Unt3: Ch 37- Thyroid and Parathyroid Agents (Karch 7th Ed) Flashcards
The nurse is teaching the patient, newly diagnosed with Graves’s disease, about the normal functioning
of the thyroid gland. What hormone will the nurse tell the patient controls production and release of
thyroid hormones?
A) Thyrotropin-releasing hormone (TRH)
B) Thyroid-stimulating hormone (TSH)
C) Tetraiodothyronine
D) Triiodothyronine
Ans: B
Feedback:
Thyroid hormone production and release are regulated by the anterior pituitary hormone called thyroidstimulating
hormone (TSH). The secretion of TSH is regulated by thyrotropin-releasing hormone
(TRH), a hypothalamic regulating factor. Tetraiodothyronine and triiodothyronine are thyroid
hormones produced by the thyroid gland because of TSH stimulation.
A child is diagnosed with hypothyroidism. The nurse anticipates an order for the drug of choice when treating children, which is what? A) Liothyronine (Cytomel) B) Liotrix (Thyrolar) C) Levothyroxine (Synthroid) D) Methimazole (Tapazole)
Ans: C
Feedback:
Levothyroxine is the drug of choice in children because of its predictable bioavailability and reliability.
Liothyronine and liotrix tend to have more adverse effects and, although they can be used in children,
are not the drugs of choice. Methimazole is an antithyroid drug and is used to treat hyperthyroidism.
A patient is at risk for thrombosis formation and is taking an oral anticoagulant. The patient has been
newly diagnosed with hypothyroidism and placed on levothyroxine (Synthroid). What will the nurse monitor the patient for?
A) Tachycardia
B) Elevated body temperature
C) Increased time spent sleeping
D) Increased bruising and bleeding
Ans: D
Feedback:
The effectiveness of an oral anticoagulant is increased if it is used in combination with a thyroid
hormone. This may lead to increased bleeding and the need to decrease the dosage of the oral
anticoagulant. Tachycardia would be found with hyperthyroidism and the effect of levothyroxine is not
increased with the drug combination. Increased time spent sleeping would indicate lowering of thyroid
function and the treatment should increase thyroid function. Increased body temperature is associated
with hyperthyroidism.
The nurse is providing patient teaching regarding the administration of levothyroxine (Synthroid).
What is the nurse’s priority teaching point?
A) Take the medication after breakfast.
B) Take the medication with a full glass of water.
C) Remain in the upright position for 30 minutes after administering.
D) Take the medication before going to bed at night.
Ans: B
Feedback:
The patient should be instructed to take the medication with a full glass of water to help prevent
difficulty swallowing and esophageal atresia. The medication should be taken on an empty stomach
before breakfast. There is no need to maintain an upright position. The medication should be taken as a
single daily dose before breakfast each day to ensure consistent therapeutic levels.
The nurse instructs the patient with a new prescription to treat hyperthyroidism and includes the
importance of regular lab studies to monitor for bone marrow suppression, which can be an adverse
effect of this drug. What drug is the nurse teaching the patient about?
A) Methimazole (Tapazole)
B) Propylthiouracil (PTU)
C) Sodium iodide I131 (Generic)
D) Potassium iodide (Thyro-Block)
Ans: A
Feedback:
Methimazole is associated with bone marrow suppression, so the patient using this drug must have
frequent blood tests to monitor for this effect. Propylthiouracil is associated with GI effects. The most
common adverse effect of sodium iodide I131 and potassium iodide is hypothyroidism. Other effects of
these two drugs include metallic taste and burning in the mouth, sore teeth and gums, diarrhea, cold
symptoms, stomach upset, stained teeth, rash, and the development of goiter.
A patient is seen in the clinic and diagnosed with hyperthyroidism. Potassium iodide is prescribed. The
nurse reviews the patient’s medical record before administering the drug. What assessment finding
would cause the nurse to alter the plan of care?
