Endocrine Drugs

Anti-thyroid drugs for hyperthyroidism: SATA A. Levothyroxine B. Methimazole (Tapazole) C. Liothyronine D. Liotrix E. Propylthiouracil (PTU)

B, E

A client with hyperthyroidism has been given methimazole (Tapazole). Which nursing considerations are associated with this medication? Select all that apply. 1. administer methimazole with food 2. place the client on a low-calorie low protein diet 3. assess the client for unexplained bruising or bleeding 4. instruct the client to report side/adverse effects such as a sore throat, fever, or headaches 5. use special radioactive precautions when handling the clients urine for the first 24 hours following initial administration

1, 3, 4 Common side effects of methimazole include nausea, vomiting, and diarrhea. To address the side effects, this medication should be taken with food. Because of the increase in metabolism that occurs and hyperthyroidism, the client should consume a high calorie diet. Anti-thyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache or bleeding may indicate agranularcytosis and the HCP should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly, due to the risk of thyroid storm.

When administering hydrocortisone (Cortef, hydrocortone, etc.), the nurse recognizes it may mask which symptoms? 1. Signs and symptoms of infection 2. Signs and symptoms of heart failure 3. Hearing loss 4. Skin infections

1.

A client with hyperthyroidism has been given methimazole. Which nursing considerations are appropriate with this medication? Select all that apply. 1. Admin methimazole with food. 2. Place the client on a low-cal, low protein diet. 3. Assess client for unexplained bruising or bleeding. 4. Instruct client to report side effect such as sore throat, fever, or headaches. 5. Use special radioactive precautions when handling the client's urine for the first 24 hours following the initial assessment.

1. Admin methimazole with food. 3. Assess client for unexplained bruising or bleeding. 4. Instruct client to report side effect such as sore throat, fever, or headaches.

Which medication should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy? 1. Sodium phosphate 2. calcium gluconate 3. echothiophate iodide 4. sodium bicarbonate

2

A nurse is administering Levothyroxine (Syndthroid) to a patient with hypothyroidism. When should the nurse not administer this medication? 1. If the patient is dehydrated 2. If the patient has a BP of 100/50 3. If the patients resting heart rate is more than 100 bpm 4. none of the above

3. The nurse should hold the med if resting HR is above 100 because it increases the body's metabolic rate which would just increase the HR more

Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse would expect the client's symptoms to subside: 1. in a few days. 2. in 3 to 4 months. 3. immediately. 4. in 1 to 2 weeks.

4 Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the conversion of thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU effects are also seen in 1 to 2 weeks. To relieve symptoms of hyperthyroidism in the interim, clients are usually given a beta-adrenergic blocker such as propranolol.

A type I diabetic on insulin reports that he takes propranolol (Inderal) for his hypertension. This raises a concern and the nurse will teach the patient to check glucose levels more frequently because: 1. The beta blocker can produce insulin resistance. 2. The two agents used together will increase the risk of ketoacidosis. 3. Propranolol will increase insulin requirements by antagonizing the effects at the receptors. 4. The beta blocker can mask symptoms of hypoglycemia.

4. Beta blockers decrease the body's adrenergic "fight-or-flight" response and may block the symptoms and signals of hypoglycemia that a diabetic normally perceives as the blood sugar drops. Beta blockers may inhibit glycogenolysis, resulting in hypoglycemia and have no effect on the development of insulin resistance.

What would the nurse assess when monitoring for the therapeutic effectiveness of vasopressin? A. Fluid balance B. Patient's pain scale C. Serum albumin levels D. Adrenocorticotropic hormone (ACTH) level

A. Fluid balance Vasopressin causes decreased water excretion in the renal tubule, thus decreasing urine output. It is used to treat diabetes insipidus, which presents with polyuria and dehydration.

Why would a patient be taking propranolol with hyperthyroidism? 1. Increases T4 conversion to T3 in the hypothalamus 2. Controls symptoms of hyperthyroidism due to excessive stimulation of SNS 3. Enhances acidity buffer in the jejunum 4. Decreases metabolic rate and increases O2 consumption by the CNS

Answer 2. Propranolol blocks beta-adrenergic receptors in various organs and thereby controls symptoms of hyperthyroidism from excessive stimulation of the SNS. These symptoms include tachycardia, palpitations, excessive sweating, tremors, and nervousness.

