Chapter 24: Drugs for Endocrine Problems Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 24: Drugs for Endocrine Problems

Test Bank

MULTIPLE CHOICE

1. Which mineral is critical for the thyroid to use in making thyroid hormones?
a. Lithium
b. Sodium
c. Chloride
d. Iodine
ANS: D
Thyroid hormones (TH) are made from the amino acid tyrosine and the mineral iodine. For the thyroid gland to make correct amounts of TH, the diet must contain enough protein and iodine.

PTS: 0 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 425 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

2. Laboratory blood tests show that a patient has a T3 level of 190 ng/dL. How does the nurse interpret this finding?
a. Hypothyroidism
b. Hyperthyroidism
c. Normal thyroid function
d. Thyroid function totally absent
ANS: C
The normal level for T3 (triiodothyronine) ranges between 70 and 205 ng/dL.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 426 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

3. A patient with hypothyroidism as a result of Hashimotos thyroiditis asks how long thyroid replacement drugs will need to be taken. What is the nurses best response?
a. You will need to take the thyroid replacement drug until the goiter is completely gone.
b. You will need thyroid replacement drugs for the rest of your life because thyroid function will not return.
c. The thyroiditis will be cured with antibiotics and then you will no longer need the thyroid replacement drugs.
d. When your thyroid function studies indicate a normal blood level of thyroid hormones you will be able to discontinue the drugs.
ANS: B
Hashimotos thyroiditis results in a permanent loss of thyroid function. Without continuous thyroid replacement drugs, the patients metabolism would eventually stop and death would occur.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

4. Which assessment is most important for the nurse to perform before giving a patient who is prescribed levothyroxine (Synthroid) the first dose of the drug?
a. Measuring heart rate and rhythm
b. Determining level of consciousness
c. Asking about an allergy to sulfa drugs
d. Checking intake and output for the last 24 hours
ANS: A
The side effects and adverse effects of thyroid hormone replacement drugs increase metabolic rate and cardiac activity. Checking heart rate and rhythm before giving the drug provides a baseline to determine whether or not the drug is working correctly or is causing an overdose effect.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

5. A patient is prescribed levothyroxine 25 mcg by IV push. The drug on hand is levothyroxine sodium 100 mcg/mL. How many milliliters does the nurse administer?
a. 2.5
b. 1
c. 0.5
d. 0.25
ANS: D
Want 25 mcg per /X mL, Have 100 mcg per 1 mL; 25/100 = 0.25 1 mL = 0.25 mL.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

6. A patient who is prescribed liothyronine (Cytomel) also takes warfarin (Coumadin). Which laboratory blood test result indicates to the nurse a possible drug interaction?
a. Hematocrit 42%
b. Hemoglobin 14.2 g/dL
c. Blood urea nitrogen (BUN) 12 mg/dL
d. International normalized ratio (INR) 4.5
ANS: D
Liothyronine increases the effectiveness of warfarin. Warfarins effectiveness is measured by the INR. This value should be between 1.5 and 3.0 in a patient taking warfarin. With an INR level of 4.5 the patient is at extreme risk for excessive bleeding.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

7. A patient who has been taking levothyroxine (Synthroid) for 2 months has all of the following conditions. Which condition indicates to the nurse that the drug therapy is effective?
a. Increased thirst
b. Daily bowel movement for 1 week
c. White blood cell count of 6000/mm3
d. Weight unchanged for the last 3 weeks
ANS: B
Hypothyroidism decreases GI motility significantly. One of the parameters that can be used to determine if changes in the dose of a thyroid replacement drug should be adjusted is the frequency of bowel movements. A bowel movement every day is a strong indication that the dose of thyroid replacement hormone is adequate.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