A) A daily walk of 3 miles a day
B) A low fat, low sodium diet
C) A bowel movement every 2 to 3 days
D) Digoxin 0.125 mg daily
Ans: D
Feedback:
Potassium iodide will cause the patient to move from hyperthyroidism to hypothyroidism, thus altering
the patient’s metabolism. Digoxin has a small margin of safety that could be altered by a change in
thyroid function. The patient will need to be monitored carefully for an alteration in digoxin effects that
may include an increased heart rate, arrhythmia, or reduced cardiac output. A daily walk of 3 miles, a
low fat, low sodium diet, and a bowel movement every 2 to 3 days are important for maintenance of a
healthy lifestyle but would not alter the plan of care.
A patient with Paget’s disease calls the clinic and tells the nurse that she is experiencing flushing of the
face and hands and a rash. The patient states that she is taking calcitonin, salmon (Calcimar) for her
Paget’s disease. What is the nurse’s best response?
A) We expected this to happen. Just ignore it and please do not worry about it.
B) You will need to see the doctor immediately. Come in as soon as possible.
C) This is a common adverse effect of your medication that will lessen with time.
D) This is a serious adverse effect. Stop taking the drug and see the doctor today.
Ans: C
Feedback:
The most common adverse effects seen with this drug include flushing of the face and hands, rash,
nausea and vomiting, urinary frequency, and local inflammation at the site of injection. Many of these
adverse effects lessen with time, the duration varying with each individual patient. Although it is an
expected adverse effect, the nurse needs to provide more teaching instead of simply telling the patient
to ignore it and to not worry. The patient does not need to be seen and this is not a serious adverse
effect.
The nurse is teaching the patient with a new prescription for ibandronate (Boniva) how to take the
medication. Which instruction provided by the nurse is correct?
A) Take 150 mg once a month on the same day of the month.
B) Take 70 mg once a week on the same day of the week.
C) Take 400 mg/d.
D) Take 3 mg once per month on the same day of the month.
Ans: A
Feedback:
Ibandronate can be taken daily, monthly, or every 3 months. Taking 150 mg orally once a month on the
same day of the month would be correct. If given IV every 3 months, the dose is 3 mg and if taken
daily, the dose is 2.5 mg/d. All other options are incorrect.
The nurse admits an elderly patient in thyroid crisis for whom surgery is not an option. What
antithyroid drug would the nurse expect will be ordered?
A) Methimazole (Tapazole)
B) Radioactive iodine (Generic)
C) Propylthiouracil (PTU)
D) Potassium iodide (Thyro-Block)
Ans: B
Feedback:
If antithyroid agents are needed in the older adult patient, sodium iodide I131 may be the drug of choice
because it has fewer adverse effects than the other agents. The use of sodium iodide is reserved for
those patients who are not candidates for surgery, women who cannot become pregnant, and elderly
patients with such severe, complicating conditions that immediate thyroid destruction is needed.
Radioactive iodine targets the thyroid cells and destroys them without many adverse effects.
Methimazole and propylthiouracil are antithyroid drugs but have cardiovascular adverse effects that
might be unacceptable in an elderly patient who is not a candidate for surgery. Effects of potassium
iodide are short-lived and may precipitate further thyroid enlargement and dysfunction so they would
not be used in a patient who is not a candidate for surgery because they would not provoke long-term
effects.
The nurse is providing care for a man diagnosed with osteoporosis. What drug will the nurse administer
that is the only drug approved for treatment in men?
A) Etidronate (Didronel)
B) Pamidronate (Aredia)
C) Tiludronate (Skelid)
D) Alendronate (Fosamax)
Ans: D
Feedback:
Alendronate is the only bisphosphonate that has been approved for the treatment of osteoporosis in
men. Etidronate is used to treat Paget’s disease, postmenopausal osteoporosis, and heterotopic
ossification. Pamidronate is used to treat Paget’s disease, postmenopausal osteoporosis in women,
hypercalcemia of malignancy, and osteolytic bone lesions in cancer patients. Tiludronate is used to treat
Paget’s disease that is not responsive to other treatment.
