Chapter 58: Thyroid Disorders

Question 1

1. A patient has a free T4 level of 0.6 ng/dL and a free T3 of 220 pg/dL. The patient asks the nurse what these laboratory values mean. How will the nurse respond?
   a.
   “These laboratory values indicate that you may have Graves’ disease.”
   b.
   “These results suggest you may have hyperthyroidism.”
   c.
   “We will need to obtain a total T4 and a total T3 to tell for sure.”
   d.
   “We will need to obtain a TSH level to better evaluate your diagnosis.”

Answer 1

D

Question 2

2.	A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats per minute, a blood pressure of 105/62 mm Hg, and a temperature of 96.2°F. The patient appears pale and complains of always feeling cold and tired. The nurse will contact the provider to discuss tests for which condition?
a.
Cretinism
b.
Graves’ disease
c.
Hypothyroidism
d.
Plummer’s disease

Answer 2

C

Question 3

3. The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient?
   a.
   Hypothyroidism is a normal effect of pregnancy and usually is of no consequence.
   b.
   Neuropsychologic deficits in the fetus can occur if the condition is not treated.
   c.
   No danger to the fetus exists until the third trimester.
   d.
   Treatment is required only if the patient is experiencing symptoms.

Answer 3

B

Question 4

4.	A nurse caring for a patient notes that the patient has a temperature of 104°F and a heart rate of 110 beats per minute. The patient’s skin is warm and moist, and the patient complains that the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will contact the provider to discuss:
a.
cretinism.
b.
Graves’ disease.
c.
myxedema.
d.
Plummer’s disease.

Answer 4

B

Question 5

5. A patient in her twenties with Graves’ disease who takes methimazole [Tapazole] tells a nurse that she is trying to conceive and asks about disease management during pregnancy. What will the nurse tell her?
   a.
   Methimazole is safe to take throughout pregnancy.
   b.
   Propylthiouracil should be taken throughout her pregnancy.
   c.
   The patient should discuss changing to propylthiouracil from now until her second trimester with her provider.
   d.
   The patient should discuss therapy with iodine-131 instead of medications with her provider.

Answer 5

C

Question 6

6. A nurse is teaching a patient who has been diagnosed with hypothyroidism about levothyroxine [Synthroid]. Which statement by the patient indicates a need for further teaching?
   a.
   “I should not take heartburn medication without consulting my provider.”
   b.
   “I should report insomnia, tremors, and an increased heart rate to my provider.”
   c.
   “If I take a multivitamin with iron, I should take it 4 hours after the Synthroid.”
   d.
   “If I take calcium supplements, I may need to decrease my dose of Synthroid.”

Answer 6

D

Question 7

7. A patient has been taking levothyroxine for several years and reports that “for the past 2 weeks, the drug doesn’t seem to work as well as before.” What will the nurse do?
   a.
   Ask the patient when the prescription was last refilled.
   b.
   Expect the patient to have an elevated temperature and tachycardia.
   c.
   Suggest that the patient begin taking calcium supplements.
   d.
   Tell the patient to try taking the medication with fo

Answer 7

A

Question 8

8.	A patient with hypothyroidism begins taking PO levothyroxine [Synthroid]. The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature of 97.2°F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request an order for which drug?
a.
Beta blocker
b.
Increased dose of PO levothyroxine
c.
Intravenous levothyroxine
d.
Methimazole [Tapazole]

Answer 8

C

Question 9

9.	A patient is admitted to the hospital and will begin taking levothyroxine [Synthroid]. The nurse learns that the patient also takes warfarin [Coumadin]. The nurse will notify the provider to discuss \_\_\_\_ the \_\_\_\_ dose.
a.
reducing; levothyroxine
b.
reducing; warfarin
c.
increasing; levothyroxine
d.
increasing; warfari

Answer 9

B

Question 10

10. An older adult patient is diagnosed with hypothyroidism. The initial free T4 level is 0.5 mg/dL, and the TSH level is 8 microunits/mL. The prescriber orders levothyroxine [Levothroid] 100 mcg/day PO. What will the nurse do?
    a.
    Administer the medication as ordered.
    b.
    Contact the provider to discuss giving the levothyroxine IV.
    c.
    Request an order to give desiccated thyroid (Armour Thyroid).
    d.
    Suggest that the provider lower the dose.

Answer 10

D

Question 11

11. A 1-year-old child with cretinism has been receiving 8 mcg/kg/day of levothyroxine [Synthroid]. The child comes to the clinic for a well-child checkup. The nurse will expect the provider to:
    a.
    change the dose of levothyroxine to 6 mcg/kg/day.
    b.
    discontinue the drug if the child’s physical and mental development are normal.
    c.
    increase the dose to accommodate the child’s increased growth.
    d.
    stop the drug for 4 weeks and check the child’s TSH level.

Answer 11

A

Question 12

12. The nurse prepares a patient with Graves’ disease for radioactive iodine (131I) therapy. Which statement made by the patient best demonstrates understanding of 131I therapy?
    a.
    “I will have to isolate myself from my family for 1 week so that I don’t expose them to radiation.”
    b.
    “This drug will be taken up by the thyroid gland and will destroy the cells to reduce my hyperthyroidism.”
    c.
    “This drug will help reduce my cold intolerance and weight gain.”
    d.
    “I will need to take this drug on a daily basis for at least 1 year.”

Answer 12

B

Question 13

13. A nurse is teaching a patient who will begin taking methimazole [Tapazole] for Graves’ disease about the medication. Which statement by the patient indicates understanding of the teaching?
    a.
    “Because of the risk for liver toxicity, I will need frequent liver function tests.”
    b.
    “I should report a sore throat or fever to my provider if either occurs.”
    c.
    “I will need a complete blood count every few months.”
    d.
    “It is safe to get pregnant while taking this medication.”

Answer 13

B

Question 14

14.	A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105°F. The patient’s skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer:
a.
intravenous levothyroxine.
b.
iodine-131 (131I).
c.
methimazole [Tapazole].
d.
propylthiouracil (PTU

Answer 14

D