ch 37: thyroid/parathyroid
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?" "Does anyone ever have trouble finding your veins?" "Are you afraid of needles?"
"Do you have any trouble swallowing?" 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. Radioactive iodine is given for the treatment of hyperthyroidism or cancer of the thyroid. The question states this client is taking radioactive iodine for hyperthyroidism.
A client is prescribed calcitriol. Which instruction would be most important for the nurse to include in the teaching plan? "Limit your intake of dairy products." "Take the drug with food if gastrointestinal issues occur." "Take the drug with a magnesium antacid." "Have your calcium levels checked periodically."
"Have your calcium levels checked periodically." Calcitriol increases serum calcium levels; therefore, periodic monitoring is important to ensure effectiveness of therapy without causing hypercalcemia. Antacids containing magnesium should be avoided due to the increased risk for hypermagnesemia. Calcitriol is often combined with dietary supplementation of calcium. Dairy products are a good source of calcium and should not be limited. The drug can cause nausea, vomiting, and dry mouth. Taking the drug with food may help alleviate these effects.
A young adult client is frustrated by her efforts to lose weight, despite attempts with multiple diet and exercise plans over the years. The client asks the nurse, "My sister-in-law lost a lot of weight when she went on thyroid supplements. Do you think that might work for me?" What is the nurse's best response? "Please mention this with your health care provider, because you would have to be screened carefully before these medications would be prescribed." "Your health care provider would need to rule out several other health problems before prescribing this." "Thyroid medications are considered an intervention of last resort, when more conservative weight loss programs have failed." "I'd encourage you to discuss this with your health care provider, but thyroid drugs can't be safely used for weight loss."
"I'd encourage you to discuss this with your health care provider, but thyroid drugs can't be safely used for weight loss." There is a black box warning against the use of levothyroxine for weight loss. The nurse should encourage further discussion, but it is within the nurse's scope to cite this general prohibition.
/An older adult client has been using levothyroxine for several years on an outpatient basis. Which client statement should the nurse attribute to the decreased effect of levothyroxine? "Overall, I'd say that I'm under a lot of stress lately." "I've stopped taking aspirin for my arthritis and started using acetaminophen." "My daughter and I have started the Atkins diet to try to lose some weight." "I've been using a lot of antacids lately because of my indigestion."
"I've been using a lot of antacids lately because of my indigestion." Antacids may decrease the effect of levothyroxine. Acetaminophen, stress, and high protein intake do not have this effect.
A client with osteoporosis asks, "Why do I have to stop smoking?" Which response will the nurse make to this client that explains the role of smoking in osteoporosis? "Smoking decreases estrogen levels, which accelerates bone loss." "Smoking reduces the rate of bone breakdown." "Smoking reduces bone resorption." "Smoking increases the availability of vitamin D."
"Smoking decreases estrogen levels, which accelerates bone loss." Lifestyle factors can adversely affect calcium level in the body. Smoking decreases the amount of active estrogen in the body, resulting in acceleration of bone loss. Smoking can reduce availability of vitamin D. Smoking contributes to an increase in bone resorption and acceleration of bone breakdown.
When learning about antithyroid drugs in their pharmacology class, the nursing students learn that strong iodine products are commonly administered for how long? 6 weeks 6 months 5 years A lifetime
6 weeks Strong iodine products may be used as primary treatment for 6 weeks. The options 6 months, 5 years, or a lifetime are incorrect answers.
Serum levels of calcium must be maintained in a narrow range within the body. What is the normal range of serum calcium? 9 and 11 mg/dL 4 and 6 mg/dL 1 and 3 mg/dL 6 and 8 mg/dL
9 and 11 mg/dL Calcium is an electrolyte that is used in many of the body's metabolic processes. These processes include membrane transport systems, conduction of nerve impulses, muscle contraction, and blood clotting. To achieve all of these effects, serum levels of calcium must be maintained between 9 and 11 mg/dL.
A client with symptomatic hyperthyroidism is prescribed propranolol. Which clinical manifestation would the nurse identify that indicates the medication is having the desired effect? A heart rate of 72 beats/min Profuse diaphoresis A blood glucose of 86 mg/dL A blood pressure of 160/92
A heart rate of 72 beats/min Propranolol is recommended for use in all clients with symptomatic hyperthyroidism because it blocks beta-adrenergic receptors in various organs and thereby controls symptoms of hyperthyroidism resulting from excessive stimulation of the sympathetic nervous system. Since tachycardia is associated with hyperthyroidism, a heart rate of 72 beats/min indicates that the drug is having the desired effect. Profuse diaphoresis indicates that the medication is not effective or having the desired effect intended. The blood glucose is not affected by the propranolol use. The blood pressure of this client is not well controlled and still considered hypertensive.
A client is diagnosed with both hypothyroidism and adrenal insufficiency. If the adrenal insufficiency is not treated first, what may occur with the administration of thyroid hormone? Acute adrenocortical insufficiency Acute congestive heart failure Hypertensive crisis 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.
