Chapter 14 - Book Qs & Evolve Qs

Question 1

1. What is the goal of therapy with thyroid hormone agonists?

A. To cure hypothyroidism B. To reduce the size of the goiter C. To increase metabolism to normal levels D. To suppress natural thyroid hormone secretion from the thyroid gland

Answer 1

C

Question 2

2. Which problem is an adverse effect of levothyroxine (Synthroid)?

A. Obesity B. Heart failure C. Type 2 diabetes mellitus D. Venous thromboembolism

Answer 2

B

Question 3

3. A patient taking levothyroxine sodium (Synthroid) reports all of the following changes. Which one should you report to the prescriber as an indication that the dose may be too high?

A. An intended weight loss of 6lb over a 3-week period B. Increased interest in sexual activity C. Increased thirst and urine output D. Nightly insomnia

Answer 3

D

Question 4

4. Which electrolytes are most important to monitor for a patient who is taking fludrocortisone (Florinef) as hormone replacement therapy for aldosterone deficiency?

A. Calcium and chloride B. Sodium and potassium C. Glucose and glucagon D. Magnesium and phosphorus

Answer 4

B

Question 5

5. Which adrenal hormone-suppressing drug can cause pregnancy loss?

A. aminoglutethimide (Cytadren) B. spironolactone (Aldactone) C. mifepristone (Korlym) D. mitotane (Lysodren)

Answer 5

C. mifepristone (Korlym)

Question 6

6. Which drug used to treat adrenal gland problems can cause the side effect of bloody urine?

A. aminoglutethimide (Cytadren) B. fludrocortisone (Florinef) C. mifepristone (Korlym) D. mitotane (Lysodren)

Answer 6

D

Question 7

7. Which precaution is most important to teach a patient taking hormone replacement therapy for hypothyroidism?

A. Report episodes of constipation or cold intolerance to the prescriber immediately. B. Be sure to take the drug with a full glass of water and drink at least 2L daily. C. Call the prescriber if you are unable to take the drug dose orally. D. Do not drink alcoholic beverages while taking this drug.

Answer 7

C

Question 8

8. A patient is newly pregnant and tells you that she has been taking levothyroxine (Synthroid) for the past 12 years for hypothyroidism. She asks you whether she should take this drug during pregnancy and while breastfeeding. What is your best response?

A. “This drug should not be taken during pregnancy or while breastfeeding.” B. “This drug can be taken during pregnancy but not while breastfeeding.” C. “This drug can be taken during pregnancy and while breastfeeding.” D. “This drug should not be taken during pregnancy but can be taken while breastfeeding.”

Answer 8

B

Question 9

9. A mother whose infant was born with hypothyroidism asks how long her baby girl will have to take thyroid hormone replacement therapy. What is your best response?

A. “Because the thyroid gland will increase in size during puberty, she can stop taking the drug after she starts menstruating.” B. “Most infants develop normal thyroid function by 1 year of age, so she will probably not have to take the drug after her first birthday.” C. “It is too early in the therapy regimen to tell how long thyroid hormone replacement therapy will be needed.” D. “Because she was born without a thyroid gland, she will have to take the drug for the rest of her life.”

Answer 9

D

Question 10

10. Which precaution is important to teach a patient taking propylthiouracil (Propacil) for hyperthyroidism before surgery?

A. Avoid crowds and people who are ill. B. Expect your urine to become an orange-red color. C. Report a loss of taste sensation to the prescriber immediately. D. If you develop diarrhea, skip the drug until the diarrhea has resolved.

Answer 10

A

Question 11

11. Which laboratory value indicates that drug therapy for adrenal hypofunction is effective?

A. International normalized ratio (INR) is 0.9 B. Serum potassium is 4.5mEq/L C. Serum sodium is 131mEq/L D. Hematocrit is 44%

Answer 11

B

Question 12

12. Why are the effects of methimazole (Tapazole) delayed for the first 3 weeks?

A. The metabolism of the patient with hyperthyroidism is so high that the drug is eliminated before it has a chance to work. B. The dose of the drug has to be increased slowly to reach an effective blood level without causing side effects. C. Time is needed for the drug to reduce the size of the thyroid gland.

Answer 12

D

Question 13

The nurse is discharging a patient with a prescription for a thyroid replacement drug. The nurse should tell the patient to notify his or her prescriber if what signs or symptoms should occur? (select all that apply)

Pulse rate that is 20 beats higher than normal and that lasts for 1 day
Pulse rate that is 20 beats higher than normal and that lasts for 1 week
Irregular pulse rate
Vomiting
Improved, regular bowel movements

Answer 13

Pulse rate that is 20 beats higher than normal and that lasts for 1 week

Irregular pulse rate

Vomiting

Question 14

Which actions, side effects, conditions, or problems are associated with perimenopausal hormone replacement drugs? (select all that apply)

The primary purpose of this therapy is to reduce the risk for pregnancy.

