Chapter 44: Thyroid/Antithyroid Drugs PrepU
12 See full question 15s What would expected findings during an assessment of a client with hyperthyroidism include? (Select all that apply.)
Increased appetite Tachycardia Goiter Explanation: Signs and symptoms of hyperthyroidism include increased metabolism with increased appetite; weight loss; tachycardia; flushed, warm skin; thinning hair; goiter. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 520. Chapter 44: Thyroid and Antithyroid Drugs - Page 520 Add a Note
15 See full question 20s What is a common cause of primary hypothyroidism? Select all that apply.
hyperthyroidism medication therapy Hashimoto's thyroiditis radiation to the neck Explanation: 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 520. Chapter 44: Thyroid and Antithyroid Drugs - Page 520 Add a Note
19 See full question 12s 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.
9 to 10 days Explanation: Levothyroxine has a long half-life, about 6 to 7 days in euthyroidism (normal thyroid function), but it is prolonged to 9 to 10 days in hypothyroidism and shortened to 3 to 4 days in hyperthyroidism. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 523. Chapter 44: Thyroid and Antithyroid Drugs - Page 523 Add a Note
6 See full question 10s A client diagnosed with hypothyroidism is started on levothyroxine. What should the client be taught regarding medication administration in the home setting?
Take the medication on an empty stomach. Explanation: Levothyroxine should be taken on an empty stomach to increase absorption. The medication should not be taken with food. The implementation of exercise has no effect on the administration of the medication. Levothyroxine has a long half-life of about 6 to 7 days. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 524. Chapter 44: Thyroid and Antithyroid Drugs - Page 524 Add a Note
2 See full question 3s Levothyroxine is classified in which pregnancy category?
category A Explanation: Levothyroxine is in pregnancy category A, and it is safe to use during pregnancy. Radioactive iodine (pregnancy category X) is contraindicated during pregnancy and lactation. Methimazole and propylthiouracil are used with extreme caution during pregnancy (pregnancy category D) because they can cause hypothyroidism in the fetus, no drugs in this chapter are listed as category B or C. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 521. Chapter 44: Thyroid and Antithyroid Drugs - Page 521 Add a Note
20 See full question 20s 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 most likely take this drug for the rest of your life." Explanation: 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.
18 See full question 14s 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?
"You'll need to take these pills every 8 hours." Explanation: Propylthiouracil is well absorbed with oral administration. Because the half-life in the thyroid is relatively short, propylthiouracil must be given every 8 hours. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, pp. 523-424. Chapter 44: Thyroid and Antithyroid Drugs - Page 523-424 Add a Note
3 See full question 17s Elderly clients are at increased risk for adverse cardiovascular reactions when taking thyroid drugs; therefore, increases in dosage, if needed, are made in smaller increments during a period of how many weeks?
8 weeks Explanation: Elderly clients are at increased risk for adverse cardiovascular reactions when taking thyroid drugs; therefore, increases in dosage, if needed, are made in smaller increments during a period of 8 weeks. Due to the gradual increase the increment of 1 to 6 weeks is not enough time to increase slowly. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 523. Chapter 44: Thyroid and Antithyroid Drugs - Page 523 Add a Note
8 See full question 10s The nurse should expect which assessment findings in a client diagnosed with Hashimoto's thyroiditis?
Blood pressure 110/70 Explanation: Hashimoto's thyroiditis causes hypothyroidism. Some common signs include bradycardia, pale and cool skin, coarse hair, and moderate hypotension. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 524. Chapter 44: Thyroid and Antithyroid Drugs - Page 524 Add a Note
12 See full question 43s The nurse is caring for a client newly diagnosed with hypothyroidism. The client also takes theophylline to control asthma symptoms. What change may need to be made to the client's theophylline dose?
