Chapter 37: Thyroid and Parathyroid Agents

A female client with a six-month-old infant has been prescribed propylthiouracil (PTU). What is the most important question the nurse should ask this client?

"Are you breastfeeding your child?"

The nurse is teaching a patient who is prescribed calcitriol about the drug. Which patient statement indicates that the teaching was successful?

"I need to have my calcium levels checked periodically."

A nurse is caring for a patient with hypothyroidism. The nurse would know that the effects of hypothyroidism include:

Decreased cardiac output

The nurse has just completed discharge instructions to a client who will be using a pen device to deliver his insulin dose. What statement by the client indicates a need for further instruction?

"If I forget to take my insulin pen, I will be able to use the one that my wife uses."

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."

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?

"Separate taking the two drugs by about a half hour."

The nurse is caring for a 42-year-old client who recently had a total hysterectomy that involved removal of her ovaries. What statement by the client suggests that she understands her risk of developing osteoporosis?

"The surgery increased my risk of developing the disease."

A patient with Paget's disease experiences bone pain after taking alendronate. Which response by the nurse would be most appropriate?

"This pain should begin to subside after a few days to a few weeks."

An adult client has been diagnosed with hypothyroidism and is expected to receive a prescription for levothyroxine shortly. The client asks the nurse, "How long do you think I'll have to take the medication for?" What is the nurse's best response?

"You will likely need to take the medication for the rest of your life."

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.

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 Decreased respirations Decreased blood pressure

A client with diabetes is undergoing testing for glycosylated hemoglobin. The nurse instructs the client that this test measures average blood glucose over what time period?

the past 3 or 4 months

The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs?

weakness, sweating, and decreased mentation.

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

weeks

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

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

The nurse is caring for a client who has been prescribed glyburide. Which factor, if identified in the client history, would cause the nurse to inform the health care provider of a contraindication to use?

Allergy to sulfonamides

A client presents to the emergency department with an apparent reaction to recently started thyroid therapy. Which assessment finding would lead the nurse to question that this client is experiencing a thyroid storm?

Altered mental status

An older adult client living in a long-term care facility is newly diagnosed with hypothyroidism. The nurse is providing care and education to the client. What should be the nurse's priority action when managing hypothyroidism in the older adult?

Assess the client for potential drug interactions and age-related changes affecting medication metabolism.

The nurse elicits a positive Chvostek sign when tapping on the facial nerve. What action by the nurse is a priority after this assessment is complete?

Assess the client's calcium level for hypocalcemia

A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine?

Avoid mixing glargine with other insulin.

The nurse is educating a client who is beginning therapy with acarbose and tells the client to take the medication with the first bite of each main meal to help prevent what adverse effect?

Bloating and diarrhea

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 Feeding difficulties Lethargy

A patient has hypocalcemia secondary to hypoparathyroidism. Which would the nurse expect to be ordered?

Calcitriol

The nurse should review which lab result before advising a client about taking the first dose of ibandronate (Boniva)?

Calcium

A nurse completing a pre-administration assessment on a 70-year-old client prior to the administration of levothyroxine (Synthroid) may confuse which symptom of hypothyroidism with which symptom associated with the aging process? (Select all that apply.)

Confusion Unsteady gait Cold intolerance

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

7 Children who do not have a thyroid gland or have a nonfunctioning gland develop ___________.

Cretinism

The nurse is providing client education regarding the administration of levothyroxine (Synthroid). Which information should the nurse include?

Take with a full glass of water.

he nurse is caring for a client with diabetes and administered the client's scheduled dose of regular insulin and NPH insulin at 08:00. At 09:30 the nurse checks the client's blood glucose level, which is 140 mg/dL. What is the nurse's best action?

Document the finding and check the client's blood glucose level in one hour

A client at a primary health care provider's office is diagnosed with multinodular goiter. The client has normal thyroid function and experiences no compressive symptoms. The health care provider prescribes levothyroxine. What is the nurse's priority action when educating the client about this treatment plan?

Educate the client about the potential risks and benefits of levothyroxine treatment and the need for ongoing monitoring.

Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which action does this enable?

Entry of glucose into the cells

Which would a nurse expect to assess in a client experiencing hyperthyroidism?

Flushed, warm skin

The nurse is providing education to a client who has been prescribed therapy with an antidiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb?

Garlic

The most common cause of hyperthyroidism in adults is ___________ disease.

Graves

The nurse is preparing to administer 20 units of NPH insulin to a client. Before administering the medication, the nurse should implement which intervention?

Have a colleague confirm the dosage.

The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not record glucometer readings. What laboratory test does the nurse anticipate the health care provider will order for this client?

HbA1c

The nurse is preparing to administer levothyroxine to a client. Which assessment finding would cause the nurse to hold the medication?

Heart rate of 110 beats per minute

What is the best position for the client after the administration of a bisphosphonate medication?

High Fowler's

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

Hyperthyroidism

The health care provider has ordered a change of prescription from rapid-acting insulin to an intermediate-acting type. Which adverse effect must the nurse closely monitor for in the client?

