who develops a sore throat and fever has also developed agranulocytosis.

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

Decreased level of consciousness Decreased respirations Decreased blood pressure Symptoms of myxedema coma include coma, hypothermia, cardiovascular collapse, hypoventilation, hypoglycemia, and lactic acidosis. NO FEVER.

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.

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, elevated T3, and reduced T4 levels Reduced TSH, elevated T3 and T4 levels Elevated TSH, reduced T3 and T4 levels Reduced TSH, T3, and T4 levels

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

The most common cause of subclinical hypothyroidism is: Untreated osteoporosis. Excess thyroid hormone therapy. Previous neck radiation. Taking central nervous system depressants.

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

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

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

T/F: More patients experience hyperthyroidism than hypothyroidism.

False Hypothyroidism is the most common type of thyroid dysfunction.

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.) Intolerance to heat Weight gain Fever Lethargy Insomnia

Fever Insomnia Intolerance to heat Explanation: Adverse effects of levothyroxine include irritability, fever, weight loss, insomnia, and intolerance to heat.

Which of the following would a nurse expect to assess in a client experiencing hyperthyroidism? Intolerance to cold Flushed, warm skin Underactive deep tendon reflexes Bradycardia

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

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

Hot, dry skin Explanation:The client with diabetes who begins thyroid replacement hormones should be monitored closely for signs of hyperglycemia: increased thirst, increased hunger, polyuria (increased uri ... (more)

What would expected findings during an assessment of a client with hyperthyroidism include? (Select all that apply.) Increased appetite Weight gain Tachycardia Puffiness in the face Goiter

Increased appetite Tachycardia Goiter Signs and symptoms of hyperthyroidism include increased metabolism with increased appetite; weight loss; tachycardia; flushed, warm skin; thinning hair; goiter.

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

A health care provider has prescribed a medication for a client who is diagnosed with euthyroid goiter. The nurse would expect to administer which drug? Levothyroxine Methimazole Propylthiouracil Sodium iodide

Levothyroxine Euthyroid goiter is treated with thyroid hormones, such as levothyroxine. Methimazole, propylthiouracil, and sodium iodide are used to treat hyperthyroidism.

You are instructing the patient on a drug that has been prescribed for hyperthyroidism. You will encourage the patient to have a complete blood count and differential monitored regularly. According to the patient instruction, what drug has been prescribed for the patient? Propylthiouracil (PTU) Methimazole (Tapazole) ketoconazole

Methimazole Explanation: Hematological adverse effects are more common with methimazole, so a complete blood count and differential should be done regularly in patients taking this drug.

Which of the following drug types is most likely to cause respiratory depression and myxedema coma in clients with thyroid disorders? Methimazole Opioid analgesics

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

When 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 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.

Thioamide antithyroid drugs treat hyperthyroidism by inhibiting the synthesis of thyroid hormone. What is the prototype of the thioamide anti-thyroid drugs?

Propylthiouracil Propylthiouracil is the prototype of the thioamide antithyroid drugs. Although propranolol is used to treat some symptoms of hyperthyroidism, it is an antiadrenergic, not an antith ... (more)

A client who is receiving warfarin has been prescribed medication for a thyroid issue. The nurse will monitor for potential signs of bleeding if which drug(s) is initiated? Select all that apply. Propylthiouracil Desiccated thyroid Sodium iodine Methimazole Liothyronine

Propylthiouracil Desiccated thyroid Methimazole Liothyronine All of the thyroid hormone replacements such as levothyroxine, liothyronine, liotrix, and desiccated thyroid and antithyroid preparations such as methimazole and propylthiouracil can increase the risk for bleeding when clients are also administered warfarin.

A nurse is providing care for a client diagnosed with thyroid cancer. Which drug would the nurse anticipate being prescribed for the client? Iodine 131 Methimazole Propylthiouracil Liothyronine

Radioactive iodine (13I) is used for the treatment of hyperthyroidism and cancer of the thyroid. Methimazole and propylthiouracil are used to manage hyperthyroidism. Liothyronine is used to treat hypothyroidism.

After 48 hours of thyroid hormone replacement therapy, a client reports still having no appetite. Which is the nurse's best action? Document the client's report and suggest increasing the dose of medication. Reassure the client that more time is needed to see results.

