(P) Thyroid Drugs
During an assessment, a patient asks the nurse, "What should I do if I miss two or three doses of thyroid replacement drug in a row?" Which is the nurse's best response? 1 "You should consult your primary healthcare provider." 2 "You can take the dose immediately when you remember it." 3 "Skip the missed dose and resume your usual dosage schedule." 4 "If it is almost the time for your next dose, then take a double dose of the drug."
1 Rationale: If a patient misses two or more doses of thyroid replacement drug in a row, then the patient should consult the primary healthcare provider. This will help the primary healthcare provider plan effective treatment and avoid probable complications by modifying the dosage regimen. Taking doses at irregular periods, skipping a dose, or taking a double dose are not appropriate. These actions may cause adverse effects, and the treatment may not be effective.
While reviewing the history and the lab reports of an adult patient, the nurse finds that the patient has decreased metabolic rate, weight gain, and hair loss. What can the nurse interpret from these findings? 1 The patient may have cretinism. 2 The patient may have myxedema. 3 The patient may have Graves' disease. 4 The patient may have Plummer's disease.
2 Rationale: Hyposecretion of thyroid hormone as an adult may lead to myxedema. The manifestations of myxedema are decreased metabolic rate, weight gain, hair loss, and yellowish discoloration of the skin. Hyposecretion of thyroid hormone during youth leads to cretinism. The characteristics are a low metabolic rate, retarded growth and sexual development, and possible mental retardation. Graves' disease and Plummer's disease are caused by excessive secretion of thyroid hormones, forms of hyperthyroidism.
Which prescribed treatment would the nurse anticipate for a patient with a thyroid-stimulating hormone (TSH) level of 7 microunits/mL? 1 An order for methimozole. 2 An order for levothyroxine. 3 Treatment with radioactive iodine. 4 Surgical removal of the thyroid tissue.
2 Rationale: Normal TSH levels are 0.3-6 microunits/mL, so this patient's TSH level is high, indicating the presence of primary hypothyroiditis. Levothyroxine is a synthetic preparation of thyroxine, a naturally occurring thyroid hormone, and the standard treatment for primary hypothyroidism. Methimazole, radioactive iodine, and surgical removal of the thyroid would be used to treat hyperthyroidism.
The patient newly diagnosed with hypothyroidism has been prescribed levothyroxine. The nurse should give the patient which instruction(s)? Select all that apply. 1 Levothyroxine should be taken with food. 2 Levothyroxine brands should not be changed, if possible. 3 Levothyroxine can affect the metabolism of other medications. 4 Levothyroxine should be taken at night to avoid adverse effects. 5 Levothyroxine can be given intravenously but is usually taken orally.
2, 3, 5 Rationale: Levothyroxine is usually administered by mouth. Oral doses should be taken once daily on an empty stomach (to enhance absorption). Dosing is usually done in the morning at least 30 to 60 minutes before breakfast. Patients should be maintained on the same brand-name levothyroxine product. Intravenous administration is used for myxedema coma and for patients who cannot take levothyroxine orally. Levothyroxine affects the metabolism of other medications including warfarin.
Which finding in a patient taking levothyroxine and warfarin would require follow-up by a nurse? 1 Excessive bruising 2 Weight loss of 5 kg 3 Shortness of breath 4 Cardiac dysrhythmias
1 Rationale: Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced if there is excessive bruising. Cardiac dysrhythmias, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.
The endocrinologist prescribes radioactive iodine to an adult patient who has thyroid cancer. What is the reason for prescribing this drug to the patient? 1 It destroys cancerous or overactive thyroid tissue. 2 It acts as a prophylactic agent against radiation exposure. 3 It inhibits the conversion of T 4 to T 3 in the peripheral circulation. 4 It increases the cellular metabolic rate and oxygen consumption.
1 Rationale: Radioactive iodine is a commonly used treatment for both hyperthyroidism and thyroid cancer. It emits destructive beta rays into the follicles of the thyroid gland, destroying it in a process known as ablation. Potassium iodide is used as prophylaxis for radiation exposure. Thyroid replacement drugs increase the cellular metabolic rate and oxygen consumption as the endogenous thyroid hormones. Propylthiouracil inhibits the conversion of T 4 to T 3 in the peripheral circulation to decrease the level of thyroid hormone.
Which clinical findings are associated with acute levothyroxine toxicity? Select all that apply. 1 Angina 2 Headache 3 Tachycardia 4 Hyperthermia 5 Atrial fibrillation
1, 3, 4 Rationale: Thyrotoxicosis can occur in a patient who has acutely overdosed on levothyroxine. Clinical findings of this include angina, tachycardia, and hyperthermia. A headache is not associated with levothyroxine toxicity. Atrial fibrillation can occur as a result of chronic overtreatment with levothyroxine but is not associated with an acute overdose.