The use of conjugated estrogens lowers the blood levels of follicle-stimulating hormone.

Patients should be cautioned not to smoke cigarettes while taking these drugs.

Patients taking these drugs must avoid all alcoholic beverages.

Women who take these drugs have a greater risk for lung and colon cancers.

This therapy should be used with caution or not used at all in patients with hypertension.

Women who have had a hysterectomy should only take estrogen along with progesterone.

Women who take estrogen-based hormone replacement therapy have a lower risk for osteoporosis and heart disease.

Answer 14

The use of conjugated estrogens lowers the blood levels of follicle-stimulating hormone.

Patients should be cautioned not to smoke cigarettes while taking these drugs.

This therapy should be used with caution or not used at all in patients with hypertension.

Question 15

The nurse is reviewing care of patients with thyroid disease. The nurse knows that infants, children, and pregnant women who take thyroid hormone replacement drugs need a __drug amount per kilogram of body weight than an adult.

higher

lower

similar

none; it should not be given to children or pregnant women

Answer 15

higher

Children may develop hypothyroidism or may have been born with the problem. They must take thyroid hormone replacement drugs for their entire life. During infancy and early childhood when the patient is going through periods of rapid growth, he or she actually needs a higher drug amount per kilogram of body weight than does an adult. Women with hypothyroidism usually have difficulty becoming pregnant. Once pregnant, however, thyroid hormone replacement drugs are safe to take during pregnancy. In fact, for a pregnant woman who has hypothyroidism, not taking the drug can lead to problems with the pregnancy and the fetus. Pregnant women often need a higher dose of the drug. Because thyroid hormone replacement drugs can enter breast milk and increase the infant’s metabolism, the mother taking these drugs should not breastfeed.

Question 16

The nurse is discharging a patient who has been given a prescription for a drug to suppress adrenal hormone production. What is the most important point the nurse needs to teach the patient?

To take the drug in the morning on an empty stomach.

To learn the signs and symptoms of adrenal insufficiency.

To have blood pressure taken every other day to check for high readings.

To make sure to have magnesium level tested as ordered.

Answer 16

To learn the signs and symptoms of adrenal insufficiency.

It is most important for a patient taking any drug to suppress adrenal hormone production to know about the signs and symptoms of adrenal insufficiency. These include hypoglycemia, salt craving, muscle weakness, hypotension (not hypertension), and fatigue.These drugs alter blood levels of sodium and potassium and not magnesium. So remind patients to keep all appointments for laboratory blood work. Drugs to suppress adrenal hormone production can also cause nausea, vomiting, and other gastrointestinal upsets, so patients need to take these drugs with food and not on an empty stomach. In addition, women of childbearing age who are sexually active need to use two reliable forms of birth control while taking mifepristone.

Question 17

The nurse is caring for a patient with a thyroid problem. The nurse knows that what factors can trigger a thyroid crisis or thyroid storm? (select all that apply)

Missed dose of thyroid replacement hormone
Pregnancy
Infection
Trauma
Thyroidectomy

Answer 17

Pregnancy
Infection
Trauma

Question 18

The nurse is instructing a patient about dietary iodine. The nurse tells the patient what items are the most common sources of dietary iodine? (select all that apply)

Saltwater fish
Enhanced salt
Red meat
Whole grain
Paprika

Answer 18

Saltwater fish
Enhanced salt

The most common dietary sources of iodine are saltwater fish and table salt to which iodide is added. Thyroid cells may fail to produce enough thyroid hormones because they have been damaged and no longer function, or because the person’s diet does not include enough iodine or tyrosine to make thyroid hormones. Red meat is a good source of protein and iron, but not iodine. Whole grain is a good source of bran and vitamins, but not iodine. Although it is similar in color to antiseptic iodine, paprika is not a good source of dietary iodine.

Question 19

The nurse is discharging a patient with a prescription for a thyroid hormone (TH). What body functions are controlled by this type of drug? (select all that apply)

Digestion
Bone formation
Memory and learning
Respiration
Heart muscle function

Answer 19

Bone formation
Memory and learning
Respiration
Heart muscle function

Thyroid hormones regulate whole body metabolism and increase the rate of metabolism in any cell that they enter by speeding up the energy use and work output of each cell. Important functions controlled by thyroid hormones include: maintaining heart and skeletal muscle function; assisting in brain development before birth and during early childhood; maintaining brain function throughout the life span including the ability to think, remember, and learn; ensuring continued production of other hormones; and maintaining effective respiratory function and cell uptake of oxygen. TH has no effect on digestion.

Question 20

The nurse is about to give a thyroid replacement drug to a patient. What administration consideration is important for the nurse to remember?

