Chapter 42- Drug Therapy for Hyperthyroidism and Hypothyroidism-Test-Bank-Tank PDF

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1. A child is born with cretinism. What element was lacking in the mother's diet during pregnancy? A) Potassium B) Iodine C) Sodium D) Magnesium Ans: B Feedback: Cretinism is uncommon in the United States but may occur with a lack of iodine in the mother's diet. A lack of potassium, sodium, and magnesium in the mother's diet will not cause cretinism.

2. A patient suffers from hyponatremia, hypoglycemia, and lactic acidosis. What condition is most consistent with this clinical presentation? A) Myxedema coma B) Psychotic depression C) Cretinism D) Congenital hypothyroidism Ans: A Feedback: Myxedema coma is severe, life-threatening hypothyroidism characterized by coma, hypothermia, cardiovascular collapse, hypoventilation, and severe metabolic disorders, such as hyponatremia, hypoglycemia, and lactic acidosis.

3. A woman is started on propylthiouracil (PTU). What is the primary mode of action for propylthiouracil? A) Destroys part of the thyroid gland B) Inhibits production of thyroid hormone C) Suppresses the anterior pituitary hormones D) Stimulates the thyroid cells Ans: B Feedback: The thioamide drugs inhibit synthesis of thyroid hormone. Iodine preparations inhibit the release of thyroid hormones and cause them to be stored within the thyroid gland. Propylthiouracil does not destroy part of the thyroid gland. Propylthiouracil does not suppress the anterior pituitary hormones. Propylthiouracil does not sedate the central nervous system or suppress the cardiac output.

4. A patient with hypothyroidism is started on levothyroxine (Synthroid). What should the patient be taught regarding medication administration in the home setting? A) Take medication with milk or food. B) Do not exercise with the medication. C) Take the medication on an empty stomach.

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D) Levothyroxine has a short half-life. Ans: C Feedback: Levothyroxine (Synthroid) should be taken on an empty stomach to increase absorption. The medication should not be taken with food. Exercise has no effect on the administration of the medication. Levothyroxine has a long half-life of about 6 to 7 days.

5. A 5-year-old child is diagnosed with hypothyroidism. What will the patient likely develop if the condition is left untreated? A) Mental retardation B) Renal dysfunction C) An immune disorder D) Paralytic ileus Ans: A Feedback: If cretinism is untreated until the child is several months old, permanent mental retardation is likely to result. The patient will not suffer from renal dysfunction, an immune disorder, or paralytic ileus.

6. A patient has been diagnosed with myxedema. She currently takes ibuprofen (Motrin) for knee pain. For what is this patient at increased risk? A) Nephrotoxicity B) Pulmonary congestion C) Tachycardia D) Apnea Ans: A Feedback: A patient diagnosed with myxedema cannot metabolize and excrete drugs, so she is at an increased risk of developing nephrotoxicity. Pulmonary congestion, tachycardia, and apnea are not adverse effects related to myxedema or the administration of ibuprofen (Motrin).

7. A patient is scheduled for a thyroidectomy to treat thyroid cancer. What is the medication of choice administered preoperatively? A) Sodium iodide 131I (Iodotope) B) Methimazole (Tapazole) C) Propylthiouracil (PTU) D) Propranolol (Inderal) Ans: C Feedback: Propylthiouracil (PTU) is administered preoperatively for thyroidectomy. Sodium iodide131 (Iodotope) is a radioactive iodide that is used to destroy thyroid tissue.

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Methimazole (Tapazole) is similar to PTU but is not the drug of choice preoperatively. Propranolol (Inderal) is used to treat cardiovascular conditions, such as hypertension. It is not used in the preoperative phase of thyroidectomy.