The nurse should assess for an enlarged thyroid by palpating which area? Mid-sternum Submandibular Anterior neck Supraclavicular
Anterior neck The thyroid gland is located in the neck in front of the trachea. It is not located in the submandibular, midsternal, or supraclavicular areas.
client taking methimazole develops a rash. What is the nurse's best recommendation to treat the rash? Use an antibacterial soap when bathing. Wear gloves to prevent scratching and subsequent skin damage. Avoid topical lubricants. Apply a soothing cream until the rash subsides.
Apply a soothing cream until the rash subsides. 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. Drug dosing may need to be changed, so the next step is to notify the health care provider. Wearing gloves does not address how to care for the rash.
The nurse knows that which assessment finding suggests hyperthyroidism? Hard, thick nails Cool, dry skin Heart rate 55 beats per minute Blood pressure 145/87
Blood pressure 145/87 Moderate hypertension is a sign of hyperthyroidism. Bradycardia, cool and dry skin, and hard, thick nails are suggestive of hypothyroidism.
The nurse in the newborn nursery is assessing an infant with suspected congenital hypothyroidism. What assessment findings support this diagnosis? (Select all that apply.) Bradycardia Lethargy Feeding difficulties Diarrhea Elevated temperature
Bradycardia Lethargy Feeding difficulties Symptoms that support a diagnosis of congenital hypothyroidism include subnormal temperature, low heart rate, feeding difficulties, lethargy, and constipation.
The anatomy and physiology instructor is discussing bone development in the human body. According to the instructor, what hormone inhibits bone resorption? Calcitonin Parathyroid Both of the above Neither of the above
Calcitonin Calcitonin inhibits bone resorption, whereas parathyroid hormone (PTH) increases resorption.
When describing the parafollicular cells to a group of students, which hormone would the instructor identify as being produced by these cells? Liothyronine Parathormone Levothyroxine Calcitonin
Calcitonin The parafollicular cells of the thyroid produce calcitonin. Parathormone is produced by the parathyroid glands. Levothyroxine and liothyronine are produced by the thyroid gland and stored in the follicular cells.
A patient has hypocalcemia secondary to hypoparathyroidism. Which would the nurse expect to be ordered? Methimazole Propylthiouracil Calcitriol Levothyroxine
Calcitriol Calcitriol is an antithypocalcemic agent used to treat hypoparathyroidism. Levothyroxine would be used to treat a deficiency of thyroid hormone or hypothyroidism. Methimazole is an antithyroid agent used to treat hyperthyroidism. Propylthiouracil is an antithyroid agent used to treat hyperthyroidism.
The nurse should review which lab result before advising a client about taking the first dose of ibandronate (Boniva)? Calcium Magnesium Potassium Glucose
Calcium When bisphosphonates are administered, serum calcium levels are monitored before, during, and after therapy.
The nurse is reviewing the client's medication history. The client is to receive ibandronate. Which supplements would the nurse identify as possibly interfering with the drug's absorption? (Select all that apply.) Calcium Aspirin Antacids Iron Multiple vitamins
Calcium Antacids Iron Multiple vitamins the absorption of oral bisphosphonates, such as ibandronate. Calcium decreases the absorption of oral bisphosphonates, such as ibandronate. Multiple vitamins decrease the absorption of oral bisphosphonates, such as ibandronate. Aspirin increases the GI distress associated with bisphosphonates, but does not affect absorption.
A client's low ionized calcium levels have necessitated an infusion of an IV calcium preparation. During the administration of this medication, the nurse should prioritize what assessment? Oxygen saturation levels Assessment of cognition Cardiac monitoring Assessment for visual changes
Cardiac monitoring Calcium imbalances can result in alterations in heart rate and rhythm; cardiac monitoring is thus necessary. The client is less likely to experience alterations in respiratory function, cognition, or vision since they are not cardiac related.
A nurse is caring for a patient with hypothyroidism. The nurse would know that the effects of hypothyroidism include: Decreased cardiac output Nervousness and restlessness Increased blood pressure Fever
Decreased cardiac output Decreased cardiac output is an effect of hypothyroidism. Low-grade fever, nervousness and restlessness, and increased systolic blood pressure are among the effects of hyperthyroidism.
Which would a nurse expect to assess in a client experiencing hyperthyroidism? Bradycardia Slow and deep tendon reflexes Intolerance to cold Flushed, warm skin
Flushed, warm skin Clients with hyperthyroidism typically exhibit flushed, warm skin; hyperactive deep tendon reflexes; tachycardia; and intolerance to heat.
