Florida National University - NURSING NUR 3525C

Chapter 14: Drug Therapy for Thyroid and Adrenal Gland Problems

Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition

MULTIPLE CHOICE

BASIC CONCEPTS

1)Which mineral is critical for the thyroid to use in making thyroid hormones?

1. 1. Lithium
   2. Sodium
   3. Chloride
   4. Iodine

2. Which symptom of hyperthyroidism occurs only with the Graves’ disease form of the problem?
   1. Goiter
   2. Hypertension

1. 3. Exophthalmos
   4. Thinning scalp hair

3. Which term means the energy use of each cell and the work performed by the body?
   1. Goiter
   2. Menarche
   3. Metabolism
   4. Thyrotoxicosis

4. What does a goiter indicate?

1. 1. Hypothyroidism
   2. Hyperthyroidism
   3. Thyroid problem
   4. Premature menopause

5. Which problem is a side effect of excessive thyroid hormone replacement drugs?
   1. Weight gain
   2. Hypertension
   3. Peripheral neuropathy
   4. Increased daytime sleepiness

6. Which is the best dietary source of iodine
   1. Salt substitutes
   2. Salted nuts
   3. Saltwater fish
   4. Salted chips

7. The action of which drug is known to be increased by thyroid hormone replacement drugs?
   1. Warfarin (Coumadin)
   2. Acetaminophen (Tylenol)
   3. Diphenhydramine (Benadryl)
   4. Fiber supplements (FiberCon)

8. Which drug suppresses thyroid activity?
   1. Methimazole (Tapazole)
   2. Metolazone (Mykrox)
   3. Levothyroxine (Synthroid)
   4. Liothyronine (Cytomel)

9. Which statement about adrenal cortex hormones is true?
   1. When underproduced, these hormones can lead to high blood pressure and stroke.
   2. When overproduced, these hormones can cause cancer.
   3. These hormones differ between men and women.
   4. These hormones are essential for life.

10. Which drug belongs to the mineralocorticoid class?
    1. Aminoglutethimide (Cytadren)
    2. Fludrocortisone (Florinef)
    3. Cortisol (Prednisone)
    4. Mitotane (Lysodren)

11. Which side effects are most common when taking any drug to manage adrenal gland hyperfunction?
    1. Decreased urine output and increased sweating
    2. Blurred vision and dry mouth
    3. Headache and mouth sores
    4. Nausea/vomiting

ADVANCED CONCEPTS

12. Laboratory blood tests show that a patient has a T3 level of 190 ng/dL. How should you interpret this finding?
    1. Hypothyroidism
    2. Hyperthyroidism
    3. Normal thyroid function
    4. Thyroid function totally absent

13. A patient with hypothyroidism as a result of Hashimoto’s thyroiditis asks how long thyroid replacement drugs will need to be taken. What is your best response?
    1. “You will need to take the thyroid replacement drug until the goiter is completely gone.”
    2.  

1. 3. “The thyroiditis will be cured with antibiotics and then you will no longer need the thyroid replacement drugs.”
   4. “When your thyroid function studies indicate a normal blood level of thyroid hormones you will be able to discontinue the drugs.”

14. Which assessment is most important to perform before giving a patient who is prescribed levothyroxine (Synthroid) the first dose of the drug?
    1. Measuring heart rate and rhythm
    2. Determining level of consciousness
    3. Asking about an allergy to “sulfa” drugs
    4. Checking intake and output for the last 24 hours

15. A patient is prescribed levothyroxine 25 mcg by IV push. The drug on hand is levothyroxine sodium 100 mcg/mL. How many milliliters should you administer?

a.   2.5

b. 1

c.   0.5

d.   0.25

16. A patient is prescribed levothyroxine sodium (Synthroid) 25 mcg orally once a day. The pharmacy sends liothyronine sodium (Cytomel) 25 mcg. What is your best action?
    1. Give the drug as sent from the pharmacy.
    2. Contact the nurse manager for advice.
    3. Call the pharmacy to send the correct drug.
    4. Explain to the patient that both drugs are thyroid hormone agonists.