Give with a fiber supplement.

Give in the evening.

Give with warfarin (Coumadin).

Give after taking vital signs.

Answer 20

Give after taking vital signs.

Check the patient’s blood pressure and heart rate and rhythm to determine whether the drug is working and if there are side effects. Ask the patient whether he or she has any chest pain or discomfort. This symptom may be the first indication of an adverse cardiac effect. Ensure that the drug is given 2 hours before a meal or fiber supplement or at least 3 hours after a meal or fiber supplement. Food and fiber impair the absorption of thyroid hormone agonists from the intestinal tract. The dose for the first several weeks is low and is increased slowly every 2 to 3 weeks until the patient has normal blood levels of TH and signs of normal metabolism. Teach patients not to increase the dose beyond what is prescribed for them and to check their own pulse each morning before taking the drug and again each evening before going to bed. If the pulse rate becomes 20 beats higher than the normal rate for 1 week or if it becomes consistently irregular, they should notify their prescriber and go to the emergency department immediately if they have chest pain. Teach patients that they need to take the drug daily to maintain normal body function and not stop the drug suddenly or to change the dose (up or down) without contacting their prescriber. They do not need to be taken with warfarin.

Question 21

The pharmacy has sent a generic brand of thyroid replacement drug that is different from what the patient takes at home. What should the nurse do next?

Give the medication as long as it is the same drug type and dose.

Hold the drug and contact the prescriber immediately.

Tell the patient to take his or her own medication from home.

Ask the pharmacy to send the same drug brand that the patient takes at home.

Answer 21

Ask the pharmacy to send the same drug brand that the patient takes at home.

Never substitute one type or brand of thyroid hormone replacement drug with another. Drug strengths vary (e.g., liothyronine is four times as potent as levothyroxine), and patient responses vary. Have the pharmacy to send the same drug brand that the patient takes at home. Do not give the medication even if it is the same drug type and dose, it must be exactly the same drug as the patient takes at home. The prescriber does not need to be contacted. Institutions do not allow patients to take their own medication from home, unless with a specific prescriber order and after the medication has been personally verified by the pharmacy.

Question 22

The nurse is caring for a patient with Graves’ disease. What is the most common type of disorder related to this disease?

Hypothyroidism

Thyrotoxicosis

Myxedema

Thyroid storm

Answer 22

Thyrotoxicosis

Graves’ disease is the most common type of hyperthyroidism. Hyperthyroidism is an increase in thyroid gland activity causing high blood levels of thyroid hormones (T3 and T4) and symptoms of increased metabolism. Another name for hyperthyroidism is thyrotoxicosis because the side effects of excessive thyroid hormones can cause toxic side effects to some organs. This health problem is also called an overactive thyroid. Thyroid cells may produce excessive thyroid hormones for several reasons. Excessive production of thyroid hormones makes the body metabolism much faster than normal and makes every organ work harder, especially the heart. Patients may also have a goiter. Additional symptoms that occur only with hyperthyroidism caused by Graves’ disease include bulging or protruding eyes (exophthalmos) and blurred vision. Myxedema is a severe type of hypothyroidism and not hyperthyroidism and requires immediate medical attention. Thyroid storm is an extreme state of hyperthyroidism and is not associated with Graves’ disease.

Question 23

Which actions, side effects, conditions, or problems are associated with thyroid-suppressing drugs? (select all that apply)

Can cause birth defects.

Work by destroying cells within the thyroid gland.

Begin to lower thyroid hormone levels within the first 24 hours after taking the drug.

Patients have an increased risk for infection while taking one of these drugs.

A yellow tinge to the soles of the feet is an indication to stop taking these drugs.

Any older adult taking one of these drugs along with warfarin should have his or her international normalized ratio (INR) checked weekly.

Answer 23

Can cause birth defects.

Patients have an increased risk for infection while taking one of these drugs.

Any older adult taking one of these drugs along with warfarin should have his or her international normalized ratio (INR) checked weekly.

Question 24

The nurse is caring for a patient taking thyroid hormone replacement drugs. The nurse knows that people who are taking these drugs typically must __ anticoagulant doses and __ diabetes medication doses.

decrease, decrease

increase, increase

decrease, increase

increase, decrease

Answer 24

decrease, increase

People who are taking thyroid hormone replacement drugs typically must decrease anticoagulant doses and increase diabetes medication doses. Thyroid hormone agonists enhance the action of drugs that reduce blood clotting (anticoagulants), especially warfarin (Coumadin), leading to excessive bruising and bleeding. These patients need to be checked at least once each shift for any sign of increased bleeding from the gums; unusual or excessive bruising anywhere on the skin; bleeding around IV sites or for more than 5 minutes after discontinuing an IV; and for the presence of blood in urine, stool, or vomitus. Thyroid hormone replacement drugs change the effectiveness of insulin and other drugs for diabetes, and often drugs for diabetes need to be increased to prevent high blood sugar levels (hyperglycemia).