The nurse is preparing to administer a scheduled dose of levothyroxine to a client. What assessment should the nurse perform prior to giving the drug? Level of consciousness and orientation Heart rate Oxygen saturation level Respiratory rate
Heart rate Regular monitoring of blood pressure and pulse is essential in older adults receiving levothyroxine. As a general rule, levothyroxine should not be given if the resting heart rate is more than 100 beats/min. This medication does not impact any of the other functions and so assessment is not necessary.
A client presents at the clinic reporting weight loss despite an increased appetite. For which condition should this client be assessed? Hyperthyroidism Chronic thyroiditis Hypothyroidism Hyperglycemia
Hyperthyroidism Hyperthyroidism is manifested by increased appetite and metabolism. Without treatment, it may be difficult for hyperthyroid individuals to consume enough calories to prevent weight loss. Hypothyroidism, which may be caused by thyroiditis, causes decreased appetite and metabolism, and hypothyroid patients frequently experience weight gain.
The nurse administers teriparatide (Forteo) and evaluates the drug as effective in achieving desired effects when what is assessed? Increase in serum calcium and decrease in serum phosphorous Increase in serum calcium and phosphorous Decrease in serum calcium and increase in serum phosphorous Decrease in serum calcium and phosphorous
Increase in serum calcium and decrease in serum phosphorous With once-daily administration, teriparatide stimulates new bone formation, leading to an increase in skeletal mass. It increases serum calcium and decreases serum phosphorous.
Thyroid hormones are principally concerned with the increase in metabolic rate of tissues that can result in certain effects. What are some of these effects? Select all that apply. Increased heart rate Decreased respiratory rate Decreased oxygen consumption Increased cardiac output Increased body temperature
Increased heart rate Increased cardiac output Increased body temperature Thyroid hormones are principally concerned with the increase in metabolic rate of tissues, which results in increased heart and respiratory rate, body temperature, cardiac output, oxygen consumption, and the metabolism of fats, proteins, and carbohydrates.
Which statement best summarizes the negative feedback loop of the hormones that regulate calcium and bone metabolism? When hormonal levels are decreased, serum calcium levels are secreted. When serum calcium levels are decreased, hormonal mechanisms increase them. When hormonal levels are increased, serum calcium levels are inhibited. When serum calcium levels are increased, hormonal mechanisms increase them.
When serum calcium levels are decreased, hormonal mechanisms increase them.
A client with hyperthyroidism began treatment with propylthiouracil two weeks ago and has presented for a follow-up assessment. The nurse's assessment findings include a heart rate of 58 beats/min with regular rhythm and blood pressure of 89/61 mm Hg. What is the nurse's most appropriate action? Inform the health care provider. Document the expected reductions in heart rate and blood pressure in the client health record. Teach the client how to self-monitor blood pressure and heart rate in the home. Assess the client's risk for falls.
Inform the health care provider. While a reduction in blood pressure and heart rate is a desired effect of propylthiouracil these findings would likely be characterized as bradycardia and hypotension, and would warrant medical follow-up to reevaluate the drug regimen. Facilitating this follow-up is a priority nursing action, even though the data would certainly be documented. Similarly, it would be appropriate to assess the client's associated falls risk and reinforce self-monitoring, but neither of these actions directly addresses the need to have the regimen reevaluated by the care provider.
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 Sedation of the central nervous system and suppression of cardiac function Destruction of part of the thyroid gland Suppression of the anterior pituitary gland's hormonal secretions
Inhibition of production of thyroid hormone Propylthiouracil acts by inhibiting production of thyroid hormones and peripheral conversion of thyroxine (T4) to the more active triiodothyronine (T3).
Which would the nurse expect to assess in a patient who is to start therapy with bisphosphonates? Paresthesias Muscle weakness Tetany Hyperactive reflexes
Muscle weakness Muscle weakness is a sign of hypercalcemia for which bisphosphonate, an antihypercalcemic agent, would be used. Hyperactive reflexes suggest hypocalcemia for which an antihypocalcemic agent would be used. Tetany suggests hypocalcemia for which an antihypocalcemic agent would be used. Paresthesias suggest hypocalcemia for which an antihypocalcemic agent would be used.
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? Slow speech and mental dullness Drowsiness and bradycardia Nervousness and tachycardia Skin rash and itching
Nervousness and tachycardia Excessive doses of levothyroxine, a thyroid drug, can cause the same signs and symptoms that occur with hyperthyroidism. These include nervousness and tachycardia.
The nurse is caring for a client who is seeking care for a chronic condition. The nurse is aware that the FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of what condition? Hypotension GERD Diabetes mellitus type 1 Obesity
Obesity The FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of obesity or for weight loss, either alone or with other therapeutic agents. Significant and serious complications may develop in euthyroid people taking thyroid hormones.
After teaching a group of students about bisphosphonates, the students demonstrate understanding of the information when they identify which drug as an example? Calcitonin-salmon Teriparatide Pamidronate Dihydrotachysterol
Pamidronate Pamidronate is an example of a bisphosphonate. Teriparatide and dihydrotachysterol are antihypocalcemic agents. Calcitonin-salmon is a calcitonin used to treat hypercalcemia.