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride: A) Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. B) Increases norepinephrine secretion and thus decreases blood pressure and heart rate. C) Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. D) Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

Answer: A Rationale: Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.

A patient recently diagnosed with hypothyroidism is prescribed levothyroxine. The nurse should include which of the following in his teaching plan? select all that apply. A. Do not take with antacid. B. Take at bedtime. C. Take at meal time. D Take early in the morning on an empty stomach.

Answer: A & D Levothyroxine should be taken early in the morning to avoid interfering with sleep (side effects: insomnia, anxiety and nervousness) Levothyroxine should not be taken with food to increase absorption. Also, levothyroxine should not be taken within 4hrs of using multivitamins, antacids or iron supplements. It is chelated with certain elements.

The nurse is teaching a patient taking an antithyroid medication to avoid food items high in iodine. Which food item should the nurse instruct the patient to avoid? A. Chicken B. Seafood C. Milk D. Eggs

B

The nurse would suspect a patient is taking too much levothyroxine (Synthroid) when the patient exhibits which adverse effect? A. Lethargy B. Irritability C. Weight Gain D. Feeling Cold

B

A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication: a) in the morning to prevent insomnia b) only when the client complains of fatigue and cold intolerance c) at various times during the day to prevent tolerance from occurring d) three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels

a) in the morning to prevent insomnia Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases cellular metabolism. Levothyroxine should be given in the morning in a single dose to prevent insomnia and should be given at the same time each day to maintain an adequate drug level. Therefore, options B, C, and D are incorrect.

A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for: a) relief of pain b) signs of renal toxicity c) signs and symptoms of hyperglycemia d) signs and symptoms of hypothyroidism

d) signs and symptoms of hypothyroidism Excessive dosing with propylthiouracil (PTU) may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity.

A patient with hyperthyroidism is taking propylthiouracil (PTU). The nurse will monitor the patient for: A) gingival hyperplasia and lycopenemia. B) dyspnea and a dry cough. C) blurred vision and nystagmus. D) fever and sore throat

D) fever and sore throat.

The nurse has a prescription to administer vasopressin (Pitressin) to a pediatric patient for gastrointestinal hemorrhage. The dose prescribed is 0.003 units/kg/min. The patient's weight is 55 lb. What is the correct infusion rate for vasopressin?

0.075 units/min The patient's weight of 55 lb is converted to kilograms by dividing 55 by 2.2, which equals 25 kg. When 25 kg is multiplied by 0.003 units/kg/min, the result is 0.075 units/min.

A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help relieve his symptoms. What is the nurse's best response?" 1. Propylthiouracil inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism. 2. Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal. 3. Propylthiouracil helps your thyroid gland use iodine and synthesize hormones better. 4. Propylthiouracil stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH), which inhibits the production of hormones by the thyroid gland.

2.

When hydrocortisone use is discontinued abruptly, the nurse must assess for which side effect? 1. Development of myxedema 2. Circulatory collapse 3. Development of Cushing's syndrome 4. Development of diabetes insipidus

2.

A patient is given a prescription for propranolol (Inderal) 40 mg bid. The most important instruction for the nurse to give this patient is: 1. Take this medication on an empty stomach, as food interferes with its absorption. 2. Do not stop taking this medication abruptly; the dosage must be decreased gradually if it is discontinued. 3. If the patient experiences any disturbances in hearing, the patient should notify the health care provider immediately. 4. The patient may become very sleepy while taking this medication; do not drive.

2. Beta blockers such as propranolol should never be stopped abruptly because of the possible rebound hypertension and increased dysrhythmias that may occur. The nurse may teach the patient to take the medication on an empty stomach and to be cautious with drowsiness while taking beta blockers.

