Mastery EAQ Ch. 31

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Question #1

The nurse is assessing a patient undergoing levothyroxine therapy. Which symptom makes the nurse suspect excessive thyroid replacement?

A Bradycardia

B Irritability

C Intolerance to cold

D Drowsiness

Question #2

The nurse is taking the history of a female patient who has been prescribed thyroid replacement drugs. The nurse finds that the patient is receiving estrogen supplements as part of hormone replacement therapy. Which possible drug interaction may the nurse anticipate?

A Decreased thyroid drug activity

B Decreased blood glucose level

C Increased blood glucose level

D Increased estrogen levels in the blood

Question #3

The nurse is caring for a patient who has just started taking levothyroxine. Which assessment finding is necessary for the nurse to address?

A Brittle nails

B Weight gain of 3 pounds in the last week

C Irritability

D Intolerance to cold

Question #4

A patient walks into a clinic shivering and looking depressed and tired. The caregiver reports, “The patient was normal until last month but then suddenly started to gain weight.” Further assessment from the primary health care provider shows brittle hair and fingernails. Which medication would the nurse expect in the patient’s prescription?

A Methimazole 20 mg/day orally

B Liotrix 50 mg/day orally

C Levothyroxine 300 mcg intravenous (IV)

D Propylthiouracil 300 mg/day orally

Question #5

The nurse is educating a patient who is taking thyroid hormone replacement therapy. Which response given by the patient indicates effective learning?

A “I should take the tablet every morning on an empty stomach.”

B “I can stop the medication whenever I want without consulting my primary health care provider.”

C “I should take the tablet twice daily, before breakfast and after breakfast.”

D “I should take the thyroid tablet every night after dinner.”

Question #6

The nurse is teaching safe administration of medication to a patient who has been prescribed levothyroxine. Which statement would the nurse include in the teaching session?

A “There are no dietary restrictions while taking this medication.”

B “Always take the medication thrice a day, after meals.”

C “Consult your provider before taking over-the-counter medications.”

D “Take this medication with 250 mL of orange juice regularly.”

Question #7

A patient who is taking propylthiouracil reports, “It’s been 10 days since I started taking the medication, but my hunger is still not suppressed.” Which explanation would the nurse provide?

A “Your hunger will subside in another 10 days.”

B “Take the drug on an empty stomach before breakfast.”

C “Make an appointment with your primary health care provider.”

D “Increase the amount of fiber in your diet.”

Question #8

The nurse is providing prenatal counseling for a patient who has hyperthyroidism and is prescribed methimazole. The nurse instructs the patient to discuss discontinuing the medication with the provider in the event of conception. Which fetal abnormality is the nurse trying to prevent?

A Walking abnormality

B Eating abnormality

C Breathing abnormality

D Scalp abnormality

Question #9

The nurse is caring for a patient who has congenital hypothyroidism. Which medication would the nurse expect the primary health care provider to prescribe?

A Levothyroxine

B Propylthiouracil

C Liotrix

D Methimazole

Question #10

Which instruction is the nurse’s priority when informing a patient who is in the first trimester of pregnancy with a low thyroid-stimulating hormone (TSH) level if the patient indicates a preference for herbal therapy?

A “Fetal growth rate may be reduced if untreated safely.”

B “Additional weight gain occurs with low thyroid.”

C “The herbal therapy is not the first treatment recommendation.”

D “Thyroid levels may return to normal after the pregnancy.”

Question #11

A patient who has been on propylthiouracil for 2 weeks approaches the nurse for a routine medical checkup. Which is a priority assessment for this patient?

A Creatinine levels

B Calcium levels

C Platelet count

D Glucose levels

Question #12

A health care provider prescribes a drug for a patient who is underweight and shows symptoms of diarrhea, increased appetite, and flushing. Which other drug in the patient’s medication history would be of concern for the nurse?

A Antidiabetics

B Beta-lactam antibiotics

C Anticoagulants

D Antihistamines

Question #13

The nurse prepares to administer an initial dose of propylthiouracil to a patient with toxic nodular disease of the thyroid gland. Which baseline patient assessment is a priority for the nurse before the start of therapy?

A Coloration of the urine

B Size of the thyroid

C Leukocyte count

D Skin condition

Question #14

A patient with hypothyroidism has been taking 50 mg of levothyroxine for 2 years. On reviewing the lab reports, the nurse finds that the patient’s thyroid hormone levels are constantly fluctuating, even though he takes the medication regularly. Which error during the self-administration of the medication may have caused this?

A The patient takes 50 mg of levothyroxine of different brands.

B The patient takes 50 mg of levothyroxine once a day before meals.

C The patient avoids taking a double dose of medication after missing a dose.

D The patient consumes cheese and legumes while taking the medication.

