NURS 317 Unit 3 Chapter 37 Pharm Point Questions

Question 1

A client has been admitted with signs and symptoms of hypothyroidism. When planning this client’s care, what nursing diagnosis should the nurse include?

A) Risk for falls related to hypotension

B) Anxiety related to sympathetic nervous stimulation

C) Functional urinary incontinence related to detrusor stimulation

D) Chronic confusion related to central nervous system depression

Answer 1

A) Risk for falls related to hypotension

Rationale:Hypothyroidism is associated with hypotension, which creates a risk for falls. Apathy and depression may occur, but chronic confusion is atypical. Urinary effects are rare, and anxiety is more closely associated with hyperthyroidism.

Question 2

A positive Chvostek sign suggests hypercalcemia.

A) FALSE

B) TRUE

Answer 2

A) FALSE

Rationale:Hypocalcemia is indicated by a positive Chvostek sign.

Question 3

Thyroid hormones can be measured as protein-bound iodine.

A) FALSE

B) TRUE

Answer 3

B) TRUE

Rationale:When thyroid hormone is needed in the body, the stored thyroid hormone molecule is absorbed into the thyroid cells, where the T3 and T4 are broken off and released into circulation. These hormones are carried on plasma proteins, which can be measured as protein-bound iodine (PBI) levels.

Question 4

A client has been diagnosed with low bone density and daily intranasal administration of calcitonin salmon has been prescribed. When reviewing the client’s medication record, the nurse notices that the client also takes a beta-adrenergic blocker and a loop diuretic for the treatment of hypertension. What is the nurse’s best action?

A) Administer each of the client’s medications as prescribed.

B) Contact the care provider to question the use of calcitonin in this client.

C) Ensure that the calcitonin is given at least 30 minutes before the beta-blocker and diuretic.

D) Contact the care provider to determine whether the diuretic should be put on hold.

Answer 4

A) Administer each of the client’s medications as prescribed.

Rationale:There have been no clinically important drug–drug interactions reported with the use of calcitonin. There is no clear reason to question this order, and the drugs do not have to be separated by time.

Question 5

The nurse is caring for a client newly diagnosed with hypothyroidism who is prescribed levothyroxine. What drug teaching will the nurse provide this client? Select all that apply.

A) “Take the tablet on a full stomach.”

B) “You will need to take this drug every day for the rest of your life.”

C) “Initially you will need to have thyroid levels drawn daily.”

D) “Take the tablet at the same time every day.”

E) “Take the medication with a full glass of water.”

Answer 5

B) “You will need to take this drug every day for the rest of your life.”
D) “Take the tablet at the same time every day.”

Rationale:Adults who require thyroid replacement therapy need to understand that this will be a lifelong replacement need. An established routine of taking the tablet first thing in the morning may help the client to comply with the drug regimen. These drugs should always be taken with a full glass of water to decrease the risk of esophageal atresia. Thyroid levels are generally drawn every few weeks to months initially because introduction of the exogenous hormone causes a period of hormonal adjustment that does not stabilize immediately. The drug should be taken on an empty stomach to promote absorption.E) “Take the medication with a full glass of water.

Question 6

What would the nurse expect to assess if a client was receiving too much methimazole?

A) Nervousness

B) Decreased appetite

C) Flushed warm skin

D) Tachycardia

Answer 6

B) Decreased appetite

Rationale:Decreased appetite is associated with hypothyroidism, suggesting that the client is receiving too much methimazole, an antithyroid drug. Nervousness, flushed skin, and tachycardia would indicate hyperthyroidism, suggesting that the client is not receiving enough methimazole rather than too much.

Question 7

Calcitonin balances the effects of parathyroid hormone.

A) FALSE

B) TRUE

Answer 7

B) TRUE

Rationale:The thyroid gland is made up of cells arranged in circular follicles. The center of each follicle is composed of colloid tissue, in which the thyroid hormones produced by the gland are stored. These cells produce the hormone calcitonin, which affects calcium levels and acts to balance the effects of the parathyroid hormone parathormone.

Question 8

The nurse is assessing a client receiving strong iodide solution. What would alert the nurse to the possible development of iodism? Select all that apply.

