Pharm Adapt Quiz: Ch. 31 Thyroid & Antithyroid Drugs

The nurse is teaching safe administration of medication to a patient who has been prescribed levothyroxine. Which statement will the nurse include in the teaching session?

"Consult your provider before taking over-the-counter medications."

Which statement made by a student nurse about hypothyroidism needs correction?

"Graves' disease is the most common cause of hypothyroidism."

The nurse is educating a patient who is taking thyroid hormone replacement therapy. Which response given by the patient indicates effective learning?

"I should take the tablet every morning with an empty stomach."

The nurse is caring for a patient who is receiving levothyroxine. The patient asks when the symptoms of hypothyroidism will stop. What is the nurse's best answer?

"It can take 1 to 4 weeks before the medication is effective."

A patient receiving propylthiouracil asks the nurse, "How will this medication help relieve my symptoms?" What is the nurse's best response?

"It inhibits formation of new thyroid hormone, thus gradually returning your metabolism to normal."

The clinical instructor asks the nursing student about various drug interactions of thyroid drugs. Which statement by the nursing student indicates effective learning?

"Thyroid drugs may decrease the activity of hypoglycemic drugs."

The nurse is teaching a patient who has a first-time prescription for the antithyroid drug propylthiouracil. About what will the nurse inform the patient? Select all that apply.

"You need to be aware of the manifestations of hypothyroidism." "Take the medication along with a meal to prevent stomach upset." "You need to avoid eating salt, shellfish, and foods high in iodine."

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?" What is the best response given by the nurse?

"You should consult your primary health care provider immediately."

A patient who is taking propylthiouracil complains, "It's been 10 days since I started taking the medication, but my hunger is still not suppressed." What advice will the nurse provide?

"Your hunger will subside in another 10 days."

The nurse is giving an intravenous injection of levothyroxine to a patient with myxedema coma. The prescription reads: 0.5 mg levothyroxine, intravenous push, single dose. The nurse finds that the concentration of the drug is available in micrograms. What is the dose of levothyroxine administered by the nurse in micrograms? Record your answer using a whole number. _____ mcg

1 milligram (mg) is equal to 1000 micrograms (mcg). The prescribed 0.5 mg is equal to 500 mcg. Therefore, the nurse should administer 500 mcg.

While assessing a patient who is receiving levothyroxine therapy, the nurse advises the patient to take the oral dose before breakfast. What dosage is the patient ordered in the prescription?

100 mcg

Which process is characterized by destruction of the thyroid gland?

Ablation

A patient walks into a clinic, shivering and looking depressed and tired. The caregiver reports, "The patient was normal until last month but then suddenly started to gain weight." Further assessment from the primary health care provider shows brittle hair and fingers. What medication will the nurse expect in the patient's prescription?

Liotrix 50 mg/day orally

The nurse is caring for a patient who has hyperthyroidism. The primary health care provider has prescribed methimazole. Which is the first and most important nursing action in this situation?

Assess signs and symptoms of thyroid storm.

A primary health care provider prescribes a drug for a patient who is underweight and shows symptoms of diarrhea, increased appetite, and flushing. Which other drug in the patient's medication history would be of concern for the nurse?

Anticoagulants

The patient is prescribed levothyroxine, 0.3 mg, intravenously (IV). The drug is available in a 500-mcg vial. Arrange the steps of intravenous levothyroxine administration in the correct order.

Before administering any medication to the patient, the nurse should check for the patient's written prescription. Following this, the nurse should reconstitute the vial before calculating the dosage to minimize medication errors and high-dose effects. The nurse reconstitutes the vial with 5 mL of 0.9% NaCl. The nurse should calculate the dosage based on the concentration of the reconstituted vial. For 300 mcg, 3 mL of the drug should be drawn into the syringe and slowly administered by the intravenous route.

A patient with primary hypothyroidism receives levothyroxine and regular insulin. Which finding does the nurse monitor in the patient to help prevent complications of the pharmacotherapy?

Blood glucose

The primary health care provider prescribes a thyroid replacement drug to a patient with hypothyroidism. Which is the first intervention that helps determine the dosage of thyroid replacement drug for the patient?