A health care provider has prescribed thyroid drugs to a client with euthyroid goiter. Which should the nurse include in the nursing diagnosis checklist? Risk for impaired skin integrity related to adverse reactions Anxiety related to symptoms, adverse reactions, and treatment regimen Disturbed thought processes related to adverse drug reactions 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
A nurse educating a client and their family about levothyroxine (Synthroid) for the treatment of hypothyroidism should advise the client to contact the health care provider if which occur? (Select all that apply.) Significant weight changes Excessive diaphoresis Chest pain Palpitation Constipation
Significant weight changes Chest pain Palpitation Excessive diaphoresis A nurse educating a client and their family about levothyroxine (Synthroid) for the treatment of hypothyroidism should advise the client to contact the provider if any of the following occur: headache, nervousness, palpitations, diarrhea, excessive diaphoresis, heat intolerance, chest pain, increased pulse rate, significant weight changes, or any unusual physical change or event.
A client is to receive teriparatide. The nurse would instruct the client in: Subcutaneous injection Intranasal spray administration Oral administration Transdermal application
Subcutaneous injection Teriparatide is administered subcutaneously.
What is the body's physiological response when blood levels of calcium are excessive? The thyroid stops making parathyroid hormone. The parathyroid begins absorbing calcium. The parathyroid stops absorbing calcium. The parathyroid glands stop making parathyroid hormone.
The parathyroid glands stop making parathyroid hormone. When blood calcium levels increase above a certain point, calcium-sensing receptors in the parathyroid gland are activated to decrease hormone production. The thyroid gland does not produce parathyroid hormone. Calcium is absorbed in the intestines, not in the parathyroid gland.
Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which assessment finding should prompt the nurse to withhold a scheduled dose of levothyroxine? The resident received her annual influenza vaccination the previous day. The resident has not eaten breakfast because of a recent loss of appetite. The resident had a fall during the night while transferring from her bed to her bathroom. The resident's apical heart rate is 112 beats/minute with a regular rhythm.
The resident's apical heart rate is 112 beats/minute with a regular rhythm. If the pulse rate is greater than 100 bpm, it is necessary to withhold a levothyroxine dose in an older adult. Anorexia, recent vaccination, and recent falls do not necessary indicate a need to withhold this medication.
Which vitamin supplements should the nurse recommend while a postmenopausal client is taking alendronate (Fosamax)? Vitamin D and calcium Vitamin C and vitamin A Vitamin K and calcium Vitamin E and vitamin D
Vitamin D and calcium Fosamax is a bisphosphonate medication. An intake of 1500 mg calcium and 400 to 800 units of vitamin D are recommended daily while taking bisphosphonates.
A client has been diagnosed with subclinical hypothyroidism. The client reports feeling fine and does not want to take any medications. The nurse informs the client that some medical providers encourage pharmacological intervention to improve all of the following EXCEPT: Cholesterol metabolism. Muscle function. Left ventricular function. Weight loss.
Weight loss. The FDA has issued a BLACK BOX WARNING regarding the use of thyroid hormones for the treatment of obesity or for weight loss, either alone or with other therapeutic agents. Significant and serious complications may develop.
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." "Thyroid replacement is lifelong; dosage changes must come from my provider." "The levothyroxine can increase my glucose, so I need to report hyperglycemia." "I will take the drug thirty minutes before breakfast the same time each day."
"It does not matter which brand of the drug I take, they are all the same." Clients should be taught to avoid whole grain cereals in the meal before taking calcium because they interfere with calcium absorption. The restriction is not related to serum phosphate levels, adverse effects, or the nutritional content of the grain products.
An older adult client has experienced recent declines in bone density and has consequently been deemed a candidate for treatment with alendronate. During health education, what teaching point should the nurse emphasize? "Make sure to let your health care provider know promptly if you experience bone pain." "It's important that you not lie down for half an hour after taking your alendronate." "You'll have less stomach upset if you take your alendronate with some bland food." "Your alendronate will be most effective if you couple it with an increase in your consumption of dairy products."
"It's important that you not lie down for half an hour after taking your alendronate." The person must remain upright (with head elevated 90 degrees if in bed, sitting upright in a chair, or standing) for at least 30 minutes after administration of alendronate. It is always necessary to take the drug with a full glass of water, not juice or coffee, at least 30 minutes before breakfast and before taking other drugs. Bone pain is a possible adverse effect, but prevention of esophageal ulceration is a priority. Increased dairy consumption is not vital.
While reviewing the medication history of a client receiving alendronate, the nurse notes that the client also takes a multivitamin. Which instruction would be most appropriate? "Stop taking the multivitamin at once." "Take the multivitamin just before the alendronate." "Take the alendronate with an antacid before the multivitamin." "Separate taking the two drugs by about a half hour."