Decrease theophylline dosage immediately. Explanation: Theophylline clearance is decreased in hypothyroid states. As a result, the client may require a decreased dose of the drug. As the client approaches normal thyroid function, the theophylline dose may need to be increased back to its regular level. . Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 521. Chapter 44: Thyroid and Antithyroid Drugs - Page 521 Add a Note
2 See full question 20s What would the nurse expect to assess if a client was receiving too much methimazole?
Decreased appetite Explanation: Decreased appetite is associated with hypothyroidism, suggesting that the client is receiving too much methimazole, an antithyroid drug. Nervousness would indicate hyperthyroidism suggesting that the client is not receiving enough methimazole, an antithyroid drug. Flushed warm skin would indicate hyperthyroidism, suggesting that the client is not receiving enough methimazole, an antithyroid drug. Tachycardia would indicate hyperthyroidism, suggesting that the client is not receiving enough methimazole, an antithyroid drug. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 524. Chapter 44: Thyroid and Antithyroid Drugs - Page 524 Add a Note
8 See full question 19s A nurse caring for a client with hypothyroidism knows that the complications of hypothyroidism include:
Decreased cardiac output. Explanation: Decreased cardiac output is related to hypothyroidism. Hypothyroidism is not related to Imbalanced nutrition: Less than body requirements; Ineffective thermoregulation: Excess, or ineffective airway clearance. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 520. Chapter 44: Thyroid and Antithyroid Drugs - Page 520 Add a Note
11 See full question 18s The nurse is caring for an older adult who will be beginning thyroid hormone replacement therapy. The nurse should be alert to which signs and symptoms of hypothyroidism that may be confused with other conditions associated with aging? (Select all that apply.)
Depression Unsteady gait Weight gain Confusion Explanation: Hypothyroidism may be confused with other conditions associated with aging, such as depression, cold intolerance, weight gain, confusion, or unsteady gait. These symptoms should be thoroughly evaluated before thyroid treatment is started. Hypertension is a sign of hyperthyroidism. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 522. Chapter 44: Thyroid and Antithyroid Drugs - Page 522 Add a Note
14 See full question 21s The client with hypothyroidism takes levothyroxine daily and has triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) levels drawn in the laboratory to check appropriateness of prescribed dosage. What results would the nurse analyze as indicating the need for a higher dosage of medication?
Elevated TSH, reduced T3 and T4 levels Explanation: 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 519. Chapter 44: Thyroid and Antithyroid Drugs - Page 519 Add a Note
13 See full question 14s After a client takes a radioactive iodine preparation, the nurse should teach the client to do which of the following? Select all that apply.
Flush twice after using the toilet facilities. Wash eating utensils and laundry separately. Avoid contact with pregnant women for two to four days. Remain in separate area of the house as much as possible. Explanation: When the client returns home after taking a radioactive preparation, a place in the home where others can be avoided should be arranged. Avoiding contact with small children and pregnant women is very important. Private toilet facilities are recommended as well as flushing twice. Eating utensils and laundry should be cleaned separately and the client should sleep alone. These recommendations are usually in effect for two to four days; the exact time frame will be recommended by the health care provider. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 523. Chapter 44: Thyroid and Antithyroid Drugs - Page 523 Add a Note
1 See full question 30s All of the following are specific physiological effects of thyroid hormones, EXCEPT:
Increased pituitary secretion of TSH. Explanation: 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 TSH. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 519. Chapter 44: Thyroid and Antithyroid Drugs - Page 519 Add a Note
10 See full question 22s The nurse is caring for a client who just received radioactive iodine. What should the nurse assess first when receiving the client into care after the procedure?
Infection Explanation: A severe system reaction to radioactive iodine is agranulocytosis, which can lead to severe infection. Nausea, headache, and paresthesias are generalized system reactions. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 522. Chapter 44: Thyroid and Antithyroid Drugs - Page 522 Add a Note
19 See full question 13s 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. Explanation: 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 523. Chapter 44: Thyroid and Antithyroid Drugs - Page 523 Add a Note
6 See full question 7s A child is diagnosed with hypothyroidism. The nurse knows that the drug of choice for this child will most likely be:
Levothyroxine (Synthroid) Explanation: Levothyroxine is the drug of choice in children because of its predictable bioavailability and reliability. Liothyronine and iotrix tend to have more adverse effects, and methimazole is an antithyroid drug and is used to treat hyperthyroidism. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 521. Chapter 44: Thyroid and Antithyroid Drugs - Page 521 Add a Note
7 See full question 24s The nurse has admitted an elderly client in thyroid crisis to the unit. Since surgery is not an option, the client requires an antithyroid drug. What would be the best choice of drug for this client?