17. A patient who is prescribed liothyronine (Cytomel) also takes warfarin (Coumadin). Which laboratory blood test result indicates a possible drug interaction?
    1. Hematocrit 42%
    2. Hemoglobin 14.2 g/dL
    3. Blood urea nitrogen (BUN) 12 mg/dL
    4. International normalized ratio (INR) 4.5

18. A patient who has been taking levothyroxine (Synthroid) for 2 months has all of the following conditions. Which condition indicates that the drug therapy is effective?
    1. Increased thirst
    2. Daily bowel movement for 1 week
    3. White blood cell count of 6000/mm³
    4. Weight unchanged for the last 3 weeks

19. Which precaution is most important to teach a patient who is newly prescribed a thyroid hormone replacement drug?
    1. “Avoid taking fiber supplements while on this drug.”
    2. “Be sure to take this drug at the same time everyday.”
    3. “Weigh yourself daily and keep a record of these weights.”
    4. “Do not increase the dose without your prescriber’s knowledge.”

20. Why should pregnant patients who have hypothyroidism continue to take thyroid replacement drugs throughout pregnancy?
    1.  

1. 2. Without continuing thyroid replacement drugs, the pregnancy may not continue.
   3. Pregnancy is a high metabolism condition and less drug is needed but should still be taken.
   4. The fetus produces thyroid hormones that help supplement the pregnant woman’s hormone level, but minimal replacement is needed during pregnancy.

21. How do thyroid replacement drugs work to treat hypothyroidism?
    1. Forcing the thyroid gland to secrete more thyroid hormones
    2. Inhibiting the enzymes that break down thyroid hormones
    3. Preventing damage to thyroid endocrine cells
    4. Providing thyroid hormones

22. How do thyroid replacement drugs affect diabetes?
    1. Thyroid replacement drugs reduce the effectiveness of all antidiabetic drugs.
    2. When thyroid replacement drugs return metabolism to normal, diabetes is gone.
    3. Thyroid replacement drugs can allow a patient to switch from insulin to an oral antidiabetic drug.
    4. Thyroid replacement drugs require that a patient taking an oral antidiabetic drug be placed on insulin.

23. A patient is prescribed levothyroxine (Synthroid) and a fiber supplement. What key point would you be sure to teach the patient about these drugs?
    1. “Take the drugs together as there are no interactions between them.”
    2. “Be sure to take the fiber supplement 2 hours before a meal and the levothyroxine 3 hours after a meal.”
    3. “Take the fiber supplement in the morning with breakfast and the levothyroxine in the evening before you go to bed.”
    4. “Do not take the drugs together because a fiber supplement will decrease the absorption of your levothNyrUoxRiSneI

24. Which patient condition indicates that drug therapy for hypothyroidism is effective?
    1. The patient is thirsty.
    2. The patient’s weight has been the same for 3 weeks.
    3. The patient’s total white blood cell count is 6000 cells/mm³.
    4. The patient has had a daily bowel movement for the past 8 days.

25. Which statement made by a patient who is taking a thyroid replacement drug indicates that a higher dose may be needed?
    1. “My goiter seems to be smaller.”

1. 2. “I seem to feel the heat more than other people.”
   3. “Food just doesn’t taste good without a lot of salt.”
   4. “I am always tired, even when I get 10 or 12 hours of sleep.”