"Separate taking the two drugs by about a half hour." Alendronate can interact with a multivitamin, decreasing the absorption of the bisphosphonate. Therefore, the drugs should be separated by at least a half hour. The multivitamin does not need to be stopped. The alendronate should be taken on arising in the morning before anything else. Antacids also can decrease the absorption of alendronate, and these should also be separated by at least a half hour.
A nurse is providing education to a client who will soon begin taking levothyroxine for the first time. Which teaching point should the nurse include in this education session? "You'll need to adhere to a strict diet with high protein and low carbohydrates." "You'll most likely take this drug for the rest of your life." "I'll teach you how to check your blood sugar levels for the first few weeks that you take the drug." "I'll help you arrange to come to an outpatient clinic for IV administration of levothyroxine."
"You'll most likely take this drug for the rest of your life." Levothyroxine is normally taken for the duration of the client's life. It is only administered by the IV route in cases of myxedema coma. It does not require a strict diet of high protein and low carbohydrates and it does not create a need for blood glucose monitoring. The medication should be taken on an empty stomach at least one hour before breakfast or two hours after a meal.
Laboratory testing reveals that a client is in a severely hyperthyroid state, and propylthiouracil has been prescribed. When providing health education related to this drug, the nurse should stress what information to the client? "At first, you'll come to the outpatient clinic for your IV infusion once per day." "It's best to inject propylthiouracil into your abdomen rather than your arm." "I'm going to show you how to perform your daily injection." "You'll need to take these pills every 8 hours."
"You'll need to take these pills every 8 hours." Propylthiouracil is well absorbed with oral administration. Because the half-life in the thyroid is relatively short, propylthiouracil must be given every 8 hours.
A client diagnosed with hypothyroidism admits knowing the term "thyroid gland" but not knowing its function. The nurse should explain the fact that thyroid hormone is responsible for which action? Controlling the rate of cell metabolism throughout the body Stimulating the brain and sex organs Regulating levels of glucose in the blood and body tissues Regulating the levels of most other hormones in the body
Controlling the rate of cell metabolism throughout the body Thyroid hormones control the rate of cellular metabolism and thus influence the functioning of virtually every cell in the body. The heart, skeletal muscle, liver, and kidneys are especially responsive to the stimulating effects of thyroid hormones. The brain, spleen, and gonads are less responsive. Thyroid hormone does not primarily influence glucose levels or the function of the endocrine system.
The nurse is providing education to a client who has been prescribed alendronate. The nurse should reinforce correct administration to reduce the risk for what disorder? Decreased joint range of motion Esophageal bleeding Ischemic stroke Coronary artery disease (CAD)
Esophageal bleeding Clients who do not follow the dosing instructions for alendronate are at greater risk for esophagitis, dysphagia, and esophageal ulcers/erosions. There is no direct risk of CAD, stroke, or decreased joint range of motion.
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. It will inhibit the release of hormones from the anterior pituitary gland. It stimulates the parasympathetic nervous system. It limits the action potential involved in cardiac conduction.
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.
Which agent would a nurse expect to administer to a client with hypothyroidism? Methimazole Levothyroxine Calcitriol Propylthiouracil
Levothyroxine Levothyroxine would be used to treat a deficiency of thyroid hormone or hypothyroidism. Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Calcitriol is an antihypocalcemic agent used to treat hypoparathyroidism.
The nurse is instructing the patient on a drug that has been prescribed for hyperthyroidism. The nurse 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? Potassium iodide (Thyro-Block) Propylthiouracil (PTU) Sodium iodide I 131 (Generic) Methimazole (Tapazole)
Methimazole (Tapazole) Hematological adverse effects are more common with methimazole, so a complete blood count and differential should be done regularly in patients taking this drug. Propylthiouracil is associated with GI effects. The most common adverse effect of sodium iodide I131 and potassium iodide is hypothyroidism. Other effects of these two drugs include metallic taste and burning in the mouth, sore teeth and gums, diarrhea, cold symptoms, stomach upset, staining of teeth, skin rash, and the development of goiter.
A client taking levothyroxine (Synthroid) is starting a new job and will be using a new health insurance and pharmacy formulary. What teaching should the nurse provide to this client regarding Synthroid? Continue the equivalent dose if a generic brand is used. Choose the cheapest brand to save money. Notify the primary care provider if Synthroid is not covered by insurance. The dosage may be changed to twice a day if brands are changed.
Notify the primary care provider if Synthroid is not covered by insurance. Thyroid hormone replacement drugs are not equivalent to each other. Client should not change brands without first checking with the primary care provider. The provider needs to determine the equivalent dosages when changing medication brands. Thyroid hormones are usually taken once per day.
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. Record weight and report weight gain or loss. Avoid using soap to cleanse affected areas. Provide soothing cream to affected areas.