Question #15

The nurse is caring for a patient who has hyperthyroidism. The health care provider has prescribed methimazole. Which assessment is a priority?

A Assess the patient’s urine output.

B Assess signs and symptoms of thyroid storm.

C Assess signs of cardiac irregularities.

D Assess the patient’s serum creatinine levels.

Question #16

The nurse is assessing a patient who has been prescribed thyroid replacement drugs for the first time. The nurse asks the patient to take the daily medication every morning on an empty stomach. Which is the reason for this instruction?

A To minimize the therapeutic effects. To decrease the likelihood of insomnia. To increase the likelihood of daytime sleep

B To decrease the likelihood of insomnia. To decrease the risk of drug-drug interactions. To maintain consistent blood levels of the drug.

C To maintain consistent blood levels of the drug. To increase the likelihood of daytime sleep. To minimize the therapeutic effects.

D To minimize the therapeutic effects. To increase the likelihood of daytime sleep. To decrease the risk of drug-drug interactions.

Question #17

Which action will the nurse take for a patient who is prescribed levothyroxine 100 mg orally daily if the time is 1800 and the patient’s thyroid-stimulating hormone (TSH) is at a high level?

A Administer the medication as prescribed today at 1800.

B Schedule the medication the next morning at breakfast.

C Review the prescription dose with the health care provider.

D Confirm laboratory value with the health care provider

Question #18

Which teaching point will the nurse include when administering the first dose of prescribed levothyroxine?

A The medication is quickly eliminated from the body the next day.

B Symptoms of low thyroid should improve in 24 hours.

C High or low therapeutic levels are monitored if symptoms occur.

D The medication action is noticed at 3 to 5 days.

Question #19

Which concern would the nurse have with this patient’s information on the day of surgery?

Admitting Diagnosis: Appendicitis
Surgery: Appendectomy
Home Medications: Levothyroxine 100 mcg/day orally

Current Medications:
Levothyroxine 100 mcg/day intravenously in the am
Ceftriaxone (50 mg/kg) andmetronidazole (30 mg/kg) intravenous one dose each before surgery

Additional Treatment:
0.9% saline 100 mL/hour intravenously
Nothing by mouth today
Activity as tolerated
Complete blood count and serum electrolytes before and after surgery

A Levothyroxine intravenous dose is the same as the oral dose.

B Compatibility of levothyroxine with a saline infusion.

C Medication interactions may occur with this combination.

D Sodium levels may increase with intravenous infusion of normal saline.

Question #20

Which prescribed therapy will the nurse clarify with the health care provider for a patient who is scheduled for a radioactive iodine isotope study?

A Documenting the current thyroid therapy on the results of the study.

B Initiating thyroid therapy with the study to monitor the results of therapy.

C Administering thyroid therapy up to the day before the study.

D Holding the thyroid replacement medication prior to the study.

Question #21

Which patient with a thyroid disorder is considered safe to receive radioactive iodine?

A Symptoms of myxedema

B Recently diagnosed with thyroid cancer

C Hyperthyroid during the first-trimester pregnancy

D Toxic levels of levothyroxine

Question #22

Which statement describes what the nurse would teach a patient who has a first-time prescription for the antithyroid drug propylthiouracil?

A “This drug is given to raise the thyroid hormone levels in your blood.”
“Take the medication along with a meal to prevent stomach upset.”
“Take the medication daily on an empty stomach to reduce liver damage.”

B “This drug is given to raise the thyroid hormone levels in your blood.”
“Take the medication daily on an empty stomach to reduce liver damage.”
“You need to be aware of the manifestations of hypothyroidism.”

C “You need to avoid eating salt, shellfish, and foods high in iodine.”
“This drug is given to raise the thyroid hormone levels in your blood.”
“Take the medication daily on an empty stomach to reduce liver damage.”

D “You need to be aware of the manifestations of hypothyroidism.”
“Take the medication along with a meal to prevent stomach upset.”
“You need to avoid eating salt, shellfish, and foods high in iodine.”

Question #23

The nurse is assessing an older adult who has been taking liotrix for 6 months. The nurse finds that the patient has anxiety, tremors, and insomnia. Which finding will the nurse interpret from these symptoms?

A The patient is not responding to the thyroid drugs.

B The patient is experiencing adverse effects of the thyroid drugs.

C The patient has common age-related symptoms.

D The patient is hypersensitive to thyroid drugs.

Question #24

A patient with hypothyroidism reports severe sleeping disturbances. Which statement given by the patient is helpful in identifying the reason for the insomnia?

A “I take the tablet every morning on an empty stomach.”

B “I take the tablet every morning at the same time.”

C “I always take the same brand of tablet.”

D “I take the tablet every evening at the same time.”