Checking the pt's serum TSH levels

What are the adverse effects of thyroid replacement drugs? Select all that

Chest pain and palpitations

Which adverse effect occurs when thyroid drugs are coadministered with epinephrine?

Coronary insufficiency

The nurse is taking the history of a female patient who has been prescribed thyroid replacement drugs. The nurse finds that the patient is receiving estrogen supplements as part of hormone replacement therapy. What possible drug interaction may the nurse anticipate?

Decreased thyroid drug activity

What are the symptoms of hypothyroidism? Select all that apply.

Depression Cold intolerance Dry, brittle hair and nails

Which symptoms are clinical indicators of Graves' disease? Select all that apply.

Diarrhea Flushing Heat intolerance Altered menstrual flow

The nurse teaches a nursing student about liotrix. Which statement made by the nurse is appropriate?

Liotrix contains T4 and T3 in a 4:1 ratio.

The nurse reviews a patient's laboratory report and notes elevated thyroxin levels. What condition does the patient have?

Graves' disease

The nurse is assessing a patient who has been taking propylthiouracil for the past 2 weeks and has normal thyroid-stimulating hormone (TSH) levels. For what symptom will the nurse primarily monitor the patient?

Heart palpitations

The nurse administers atenolol to a patient who has multinodular thyroid disease. Which parameter does the nurse assess to evaluate the therapeutic effect of the pharmacotherapy?

Heart rate

The nurse is caring for a patient who has myxedema. The nurse administers a hypothyroid drug and later learns that the drug was improperly mixed and that an increased dose of the drug was administered to the patient. For what symptoms will the nurse initially assess?

Increased heart rate

The nurse is assessing a patient who has loss of memory, hair loss, and yellow discoloration of the skin. Which laboratory findings will the nurse suspect from these observations?

Increased thyroid-stimulating hormone

The nurse is assessing a patient undergoing levothyroxine therapy. What symptom makes the nurse suspect excessive thyroid replacement?

Irritability

The nurse is caring for a patient who has just started taking levothyroxine. What assessment finding is priority for the nurse to address?

Irritability

The primary health care provider prescribes radioactive iodine to an adult patient who has thyroid cancer. What is the reason for prescribing this drug to the patient?

It takes up beta rays into the follicles of the thyroid gland.

The nurse prepares to administer an initial dose of propylthiouracil to a patient with toxic nodular disease of the thyroid gland. What baseline patient assessment is a priority for the nurse before the start of therapy?

Leukocyte count

The nurse is caring for a patient who has congenital hypothyroidism. Which medication will the nurse expect the primary health care provider to prescribe?

Levothyroxine

The nurse is reviewing the prescription of a patient who has myxedema coma. What drug will the nurse most likely expect the primary health care provider to prescribe to the patient?

Levothyroxine

Which drug used to treat hypothyroidism is also used to diagnose hyperthyroidism?

Levothyroxine

What assessment findings will the nurse expect in a child who has cretinism? Select all that apply.

Mental retardation Low metabolic rate

A patient with a thyroid disorder states, "I am unable to distinguish between the tastes of different foods." Which medication will the nurse expect is responsible for this condition?

Methimazole

The nurse is assessing a pregnant patient in the second trimester who has hyperthyroid activity. What will the nurse expect the primary health care provider to order?

Methimazole

The nurse is caring for a patient who is taking levothyroxine and warfarin. Which intervention is the highest priority for the nurse?

Monitor the patient for increased risk of bleeding.

The nurse is assessing a patient who has chest pain. After reviewing the patient's medical history, the nurse finds that the patient is receiving digoxin and levothyroxine therapy. What are other complications that the nurse may find in the patient? Select all that apply.

Palpitations Tachycardia Dysrhythmias

A patient who has been on propylthiouracil for 2 weeks approaches the nurse for a routine medical checkup. What is the priority assessment for this patient?

Platelet count

A patient with stage III laryngeal cancer underwent laryngectomy with concurrent removal of the thyroid gland. What type of hypothyroidism will occur in this case?

Primary hypothyroidism

A patient who has been taking levothyroxine is experiencing weight loss, tremors, and hypertension. Which pharmacokinetic property of levothyroxine is responsible for causing toxic manifestations?