Thyroxine has recently been added to the routine medications for a patient who also uses insulin, warfarin, cholestyramine, and antacids daily. Which statement by the nurse should would be included in medication education? 1 "The dosage of insulin that you take may need to be decreased." 2 "Take your cholestyramine at least 4 hours apart from the levothyroxine." 3 "You will need to avoid aluminum-containing antacids such as Maalox and Mylanta." 4 "Your dose of warfarin will have to be increased while you are taking this medication."
2 Rationale: Cholestyramine reduces the absorption of levothyroxine, so the patient should be instructed to take the cholestyramine at least 4 hours apart from the levothyroxine. Levothyroxine can increase requirements for insulin, therefore the dosage may need to be increased. Aluminum-containing antacids decrease the absorption of levothyroxine, so the patient should be instructed to take the medications four hours apart from each other; it is not necessary for the patient to avoid antacids entirely. Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, effects of warfarin, an anticoagulant, are enhanced so the dosage may need to be reduced.
A patient with Graves' disease is treated with iodine-131 therapy. Which statement by the patient indicates an understanding of the treatment's effects? 1 "I'll need to take this drug on a daily basis for at least 1 year." 2 "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." 3 "I'm looking forward to feeling better immediately after this treatment." 4 "I'll have to isolate myself from my family so I don't expose them to radiation."
2 Rationale: Iodine-131 usually is given as a single treatment to produce remission of Graves' disease. Fatigue, hair loss, and cold intolerance are signs of hypothyroidism, which is a complication of the treatment. Dosages of iodine-131 for treating Graves' disease are low and iodine-131 has a quick radioactive decay and half-life of 8 days; therefore, isolation is not needed, but it can take up to 2 months for the desired response to develop. Treatment of thyroid cancer with higher doses of iodine-131 requires proper disposal of radioactive body wastes.
A patient with Graves' disease is treated with iodine-131 therapy. Which statement by the patient indicates an understanding of the treatment's effects? 1 "I'll need to take this drug on a daily basis for at least 1 year." 2 "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." 3 "I'm looking forward to feeling better immediately after this treatment." 4 "I'll have to isolate myself from my family so I don't expose them to radiation."
2 Rationale: Iodine-131 usually is given as a single treatment to produce remission of Graves' disease. Fatigue, hair loss, and cold intolerance are signs of hypothyroidism, which is a complication of the treatment. Dosages of iodine-131 for treating Graves' disease are low and iodine-131 has a quick radioactive decay and half-life of 8 days; therefore, isolation is not needed, but it can take up to 2 months for the desired response to develop. Treatment of thyroid cancer with higher doses of iodine-131 requires proper disposal of radioactive body wastes.
A nurse is caring for a patient with decreased triiodothyronine (T 3) and thyroxine (T 4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from which condition? 1 Thyrotoxicosis 2 Hypothyroidism 3 Graves' disease 4 Hyperthyroidism
2 Rationale: The anterior pituitary increases production of TSH when thyroid hormone levels of T 3 and T 4 are reduced reflecting primary hypothyroidism. Patients may experience fatigue caused by a lowered basal metabolic rate. Thyrotoxicosis, hyperthyroidism, and Graves' disease are medical conditions indicative of excessive thyroid activity; in these instances the TSH levels will be low or normal.
A patient diagnosed with thyroid cancer undergoes a thyroidectomy and is prescribed levothyroxine sodium. What instructions should the nurse give the patient about taking this medication? 1 Take on a full stomach. 2 Take on an empty stomach. 3 Take immediately after arising. 4 Take immediately before bedtime.
2 Rationale: The medication is to be taken on an empty stomach. There is no specification for it to be taken just before bedtime or immediately upon arising in the morning. Taking this medication with food or on a full stomach, such as before bedtime, will decrease absorption and efficacy of levothyroxine.
The clinical instructor asks the nursing student about various drug interactions of thyroid drugs. Which statement by the nursing student indicates effective learning? 1 "Thyroid drugs may increase serum digitalis levels." 2 "Thyroid drugs should not be taken to treat obesity." 3 "Thyroid drug absorption is increased by cholestyramine." 4 "Thyroid drugs may decrease the activity of oral anticoagulants."
2 Rationale: Thyroid drugs should not be taken to treat obesity. Thyroid drugs may increase the activity of oral anticoagulants. Thyroid drugs may decrease serum digitalis levels when administered concurrently. Cholestyramine decreases the absorption of thyroid drugs by binding to thyroid hormone in the gastrointestinal tract. This may reduce the absorption of both drugs.
The patient reports that she had to switch pharmacies to save money. She noted that her thyroid pill looked different. The nurse anticipates that the healthcare provider will order which test? 1 Creatinine level 2 Electrocardiogram (ECG) 3 Thyroid stimulating hormone (TSH) 4 Beta human chorionic gonadotropin test
3 Rationale: If a switch is made (from one branded product to another, from a branded product to a generic product, or from one generic product to another), retest serum TSH in 6 weeks and adjust the levothyroxine dosage as indicated. The creatinine level, ECG, and results of pregnancy tests are not directly correlated with differing preparations of thyroid replacement therapy.