A) Salivary gland swelling

B) Sore teeth

C) Throat burning

D) Constipation

E) Metallic taste

Answer 8

B) Sore teeth
C) Throat burning
E) Metallic taste

Rationale:Signs of iodism include a metallic taste, burning mouth and throat, sore teeth and gums, head cold symptoms, stomach upset, and diarrhea. Salivary gland swelling is an adverse effect of strong iodide solution but not an indication of iodism.

Question 9

The care team is planning the medication regimen for a client with hypothyroidism. What assessment best addresses the possible adverse effects of using liotrix?

A) “Do you have any allergies to shellfish or contrast solution?”

B) “Do you do shift work or have significant disruptions in your sleep cycle.”

C) “Do you have any history of heart disease?”

D) “Are you currently taking any vitamin supplements?”

Answer 9

C) “Do you have any history of heart disease?”

Rationale:Liotrix is contraindicated in clients with heart disease. Client variables related to sleep patterns, vitamins, or allergies would not necessary contraindicate its use.

Question 10

A client is receiving calcitonin by IM injection. The nurse would expect the drug to exert its peak action within which time frame?

A) 1 to 2 hours

B) 3 to 4 hours

C) ½ to 1 hour

D) 2 to 3 hours

Answer 10

B) 3 to 4 hours

Rationale:Calcitonin by IM injection peaks in 3 to 4 hours.

Question 11

Graves disease is the most common cause of hyperthyroidism.

A) FALSE

B) TRUE

Answer 11

B) TRUE

Rationale:Graves disease, a poorly understood condition that is thought to be an autoimmune problem, is the most common cause of hyperthyroidism.

Question 12

An 85-year-old long-term care resident with a diagnosis of osteoarthritis has been taking alendronate for several years. The client’s most recent laboratory testing reveals a serum calcium level of 6.1 mg/dL. What is the nurse’s best action?

A) Administer the alendronate with a calcium supplement.

B) Recognize this finding as evidence of therapeutic effect.

C) Assess the client for signs and symptoms of hypercalcemia.

D) Contact the provider to check whether the alendronate should be withheld.

Answer 12

D) Contact the provider to check whether the alendronate should be withheld.

Rationale:A bisphosphonate could exacerbate the client’s hypocalcemia. The nurse should consequently collaborate with the care provider. Hypocalcemia is a not a desired effect of the drug. Alendronate should not be taken with other supplements, which would not be beneficial.

Question 13

What does the nurse identify as being stored in the follicular cells of the thyroid? Select all that apply.

A) Calcitonin

B) T4

C) Iodine

D) Parathormone

E) T3

Answer 13

B) T4
E) T3

Rationale:T3 and T4 are produced by the thyroid gland and stored in the follicular cells. The parafollicular cells of the thyroid produce calcitonin. Parathormone is produced by the parathyroid glands. Iodine is supplied by the diet.

Question 14

The nurse receives an order to administer 15 mcg/kg/day of levothyroxine to a 4-year-old child who weighs 23 kg. How many micrograms of medication will the nurse administer?
_____________ mcg

Answer 14

345mg

Rationale:Calculate the proper dosage by multiplying weight in kilograms by micrograms per kilogram to administer. 15 × 23 = 345 mcg.

Question 15

The nurse is describing the normal physiology of the thyroid gland to a client. What should the nurse teach the client?

A) “T3 is less common, but more physiologically active, than T4.”

B) “More T3 is released into circulation than T4.”

C) “T3 and T4 are attached to glucose for transport throughout the body.”

D) “Thyroid hormone is released as T3 and then subsequently converted into T4.”

Answer 15

A) “T3 is less common, but more physiologically active, than T4.”

Rationale:T3 is approximately four times more active than T4, though it exists in smaller quantities. Most T4 is converted into T3. T3 and T4 are carried on plasma proteins, not glucose.

Question 16

The nurse is teaching a client who is prescribed calcitriol about the drug. Which client statement indicates that the teaching was successful?

A) “I must take the drug on an empty stomach.”

B) “I need to use an antacid that contains magnesium to prevent problems.”