26. A patient with hyperthyroidism is in the hospital waiting for surgery to remove the thyroid gland. This patient has all of the following conditions. For which condition should you notify the prescriber immediately?
    1. High level of anxiety about having surgery on the neck
    2. Temperature increase of 2? F
    3. Pulse pressure decrease of 10 mm Hg
    4. Increased bowel sounds and flatulence

27. Why does a patient who is taking drugs for thyroid suppression continue to have symptoms of hyperthyroidism for 3 weeks (or longer) after drug therapy is started?
    1. Thyroid hormones are stored and thyroid suppressing drugs only stop the synthesis of new hormones.
    2. At first, the patient’s metabolism is so high that the thyroid cells continue to synthesize thyroid hormones.
    3. The activity of the intestinal tract is increased and the drug is eliminated before complete suppression can occur.
    4. The side effects of thyroid suppression drugs are so uncomfortable that most patients do not take the full dose of the drug that is needed to prevent further hormone secretion.

28. A patient who has been taking methimazole (Tapazole) for 3 weeks has all of the following laboratory blood test results. Which result do you report immediately to the prescriber?
    1. White blood cell count 3500 cells/mm³
    2. Lactate dehydrogenase 990 IU/L
    3. Sodium 132 mEq/L
    4. Hematocrit 32%

29. With which patient should you question the order for methimazole (Tapazole)?
    1. 10-year-old girl who has new onset hyperthyroidism
    2. 30-year-old woman who also takes oral contraceptives
    3. 50-year-old man who has active hepatitis B
    4. 60-year-old man who has an enlarged prostate gland

30. A patient who is prescribed propylthiouracil (Propacil) also takes warfarin (Coumadin).

Which laboratory blood test result indicates a possible drug interaction?

1. 1. Hematocrit 42%
   2. Hemoglobin 14.2 g/dL
   3. Blood urea nitrogen (BUN) 12 mg/dL
   4. International normalized ratio (INR) 5.0

31. Which precaution is important to teach an older patient who is prescribed methimazole (Tapazole)?
    1. “If you miss a dose, go to the nearest emergency department and get an injection of methimazole.”
    2. “Be sure to wear sunscreen and a hat whenever you go outside into the sunshine.”
    3. “Drink at least 3 L of fluid daily while taking this drug.”
    4. “Avoid contact with crowds or anyone who is ill.”

32. Which new assessment finding in a patient taking fludrocortisone (Florinef) indicates the dose may be too high?
    1. Serum potassium change from 5.2 to 4.4 mEq/L
    2. Heart rate decrease from 88 to 76 beats/min
    3. Crackles in the bases of the lungs
    4. Decreased taste sensation

33. With which patient is an order for mifepristone (Korlym) most appropriate?
    1. 62-year-old patient who has adrenal gland hypofunction and breast cancer
    2. 52-year-old patient who has adrenal gland hyperfunction and type 2 diabetes
    3. 42-year-old patient who has adrenal gland hypofunction and type 1 diabetes
    4. 32-year-old who has adrenal gland hyperfunction and is 4 months pregnant

34. Which precaution is most important to teach a patient taking fludrocortisone (Florinef)?
    1. “Weigh yourself daily and keep a record.”
    2. “Avoid aspirin and aspirin-containing drugs.”
    3. “Increase your intake of carbohydrates while taking this drug.”
    4. “Do not take prednisone or prednisolone while taking this drug.”

MULTIPLE RESPONSE

ADVANCED CONCEPTS

1. Which are intended responses of thyroid hormone agonist drugs? (select all that apply)
   1. Body temperature is normal.
   2. Activity level is decreased.
   3. Vital signs are normal.
   4. Body weight is maintained.
   5. Bowel movements occur at least twice a week.
   6. Patient is mentally alert.

COMPLETION

ADVANCED CONCEPTS

1. A patient with hyperthyroidism is prescribed an immediate dose of propylthiouracil (Propacil) 150 mg orally. The available drug is propylthiouracil 50 mg/tablet. How many tablets should you administer?

           tablets

2. A 6-year-old child is being started on levothyroxine (Synthroid) intravenously and is prescribed 5 mcg/kg. The child weighs 32lb. The drug vial contains 100 mcg/mL. How many milliliters should you draw up for a correct dose?