Notify the primary health care provider. Whenever a client develops a skin rash after taking propylthiouracil, the nurse must notify the primary health care provider immediately because it may be an adverse reaction. The other measures are important to protect the skin integrity: avoid soap and apply soothing cream to affected areas. Recording the weight and reporting weight gain or loss are also important.
A client is prescribed ibandronate. The nurse instructs the client to take the drug at which frequency? Once every 2 weeks Once a month Once a week Once every 3 months
Once a month Ibandronate is taken once a month on the same day each month.
A nurse is reviewing the laboratory values of a client being treated for a diagnosis of hypocalcemia. The current serum calcium level is 8.1 mg/dL. What intervention does the nurse expect the prescriber to order? Prescribe potassium chloride infusion. Order an additional calcium supplement. The prescriber will not order any intervention. Redraw the serum level of calcium.
Order an additional calcium supplement. Normal serum calcium levels are in the range of 8.5 to 10.5 mg/dL. The nurse would anticipate that the level is below the therapeutic range and the prescriber should order another calcium supplement. Once the hypocalcemia is stabilized, finding the underlying cause of recurrence is priority. Measurement of serum magnesium levels should also be completed to correct the hypocalcemia. The potassium chloride infusion is not associated with calcium.
The nurse is discussing the use of corticosteroids with a group of nursing students and tells that students that both men and women who take corticosteroids are at risk for what side effect? Infertility Hypertension Paget's disease Osteoporosis
Osteoporosis Both men and women who take corticosteroids are at risk for osteoporosis.
An older adult resident of a long-term care facility has been prescribed calcium citrate to address decreasing bone density. The nurse should review the resident's medication administration record knowing that what medication may decrease the effects of calcium? Diltiazem Ibuprofen Hydrochlorothiazide Prednisone
Prednisone Corticosteroids reduce the effects of calcium by various mechanisms. Thiazide diuretics have the opposite effect. NSAIDs, calcium channel blockers, and beta-blockers do not appreciably affect the pharmacokinetics of calcium supplements.
After 48 hours of thyroid hormone replacement therapy, a client reports still having no appetite. Which is the nurse's best action? Assess the client for signs of toxicity Suggest that the client eliminate sodium from the diet. 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. 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 lack of appetite at this stage in treatment is not indicative of toxicity. The client should not be told to adjust the dose without the supervision of a health care provider. Although reducing sodium may be suggested, eliminating sodium is not usually recommended. More time is needed to see the full effects of treatment.
The nurse should monitor a client for which effect of a drug interaction in a client taking thyroid hormones and a beta blocker? Prolonged bleeding Tachycardia Hypoglycemia Visual changes
Tachycardia Beta blockers and thyroid hormones interact, leading to decreased effectiveness of the beta blocker (i.e., cardiac drug, adrenergic blocker). Hypoglycemia may occur when thyroid hormones are taken with oral antidiabetic agents and insulin. Prolonged bleeding can occur when thyroid hormones and oral anticoagulants are taken together. Visual changes do not occur when beta blockers are taken with thyroid hormones.
A nurse is caring for a patient with thyrotoxicosis. The physician prescribes liotrix to the patient. Which adverse reaction to the drug should the nurse monitor for in the patient? Agranulocytosis Skin rash Loss of hair Tachycardia
Tachycardia The nurse should monitor for tachycardia, palpitations, headache, nervousness, insomnia, diarrhea, vomiting, weight loss, fatigue, sweating, and flushing as adverse reactions after administering liotrix to the patient with thyrotoxicosis. Agranulocytosis, loss of hair, and skin rash are not the adverse reactions to liotrix. Agranulocytosis, loss of hair, and skin rash are adverse reactions found in a patient receiving a methimazole drug.
A nurse is caring for a patient with thyrotoxicosis. The physician prescribes liotrix to the patient. Which adverse reaction to the drug should the nurse monitor for in the patient? Tachycardia Agranulocytosis Loss of hair Skin rash
Tachycardia The nurse should monitor for tachycardia, palpitations, headache, nervousness, insomnia, diarrhea, vomiting, weight loss, fatigue, sweating, and flushing as adverse reactions after administering liotrix to the patient with thyrotoxicosis. Agranulocytosis, loss of hair, and skin rash are not the adverse reactions to liotrix. Agranulocytosis, loss of hair, and skin rash are adverse reactions found in a patient receiving a methimazole drug.
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 before breakfast. Take the drug just before dinner. Take the drug after lunch.
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. 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.
The nurse is providing client education regarding the administration of levothyroxine (Synthroid). Which information should the nurse include? Take the medication before going to bed at night. Take the medication on a full stomach. Take with a full glass of water. Remain in the upright position for 30 minutes after taking the medication.
Take with a full glass of water. The client should be instructed to take the medication with a full glass of water to help prevent difficulty swallowing. The medication does not need to be taken on a full stomach and the client does not have to remain in the upright position after taking the medication. The medication should be taken as a single daily dose before breakfast each day to ensure consistent therapeutic levels.
