Seminars REVIEW Flashcards
Question 1
A patient with hypothyroidism is prescribed levothyroxine. The nurse understands that levothyroxine works by:
A. Replacing T3 and T4 to restore thyroid hormone levels.
B. Stimulating the thyroid gland to produce more thyroid hormone.
C. Binding to iodine to create active thyroid hormone.
D. Suppressing the production of thyroid-stimulating hormone (TSH).
Answer: C. Take the medication in the morning on an empty stomach.
Rationale:
C (Correct): Levothyroxine should be taken on an empty stomach in the morning to maximize absorption.
A (Incorrect): Food can decrease the absorption of levothyroxine, so it should not be taken with meals.
B (Incorrect): Taking levothyroxine at bedtime is not ideal due to interactions with food or other substances consumed earlier.
D (Incorrect): The patient should not stop taking the medication without consulting their healthcare provider.
Which patient condition is a contraindication for the use of levothyroxine?
A. History of diabetes mellitus
B. History of myocardial infarction
C. Anemia
D. Asthma
Answer: B. History of myocardial infarction
Rationale:
B (Correct): Levothyroxine should be used cautiously in patients with heart conditions, including a history of heart attack, due to its effects on metabolism and cardiovascular stimulation.
A (Incorrect): While diabetes requires monitoring during thyroid treatment, it is not a direct contraindication.
C (Incorrect): Anemia is not a contraindication for levothyroxine.
D (Incorrect): Asthma is unrelated to the use of levothyroxine.
A patient is prescribed diphenhydramine for seasonal allergies. The nurse explains that diphenhydramine works by:
A. Blocking H2 receptors in the stomach to reduce histamine release.
B. Acting as an inverse agonist at H1 receptors to reverse histamine effects.
C. Blocking IgE antibodies from binding to mast cells.
D. Suppressing the immune system to prevent allergic responses.
Answer: B. Acting as an inverse agonist at H1 receptors to reverse histamine effects.
Rationale:
B (Correct): Diphenhydramine is an H1 receptor antagonist that blocks histamine’s effects, such as vasodilation and bronchoconstriction.
A (Incorrect): H2 receptors are found in the stomach and are not related to diphenhydramine’s action.
C (Incorrect): Diphenhydramine does not block IgE antibodies; it acts on histamine receptors.
D (Incorrect): Diphenhydramine does not suppress the immune system; it alleviates symptoms of histamine release.
A patient taking diphenhydramine complains of drowsiness and fatigue. What should the nurse include in their teaching?
A. “These side effects are uncommon and should be reported immediately.”
B. “Avoid driving or operating machinery until you know how the medication affects you.”
C. “These side effects indicate an allergy to the medication, and you should stop taking it.”
D. “Switch to a higher dose to reduce the frequency of side effects.”
Answer: B. “Avoid driving or operating machinery until you know how the medication affects you.”
Rationale:
B (Correct): Drowsiness and fatigue are common side effects of diphenhydramine, and patients should avoid activities requiring alertness until they understand how the medication affects them.
A (Incorrect): These side effects are expected, not uncommon.
C (Incorrect): Drowsiness does not indicate an allergy to diphenhydramine.
D (Incorrect): Increasing the dose could worsen the side effects.
Which of the following patients should avoid diphenhydramine?
A. A patient with seasonal allergies.
B. A patient with myasthenia gravis.
C. A patient with nausea from motion sickness.
D. A patient with occasional insomnia.
Answer: B. A patient with myasthenia gravis.
Rationale:
B (Correct): Diphenhydramine can worsen muscle weakness in patients with myasthenia gravis and should be avoided.
A (Incorrect): Diphenhydramine is commonly used to treat seasonal allergies.
C (Incorrect): Diphenhydramine can be used as an antiemetic for motion sickness.
D (Incorrect): Diphenhydramine is sometimes used for short-term treatment of insomnia.
A nurse is caring for a patient taking levothyroxine who reports symptoms of irritability, palpitations, and weight loss. What is the nurse’s best action?
A. Instruct the patient to stop taking the medication immediately.
B. Notify the healthcare provider about possible signs of overmedication.
C. Reassure the patient that these are common symptoms of hypothyroidism.
D. Advise the patient to double the dose until symptoms subside.
Answer: B. Notify the healthcare provider about possible signs of overmedication.