8. A patient is to receive a medication that the nurse recognizes as an expectorant that is normally administered for the treatment of hyperthyroidism. Which medication will be administered? A) Propylthiouracil (PTU) B) Methimazole (Tapazole) C) Saturated solution of potassium iodide (SSKI) D) Sodium iodide131I (Iodotope) Ans: C Feedback: Saturated solution of potassium iodide (SSKI) is more often used as an expectorant but may be given as a preparation for thyroidectomy. Propylthiouracil (PTU) is not administered as an expectorant. Methimazole (Tapazole) is not administered as an expectorant. Sodium iodide 131I (Iodotope) is not administered as an expectorant.

9. A patient has been diagnosed with hyperthyroidism. She is scheduled to receive a medication to destroy the thyroid gland. Which medication will be administered? A) Propylthiouracil (PTU) B) Methimazole (Tapazole) C) Saturated solution of potassium iodide (SSKI) D) Sodium iodide 131I (Iodotope) Ans: D Feedback: Sodium iodide 131I (Iodotope) is a radioactive isotope of iodine. Therapeutic doses act by emitting beta and gamma rays, which destroy thyroid tissue and thereby decrease the production of thyroid hormones. Propylthiouracil (PTU) is not administered to destroy thyroid tissue. Methimazole (Tapazole) is not administered to destroy thyroid tissue. Saturated solution of potassium iodide (SSKI) is not administered to destroy thyroid tissue.

10. A patient is being administered propranolol (Inderal) to treat hypertension related to hyperthyroidism. Which condition will warrant the tapering and discontinuation of the propranolol (Inderal)? A) Hyperthyroidism B) Hypertension C) Angina pectoris D) Euthyroid state Ans: D Feedback: When the patient becomes euthyroid and hyperthyroid symptoms are controlled by

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definitive treatment measures, propranolol should be tapered and discontinued. Hyperthyroidism, hypertension, and angina pectoris all warrant the administration of propranolol (Inderal).

11. A patient is started on levothyroxine (Synthroid) for treatment of hypothyroidism. During patient teaching, how frequently can the dosage be increased until symptoms are relieved? A) Every 3 to 5 days B) Weekly C) Every 2 weeks D) Monthly Ans: C Feedback: Dosage is influenced by the choice of drug. As a general rule, initial dosage is relatively small. Dosage is gradually increased at approximately 2-week intervals until symptoms are relieved. The dosage is not increased in 3 to 5 days. The dosage is not increased in 1 week. The dosage is not increased monthly.

12. A patient is being treated for hypothyroidism and has developed symptoms of adrenal insufficiency. What medication will be added to the patient's medication regimen? A) Anti-infective agent B) Corticosteroid agent C) Nonsteroidal anti-inflammatory agent D) Antiadrenergic agent Ans: B Feedback: When hypothyroidism and adrenal insufficiency coexist, the adrenal insufficiency should be treated with a corticosteroid drug before starting thyroid replacement. Antiinfective agents, nonsteroidal anti-inflammatory agents, or antiadrenergic agents are not administered for adrenal insufficiency.

13. A patient has been diagnosed with hypothyroidism and admits to the nurse that she has heard of her thyroid gland but does not know the function of thyroid hormone. The nurse should explain the fact that thyroid hormone is responsible for A) regulating the levels of most other hormones in the body. B) stimulating the brain and sex organs. C) controlling the rate of cell metabolism throughout the body. D) regulating levels of glucose in the blood and body tissues. Ans: C Feedback: Thyroid hormones control the rate of cellular metabolism and thus influence the functioning of virtually every cell in the body. The heart, skeletal muscle, liver, and kidneys are especially responsive to the stimulating effects of thyroid hormones. The

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brain, spleen, and gonads are less responsive. Thyroid hormone does not primarily influence glucose levels or the function of the endocrine system.

14. Following the completion of diagnostic testing, an adult patient has received a diagnosis of hyperthyroidism. What nursing diagnosis should the nurse prioritize in this patient's care? A) Risk for hypothermia related to hyperthyroidism B) Constipation related to hyperthyroidism C) Risk for imbalanced nutrition: less than body requirements related to hyperthyroidism D) Anxiety related to hyperthyroidism Ans: D Feedback: Anxiety is characteristic of a hyperthyroid state. Constipation, cold intolerance, and loss of appetite are associated with hypothyroidism.

