Chapter 58 Endocrine (Nursing pharm)
Which statement is the most important for a nurse to make to a patient who is taking methimazole? "You need to notify your doctor if you have a sore throat and fever." "Another medication can be given if you experience any nausea." "You may experience some muscle soreness with this medicine." "Headache and dizziness may occur but not very frequently."
"You need to notify your doctor if you have a sore throat and fever." 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, and headache and dizziness are other adverse effects of methimazole that are not as serious as agranulocytosis.
The healthcare provider orders 150 mcg of levothyroxine [Synthroid] PO every morning. The medication available is levothyroxine [Synthroid] 75 mcg tablets. How many tablets will the nurse administer? 0.5 1 2 4
2 Ordered dose/Available dose= 150 mcg/75 mcg= 2 tablets
A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131? White blood cell (WBC) count Electrocardiogram (ECG) Beta human chorionic gonadotropin (hCG) test Creatinine level
Beta human chorionic gonadotropin (hCG) test Any female patient of reproductive age requires a negative result on a beta hCG (pregnancy hormone) test before iodine-131
Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? Cardiac dysrhythmias Excessive bruising Weight loss of 5 kg Shortness of breath
Excessive bruising Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced. Bruising, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.
A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what? Thyrotoxicosis Hypothyroidism Hyperthyroidism Graves' disease
Hypothyroidism The anterior pituitary increases production of TSH when thyroid hormone levels of T
The patient reports that she had to switch pharmacies to save money. She noticed that her "thyroid pill" looks different. The nurse anticipates that the healthcare provider will order what? Thyroid stimulating hormone (TSH) Electrocardiogram (ECG) Beta human chorionic gonadotropin (hCG) test Creatinine level
Thyroid stimulating hormone (TSH) 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.
A patient has been given instructions about levothyroxine [Synthroid]. Which statement by the patient indicates understanding of these instructions? "I'll take this medication in the morning so as not to interfere with sleep." "I'll plan to double my dose if I gain more than 1 pound per day." "It is best to take the medication with food so I don't have any nausea." "I'll be glad when I don't have to take this medication in a few months."
"I'll take this medication in the morning so as not to interfere with sleep." 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.
A patient with Graves' disease is treated with iodine-131 therapy. Which statement by the patient would indicate understanding of the treatment's effects? "I'll have to isolate myself from my family so I don't expose them to radiation." "I'm looking forward to feeling better immediately after this treatment." "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." "I'll need to take this drug on a daily basis for at least 1 year."
"I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." 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. Iodine-131 has a quick radioactive decay and half-life; therefore, isolation is not needed, but it can take up to 2 months for the desired response to develop.
Which statements about levothyroxine [Synthroid] are correct? Select all that apply. Levothyroxine should be taken with food. Levothyroxine can be given by IV but is usually taken orally. Levothyroxine brands should not be changed if possible. Levothyroxine should be taken at night to avoid adverse effects. Levothyroxine can affect the metabolism of other medications.
Levothyroxine can be given by IV but is usually taken orally. Levothyroxine brands should not be changed if possible. Levothyroxine can affect the metabolism of other medications. Levothyroxine is almost always 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. Maintain patients 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 manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? Tachycardia Tremors Insomnia Irritability
Tachycardia 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.