Question #25

The nurse is caring for a patient who has hypothyroidism. The patient is also receiving digitalis therapy. The nurse advises the patient to discuss getting an electrocardiogram (ECG) with the provider. Which reason is given for having an ECG?

A Thyroid drugs normalize the metabolic rate.

B Thyroid drugs decrease thyroid-stimulating hormone (TSH) levels.

C Thyroid drugs decrease serum digitalis levels.

D Thyroid drugs have an adverse effect of cold intolerance.

Question #26

During an assessment of a patient with hyperthyroidism, the nurse learns that the patient’s provider has recommended thyroidectomy. Which statement could describe the reason for opting for such treatment for the patient?

A The patient is obese.

B The patient has diabetes.

C The patient is pregnant.

D The patient is elderly.

Question #27

A patient with stage III laryngeal cancer underwent laryngectomy with concurrent removal of the thyroid gland. Which type of hypothyroidism will occur in this case?

A Primary hypothyroidism

B Secondary hypothyroidism

C Tertiary hypothyroidism

D Quaternary hypothyroidism

Question #28

Which is an adverse effect of antithyroid medication?

A Cramps, Vertigo, Tremor

B Vertigo, Leukopenia, Loss of taste

C Loss of taste, Tremor, Cramps

D Cramps, Tremor, Leukopenia

Question #29

Which is an adverse effect of thyroid replacement drugs?

A Fatigue, Weight gain

B Chest pain, Palpitations

C Cold intolerance, Fatigue

D Weight gain, Cold intolerance

Question #30

Which is a symptom of hypothyroidism?

A Increased appetite, Depression, Altered menstrual cycle

B Cold intolerance, Increased appetite, Altered menstrual cycle

C Dry, brittle hair and nails, Altered menstrual cycle, Increased appetite

D Depression, Cold intolerance, Dry, brittle hair and nails

Question #31

While assessing a patient who is receiving levothyroxine therapy, the nurse advises the patient to take the oral dose before breakfast. Which dosage is the patient ordered in the prescription?

A 100 mcg

B 300 mcg

C 500 mg

D 400 mg

Question #32

The nurse is assessing a patient who has been taking propylthiouracil for the past 2 weeks and has normal thyroid-stimulating hormone (TSH) levels. Which symptom would the nurse primarily monitor the patient for?

A Cold intolerance

B Heart palpitations

C Unexplained weight gain

D Loss of appetite

Question #33

Which information would the nurse include when teaching a patient with a new prescription for levothyroxine?

A Avoid the use of iodized salt or shellfish in the diet. Administer with an antacid if stomach upset occurs.

B Take the medication 30 minutes prior to breakfast. Check your heart rate prior to administration of the drug.

C Administer with an antacid if stomach upset occurs. Take the medication with food at the evening meal.

D Take the medication with food at the evening meal. Avoid the use of iodized salt or shellfish in the diet.

Question #34

A patient receiving propylthiouracil asks the nurse how this medication will help relieve symptoms. Which statement explains the action of the medication?

A “Propylthiouracil inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism.”

B “Propylthiouracil helps the thyroid gland use iodine and synthesize hormones better.”

C “This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal.”

D “This medication stimulates the pituitary gland to secrete thyroid-stimulating hormone, which inhibits the production of hormones by the thyroid gland.”

Question #35

Which symptom is a clinical indicator of Graves’ disease?

A Bradycardia, Heat intolerance, Cold intolerance, Diarrhea

B Bradycardia, Cold intolerance, Flushing, Altered menstrual flow

C Altered menstrual flow, Heat intolerance, Bradycardia, Cold intolerance

D Diarrhea, Flushing, Altered menstrual flow, Heat intolerance

Question #36

A patient who has been taking levothyroxine is experiencing weight loss, tremors, and hypertension. Which pharmacokinetic property of levothyroxine is responsible for causing toxic manifestations?

A Onset of action of 1 to 3 days

B Duration of action of 12 hours

C Prolonged half-life of 10 days

D Intravenous administration of the drug

Question #37

Which assessment finding would the nurse expect in a child who has cretinism?

A Weight gain, Heat intolerance

B Dullness of the skin, Weight gain

C Heat intolerance, Dullness of the skin

D Mental impairment, Low metabolic rate

Question #38

The health care provider prescribes radioactive iodine to an adult patient who has thyroid cancer. Which is the reason for prescribing this drug to the patient?

A It inhibits the conversion of T4 to T3 in the peripheral circulation.

B It takes up beta rays into the follicles of the thyroid gland.

C It increases the cellular metabolic rate and oxygen consumption.

D It acts as a prophylactic agent against radiation exposure.

Question #39

The nurse observes that a patient has dullness of the skin, weight gain, and severe hair loss. Which would the nurse suspect?