8. Which precaution is most important for the nurse to teach a patient who is newly prescribed a thyroid hormone replacement drug?
a. Avoid taking fiber supplements while on this drug.
b. Be sure to take this drug at the same time every day.
c. Weigh yourself daily and keep a record of these weights.
d. Do not increase the dose without your prescribers knowledge.
ANS: D
When a patient begins treatment with thyroid replacement drugs, the starting drug dosage is very low, with no attempt to bring the blood thyroid hormone level back to normal quickly. These drugs can change metabolism quickly and lead to adverse effects such as heart attack or seizure. Dosages start low and are raised very slowly (about every 3 weeks). The patient should never increase the dose unless instructed to do so by the prescriber.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

9. Why should pregnant patients who have hypothyroidism continue to take thyroid replacement drugs throughout pregnancy?
a. These drugs are pregnancy category A and have no side effects.
b. Without continuing thyroid replacement drugs, the pregnancy may not continue.
c. Pregnancy is a high metabolism condition and less drug is needed but should still be taken.
d. The fetus produces thyroid hormones that help supplement the pregnant womans hormone level, but minimal replacement is needed during pregnancy.
ANS: B
The thyroid gland secretes hormones that are necessary for life. Not taking the drug can lead to problems with the pregnancy and with the fetus. The pregnant woman often needs a higher dose of the drug.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 430 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

10. How do thyroid replacement drugs affect diabetes?
a. Thyroid replacement drugs reduce the effectiveness of all antidiabetic drugs.
b. When thyroid replacement drugs return metabolism to normal, diabetes is gone.
c. Thyroid replacement drugs can allow a patient to switch from insulin to an oral antidiabetic drug.
d. Thyroid replacement drugs require that a patient taking an oral antidiabetic drug be placed on insulin.
ANS: A
Thyroid hormone replacement drugs change the effectiveness of insulin and other drugs for diabetes, and often these drugs need to be increased to prevent high blood glucose levels (hyperglycemia). Patients with diabetes and hypothyroidism should be taught to check blood glucose levels more frequently.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 431 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

11. Which statement made by a patient who is taking a thyroid replacement drug indicates to the nurse that a higher dose may be needed?
a. My goiter seems to be smaller.
b. I seem to feel the heat more than other people.
c. Food just doesnt taste good without a lot of salt.
d. I am always tired, even when I get 10 or 12 hours of sleep.
ANS: D
When blood thyroid hormone levels are insufficient to maintain a normal metabolic rate, symptoms of hypothyroidism return. Patients usually feel tired or weak and often report an increase in time spent sleeping, sometimes up to 14 to 16 hours per day.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

12. Which symptom of hyperthyroidism occurs only with the Graves disease form of the problem?
a. Goiter
b. Hypertension
c. Exophthalmos
d. Thinning scalp hair
ANS: C
Exophthalmos is a bulging or protrusion of the eyes, causing blurred vision. This problem is unique to hyperthyroidism because the disorder causes tissue behind the eye to swell, pushing the eyeball forward.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 431 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

13. 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 does the nurse notify the prescriber immediately?
a. High level of anxiety about having surgery on the neck
b. Temperature increase of 2 F
c. Pulse pressure decrease of 10 mm Hg
d. Increased bowel sounds and flatulence
ANS: B
A complication of severe hyperthyroidism is thyroid crisis (also known as thyroid storm). Symptoms include fever, dangerously high blood pressure, and a rapid, irregular heart beat. The symptoms can develop quickly, and if not treated, this problem can lead to seizures, heart failure, and death. An elevation in temperature may be an indication of impending thyroid crisis and requires immediate attention.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

14. 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?
a. Thyroid hormones are stored and thyroid suppressing drugs only stop the synthesis of new hormones.
b. At first, the patients metabolism is so high that the thyroid cells continue to synthesize thyroid hormones.
c. The activity of the intestinal tract is increased and the drug is eliminated before complete suppression can occur.
d. 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.
ANS: A
Thyroid-suppressing drugs enter the thyroid gland and combine with the enzyme responsible for connecting iodine (iodide) with tyrosine to make active thyroid hormones, preventing further thyroid hormone synthesis. These drugs do not affect the hormones already formed and stored in the thyroid gland, so it may take as long as 3 or 4 weeks for the person to use up all the thyroid hormones made before the drug was started. Until that time, the person continues to have symptoms of hyperthyroidism.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 432 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

