Lilley Chapter 32: Thyroid and Anti-thyroid Drugs Flashcards
Which statement by the patient indicates an understanding of discharge instructions given by the nurse about the newly prescribed medication levothyroxine (Synthroid®)?
A. “I will stop the medication immediately if I feel pain or weakness in my muscles.”
B. “I will take this medication in the morning so it does not affect my sleep at night.”
C. “I will take a double dose to make up for the missed one.”
D. “I can expect improvement of my symptoms within 1 week.”
B. “I will take this medication in the morning so it does not affect my sleep at night.”
Levothyroxine increases basal metabolic rate and thus may cause insomnia. Patients should not double the dose or stop taking the medication abruptly. It may take up to 4 weeks for a therapeutic response to occur.
The nurse would suspect a patient is taking too much levothyroxine (Synthroid) when the patient exhibits which adverse effect?
A. Weight gain
B. Lethargy
C. Feeling cold
D. Irritability
D. Irritability
Irritability is a symptom of hyperthyroidism and may indicate toxicity of the medication. The other choices are signs of hypothyroidism.
For a patient taking levothyroxine 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. Increased bruising
Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing the effects of warfarin and the risk of bleeding. Bleeding commonly presents as bruising.
A patient receiving propylthiouracil (PTU) asks the nurse, “How does this medication relieve symptoms?” What is the nurse’s best response?
A. “PTU helps your thyroid gland synthesize and use iodine, which produces hormones better.”
B. “PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal.”
C. “PTU removes thyroid hormones that are already circulating in your bloodstream, thus decreasing the adverse effects of this medication.”
D. “PTU causes the pituitary gland to secrete thyroid-stimulating hormone, which blocks the production of hormones by the thyroid gland.”
B. “PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal.”
PTU is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate present hormone.
The nurse is teaching a patient taking an antithyroid medication to avoid food items high in iodine. Which food should the nurse instruct the patient to avoid?
A. Eggs
B. Milk
C. Seafood
D. Chicken
C. Seafood
Seafood contains high amounts of iodine. The other choices do not.
Which patient statement demonstrates an understanding of radioactive iodine (iodine-131) therapy?
A. “This drug will be taken up by the thyroid gland and destroy thyroid tissue.
B. “This drug will help decrease my cold intolerance and weight gain.”
C. “I will isolate myself from my family for 1 week so there is no risk of radiation exposure.”
D. “I will need to take this drug on a daily basis for at least 1 year.”
A. “This drug will be taken up by the thyroid gland and destroy thyroid tissue.
Radioactive iodine is an antithyroid medication that is administered orally. It concentrates in the thyroid gland, where its radioactivity destroys thyroid tissue in a process known as ablation.
When assessing for potential serious adverse effects of PTU, the nurse will monitor which laboratory test?
A. Serum electrolytes
B. Kidney function
C. Complete blood count (CBC)
D. Brain natriuretic peptide
C. Complete blood count (CBC)
With antithyroid medications, the nurse should monitor for possible serious adverse reactions such as agranulocytosis, leukopenia, and thrombocytopenia. An abnormal CBC result would indicate bone marrow dysfunction.
The nurse is reviewing the adverse effects of antithyroid medications for a patient prescribed PTU. What potential serious adverse effects should the nurse discuss with the patient during discharge teaching? (Select all that apply.)
A. Kidney damage
B. Liver toxicity
C. Bone marrow toxicity
D. Joint pain
E. Increased urination
B, C, D. The most damaging or serious adverse effects of the antithyroid medications are liver and bone marrow toxicity. Myalgias and arthralgias (joint pain) may also occur with PTU.