15. A 55-year-old female patient was successfully treated for thyroid storm earlier in the year. In subsequent health education, the nurse should caution the patient against excessive intake of what foods? A) Seafood and kelp B) Leafy green vegetables and beef C) Purine-rich foods D) Red wine and aged cheeses Ans: A Feedback: Iodine is associated with thyroid storm and is present in foods (especially seafood and kelp) and in radiographic contrast dyes. Reports of iodine-induced hyperthyroidism have been reported after ingestion of dietary sources of iodine.

16. Laboratory testing reveals that a patient is in a severely hyperthyroid state and propylthiouracil (PTU) has been prescribed. When providing health education related to this drug, what should the nurse teach the patient? A) “You'll need to take these pills every 8 hours.” B) “I'm going to show you how to perform your daily injection.” C) “At first, you'll come to the outpatient clinic for your IV infusion once per day.” D) “It's best to inject PTU into your abdomen rather than your arm.” Ans: A Feedback: PTU is well absorbed with oral administration. Because the half-life in the thyroid is relatively short, PTU must be given every 8 hours.

17. A patient is scheduled to begin a drug regimen for the treatment of hyperthyroidism. Prior to administering propylthiouracil (PTU), the nurse has reviewed the relevant black

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A) B) C) D) Ans:

box warning and should teach the patient about the need for what form of follow-up? Serial complete blood counts Routine liver function testing Daily nonfasting blood glucose testing Chest radiographs every 3 months B Feedback: The FDA has issued a black box warning for PTU stating that severe liver injury resulting in death or acute liver failure may occur within 6 months of treatment. All patients should receive instructions about the signs and symptoms of acute liver failure. Routine liver function testing to assess for liver failure is important. There is no specific need for chest radiographs, CBCs, or glucose monitoring.

18. A nurse who provides care at a long-term care facility is preparing to administer a resident's scheduled dose of levothyroxine (Synthroid). What assessment should the nurse perform prior to administration? A) Level of consciousness and orientation B) Oxygen saturation level C) Heart rate D) Respiratory rate Ans: C Feedback: Regular monitoring of blood pressure and pulse is essential in older adults receiving Synthroid. As a general rule, levothyroxine should not be given if the resting heart rate is more than 100 beats per minute.

19. A home care nurse observes that a client's supply of Synthroid has run out in less than half the time that it should have. What assessment findings would be most consistent with overuse of Synthroid? A) Constipation and abdominal distention B) Hyperactivity and insomnia C) Bradycardia and hypotension D) Joint pain and decreased mobility Ans: B Feedback: Adverse effects of levothyroxine include signs and symptoms of hyperthyroidism. Other more serious adverse effects are tachycardia, cardiac dysrhythmias, angina pectoris, myocardial infarction, and heart failure. Nervousness, hyperactivity, insomnia, diarrhea, abdominal cramps, nausea, vomiting, weight loss, fever, and an intolerance to heat have also been reported. Bradycardia and constipation are associated with hypothyroidism.

20. An older adult patient has been using levothyroxine (Synthroid) for several years on an outpatient basis. The patient has recently sought care, with complaints that are

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consistent with hypothyroidism. To which of the patient's following statements may the nurse attribute the decreased effect of Synthroid? A) “I've been using a lot of antacids lately because of my indigestion.” B) “My daughter and I have started the Atkin's diet to try to lose some weight.” C) “Overall, I'd say that I'm under a lot of stress lately.” D) “I've stopped taking aspirin for my arthritis and started using Tylenol.” Ans: A Feedback: Antacids may decrease the effect of levothyroxine. Acetaminophen, stress, and high protein intake do not have this effect.

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