Hypoglycemia

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

A nurse has administered levothyroxine to a client for hypothyroidism. The nurse determines the client is responding appropriately to the therapy based on which assessment finding?

Increased appetite

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 Increased body temperature Increased cardiac output

The pharmacology instructor is providing education regarding propylthiouracil to the nursing students. What would the instructor identify as the primary mode of action for this medication?

Inhibition of production of thyroid hormone

A client newly diagnosed with type 1 diabetes asks the nurse why the client cannot just take a pill. The nurse would incorporate what knowledge when responding to this client?

Insulin is needed because the beta cells of the pancreas are no longer functioning.

4 The thyroid gland needs _________ to produce the thyroid hormones that regulate body metabolism.

Iodine

A nurse is presenting an educational event at a local senior citizens' club about diabetes. What would the nurse tell the attendees at the event about diabetes?

It is a complicated disorder that alters the metabolism of glucose.

Which would be appropriate to include in teaching a client with type 2 diabetes?

It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.

Which agent would a nurse expect to administer to a client with hypothyroidism?

Levothyroxine

The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes?

Lifelong exogenous insulin is required.

A nurse is performing patient education for a woman who has just been prescribed a bisphosphonate. Which diagnostic and history findings would have prompted the woman's care provider to prescribe a bisphosphonate?

Low bone density and a family history of osteoporosis

3 The thyroid hormone regulates the rate of _________________, which is the rate at which energy is burned.

Metabolism

After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide?

Metformin

A patient taking thyroid drugs is found to be hyperthyroid. What should be done about the dosage of other drugs the patient is taking?

Nothing

A client with a history of cardiovascular disease, who is taking a thyroid hormone, reports chest pain. What is the nurse's best action?

Notify the health care provider.

A client admitted to the hospital with hyperthyroidism treated with propylthiouracil suddenly develops a skin rash. Which action would the nurse implement first?

Notify the primary health care provider.

The 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?

Obesity

A nurse is caring for a patient with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this patient?

Observe the patient for hypoglycemic episodes.

The nurse monitoring a client receiving insulin glulisine notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL (3.33 mmol/L). Which can a nurse give to treat a client with a hypoglycemic episode? (Select all that apply.)

Orange or other fruit juice Glucose tablets Hard candy

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?

Order an additional calcium supplement.

A client who is receiving a strong iodide solution, potassium iodide, develops iodism. What would the nurse expect to find?

Sore teeth

A patient is receiving teriparatide. The nurse would expect to administer this drug by which route?

Subcutaneous

After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration?

Subcutaneous injection

A client diagnosed with hypothyroidism is to start thyroid hormone replacement therapy. Which lab value should the nurse review to assist the health care provider in determining the dosage?

TSH

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

Tachycardia

A 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 breakfast.

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's apical heart rate is 112 beats/minute with a regular rhythm.

A nurse educating a client and their family about levothyroxine for the treatment of hypothyroidism should include which information? Select all that apply.

Therapy is lifelong. Weigh weekly and report significant changes to the health care provider.

Which statement reflects the relationship between calcium and phosphate?

When there is an increase in calcium, the phosphate is decreased.

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 are known to interfere with calcium absorption.

The nurse is caring for a client with osteoporosis. Which electrolyte will the nurse assess to determine the action of exogenous calcitonin in this client?

calcium

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?

cardiac disease

Liothyronine is a thyroid hormone used in replacement therapy for hypothyroidism. The drug must be used with extreme caution in patients with:

cardiac problems.

A client has been admitted to the intensive care unit with myxedema coma. What predisposing factor is considered when diagnosing myxedema coma?

core body temperature of 94°F (34°C)

A nurse at a health care facility is caring for a client who has been prescribed insulin for the first time. Which preadministration assessments should the nurse perform before the first dose of insulin is given?

general assessment of the skin

1 The leading energy source for the body is ________________.

glucose

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

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

hyperthyroidism medication therapy Hashimoto's thyroiditis radiation to the neck

A lack of sufficient levels of thyroid hormones needed to maintain normal metabolism is defined as __________________.

hypothyroidism

After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long-acting insulin?

insulin glargine

A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action?

insulin lispro

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

iodine

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

iodine.

A nurse is teaching a client about a prescribed thyroid supplement and describes a drug that is relatively inexpensive, requires once-a-day dosing, and has a more uniform potency than do other thyroid hormone replacement drugs. Which drug is the nurse describing?

levothyroxine

The nurse is providing care for a client who has been admitted with clinical hypothyroidism. What interventions should the nurse implement to address common characteristics of the disorder? Select all that apply.

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

Based on the nurse's knowledge about thyroid hormone supplements, the nurse administers levothyroxine cautiously to a client who has recently had which condition or disorder?

myocardial infarction

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

on an empty stomach.

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

opioid analgesics

A client diagnosed with excessive parathyroid production is prone to develop:

osteopenia.

What organ provides the control over the amount of calcium in the blood?

parathyroid glands

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?

regular

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?

small intestine