Radioactive iodine (Generic) Explanation: Radioactive iodine targets the thyroid cells and destroys them without many adverse effects. Methimazole and propylthiouracil are antithyroid drugs, but have cardiovascular adverse effects than might be unacceptable in an elderly client who is not a candidate for surgery. Potassium iodide could be given to further stimulate thyroid function. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 521. Chapter 44: Thyroid and Antithyroid Drugs - Page 521 Add a Note
9 See full question 28s A client asks the nurse if she's taking a standard dose of thyroid hormone medication. What is the nurse's best response?
The dose is based on your relief of symptoms from hypothyroidism. Explanation: 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 521. Chapter 44: Thyroid and Antithyroid Drugs - Page 521 Add a Note
11 See full question 14s A 23-year-old client is prescribed a thyroid-hormone antagonistic drug. Which should a nurse determine during an ongoing assessment and evaluation of the drug therapy?
Whether the client has become intolerant to cold Explanation: During ongoing assessment and evaluation of his therapy with a thyroid-hormone antagonistic drug, the nurse needs to instruct the client to report immediately if he notices a decreased cardiac rate, intolerance to cold, or weight gain. These are indications of hypothyroidism. The other three factors are possible adverse effects of the therapy, and the nurse should inform the patient about them when providing patient and family education. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 520. Chapter 44: Thyroid and Antithyroid Drugs - Page 520 Add a Note
4 See full question 9s The nurse assesses a client closely for which serious adverse reaction associated with methimazole and propylthiouracil?
agranulocytosis Explanation: Agranulocytosis is potentially the most serious adverse reaction of the antithyroid drugs methimazole and propylthiouracil. Older adult clients are at increased risk for adverse cardiovascular reactions when taking thyroid drugs. Thyroid hormone replacement therapy in clients with diabetes may increase the intensity of the symptoms of diabetes (hyperglycemia). Pancytopenia causes include chemotherapy and medications causing bone marrow suppression, other medications such as some antibiotics, hypertensives, and heart medications can cause pancytopenia. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 522. Chapter 44: Thyroid and Antithyroid Drugs - Page 522 Add a Note
10 See full question 11s A clent is diagnosed with Graves disease. Propylthiouracil (PTU) is prescribed. After 8 weeks of therapy, the client reports a fever and sore throat. The nurse is concerned that this symptoms may be early signs of:
agranulocytosis. Explanation: Agranulocytosis is a serious but rare complication of PTU therapy. Agranulocytosis is characterized by an extreme reduction of white blood cells (neutropenia) and usually occurs in the first few months of PTU therapy. Altered renal function, hepatotoxicity, and hyperthyroidism are not identified adverse effects of PTU. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, pp. 523-525. Chapter 44: Thyroid and Antithyroid Drugs - Page 523-525 Add a Note
13 See full question 20s Following the completion of diagnostic testing, an adult client has received a diagnosis of hyperthyroidism. What nursing diagnosis should the nurse prioritize in this client's care?
anxiety related to hyperthyroidism Explanation: Anxiety is characteristic of a hyperthyroid state. Constipation, cold intolerance, and loss of appetite are associated with hypothyroidism. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, pp. 520-524. Chapter 44: Thyroid and Antithyroid Drugs - Page 520-524 Add a Note
5 See full question 12s A client is undergoing sodium iodine drug therapy for the treatment of hyperthyroidism. Which adverse reactions to the drug should the nurse monitor for in the client?
