Pharm Ch 31-40
ANS: D Contraindications to thyroid preparations include known drug allergy to a given
drug product, recent myocardial infarction, adrenal insufficiency, and hyperthyroidism.
The other options are incorrect - ✔✔1. A patient, newly diagnosed with
hypothyroidism, receives a prescription for a thyroid hormone replacement drug. The
nurse assesses for which potential contraindication to this drug? a. Infection b.
Diabetes mellitus c. Liver disease d. Recent myocardial infarction
ANS: D One advantage of levothyroxine over the natural forms is that it can be
administered only once a day because of its long half-life. The other options are
incorrect. - ✔✔2. A patient with hypothyroidism is given a prescription for
levothyroxine (Synthroid). When the nurse explains that this is a synthetic form of the
thyroid hormone, he states that he prefers to receive more "natural" forms of drugs.
What will the nurse explain to him about the advantages of levothyroxine? a. It has a
stronger effect than the natural forms. b. Levothyroxine is less expensive than the
natural forms. c. The synthetic form has fewer adverse effects on the gastrointestinal
tract. d. The half-life of levothyroxine is long enough to permit once-daily dosing.
ANS: D Levothyroxine is dosed in micrograms. A common medication error is to write
the intended dose in milligrams instead of micrograms. If not caught, this error would
result in a thousandfold overdose. Doses higher than 200 mcg need to be questioned
in case this error has occurred. The other options are incorrect. - ✔✔3. The order
reads, "Give levothyroxine (Synthroid), 200 mg, PO once every morning." Which action
by the nurse is correct? a. Give the medication as ordered. b. Change the dose to 200
mcg because that is what the prescriber meant. c. Hold the drug until the prescriber
returns to see the patient. d. Question the order because the dose is higher than 200
mcg.
ANS: B Patients on antithyroid therapy need to avoid iodine-containing foods. These
foods may interfere with the effectiveness of the antithyroid drug. The other options are
incorrect. - ✔✔4. During a teaching session for a patient on antithyroid drugs, the
nurse will discuss which dietary instructions? a. Using iodized salt when cooking b.
,Avoiding foods containing iodine c. Restricting fluid intake to 2500 mL/day d.
Increasing intake of sodium- and potassium-containing foods
ANS: B Propylthiouracil impedes the formation of thyroid hormone but has no effect on
already existing thyroid hormone. The other options are incorrect. - ✔✔5. A patient
who is taking propylthiouracil (PTU) for hyperthyroidism wants to know how this
medicine works. Which explanation by the nurse is accurate? a. It blocks the action of
thyroid hormone. b. It slows down the formation of thyroid hormone. c. It destroys
overactive cells in the thyroid gland. d. It inactivates already existing thyroid hormone in
the bloodstream.
ANS: B Chapter 31: Patients need to understand that it may take up to 3 to 4 weeks to
see the full therapeutic effects of thyroid drugs. The other options are incorrect. -
✔✔6. A 19-year-old student was diagnosed with hypothyroidism and has started
thyroid replacement therapy with levothyroxine (Synthroid). After 1 week, she called
the clinic to report that she does not feel better. Which response from the nurse is
correct? a. "It will probably require surgery for a cure to happen." b. "The full
therapeutic effects may not occur for 3 to 4 weeks." c. "Is it possible that you did not
take your medication as instructed?" d. "Let's review your diet; it may be causing
absorption problems."
ANS: A If possible, it is best to administer thyroid drugs taken once daily in the morning
so as to decrease the likelihood of insomnia that may result from evening dosing. -
✔✔7. A patient, newly diagnosed with hypothyroidism, has received a prescription for
thyroid replacement therapy. The nurse will instruct the patient to take this medication
at which time of day? a. In the morning b. With the noon meal c. With the evening meal
d. At bedtime
ANS: B Antithyroid drugs may cause bone marrow suppression, resulting in
agranulocytosis, leukopenia, thrombocytopenia, and other problems. The other options
are incorrect. - ✔✔8. When reviewing the laboratory values of a patient who is taking
antithyroid drugs, the nurse will monitor for which adverse effect? a. Decreased
glucose levels b. Decreased white blood cell count c. Increased red blood cell count d.
Increased platelet count
, ANS: D Switching brands of levothyroxine during treatment can destabilize the course
of treatment. Thyroid function test results need to be monitored more carefully when
switching products. - ✔✔9. A patient has been taking levothyroxine (Synthroid) for
more than one decade for primary hypothyroidism. Today she calls because she has a
cousin who can get her the same medication in a generic form from a pharmaceutical
supply company. Which is the nurse's best advice? a. "This would be a great way to
save money." b. "There's no difference in brands of this medication." c. "This should
never be done; once you start with a certain brand, you must stay with it." d. "It's better
not to switch brands unless we check with your doctor."
ANS: C Primary hypothyroidism stems from an abnormality in the thyroid gland itself
and occurs when the thyroid gland is not able to perform one of its many functions.
Secondary hypothyroidism begins at the level of the pituitary gland and results from
reduced secretion of TSH. TSH is needed to trigger the release of the T3 and T4
stored in the thyroid gland. Tertiary hypothyroidism is caused by a reduced level of the
TRH from the hypothalamus. This reduced level, in turn, reduces TSH and thyroid
hormone levels. - ✔✔10. A patient has a diagnosis of primary hypothyroidism. Which
statement accurately describes this problem? a. The hypothalamus is not secreting
thyrotropin-releasing hormone (TRH); therefore, thyroid-stimulating hormone (TSH) is
not released from the pituitary gland. b. The pituitary gland is dysfunctional and is not
secreting TSH. c. The abnormality is in the thyroid gland itself. d. The abnormality is
caused by an insufficient intake of iodine.
ANS: D These medications must never be abruptly discontinued, and lifelong therapy
is usually the norm. The other options are incorrect. - ✔✔11. A 19-year-old woman
has been diagnosed with hypothyroidism and has started thyroid replacement therapy
with levothyroxine (Synthroid). After 6 months, she calls the nurse to say that she feels
better and wants to stop the medication. Which response by the nurse is correct? a.
"You can stop the medication if your symptoms have improved." b. "You need to stay
on the medication for at least 1 year before a decision about stopping it can be made."
c. "You need to stay on this medication until you become pregnant." d. "Medication
therapy for hypothyroidism is usually lifelong, and you should not stop taking the
medication."
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