Question 25

The nurse is caring for a patient with thyroid problems. What is the action of thyroid hormone agonists?

Mimics T3 and T4

Slows down energy use

Only goes to the thyroid gland

Suppresses the genes for metabolism

Answer 25

Mimics T3 and T4

Thyroid hormone replacement drugs are thyroid hormone agonists, which mimic the effect of thyroid hormones (T3 and T4), helping to regulate metabolism. They speed up and not slow down energy use and work output of each cell. They do not go directly to the thyroid gland but work just like the patient’s own thyroid hormones by entering the blood and going into all cells. Then they bind to receptors and activate and not suppress the genes for metabolism.

Question 26

The nurse is caring for a patient recently diagnosed with hypothyroidism and is prescribed a thyroid hormone replacement drug. What is the most important instruction the nurse needs to give the patient?

Always take the drug with food

Make sure to take the drug every other day

If you cannot take the drug orally, then get an intravenous dose of the drug

If you get chest pain, go to the emergency department (ED) immediately

Answer 26

If you get chest pain, go to the emergency department (ED) immediately.

Tell patients to go to the emergency department immediately if they start to have chest pain. This symptom may be the first indication of an adverse cardiac effect because increased metabolic rate and cardiac activity occur with this drug. Taking the drug with food or with a fiber supplement reduces the absorption of the drug. The drug must be taken daily and not every other day to maintain normal body function. If the drug cannot be taken orally, then contact the prescriber to get a parenteral and not intravenous dose of the drug.

Question 27

The nurse is caring for a patient who is taking an endocrine medication. The nurse knows that what type of endocrine medication can cause an increased risk of infection?

Thyroid hormone replacement drugs

Thyroid suppression drugs

Perimenopausal hormone replacement drugs

Conjugated estrogens

Answer 27

Thyroid suppression drugs

Thyroid-suppressing drugs also suppress bone marrow, leading to an increased risk to the patient for infection. These drugs also reduce the amount of blood cells leading to anemia. Thyroid-suppressing drugs, especially propylthiouracil, can also be hepatotoxic (liver toxic). Less often, these drugs can also damage the kidneys. Thyroid replacement hormones do not cause an increased risk of infection in patients. Perimenopausal hormone replacement drugs including conjugated estrogens do not cause an increased risk of infection in patients.

Question 28

The nurse admits a patient to the unit who has a goiter. The nurse knows that a goiter can be a symptom of what conditions? (select all that apply)

Hyperthyroidism
Hypothyroidism
Normal thyroid activity
Absence of a thyroid gland
Graves’ disease

Answer 28

Hyperthyroidism
Hypothyroidism
Graves’ disease

Question 29

Which causes, symptoms, and management strategies are associated with hypothyroidism? (select all that apply)

T3 (triiodothyronine) level of 90 ng/dL
Often caused by an infection of the thyroid gland
Hypertension
Can be corrected with thyroid surgery
Dietary deficiency of iodide can cause a goiter
Untreated hypothyroidism in infants can lead to mental retardation
Hypothyroidism is more common in girls and women than in boys and men
Constipation

Answer 29

Often caused by an infection of the thyroid gland

Dietary deficiency of iodide can cause a goiter

Untreated hypothyroidism in infants can lead to mental retardation

Hypothyroidism is more common in girls and women than in boys and men

Constipation

Question 30

The nurse is giving a thyroid-suppressing drug to a patient. How long does it typically take for patients to show improvement with this drug?

36 hours

3 days

3 weeks

3 months

Answer 30

3 weeks

The effects of thyroid-suppressing drugs are usually not seen until 3 to 4 weeks after they have been taken daily. Thyroid-suppressing drugs enter the thyroid gland and combine with the enzyme responsible for connecting iodine (iodide) with tyrosine to make active T3 and T4. This action keeps the enzyme so busy working on the drug that it does not have the opportunity to make thyroid hormones already formed and stored in the thyroid gland. So the patient will continue to have symptoms of hyperthyroidism. Thyroid-suppressing drugs take longer than 36 hours or 3 days to work. Three months is more than enough time for thyroid-suppressing drugs to begin working.

Question 31

For exam, just know how do we treat Adrenal Gland Hypofunction?

Answer 31

Hormone Replacement Drugs/Therapy…

Corticosteroids! (improves cortisol deficiency)

Question 32

For exam, just know how do we treat Adrenal Gland Hyperfunction?

Answer 32

Some drugs suppress cortisol production, directly or indirectly.

Drugs (like mifepristone & mitotane) block the production of cortisol!