bone marrow depression Explanation: The nurse should monitor for bone marrow depression, nausea, vomiting, tachycardia, itching, rash, and hives as adverse reactions to the sodium iodine drug in the client. Loss of hair, insomnia, and agranulocytosis are not adverse reactions associated with sodium iodine. The nurse needs to observe for loss of hair and agranulocytosis as adverse reactions in a client undergoing methimazole drug therapy. The nurse needs to observe for insomnia as an adverse reaction in a client undergoing levothyroxine sodium therapy. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 525. Chapter 44: Thyroid and Antithyroid Drugs - Page 525 Add a Note
14 See full question 18s An increase in what specific physiological effect is an expected outcome of thyroid hormone therapy? Select all that apply.
carbohydrate metabolism cellular metabolism oxygen consumption cardiac output Explanation: 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). Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, pp. 521-523. Chapter 44: Thyroid and Antithyroid Drugs - Page 521-523 Add a Note
4 See full question 6s A group of nursing students demonstrate understanding about the antithyroid drugs methimazole and propylthiouracil when they identify these drugs as belonging to which pregnancy category?
category D Explanation: The antithyroid drugs methimazole and propylthiouracil are in pregnancy category D and should be used with extreme caution during pregnancy. Thyroid hormones are classified as pregnancy category A and should be continued by hypothyroid women during pregnancy. Levothyroxine is in pregnancy category A, and it is safe to use during pregnancy. Radioactive iodine (pregnancy category X) is contraindicated during pregnancy and lactation. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 522. Chapter 44: Thyroid and Antithyroid Drugs - Page 522 Add a Note
16 See full question 17s 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) Explanation: Hypothermia happens when core body temperature drops below 95°F (35°C). Predisposing factors for myxedema coma include exposure to cold, infection, trauma, respiratory disease, and administration of central nervous system depressants. 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, pp. 520-521. Chapter 44: Thyroid and Antithyroid Drugs - Page 520-521 Add a Note
20 See full question 19s A nurse is preparing an ordered dose of sodium iodide 131I. The nurse should proceed knowing that this drug will help to resolve hyperthyroidism by what means?
destroying thyroid tissue Explanation: Therapeutic doses of sodium iodide 131I act by emitting beta and gamma rays, which destroy thyroid tissue and thereby decrease production of thyroid hormones. This drug does not antagonize receptors, reduce metabolic rate, or suppress the pituitary gland.
3 See full question 46s A nurse must be aware that thyroid hormone can worsen control of which disease or condition necessitating close client observation?
diabetes Explanation: Thyroid hormone replacement therapy in clients with diabetes may increase the intensity of the symptoms of diabetes (hyperglycemia). Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) which include some common over-the-counter pain relievers, such as ibuprofen and naproxen, may trigger symptoms in some people with asthma. Overuse opioids and barbiturates, including butalbital, codeine, and oxycodone, to treat their migraine are actually at risk for developing chronic migraine. Medication triggers for irritable bowel syndrome (IBS) include medications that contain sorbitol which can worsen symptoms. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 523. Chapter 44: Thyroid and Antithyroid Drugs - Page 523 Add a Note
7 See full question 6s Which condition will warrant the tapering or possible discontinuation of propranolol?
euthyroid state Explanation: When the client becomes euthyroid (normal thyroid functioning) and hyperthyroid symptoms are controlled by definitive treatment measures, propranolol should be tapered and discontinued. Hyperthyroidism, hypertension, and angina pectoris all warrant the administration of propranolol. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 519. Chapter 44: Thyroid and Antithyroid Drugs - Page 519 Add a Note
9 See full question 9s 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:
history of taking anticoagulant drugs. Explanation: 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 521. Chapter 44: Thyroid and Antithyroid Drugs - Page 521 Add a Note
15 See full question 12s A newborn is diagnosed with hypothyroidism. What will the client likely develop if the condition is left untreated?