Which medication blocks synthesis of thyroid hormone? 1. Dexamethasone 2. Methimazole 3. Potassium iodide 4. Sodium iodide

2. Methimazole

A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed preoperatively for the client. The expected outcome of using this drug is that it helps: 1.slow progression of exophthalmos 2. reduce the vascularity of the thyroid gland. 3. decrease the body's ability to store thyroxine. 4. increase the body's ability to excrete thyroxine.

2. reduce the vascularity of the thyroid gland.

A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client? 1. Calcium chloride 2. Calcium gluconate 3. Calcitonin (Miacalcin) 4. Large doses of vitamin D

3. Calcitonin (Miacalcin) Rationale:The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.

A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to: 1. Treat thyroid storm. 2. Prevent cardiac irritability. 3. Treat hypocalcemic tetany. 4. Stimulate the release of parathyroid hormone.

3. Treat hypocalcemic tetany. Rationale:Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes or muscle spasms or twitching, the health care provider is notified immediately. Calcium gluconate should be kept at the bedside.

The nurse is administering a saturated solution of potassium iodide (SSKI). The nurse should: 1. pour the solution over ice chips. 2. mix the solution with an antacid. 3. dilute the solution with water, milk, or fruit juice and have the client drink it with a straw. 4. disguise the solution in a pureed fruit or vegetable.

3. dilute the solution with water, milk, or fruit juice and have the client drink it with a straw.

When teaching a patient regarding desmopressin (DDAVP), the nurse will inform the patient to monitor for which potential side effects? (Select all that apply.) A. Headache B. Weight gain C. Nasal irritation D. Hyperglycemia E. Hypotension

A, B, C Desmopressin works to decrease urine output; thus the patient would retain fluid and gain weight. Headache may also occur as a sequential of fluid retention. Because it is administered intranasally, it can be irritating; thus nostrils should be rotated. Desmopressin does not affect serum glucose levels.

When teaching a patient the adverse effects of desmopressin (DDAVP), the nurse will instruct the patient to monitor for which potential adverse effects? (Select all that apply.) A. Headache B. Weight gain C. Hypotension D. Nasal irritation E. Hyperglycemia

A, B, D Desmopressin works to decrease urine output; thus, the patient could retain fluid and gain weight. Other common adverse effects include increased blood pressure, fever, headache, abdominal cramps, and nausea. Desmopressin does not affect serum glucose levels. Because it is administered intranasally, it can be irritating; thus, nostrils should be rotated.

A nurse in a provider's office is planning care for a client who has a new diagnosis of Graves' disease and a new prescription for methimazole (Tapazole). Which of he following should the nurse include in the plan of care? SATA A. Monitor CBC. B. Monitor T3. C. Inform the client that the medication should not be taken for more than 3 months .D. Advise the client to take the medication at the same time every day. E. Inform the client that an adverse effect of this medication is iodine toxicity.

A, B, and C. Monitor CBC: methimazole can cause a number of hematologic effects, including leukopenia and thrombocytopenia.Monitor T3: methimazole reduces thyroid hormone production. Therefore, the nurse should monitor the client's T3. Advise the client to take the medication at the same time everyday: this is to maintain blood levels

A nurse is caring for a client who is receiving continuous cardiac monitoring. Which of the following medications should the nurse anticipate administering for atrial fibrillation A. Atropine B. Propranolol (inderal) C. Epinephrine D. phenytoin (dilantin)

B. Rationale: Propranolol is used to slow the ventricular rate in atrial fibrillation -Atropine may be administered for bradycardia or in AV block-Epinephrine is administered to treat bronchospasm, cardiac arrest, and heart block-Phenytoin (dilantin) is used to treat digoxin-induced ventricular dysrhythmias

A patient with HTN and Asthma is taking propranolol, which of the following side effects is the patient most at risk to develop? A. Alopecia B. Bronchospasm C. Hypoglycemia D. insomnia

B. Rational... Propranolol inhibits beta-2 receptors in the lungs, leading to bronchospasm and bronchoconstriction. asthma places the patient at an increased risk for bronchospasm and constriction. hypoglycemia, alopecia and insomnia are all side effects associated with beta blockers, but this patient is not at an increased risk.