Which statement is the most important for a nurse to make to a patient who is taking methimazole? 1 "Headache and dizziness may occur but not very frequently." 2 "Another medication can be given if you experience any nausea." 3 "You may experience some muscle soreness with this medicine." 4 "You need to notify your doctor if you have a sore throat and fever."
4 Rationale: Agranulocytosis (the absence of granulocytes to fight infection) is the most serious toxicity associated with methimazole. Sore throat and fever may be the earliest signs. Nausea, muscle soreness, headache, and dizziness are other adverse effects of methimazole that are less serious than agranulocytosis.
A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131? 1 Creatinine level 2 Electrocardiogram (ECG) 3 White blood cell count (WBC) 4 Beta human chorionic gonadotropin (hCG) test
4 Rationale: Any female patient of reproductive age requires a negative result on a beta hCG (pregnancy hormone) test before iodine-131 ( 131I) can be administered. Iodine-131 is a radioactive isotope used to treat hyperthyroidism and is contraindicated in pregnancy and lactation. A WBC, ECG, and creatinine levels are not indicated before treatment with iodine-131.
The primary healthcare provider prescribes a thyroid replacement drug to a patient with hypothyroidism. How should the nurse monitor for return to a euthyroid state? 1 Assess for anxiety and palpitations. 2 Verify the medication history of patient and family. 3 Evaluate the patient's knowledge of thyroid therapy. 4 Analyze the patient's serum thyroid-stimulating hormone levels.
4 Rationale: Drug efficacy is assessed by monitoring the thyroid-stimulating hormone levels. The nurse will also monitor other thyroid tests, if ordered, and will assess for symptom improvement. Anxiety and palpitations would indicate a hyperthyroid state, which could occur with drug accumulation or excess. The other items, while important, do not address monitoring for a euthyroid (normal) state.
A patient has been given instructions about levothyroxine. Which statement by the patient indicates understanding of these instructions? 1 "I'll plan to double my dose if I gain more than 1 pound per day." 2 "I'll be glad when I don't have to take this medication in a few months." 3 "It is best to take the medication with food so I don't have any nausea." 4 "I'll take this medication in the morning so as not to interfere with sleep."
4 Rationale: Levothyroxine is used to treat hypothyroidism by increasing the basal metabolism and thus wakefulness. It is administered as a once-daily dose and is a lifelong therapy. It is best taken on an empty stomach to enhance absorption. The dosage should not be changed unless directed to do so by the prescribing provider.
The nurse is teaching safe administration of medication to a patient who has been prescribed levothyroxine. Which statement should the nurse include in the teaching session? 1 "Take this medication with 250 mL of orange juice." 2 "Always take the medication 3 times a day, after meals." 3 "There are no dietary restrictions while taking this medication." 4 "Take this medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating."
4 Rationale: Patients who are prescribed thyroid replacements or antithyroid drugs should be advised to take the medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating. This helps enhance the absorption of the drug. Taking the medication twice a day after meals may reduce the therapeutic effectiveness of the medication and cause adverse effects. A patient needs to avoid eating foods that may reduce thyroid hormone production and reduce the effectiveness of the medication. Therefore, the nurse should not give false information that the patient need not follow dietary restrictions. This medication should be taken with water rather than orange juice because it helps enhance the disintegration and absorption of the drug.
The nurse is assessing an elderly patient who has been taking levothyroxine for 6 months. The nurse finds that the patient has anxiety, tachycardia, and insomnia. What should the nurse interpret from these findings? 1 The patient is hypersensitive to thyroid drugs. 2 The patient has common age-related symptoms. 3 The patient is not responding to the thyroid drugs. 4 The patient is experiencing adverse effects of the thyroid drugs.
4 Rationale; Anxiety, tachycardia, and insomnia are among the adverse effects of levothyroxine. These adverse effects may be due to accumulation of the drug in the body; thus, they appear as symptoms of hyperthyroidism. These are not signs and symptoms of an allergic (hypersensitivity) reaction. Anxiety, tachycardia, and insomnia are not anticipated age-related symptoms. If the patient was not responding to the medication, then the patient would have decreased thyroid hormone levels, which would more likely be manifested by bradycardia and increased drowsiness or sleep.
Which manifestation should a nurse investigate first when monitoring a patient who is taking levothyroxine? 1 Tremors 2 Insomnia 3 Irritability 4 Tachycardia
4 Rationale; High doses of levothyroxine may cause thyrotoxicosis, a condition of profound, excessive thyroid activity. Tachycardia is the priority assessment because it can lead to severe cardiac dysfunction. Tremors, insomnia, and irritability are other symptoms of thyrotoxicosis and should be assessed after tachycardia.