Prolonged half-life of 10 days

Which medication is used to treat hyperthyroidism during the first trimester of pregnancy?

Propylthiouracil

A patient who is receiving thyroid replacement drugs has palpitations, tachycardia, sweating, and difficulty breathing. What are the immediate steps taken by the nurse in this situation? Select all that apply.

Provide artificial ventilation to the patient. Obtain an electrocardiogram of the patient

The nurse is providing prenatal counseling for a patient who has hyperthyroidism and is prescribed methimazole. The nurse instructs the patient to discuss discontinuing the medication with the provider in the event of conception. Which fetal abnormality is the nurse trying to prevent?

Scalp abnormality

A patient is taking an antithyroid medication. Which foods will the nurse teach the patient to avoid eating?

Shrimp cocktail, boiled lobster, spinach salad without dressing, milk

Which genitourinary adverse effects does the nurse expect in the patient who is on therapy with antithyroid medication? Select all that apply.

Smoky urine Decreased urinary output

In the process of thyroid hormone development, what happens after the synthesis of T3 and T4?

T3 and T4 are stored in a complex with thyroglobulin.

The nurse counsels a patient about preventing insomnia caused by liotrix. What is the nurse's best advice?

Take the drug before breakfast

The nurse is giving an intravenous injection of levothyroxine to a child who has congenital hypothyroidism. The prescription reads: levothyroxine, 0.1 mg, intravenous, once a day for 3 days. The drug is available as a 200-mcg vial that requires reconstitution with 5 mL of 0.9% NaCl. This will give a concentration of 40 mcg/mL. What quantity of the drug will the nurse administer per dose? Record your answer to one decimal place. _____ mL

The 200 mcg of powder present in the vial must be reconstituted with 5 mL of 0.9% NaCl. This makes a concentration of 40 mcg/mL. As we know, 1 milligram is equal to 1000 micrograms, so 0.1 mg = 100 mcg. If 1 mL = 40 mcg, then 2.5 mL of reconstituted drug contains 100 mcg = 0.1 mg. Therefore the nurse should administer 2.5 mL of medication intravenously to the child.

The nurse is caring for a patient who has hyperthyroidism and who has been prescribed propylthiouracil. What will the nurse do to prevent stomach upset in the patient?

The nurse administers the medication after meals.

What are the adverse effects of antithyroid medication? Select all that apply.

Vertigo Leukopenia Loss of taste

Which thyroid preparation, considered the purest form of thyroxine (T4), is the drug of choice for hypothyroidism?

Levothyroxine

What food should a patient avoid while taking antithyroid medications?

Seafood

The nurse finds that, after 6 months of treatment for hyperthyroidism, a patient has little evidence of hyperthyroidism. What does this imply regarding the patient's present condition?

The patient has met the predicted outcomes of the treatment regimen.

The nurse is assessing an older adult who has been taking liotrix for 6 months. The nurse finds that the patient has anxiety, tremors, and insomnia. What will the nurse interpret from these findings?

The patient is experiencing adverse effects of the thyroid drugs.

A patient with hypothyroidism has been taking 50 mg of levothyroxine for 2 years. On reviewing the lab reports, the nurse finds that the patient's thyroid hormone levels are constantly fluctuating, even though he takes the medication regularly. Which error during the self-administration of the medication may have caused this?

The patient takes 50 mg of levothyroxine of different brands.

The nurse observes that a patient has yellow dullness of the skin, weight gain, and severe hair loss. What will the nurse suspect?

The pt has hypothyroidism

During an assessment of a patient with hyperthyroidism, the nurse learns that the patient's provider has recommended thyroidectomy. What could be the reason for opting for such treatment for the patient?

The pt is pregnant

The nurse is caring for a patient who has hypothyroidism. The patient is also receiving digitalis therapy. The nurse advises the patient to discuss getting an electrocardiogram with the provider. What is the reason for this advice?

Thyroid drugs decrease serum digitalis levels.

The nurse is assessing a patient who has been prescribed thyroid replacement drugs for the first time. The nurse asks the patient to take the daily medication every morning on an empty stomach. What are the reasons for this instruction? Select all that apply.

To decrease the likelihood of insomnia To decrease the risk of drug-drug interactions To maintain consistent blood levels of the drug