Which information about medication administration and meals should the nurse include in teaching a client prescribed calcium orally? Take early in the morning. Take with or after meals. Take 2 hours before a meal. Take as recommended by the pharmacist.
Take with or after meals. Oral preparations of calcium can be administered with or after meals to increase absorption. If used with an antacid, administer the calcium after a meal. The client does not need to take calcium 2 hours before a meal or early in the morning. The nurse should provide the administration recommendations while teaching about the need for the medication.
A group of students are reviewing hypo- and hypercalcemia. The students demonstrate a need for additional review when they identify what as indicating hypercalcemia? Personality changes Muscle weakness Tetany Lethargy
Tetany Tetany is an indication of hypocalcemia. Lethargy, muscle weakness, and personality changes occur with hypercalcemia.
Which statement reflects the relationship between calcium and phosphate? When there is a decrease in calcium, the phosphate is decreased. There is no relationship with calcium and phosphate. When there is an increase in calcium, the phosphate is elevated. When there is an increase in calcium, the phosphate is decreased.
When there is an increase in calcium, the phosphate is decreased. An inverse relationship exists between calcium and phosphate. When serum calcium levels increase, serum phosphate levels decrease. When the serum calcium level decreases, serum phosphate levels increase. Calcium and phosphorus are learned together as they are closely related. These mineral nutrients occur in the same food, and absorbed together.
The nurse is providing education to a client who has been newly diagnosed with osteoporosis. How should the nurse describe the role of the parathyroid on the development of the disorder? When there is too much parathyroid hormone, the bones release their calcium into the blood at a rate that is too high, resulting in bones which have too little calcium. When there is too much parathyroid hormone, the thyroid releases calcium into the blood at a rate that is too high, resulting in bones that have too little calcium. When there is too much parathyroid hormone, the bones retain calcium at a rate that is too high, resulting in bones that have too little calcium. When there is too much thyroid hormone, the parathyroid releases calcium into the blood at a rate that is too high, resulting in bones that have too little calcium.
When there is too much parathyroid hormone, the bones release their calcium into the blood at a rate that is too high, resulting in bones which have too little calcium. Osteoporosis associated with hyperparathyroidism is caused by the high parathyroid hormone that is secreted by the overactive parathyroid gland(s). This excess parathyroid hormone acts directly on the bones to remove calcium from the bones.
The nurse is providing education to a client who is taking calcium for the treatment of osteopenia. What is the rationale for the nurse suggesting that the client limit whole grains in the diet? Whole grains contain insufficient amounts of needed calcium. Whole grains increase the client's risks of adverse effects when taking calcium supplements. Whole grains are known to interfere with calcium absorption. Whole grains interact with calcium and increase serum phosphate levels.
Whole grains are known to interfere with calcium absorption. Clients should be taught to avoid whole grain cereals in the meal before taking calcium because they interfere with calcium absorption. The restriction is not related to serum phosphate levels, adverse effects, or the nutritional content of the grain products.
A nurse is caring for a client with chronic lymphocytic thyroiditis. The health care provider has prescribed liothyronine. For which condition of the client should the nurse be cautious before administering the drug? elevated body temperature cardiac disease upper respiratory tract infection diabetes
cardiac disease The nurse should be cautious about existing conditions such as cardiac disease and also cautious about lactating clients before administering liothyronine to clients with chronic lymphocytic thyroiditis. The nurse need not be cautious about administering liothyronine to those with upper respiratory tract infection, diabetes, or elevated body temperature. The nurse should observe for elevated body temperature while managing the needs of a client administered thyroid hormones.
Liothyronine is a thyroid hormone used in replacement therapy for hypothyroidism. The drug must be used with extreme caution in patients with: glaucoma. mental depression. cardiac problems. benign prostatic hyperplasia.
cardiac problems. Liothyronine has a greater incidence of cardiac side effects than most other thyroid hormones. For this reason, it is not recommended for use in patients with potential cardiac problems or patients who are prone to anxiety reactions.
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)? granulocytopenia hypoprothrombinemia diarrhea exfoliative dermatitis
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.
The nurse knows that raloxifene achieves a therapeutic effect by altering the function of what hormone? insulin thyroid-stimulating hormone (TSH) prolactin estrogen
estrogen Raloxifene is a selective estrogen receptor modulator that is used to prevent or treat postmenopausal osteoporosis. It acts like estrogen in some body tissues and prevents the action of estrogen in other body tissues. It has estrogenic effects in bone tissue, thereby decreasing bone breakdown and increasing bone mass density. The drug is unrelated to TSH, prolactin, or insulin.
What is the most common cause of subclinical hyperthyroidism? history of neck radiation excess thyroid hormone therapy untreated osteoporosis 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.