C) “I need to limit the amount of dairy products that I eat.”

D) “I need to have my calcium levels checked periodically.”

Answer 16

D) “I need to have my calcium levels checked periodically.”

Rationale:Calcitriol increases serum calcium levels; therefore, periodic monitoring is important to ensure effectiveness of therapy without causing hypercalcemia. The drug may be taken with food if GI upset occurs. Antacids containing magnesium should be avoided due to the increased risk for hypermagnesemia. Calcitriol is often combined with dietary supplementation of calcium. Dairy products are a good source of calcium and should not be limited.

Question 17

A client has become pregnant for the first time, and prenatal assessment reveals that she has low thyroid hormone levels. What principle will guide the client’s subsequent treatment?

A) Levothyroxine is contraindicated because of the suspected teratogenic effects.

B) The client cannot begin taking levothyroxine until after delivery.

C) The client cannot begin taking levothyroxine until weaning her infant.

D) Levothyroxine can safely be administered during pregnancy.

Answer 17

D) Levothyroxine can safely be administered during pregnancy.

Rationale:Levothyroxine can safely be taken during pregnancy. Caution should be exercised during breast-feeding, but it is not absolutely contraindicated.

Question 18

The nurse is caring for a client with osteoporosis who has been prescribed teriparatide. The nurse would expect to administer this drug:

A) as a one-time intravenous infusion.

B) intranasally.

C) orally, first thing each morning.

D) subcutaneously, once per day.

Answer 18

D) subcutaneously, once per day.

Rationale:Teriparatide is administered by subcutaneous injection, once per day. It is not available for IV, intranasal, or oral administration.

Question 19

The client and spouse are seen in the clinic and tell the nurse the client has been lethargic, weak, and anorexic for several weeks. The spouse also describes some behaviors described as “bizarre.” What diagnostic testing may reveal the source of the client’s change in health status?

A) Assessment of magnesium levels

B) Assessment of serum calcium levels

C) Bone density testing

D) Assessment of phosphorus levels

Answer 19

B) Assessment of serum calcium levels

Rationale:Signs and symptoms of hypercalcemia include lethargy, personality and behavior changes, polydipsia, stupor, coma, hypertension, shortening of the QT interval, atrioventricular block, anorexia, nausea, vomiting, constipation, muscle weakness, muscle atrophy, ataxia, loss of muscle tone, polyuria, flank pain, kidney stones, acute and/or chronic renal insufficiency osteopenia, and osteoporosis. These symptoms are not suggestive of disruptions to magnesium and phosphorus levels. Bone density may be affected by calcium levels but would not diagnose an imbalance in calcium levels.

Question 20

The nurse is caring for an 84-year-old client diagnosed with Graves disease. The client has multiple comorbidities and is consequently not a candidate for surgery. What is the antithyroid drug of choice for this client?

A) Sodium iodide I

B) Strong iodine solution

C) Methimazole

D) Propylthiouracil

Answer 20

A) Sodium iodide I

Rationale:If antithyroid agents are needed, sodium iodide I may be the drug of choice because it has fewer adverse effects than the other agents and surgery. The client should be monitored closely for the development of hypothyroidism, which usually occurs within a year after initiation of antithyroid therapy. Methimazole, propylthiouracil, and strong iodine solution are all antithyroid drugs but are not the drug of choice for the older adult client

Question 21

The nurse is reviewing the client’s medication history. The client is to receive ibandronate. What medications would the nurse identify as possibly interfering with the drug’s absorption? Select all that apply.

A) Multivitamins

B) Antacids

C) Calcium

D) Aspirin

E) Iron

Answer 21

A) Multivitamins
B) Antacids
C) Calcium
E) Iron

Rationale:Antacids, iron, calcium, and multivitamins can decrease the absorption of oral bisphosphonates, such as ibandronate. Aspirin increases the GI distress associated with bisphosphonates but does not affect absorption.

Question 22

A client with Paget disease experiences bone pain after taking alendronate. What is the nurse’s priority response?

A) “You need to make sure that you sit upright for 30 minutes after taking the drug.”

B) “You might be experiencing a significant increase in your calcium levels.”