What assessment findings would the nurse expect to see in a patient who overdosed on levothyroxine
(Synthroid)?
A) Nervousness, tachycardia, tremors
B) Somnolence, bradycardia, paresthesia
C) Hyperglycemia, hypertension, edema
D) Buffalo hump, constipation, sodium loss
Ans: A
Feedback:
More pronounced adverse effects of levothyroxine would be seen including tremors, headache,
nervousness, palpitations, tachycardia, allergic skin reactions, diarrhea, nausea, vomiting. Somnolence,
bradycardia, and paresthesia would be more likely with insufficient drug intake, which would cause
hypothyroidism and other symptoms. Hyperglycemia, edema, buffalo hump, constipation, or sodium
loss would not be associated with excess thyroid hormone.
After administering propylthiouracil (PTU), what effect would the nurse anticipate the drug will have
in the patient’s body?
A) To destroy part of the thyroid gland
B) To inhibit production of thyroid hormone in the thyroid gland
C) To suppress the anterior pituitary gland’s secretion of thyroid-stimulating hormone (TSH)
D) To suppress the hypothalamus’s production of thyrotropin-releasing hormone (TRH)
Ans: B
Feedback:
PTU is a thioamide that acts by lowering thyroid hormone levels by preventing the formation of thyroid
hormone in the thyroid cells, which lowers the serum levels of thyroid hormone. They also partially
inhibit the conversion of thyroxine to triiodothyronine at the cellular level. Iodine solutions
oversaturate thyroid cells and top production of thyroid hormone. Radioactive iodine destroys part of
the thyroid gland. PTU does not impact production or secretion of TSH or TRH.
The nurse provides teaching regarding levothyroxine to a 55-year-old patient diagnosed with
Hashimoto’s disease. What statement made by the patient does the nurse interpret to mean that the drug
teaching had been understood?
A) I can take this medication at any time of day.
B) I should take this medication on an empty stomach in the morning.
C) I may take this with a sip of water in the morning.
D) If I feel nauseated, I may take this drug with an antacid.
Ans: B
Feedback:
Adults who require thyroid replacement therapy need to understand that this will be a lifelong need. An
established routine of taking the tablet first thing in the morning may help the patient comply with the
drug regimen. The drug should be taken on an empty stomach with a full glass of water. Antacids
would slow or prevent absorption of the hormone replacement, so the patient should be corrected.
The nurse, developing a care plan for a patient diagnosed with hypothyroidism, creates what
appropriate nursing diagnosis?
A) Imbalanced nutrition: Less than body requirements
B) Ineffective thermoregulation: Excess or ineffective airway clearance
C) Decreased cardiac output
D) Ineffective airway clearance
Ans: C
Feedback:
Decreased cardiac output is related to hypothyroidism. Hyperthyroidism results in increased caloric
needs and the nursing diagnosis of Imbalanced nutrition: Less than body requirements. Thyroid
dysfunction would not normally result in Ineffective thermoregulation: Excess or ineffective airway
clearance.
The nurse is caring for a 5-year-old child diagnosed with hypothyroidism whose mother voices
skepticism about giving the child drugs. In explaining the need for medication, what will the nurse tell
this mother could result if her daughter’s condition remains untreated so she can make an informed
decision?
A) Mental retardation
B) Renal dysfunction
C) Immune deficiency
D) Paralytic ileus
Ans: A
Feedback: Children who are born without a thyroid gland or who have a nonfunctioning gland develop a condition
called cretinism. If untreated, these children will have poor growth and development and mental
retardation because of the lack of thyroid hormone stimulation. The child would not be at increased risk
of renal dysfunction, immune deficiency, or paralytic ileus.