Rationale:
B (Correct): Symptoms such as irritability, palpitations, and weight loss suggest overmedication, leading to symptoms of hyperthyroidism, and require adjustment of the dose.
A (Incorrect): The medication should not be stopped abruptly without consulting the provider.
C (Incorrect): These are signs of hyperthyroidism, not hypothyroidism.
D (Incorrect): Doubling the dose would worsen symptoms and increase the risk of adverse effects.
Which statement indicates that a patient taking levothyroxine understands the teaching?
A. “I can stop taking levothyroxine once my thyroid hormone levels are normal.”
B. “I will take my levothyroxine every morning with breakfast.”
C. “I may need to adjust my dose if I switch to a high-fiber diet.”
D. “It’s safe to skip doses if I feel fine.”
Answer: C. “I may need to adjust my dose if I switch to a high-fiber diet.”
Rationale:
C (Correct): A high-fiber diet can interfere with levothyroxine absorption, so the patient may need to adjust the dose or timing.
A (Incorrect): Levothyroxine is usually a lifelong therapy.
B (Incorrect): The medication should be taken on an empty stomach, not with food.
D (Incorrect): Skipping doses can lead to unstable thyroid hormone levels.
The nurse knows that which of the following medications may interfere with the effectiveness of levothyroxine? (Select all that apply)
A. Calcium supplements
B. Warfarin
C. Ferrous sulfate (iron supplements)
D. Antacids containing aluminum
E. Acetaminophen
Answers: A, C, D
Rationale:
A (Correct): Calcium supplements reduce the absorption of levothyroxine.
C (Correct): Iron supplements (ferrous sulfate) interfere with absorption.
D (Correct): Antacids containing aluminum can also block levothyroxine absorption.
B (Incorrect): Levothyroxine can increase the effect of warfarin, but it doesn’t reduce its effectiveness.
E (Incorrect): Acetaminophen does not interfere with levothyroxine.
A nurse is caring for an older adult patient who is prescribed diphenhydramine. What is the nurse’s priority concern?
A. Risk of daytime drowsiness and fatigue
B. Increased risk of confusion or delirium
C. Decreased effectiveness in managing allergy symptoms
D. Increased risk of immune suppression
Answer: B. Increased risk of confusion or delirium
Rationale:
B (Correct): Older adults are more prone to confusion or delirium when taking diphenhydramine due to its anticholinergic effects.
A (Incorrect): Drowsiness is common but less critical than confusion in older adults.
C (Incorrect): Diphenhydramine remains effective for allergies regardless of age.
D (Incorrect): Diphenhydramine does not suppress the immune system.
A patient taking diphenhydramine for allergies complains of dry mouth and difficulty urinating. What should the nurse explain?
A. These symptoms are normal and will go away with continued use.
B. The patient should reduce their fluid intake to prevent worsening symptoms.
C. These are side effects of the medication and should be reported if they worsen.
D. This indicates an allergic reaction to diphenhydramine, and the medication should be stopped.
Answer: C. These are side effects of the medication and should be reported if they worsen.
Rationale:
C (Correct): Dry mouth and difficulty urinating are anticholinergic side effects of diphenhydramine, and patients should be monitored for worsening symptoms.
A (Incorrect): These symptoms may persist and are not likely to go away without dose adjustment or stopping the medication.
B (Incorrect): Reducing fluid intake would worsen the symptoms.
D (Incorrect): These symptoms are side effects, not an allergic reaction.
A patient taking diphenhydramine also drinks alcohol daily. What should the nurse explain to the patient?
A. Alcohol can increase the risk of excessive sedation.
B. Alcohol will reduce the effectiveness of diphenhydramine.
C. Diphenhydramine will prevent the effects of alcohol.
D. It is safe to consume alcohol as long as it is limited to one drink.
Answer: A. Alcohol can increase the risk of excessive sedation.
Rationale:
A (Correct): Both alcohol and diphenhydramine cause sedation, and combining them can lead to excessive drowsiness or dangerous respiratory depression.
B (Incorrect): Alcohol does not reduce diphenhydramine’s effectiveness.
C (Incorrect): Diphenhydramine does not counteract alcohol’s effects.
D (Incorrect): Even small amounts of alcohol can enhance the sedative effects of diphenhydramine.