C) “This pain indicates that you need an increased dosage of the drug.”

D) “This pain should begin to subside after a few days to a few weeks.”

Answer 22

D) “This pain should begin to subside after a few days to a few weeks.”

Rationale:An increase in bone pain occurs in clients with Paget disease, but this effect usually subsides after a few days to a few weeks. Bone pain does not indicate that an increased drug dosage is needed. Sitting upright for at least 30 minutes after taking the drug will reduce the client’s risk for esophageal erosion but does not address the client’s pain. Bone pain may occur with hypocalcemia, but this is not the underlying reason for this complaint in this situation.

Question 23

A client is receiving a thyroid hormone to treat hypothyroidism. What finding would indicate to the nurse that the client may need a reduced dosage of the drug?

A) Intolerance to cold

B) Pale, dry skin

C) Slowed reflexes

D) Tachycardia

Answer 23

D) Tachycardia

Rationale:Tachycardia suggests hyperthyroidism due to excessive thyroid hormone; this would require a reduction in dosage. Slowed reflexes; pale, dry skin; and intolerance to cold would suggest hypothyroidism and drug ineffectiveness.

Question 24

A postmenopausal woman with osteoporosis is prescribed calcitonin salmon. What education should the nurse provide?

A) “You might get a rash at first, but it will subside with time.”

B) “Limit your intake of dairy products until you know how you respond to the drug.”

C) “You’ll need to have your thyroid levels measured every 4 weeks.”

D) “Ensure that you alternate nostrils daily.”

Answer 24

D) “Ensure that you alternate nostrils daily.”

Rationale:Calcitonin salmon is administered intranasally. A rash is not expected, and dairy products would be beneficial, not harmful. Thyroid hormone levels are irrelevant to the use of calcitonin.

Question 25

The nurse is caring for a child with hypothyroidism receiving levothyroxine as a hormone replacement. How would the nurse expect the child’s dose to compare to an adult’s dose?

A) A child’s dose tends to be higher.

B) A child’s dose tends to be lower on a milligrams per kilogram basis.

C) A child’s dose is dependent on the severity of the disease.

D) A child’s dose is comparable to an adult’s dose on a milligrams per kilogram basis

Answer 25

A) A child’s dose tends to be higher.

Rationale:Drug doses in children tend to be higher than in adults because of the higher metabolic rate of the growing child.

Question 26

A client has a calcium level of 6.2 mg/dL secondary to hypoparathyroidism. What drug would the nurse expect to be ordered?

A) Propylthiouracil

B) Methimazole

C) Calcitriol

D) Levothyroxine

Answer 26

C) Calcitriol

Rationale:Calcitriol is an antihypocalcemic agent used to treat hypoparathyroidism. This client’s calcium levels are below the norm of 9 to 11 mg/dL. Levothyroxine would be used to treat a deficiency of thyroid hormone or hypothyroidism. Methimazole is an antithyroid agent used to treat hyperthyroidism. Propylthiouracil is an antithyroid agent used to treat hyperthyroidism.

Question 27

When describing normal thyroid function, the nurse should emphasize the need for dietary intake of what?

A) Vitamin B6

B) Sodium

C) Calcium

D) Iodine

Answer 27

D) Iodine

Rationale:Iodine intake is necessary for the production of thyroid hormones. Calcium, sodium, and vitamin B6 are not necessary for the synthesis of thyroid hormone.

Question 28

The nurse is caring for a client with osteoporosis. What would the nurse expect to assess in the client when starting therapy with bisphosphonates?

A) Tetany

B) Paresthesias

C) Hyperactive reflexes

D) Nausea and diarrhea

Answer 28

D) Nausea and diarrhea

Rationale:The most common adverse effects seen with bisphosphonates are headache, nausea, and diarrhea. Hyperactive reflexes, tetany, and paresthesias suggest hypocalcemia, for which an antihypocalcemic agent would be used.

Question 29

More clients experience hyperthyroidism than hypothyroidism.

A) FALSE

B) TRUE

Answer 29

A) FALSE

Rationale:Hypothyroidism is the most common type of thyroid dysfunction.