15. A patient who has been taking methimazole (Tapazole) for 3 weeks has all of the following laboratory blood test results. Which result does the nurse report immediately to the prescriber?
a. White blood cell count 3500 cells/mm3
b. Lactate dehydrogenase 990 IU/L
c. Sodium 132 mEq/L
d. Hematocrit 32%
ANS: B
All of these blood values are abnormal; however, only the lactate dehydrogenase level is very high (four times normal). This value indicates liver impairment. Methimazole can cause liver impairment. This value must be reported immediately so that liver function can be explored and any needed changes in drug therapy made before irreversible liver damage occurs.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

16. A patient who is prescribed propylthiouracil (Propacil) also takes warfarin (Coumadin). Which laboratory blood test result indicates to the nurse a possible drug interaction?
a. Hematocrit 42%
b. Hemoglobin 14.2 g/dL
c. Blood urea nitrogen (BUN) 12 mg/dL
d. International normalized ratio (INR) 5.0
ANS: D
Propylthiouracil increases the effectiveness of warfarin. Warfarins effectiveness is measured by the INR. This value should be between 1.5 and 3.0 in a patient taking warfarin. With an INR level of 4.5 the patient is at extreme risk for excessive bleeding.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

17. Which precaution is important for the nurse to teach an older patient who is prescribed methimazole (Tapazole)?
a. If you miss a dose, go to the nearest emergency department and get an injection of methimazole.
b. Be sure to wear sunscreen and a hat whenever you go outside into the sunshine.
c. Drink at least 3 liters of fluid daily while taking this drug.
d. Avoid contact with crowds or anyone who is ill.
ANS: D
The older adults resistance to infection is already lower than a younger adults because of age-related changes that occur in the immune system. The decreased bone marrow activity caused by methimazole makes this problem worse, greatly increasing the older adults risk for infection.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

18. A patient who has just been prescribed estrogen-based hormone replacement therapy (HRT) also has all of the following health problems. For which problem does the nurse check with the prescriber to determine whether the patient should take HRT?
a. Asthma
b. Hypertension
c. Osteoporosis
d. Diabetes mellitus
ANS: B
Common side effects of menopausal HRT include breast tenderness, breakthrough bleeding, fluid retention weight gain, and acne. These occur with conjugated estrogen alone and when combined with progesterone. Fluid retention can cause or worsen hypertension. If the patients hypertension is not well controlled, she should not be taking HRT.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

1. Which precautions are important for the nurse to teach a patient who is taking hormone replacement therapy (HRT) to reduce menopausal discomfort? (Select all that apply.)
a. Use oral contraceptives.
b. Avoid cigarette smoking.
c. Avoid drinking alcoholic beverages.
d. Obtain a yearly influenza vaccination.
e. Perform monthly breast self-examinations.
f. Go to the hospital immediately if chest pains or symptoms of a stroke occur.
ANS: B, E, F
HRT with estrogens increase the risk for clot formation that could cause venous thromboembolism, stroke, and heart attack. The risk is higher if the patient also smokes. Patients taking HRT should avoid cigarette smoking and should seek medical help immediately if chest pain or symptoms of a stroke occur. Hormones like estrogen can make breast cancers grow faster. The patient should perform monthly breast self-examinations to determine the presence of any lumps that could be cancerous. Although a yearly influenza vaccination is a good health promotion practice, HRT does not increase the risk for influenza. Oral contraceptives should not be used with HRT. There is no contraindication for drinking alcohol (in moderation) while taking HRT.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 438 TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

ESSAY

1. A patient with hyperthyroidism is prescribed an immediate dose of propylthiouracil (Propacil) 150 mg orally. The available drug is propylthiouracil 50 milligrams per tablet. How many tablets does the nurse administer?
_____ tablets

ANS:
3 tablets
Want 150 mg, Have 50 mg per tablet; 150/50 = 3; 3 1 tablet = 3 tablets.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

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