A nurse is caring for a client who has been diagnosed with hypothyroidism. Levothyroxine (Synthroid) has been prescribed. Before the drug therapy is started, the nurse will assess for: the client's age. allergy to seafood. history of taking anticoagulant drugs. hirsutism.
history of taking anticoagulant drugs. If the client is taking anticoagulant drugs, there is a risk of a drug-drug interaction with levothyroxine that can result in an increased risk of bleeding. Therefore, the nurse should assess the client's medical record and drug history. Bleeding times such as INR, PR, and PTT should be closely monitored if it is necessary for the two drugs to be given together. There is no evidence that an allergy to seafood, the client's age, or hirsutism, which is excessive hair growth, would need to be assessed in this case.
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? decreased number of white blood cells increased risk of hypoglycemia increased risk of prolonged bleeding decreased effectiveness of the thyroid drug
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.
When describing thyroid function, the nurse would emphasize the need for intake of: calcium. iodine. vitamin B6. sodium.
iodine Iodine intake is necessary for the production of thyroid hormones.
A nurse is preparing to administer a scheduled dose of levothyroxine to an older adult client who is being treated in the hospital for a respiratory infection. Prior to administering the drug, the nurse should perform what assessment? chest auscultation for rales measurement of blood pressure temperature measurement assessment of pupillary response
measurement of blood pressure In older adults receiving levothyroxine, regular monitoring of blood pressure and pulse is essential. Temperature, pupillary response, and chest auscultation are not necessary before safe administration of this medication.
What drug type is most likely to cause respiratory depression and myxedema coma in clients with thyroid disorders? opioid analgesics thioamide antithyroids beta-adrenergic blockers calcium channel blockers
opioid analgesics 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 possible. None of the other options present with this contraindication
A client diagnosed with excessive parathyroid production is prone to develop: osteopenia. heart disease. Alzheimer's disease. hypertension.
osteopenia Most of the symptoms of parathyroid disease are "neurological" in origin. The most common symptoms are fatigue and tiredness. Other very common symptoms are lack of energy, memory problems, depression, problems with concentration, and problems sleeping. However, these symptoms are improved after intervention. Thus, although it may contribute to an existing diagnosis of Alzheimer's, it is not the cause. Hypertension is not commonly associated with this disorder. Excess parathyroid hormone acts directly on the bones to remove calcium from the bones. The calcium levels may cause abnormalities in heart function, but they do not cause heart disease.
What organ provides the control over the amount of calcium in the blood? kidneys thyroid gland pituitary parathyroid glands
parathyroid glands Parathyroid chief cells are cells in the parathyroid glands that produce parathyroid hormone. The end result of increased secretion by the chief cells of a parathyroid gland is an increase in the serum level of calcium. Parathyroid chief cells constitute one of the few cell types of the body that regulate intracellular calcium levels as a consequence of extracellular (or serum) changes in calcium concentration. The thyroid controls how quickly the body burns energy and makes proteins, and how sensitive the body should be to other hormones. The pituitary releases ACTH (adrenocorticotropic hormone), which in turn tells the adrenal cortex to release cortisol and aldosterone into the blood. The kidneys are complicated organs that have numerous biological roles. Their primary role is to maintain the homeostatic balance of bodily fluids by filtering and secreting metabolites (such as urea) and minerals from the blood and excreting them, along with water, as urine.
Serum calcium levels are directly related to what blood components? protein glucose potassium sodium
protein Circulating calcium is in the free, ionized form (Ca2+) or bound to blood proteins such as serum albumin. Low serum albumin decreases the total serum level of calcium by decreasing the amount of calcium that is bound to protein. Serum calcium levels are not dependent on sodium, potassium, or glucose levels.
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 lymphatic system. stored in the parathyroid glands. released into the bloodstream. stored in the thyroid gland.
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.
The nurse is preparing a teaching tool on the action of calcium preparations. The nurse will identify that calcium is absorbed through which body area? stomach mouth large intestine small intestine
small intestine The absorption of calcium occurs in the small intestines. Approximately one third of the amount of calcium consumed is actually absorbed. Calcium is not absorbed through the mouth, the stomach, or the large intestines.
Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to: stand or sit upright for at least 30 minutes after taking alendronate. take calcium and vitamin D supplements. lift weights in the gym at least five times a week. avoid drinking water with the drug.
stand or sit upright for at least 30 minutes after taking alendronate. To decrease gastrointestinal distress, the patient should stand or sit upright for at least 30 minutes after taking the drug. Drinking at least 6 to 8 oz of water with the drug helps maximize the therapeutic effect of the drug. The patient should also take calcium and vitamin D supplements along with lifting weights to improve the success of therapy, but these interventions would not directly serve to decrease gastrointestinal distress.
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? months hours weeks days
weeks The absorption of calcium occurs in the small intestines. Approximately one third of the amount of calcium consumed is actually absorbed. Calcium is not absorbed through the mouth, the stomach, or the large intestines.