A The patient has a goiter.

B The patient has hyperthyroidism.

C The patient has hypothyroidism.

D The patient has thyroid storm.

Question #40

A patient with a thyroid disorder states, “I am unable to distinguish between the tastes of different foods.” Which medication would the nurse expect is responsible for this condition?

A Liotrix

B Desiccated thyroid

C Levothyroxine

D Methimazole

Question #41

The nurse reviews a patient’s laboratory report and notes elevated thyroxin levels. Which condition does the patient have?

A Graves’ disease

B Myxedema

C Goiter

D Cretinism

Question #42

The nurse is assessing a pregnant patient in the second trimester who has hyperthyroid activity. Which would the nurse expect the health care provider to order?

A Methimazole

B Avoid the drug for 2 weeks

C Avoid folic acid supplements

D Propylthiouracil

Question #43

A patient receiving propylthiouracil asks the nurse, “How will this medication help relieve my symptoms?” With which would the nurse respond?

A “It helps your thyroid gland use iodine and synthesize hormones more efficiently.”

B “It stimulates the pituitary to secrete thyroid-stimulating hormone (TSH), which inhibits activity of the thyroid.”

C “It inhibits formation of new thyroid hormone, thus gradually returning your metabolism to normal.”

D “It inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism.”

Question #44

The nurse is caring for a patient who is taking levothyroxine and warfarin. Which intervention is a priority for the nurse?

A Weigh the patient daily for excessive weight loss.

B Monitor the patient for cardiac dysrhythmias.

C Assess peripheral pulses and Homan’s sign daily.

D Monitor the patient for increased risk of bleeding.

Question #45

The nurse is caring for a patient who has myxedema. The nurse administers a hypothyroid drug and later learns that the drug was improperly mixed and that an increased dose of the drug was administered to the patient. For which symptom would the nurse initially assess?

A Bloody stools

B Reduced urine output

C Increased heart rate

D Increased sleep

Question #46

While reading the history and the lab reports of an adult patient, the nurse finds that the patient has decreased metabolic rate, weight gain, and hair loss. Which condition can the nurse interpret from these findings?

A Plummer’s disease

B Cretinism

C Graves’ disease

D Myxedema

Question #47

Which genitourinary adverse effect does the nurse expect in the patient who is on therapy with antithyroid medication?

A Smoky urine, Decreased urinary output

B Increased serum creatinine levels, Bleeding

C Increased blood urea nitrogen, Increased serum creatinine levels

D Bleeding, Increased blood urea nitrogen

Question #48

Which thyroid preparation, considered the purest form of thyroxine (T4), is the drug of choice for hypothyroidism?

A Propylthiouracil

B Liotrix

C Liothyronine

D Levothyroxine

Question #49

Which process is characterized by destruction of the thyroid gland?

A Ablation

B Thyroid storm

C Thyroidectomy

D Desiccation

Question #50

Which drug used to treat hypothyroidism is also used to diagnose hyperthyroidism?

A Liotrix

B Propylthiouracil

C Levothyroxine

D Methimazole

Question #51

Which food should a patient avoid while taking antithyroid medications?

A Milk

B Seafood

C Eggs

D Chicken

Question #52

Which outcome will the nurse monitor for in a patient who received propylthiouracil therapy for several months?

A Pulse rate, Serum electrolytes, Serum white blood count, Weight, Mental status

B Pulse rate, Temperature, Serum white blood count, Weight, Mental status

C Pulse rate, Temperature, Serum electrolytes, Weight, Mental status

D Pulse rate, Temperature, Serum white blood count, Serum electrolytes, Mental status

Question #53

Which action will the nurse plan first after reviewing the patient’s recent data?

Patient Information
Vital Signs and Patient Data:
o Temperature 100.6° F (38.1° C)
o Apical pulse at 106 beats/min
o Respirations 20 breaths/min
o Blood pressure 138/90 mmHg
o “I feel nervous. I can’t sleep.”
o “I feel flushed.”
o “I had episodes of diarrhea.”
o “I could eat something.”
o “I had pneumonia last month.”

Prescribed Treatment and Medications:
o Propylthiouracil 100 mg daily orally
o Metoprolol 50 mg orally twice a day
o High-calorie diet
o Bed rest with assistance to ambulate to the bathroom only

A Serve a high-calorie snack

B Administer propylthiouracil

C Review serum white blood cell count

D Administer metoprolol

Question #54

Which action will the nurse take for a 75-year-old patient who is prescribed a lower dose of levothyroxine for outpatient treatment?

A Ask the health care provider about a higher dose

B Discuss options for twice-a-day dosing

C Discuss administering the medication with food

D Explain side effects to report to the prescriber

Question #55