intellectual disability Explanation: If cretinism is untreated until the child is several months old, permanent intellectual disability is likely to result. The client will not suffer from renal dysfunction, an immune disorder, or paralytic ileus. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 522. Chapter 44: Thyroid and Antithyroid Drugs - Page 522 Add a Note
18 See full question 19s When providing care for a client who has been admitted with clinical hypothyroidism, the nurse should implement what intervention to address common characteristics of the disorder? Select all that apply.
monitor for constipation implement falls risk precautions maintain a warm room temperature Explanation: Clinical hypothyroidism produces variable signs and symptoms, depending on the amount of circulating thyroid hormone. Initially, manifestations are mild and vague. They usually increase in incidence and severity over time as the thyroid gland gradually atrophies. Clients with hypothyroidism are frequently cold intolerant; a warm environmental temperature is warranted. Signs and symptoms of hypothyroidism can also include weakness, tiredness, slow speech and body movements, emotional and mental dullness, excessive sleeping, constipation, and skin changes. There is no need for either constant oxygen monitoring or a low-calorie diet. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, pp. 520-521. Chapter 44: Thyroid and Antithyroid Drugs - Page 520-521 Add a Note
16 See full question 17s A client, diagnosed with hypothyroidism, is currently taking an opioid for knee pain. This client is at increased risk for developing which adverse reaction?
myxedema coma Explanation: People with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs. Pulmonary congestion, tachycardia, and hyperventilation are not adverse effects related to hypothyroidism or the administration of opioids. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 523. Chapter 44: Thyroid and Antithyroid Drugs - Page 523 Add a Note
17 See full question 16s What medication will be a likely component of therapy for a client admitted with a diagnosis of thyroid storm? Select all that apply.
propranolol Explanation: Propranolol is a beta-adrenergic blocking agent that is recommended in all clients with symptomatic hyperthyroidism such as thyroid storm, which requires emergent treatment and hospitalization. Health care providers may use propylthiouracil alone to treat hyperthyroidism, as part of the preoperative preparation for thyroidectomy, before or after radioactive iodine therapy, and in the treatment of thyroid storm. The main treatment is to decrease the circulating thyroid hormone levels and decrease their formation. Levothyroxine is a synthetic preparation of thyroxine considered the standard of care for long-term treatment of hypothyroidism. SSKI is more often used as an expectorant but may be given as preparation for thyroidectomy. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 523. Chapter 44: Thyroid and Antithyroid Drugs - Page 523 Add a Note
17 See full question 13s A 55-year-old client was successfully treated for thyroid storm earlier in the year. In subsequent health education, the nurse should caution the client against excessive intake of what foods?
seafood and kelp Explanation: Iodine is associated with thyroid storm and is present in foods (especially seafood and kelp) and in radiographic contrast dyes. Reports of iodine-induced hyperthyroidism have been reported after ingestion of dietary sources of iodine. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 522. Chapter 44: Thyroid and Antithyroid Drugs - Page 522 Add a Note
1 See full question 1h 25m Symptoms such as severe tachycardia, fever, dehydration, heart failure, and coma are consistent with what thyroid-associated health condition?
thyroid storm Explanation: 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 522. Chapter 44: Thyroid and Antithyroid Drugs - Page 522 Add a Note
5 See full question 51s An older adult client is diagnosed with hypothyroidism, and before therapy starts, the nurse conducts a preadministration assessment. Which symptoms should be thoroughly evaluated and documented in the preadministration assessment and periodically throughout therapy by the nurse?
unsteady gait Explanation: The symptoms of hypothyroidism may be confused with symptoms associated with aging, such as unsteady gait, depression, cold intolerance, weight gain, or confusion. The presence of these symptoms should be thoroughly evaluated and documented in the preadministration assessment and periodically throughout therapy. Fatigue, fever, sore throat, and easy bruising are symptoms of adverse reactions related to antithyroid drugs. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 44: Thyroid and Antithyroid Drugs, p. 522. Chapter 44: Thyroid and Antithyroid Drugs - Page 522 Add a Note