Action of Methimazole (Tapazole) & Propylthiouracil (PTU)? SATA A. Given to replace what the thyroid gland cannot produce to achieve normal thyroid levels (euthyroid). They work the same way as thyroid hormones B. Inhibit the incorporation of iodine molecules into amino acid tyrosine C. Impede formation of thyroid hormone

B. Inhibit the incorporation of iodine molecules into amino acid tyrosine C. Impede formation of thyroid hormone

Which statement by the patient indicates an understanding of discharge instructions given by the nurse about the newly prescribed medication levothyroxine (Synthroid)? A. "I can expect improvement of my symptoms within 1 week." B. "I will stop the medication immediately if I feel pain or weakness in my muscles." C. "I will take this medication in the morning so it does not affect my sleep at night." D. "I will take a double dose to make up for the missed one."

C

The nurse is reviewing the adverse effects of antithyroid medications for a patient prescribed propylthiouracil (PTU). What potential serious adverse effects should the nurse discuss with the patient during discharge teaching? (Select all that apply.) A. Kidney Damage B. Increased urination C. Joint pain D. Bone marrow toxicity E. Liver toxicity

C, D, E

Which is a priority nursing diagnosis for a patient receiving desmopressin (DDAVP)? A. Risk for injury B. Acute pain C. Excess fluid volume D. Deficient knowledge regarding medication

C. Desmopressin is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow's hierarchy of needs.

The nurse is caring for a patient with diabetes insipidus (DI) who is receiving vasopressin (Pitressin). What therapeutic effect does the nurse expect from this drug? A. Increase in thirst B. Improved skin turgor C. Decrease in urine output D. Normal serum albumin level

C. Vasopressin increases the water reabsorption in the kidneys, thus decreasing urine output. It is used to treat DI, which presents with polydipsia, polyuria, and dehydration.

For a patient taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently, the nurse would closely monitor for which possible serious adverse effect? A. Acute confusion B. Cardiac dysrhythmias C. Orthostatic hypotension D. Increased bruising

D

When assessing for potential serious adverse effects to propylthiouracil (PTU), the nurse will monitor which laboratory test? A. Kidney function B. Brain natriuretic peptide C. Serum electrolytes D. Complete blood count (CBC)

D

When monitoring for the therapeutic effects of intranasal desmopressin (DDAVP) in a patient who has diabetes insidious, which assessment finding will the nurse look for as an indication that the medication therapy is successful? A. Increased insulin levels B. Decreased diarrhea C. Improved nasal patency D. Decreased thirst

D

Which patient statement demonstrates understanding of radioactive iodine (I-131) therapy? A. "I will need to take this drug on a daily basis for at least 1 year." B. "I will isolate myself from my family for 1 week so there is no risk of radiation exposure." C. "This drug will help decrease my cold intolerance and weight gain." D. "This drug will be taken up by the thyroid gland and destroy thyroid tissue."

D

A patient has developed DI after a head injury. Which medication should the nurse anticipate to be prescribed for the management of DI? A. Corticotrophin (Acthar) B. Octreotide (Sandostatin) C. Somatropin (Genotropin) D. Desmopressin (DDAVP)

D. Vasopressin (Pitressin) and desmopressin (DDAVP) are used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with DI caused by a deficiency of endogenous antidiuretic hormone.

A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse's best response? A. "You should see effects of this medication immediately." B. "You should see effects of this medication within 1 week." C. "You should see full effects from this medication within 1 to 2 days." D. "You should see some effects of this medication within 2 weeks."

D."You should see some effects of this medication within 2 weeks." Methimazole is an iodine preparation that decreases blood flow through the thyroid gland. This action reduces the production and release of thyroid hormone. The client should see some effects within 2 weeks; however, it may take several more weeks before metabolism returns to normal. Although onset of action is 30 to 40 minutes after an oral dose, the client will not see effects immediately. Effects will take longer than 1 week to become apparent when methimazole is used. Methimazole needs to be taken every 8 hours for an extended period of time. Levels of triiodothyronine (T3) and thyroxine (T4) will be monitored and dosages adjusted as levels fall.