Reassure the client that more time is needed to see results. Explanation: The full effects of thyroid hormone replacement therapy may not be apparent for several weeks or more, but early effects may be apparent in as little as 48 hours.

A client diagnosed with hyperthyroidism has been prescribed propylthiouracil. After administering the drug, which assessment finding should the nurse prioritize? Skin rash Tachycardia Nervousness Constipation

Skin rash The adverse reactions to propylthiouracil include paresthesias, numbness, headache, skin rash, nausea, vomiting, and agranulocytosis. Tachycardia, nervousness, and vomiting are the adverse reactions associated with the thyroid hormone levothyroxine sodium (T4).

A nurse is caring for a patient undergoing thyroid hormone replacement therapy. What should the nurse inform this patient regarding administration of the drug? Take the drug before bedtime. Take the drug just before dinner. Take the drug after lunch. Take the drug before breakfast.

Take the drug before breakfast. The nurse should inform the patient undergoing thyroid hormone replacement therapy to take the drug in the morning, preferably before breakfast on empty stomach to increase absorption. The nurse should not ask the patient to take the drug before bedtime, just before dinner, or after lunch as that is not generally recommended by the health care provider.

A client asks the nurse if she's taking a standard dose of thyroid hormone medication. What is the nurse's best response? Dosing is based solely on TSH levels. The dose is based on your relief of symptoms from hypothyroidism. Treatment is titrated incrementally by a standard dosing algorithm. Your dose has been adjusted according to your weight.

The dose is based on your relief of symptoms from hypothyroidism. Treatment of hypothyroidism is based on individualized doses of the hormone to treat symptoms, not by weight or a standard dosing algorithm. TSH levels are used to assist the prescriber is adjusting individual doses, but it is not the sole determinant.

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

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

The nurse is discussing medication therapy with a family whose infant was born with congenital hypothyroidism and informs them that drug therapy will continue for life to prevent what condition? To prevent cardiac arrhythmias To prevent seizure disorder To prevent chronic hypotension To prevent intellectual disability

To prevent intellectual disability For congenital hypothyroidism (cretinism), drug therapy should be started within 6 weeks of birth and continued for life, or intellectual disability may result.

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

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

After starting a patient with Grave's disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every: a. 1 to 2 weeks b. 3 to 4 weeks c. 2 to 3 months d. 6 to 9 months

b. 3 to 4 weeks

When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in: a. 2 weeks b. 4 weeks c. 2 months d. 6 months

b. 4 weeks

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

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

A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with: a. Methimazole b. Propylthiouracil (PTU) c. radioactive iodine d. nothing, treatment is best delayed until after her pregnancy ends

b. Propylthiouracil (PTU)

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

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

What is the desired mix of T3 to T4 drug levels in newly diagnosed endocrine patients? a. 99% of T3 and the rest is T4 to get rapid resolution. b. most needs to be T4 to mimic natural ratios of hormone. c. the ratio is unimportant. d. the mix needs to be 50-50 at first.

b. most needs to be T4 to mimic natural ratios of hormone.

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

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

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

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

When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include: a. they should feel symptomatic improvement in 1 to 2 weeks. b. drug adverse effects such as lethargy and dry skin may occur. c. it may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory testing. d. because of its short half-life, levothyroxine doses should not be missed.

c. it may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory testing.

What happens to the typical hormone replacement dose when a woman becomes pregnant? a. most women need less medication. b. most women do not require a dose change. c. the average woman needs more medication during pregnancy. d. the average woman needs more medication only if carrying multiples. e. it becomes contraindicated

c. the average woman needs more medication during pregnancy.

In hyperthyroid states, what organ system other than CV must be evaluated to establish potential adverse issues? a. the liver b. the nails and skin c. the eye d. the ear

c. the eye

Laboratory values are actually different for TSH when screening for thyroid issues and when used for medication management. Which of the follow holds true? a. screening TSH has a wider range of normal values 0.02-5.0; therapeutic levels need to remain above 5.0. b. screening values are much narrower than the acceptable range used to keep a person stable on hormone replacement. c. therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10. d. screening values are between 5 and 10, and therapeutic values are greater than 10.

c. therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10.

Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored with TSH and free T4 levels every: a. 2 weeks b. 4 weeks c. 2 months d. 6 months

d. 6 months

When methimazole is started for hyperthyroidism it may take ________ to see a total reversal of hyperthyroid symptoms. a. 2 to 4 weeks b. 1 to 2 months c. 3 to 4 months d. 6 to 12 months

d. 6 to 12 months

A female client's diagnoses include hyperthyroidism, congestive heart failure, and type 2 diabetes mellitus. What effect will the treatment of hyperthyroidism have on her routine medications for CHF and DM? (note metabolism refers to met. of the Rx) a. Metabolism will be slower than normal, and the dose will be increased. b. Metabolism will be slower than normal, and the dose will be decreased. c. Metabolism will be faster than normal, and the dose will be decreased. d. Metabolism will be faster than normal, and the dose will be increased.

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

Goals when treating hypothyroidism with thyroid replacement include: a. normal TSH and free T4 levels b. resolution of fatigue c. weight loss to baseline d. all of the above

d. all of the above

Why are "natural" thyroid products not readily prescribed for most patients? a. there is no reliability for the amount of hormone per dose. b. there is higher incidence of allergic reactions. c. there is a more reliable dose of T3 to T4 per batch. d. all of the above

d. all of the above

A client diagnosed with TSH suppression has been prescribed levothyroxine sodium (T4). The nurse caring for the client should monitor for which adverse reaction to levothyroxine sodium (T4)? exfoliative dermatitis granulocytopenia hypoprothrombinemia diarrhea

diarrhea The nurse should monitor for diarrhea, vomiting, palpitations, tachycardia, headache, nervousness, insomnia, weight loss, fatigue, sweating, and flushing as adverse reactions to levothyroxine sodium (T4). Exfoliative dermatitis, granulocytopenia, and hypoprothrombinemia are the system reactions to antithyroid drugs such as methimazole and propylthiouracil.

What is the most common cause of subclinical hyperthyroidism? untreated osteoporosis history of neck radiation excess thyroid hormone therapy central nervous system depressant therapy

excess thyroid hormone therapy 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 respiratory rate and rhythm level of consciousness blood glucose

heart rate and rhythm 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 decreased effectiveness of the thyroid drug decreased number of white blood cells increased risk of prolonged bleeding

increased risk of hypoglycemia 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.

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 propylthiouracil methimazole liotrix

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

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 cataract surgery seizure hypoglycemic episode

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

The nurse is caring for an older adult client with hypothyroidism whose comorbidities include osteoporosis and hepatitis. When administering the client's medications, the nurse should assess for which potential adverse effect? increased risk for falls after taking levothyroxine prolonged effect of levothyroxine decreased bone density thyroid storm (thyrotoxic crisis)

prolonged effect of levothyroxine Hepatitis is associated with decreased hepatic function, which may slow the metabolism of levothyroxine. In turn, this could lead to a prolonged effect of the medication. Decreased bone density is characteristic of osteoporosis, but this is not exacerbated by levothyroxine. Levothyroxine is unlikely to cause falls because it tends to increase, not decrease, blood pressure, and does not impair cognition. Thyroid storm is associated with untreated hyperthyroidism, not the effects of taking levothyroxine as prescribed.

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

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

The home care nurse may be involved in a wide range of activities when caring for the client with hyperthyroidism or hypothyroidism. What would be included in the client's plan of care? (Select all that apply.) • Provide information for rapid weight loss • Modifying medication dosages based on symptomatology • Assessing the client's response to therapy • Teaching about the disease process • Preventing and managing adverse drug effects

• Assessing the client's response to therapy • Teaching about the disease process • Preventing and managing adverse Explanation: The home care nurse may be involved in a wide range of activities, including assessing the client's response to therapy, teaching about the disease process, managing of ... (more)

The nurse is assessing a patient receiving strong iodide solution. Which of the following would alert the nurse to the possible development of iodism? • Constipation • Metallic taste • Salivary gland swelling • Throat burning • Sore teeth

• Metallic taste • Throat burning • Sore teeth Signs of iodism include a metallic taste, burning mouth and throat, sore teeth and gums, head cold symptoms, stomach upset, and diarrhea.