Mastery EAQ Ch. 31

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Below are the questions for the exam with the choices of answers:

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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 Irritability

B Bradycardia

C Drowsiness

D Intolerance to cold

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 Increased blood glucose level

C Increased estrogen levels in the blood

D Decreased blood glucose level

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 Irritability

B Weight gain of 3 pounds in the last week

C Intolerance to cold

D Brittle nails

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 Propylthiouracil 300 mg/day orally

B Liotrix 50 mg/day orally

C Levothyroxine 300 mcg intravenous (IV)

D Methimazole 20 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 can stop the medication whenever I want without consulting my primary health care provider.”

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

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

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

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

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

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

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 “Increase the amount of fiber in your diet.”

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

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

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

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 Scalp abnormality

B Walking abnormality

C Eating abnormality

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

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

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

D “Additional weight gain occurs with low thyroid.”

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 Glucose levels

B Calcium levels

C Platelet count

D Creatinine 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 Beta-lactam antibiotics

B Anticoagulants

C Antidiabetics

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 Leukocyte count

B Skin condition

C Size of the thyroid

D Coloration of the urine

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 consumes cheese and legumes while taking the medication.

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 takes 50 mg of levothyroxine of different brands.

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 signs and symptoms of thyroid storm.

B Assess the patient’s urine output.

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

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

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

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

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 Confirm laboratory value with the health care provider

B Administer the medication as prescribed today at 1800.

C Review the prescription dose with the health care provider.

D Schedule the medication the next morning at breakfast.

Question #18

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

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

B Symptoms of low thyroid should improve in 24 hours.

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

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 Sodium levels may increase with intravenous infusion of normal saline.

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

C Compatibility of levothyroxine with a saline infusion.

D Medication interactions may occur with this combination.

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 Administering thyroid therapy up to the day before the study.

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

C Holding the thyroid replacement medication prior to the study.

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

Question #21

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

A Hyperthyroid during the first-trimester pregnancy

B Recently diagnosed with thyroid cancer

C Toxic levels of levothyroxine

D Symptoms of myxedema

Question #22

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

A “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.”

B “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.”

C “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.”

D “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.”

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 has common age-related symptoms.

C The patient is hypersensitive to thyroid drugs.

D The patient is experiencing adverse effects of the 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 always take the same brand of tablet.”

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

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

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 decrease thyroid-stimulating hormone (TSH) levels.

B Thyroid drugs have an adverse effect of cold intolerance.

C Thyroid drugs normalize the metabolic rate.

D Thyroid drugs decrease serum digitalis levels.

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 pregnant.

B The patient has diabetes.

C The patient is obese.

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 Quaternary hypothyroidism

B Primary hypothyroidism

C Secondary hypothyroidism

D Tertiary hypothyroidism

Question #28

Which is an adverse effect of antithyroid medication?

A Vertigo, Leukopenia, Loss of taste

B Cramps, Tremor, Leukopenia

C Cramps, Vertigo, Tremor

D Loss of taste, Tremor, Cramps

Question #29

Which is an adverse effect of thyroid replacement drugs?

A Cold intolerance, Fatigue

B Chest pain, Palpitations

C Weight gain, Cold intolerance

D Fatigue, Weight gain

Question #30

Which is a symptom of hypothyroidism?

A Cold intolerance, Increased appetite, Altered menstrual cycle

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

C Increased appetite, Depression, Altered menstrual cycle

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

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 300 mcg

B 100 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 Loss of appetite

C Heart palpitations

D Unexplained weight gain

Question #33

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

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

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

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

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

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

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

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

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 Diarrhea, Flushing, Altered menstrual flow, Heat intolerance

D Altered menstrual flow, Heat intolerance, Bradycardia, Cold 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 Prolonged half-life of 10 days

B Intravenous administration of the drug

C Duration of action of 12 hours

D Onset of action of 1 to 3 days

Question #37

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

A Heat intolerance, Dullness of the skin

B Dullness of the skin, Weight gain

C Mental impairment, Low metabolic rate

D Weight gain, Heat intolerance

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 increases the cellular metabolic rate and oxygen consumption.

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

C It acts as a prophylactic agent against radiation exposure.

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

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 hypothyroidism.

B The patient has thyroid storm.

C The patient has a goiter.

D The patient has hyperthyroidism.

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 Methimazole

B Desiccated thyroid

C Levothyroxine

D Liotrix

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 Propylthiouracil

B Avoid the drug for 2 weeks

C Methimazole

D Avoid folic acid supplements

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

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

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

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

Question #44

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

A Monitor the patient for cardiac dysrhythmias.

B Monitor the patient for increased risk of bleeding.

C Weigh the patient daily for excessive weight loss.

D Assess peripheral pulses and Homan’s sign daily.

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 Reduced urine output

B Increased heart rate

C Increased sleep

D Bloody stools

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 Graves’ disease

C Myxedema

D Cretinism

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 Bleeding, Increased blood urea nitrogen

C Increased serum creatinine levels, Bleeding

D Increased blood urea nitrogen, Increased serum creatinine levels

Question #48

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

A Propylthiouracil

B Levothyroxine

C Liotrix

D Liothyronine

Question #49

Which process is characterized by destruction of the thyroid gland?

A Desiccation

B Ablation

C Thyroidectomy

D Thyroid storm

Question #50

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

A Levothyroxine

B Liotrix

C Propylthiouracil

D Methimazole

Question #51

Which food should a patient avoid while taking antithyroid medications?

A Chicken

B Milk

C Eggs

D Seafood

Question #52

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

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

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

C Pulse rate, Serum electrolytes, Serum white blood count, 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 Administer propylthiouracil

B Review serum white blood cell count

C Administer metoprolol

D Serve a high-calorie snack

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 Explain side effects to report to the prescriber

B Ask the health care provider about a higher dose

C Discuss administering the medication with food

D Discuss options for twice-a-day dosing

Question #55