Sherpath: Chapter 17, Drugs for Osteoporosis and Hormonal Problems: Drug Therapy for Thyroid Problems

Question 1 of 28

 Report content error

Which information would the nurse include when explaining the endocrine system? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Many hormones are necessary for life.Many hormones are necessary for life. Some hormones, such as estrogen, are useful at different times during a person’s life, but are not essential for maintaining critical physiologic functions.
• Correct
  • Hormones are proteins secreted by an endocrine gland.A hormone is a protein secreted by an endocrine gland that changes the action of another gland or tissue, known as its target tissue.
• Correct
  • Endocrine glands are ductless glands.Unlike some glandular secretions (e.g., from the salivary glands) that move through a duct directly to their site of action, hormones do not require a duct to reach their target tissues. For this reason, endocrine glands are known as ductless glands.
• Correct
  • Hormones are released into the bloodstream.The hormones are released into the bloodstream and they circulate throughout the body.
• • Regulation of hormones works on a positive feedback loop.The regulation of hormones works on a negative feedback loop, not a positive feedback loop.

Question 2 of 28

 Report content error

Which statement describes the glands of the endocrine system?

• Correct
  • “They are ductless.”Endocrine glands are known as ductless glands. The hormones are released into the bloodstream in which they circulate throughout the body.
• • “There are four of them.”There are 9 endocrine glands: hypothalamus, pineal, pituitary, thyroid, parathyroid, thymus, adrenal, pancreas, and gonads (testes and ovaries).
• • “Endocrine glands release hormones directly to the intended site of action.”Unlike other glands, the endocrine glands release hormones through the blood stream and not through a duct to the intended site of action.
• • “They release secretions in response to a positive feedback mechanism.”Endocrine glands secrete hormones which are released according to a negative feedback loop.

Question 3 of 28

 Report content error

Which gland would the nurse include when explaining the endocrine system? Select all that apply. One, some, or all responses may be correct.

• Correct
  • PinealThe pineal gland is located in the cranium and is an endocrine gland.
• • AxillaryThe axillary glands are located in the underarm region and are not considered endocrine glands.
• • CervicalThe cervical glands are located in the neck and are not considered endocrine glands.
• Correct
  • AdrenalThe adrenal glands sit on top of the kidneys and are endocrine glands.
• • InguinalThe inguinal glands are located in the groin and are not considered endocrine glands.
• Correct
  • PancreasThe pancreas is located in the mid-abdomen and is an endocrine gland.

Question 4 of 28

 Report content error

Which statement would the nurse make when describing the negative feedback loop to regulate endocrine hormones?

• • “The gland stops producing the hormone on a predetermined schedule.”Hormones are not secreted on a predetermined schedule.
• • “The hormone is continually released unless the gland is removed.”A gland can stop producing hormones without needing to be removed.
• Correct
  • “If there is enough hormone in the body, the gland will stop secreting it.”The regulation of hormones works on a negative feedback loop. When the level of a hormone is high enough to meet bodily needs, the hormone feedback loop stops secretion of the hormone.
• • “A negative feedback loop means the gland releases hormones through the duct to directly affect an organ.”The endocrine system is a ductless system, and the hormones are released into the blood stream. This does not describe a negative feedback loop.

Question 5 of 28

 Report content error

Which gland secretes a hormone that is not required for maintaining physiological function for survival?

• Correct
  • OvaryThe ovaries secrete estrogen, which is useful at different times during a female’s life. However, it is not essential for maintaining physiologic functions.
• • AdrenalThe adrenal glands secrete hormones that are essential for maintaining physiologic functions.
• • ThyroidThe thyroid secretes hormones that are essential for maintaining physiologic functions.
• • PancreasThe pancreas secretes hormones that are essential for maintaining physiologic functions.

Question 6 of 28

 Report content error

For which condition would the nurse expect a patient to be prescribed hormone replacement therapy? Select all that apply. One, some, or all responses may be correct.

• • Heart failureHormone replacement therapy is not used to treat heart failure.
• • Kidney failureHormone replacement therapy is not used to treat kidney failure.
• Correct
  • MenopauseHormone replacement therapy can be used to treat the symptoms of menopause.
• Correct
  • HypothyroidismHormone replacement therapy is used to treat hypothyroidism.
• Correct
  • Diabetes mellitusHormone replacement therapy is used to treat diabetes mellitus.

Question 7 of 28

 Report content error

Which assessment finding indicates that a patient has low levels of thyroid hormones? Select all that apply. One, some, or all responses may be correct.

• • Bone painBone pain is not a symptom associated with hypothyroidism or low levels of thyroid hormones.
• Correct
  • Weight gainWeight gain, even with minimal food intake, is associated with hypothyroidism, or low levels of thyroid hormones.
• Correct
  • Low heart rateLow heart rate is associated with hypothyroidism, or low levels of thyroid hormones.
• Correct
  • Reduced sex driveReduced sex drive is associated with hypothyroidism, or low levels of thyroid hormones.
• Correct
  • ConstipationConstipation is associated with hypothyroidism, or low levels of thyroid hormones.

Question 8 of 28

 Report content error

Which assessment finding would the nurse expect in an adult patient with hypothyroidism? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Dry skinHypothyroidism, also known as underactive thyroid, is a common problem in which the thyroid gland produces little or no thyroid hormones, slowing all aspects of metabolism. A symptom of this condition is dry skin.
• • Hand tremorsHand tremors are associated with hyperthyroidism, not hypothyroidism.
• Correct
  • Loss of scalp hairHypothyroidism, also known as underactive thyroid, is a common problem in which the thyroid gland produces little or no thyroid hormones, slowing all aspects of metabolism. Loss of scalp hair is associated with this condition.
• Correct
  • Heart rate 54 beats per minuteHypothyroidism, also known as underactive thyroid, is a common problem in which the thyroid gland produces little or no thyroid hormones, slowing all aspects of metabolism. A heart rate low for the age and size of the patient is associated with this condition.
• Correct
  • Weight gain of 8.8 lb (4 kg) in 2 monthsHypothyroidism, also known as underactive thyroid, is a common problem in which the thyroid gland produces little or no thyroid hormones, slowing all aspects of metabolism. Gaining weight while eating minimal amounts of food is associated with this condition.

Question 9 of 28

 Report content error

Which response would the nurse provide when describing a thyroid hormone agonist?

• • “It stops the effects of thyroid hormones on the body.”A thyroid hormone antagonist, not agonist, would stop the effects of thyroid hormones on the body.
• • “It reduces the rate of energy used and the work of each cell.”A thyroid hormone agonist increases, not decreases, the rate of energy used and the work of each cell by entering the cell nucleus to activate the genes for metabolism.
• Correct
  • “It acts like a natural thyroid hormone to activate the metabolism.”A thyroid hormone agonist is a drug that mimics the effect of the thyroid hormones to regulate metabolism. These drugs work like natural thyroid hormones by moving through the blood and entering all cells. The drugs then enter the nucleus and bind to receptors on the DNA, which activates the genes for metabolism. Thyroid hormone agonists increase the cells’ rate of metabolism, which speeds up the energy use and work of each cell.
• • “It enters the nucleus of cell DNA to turn off the genes for metabolism.”A thyroid agonist will activate, not turn off, the genes that control metabolism by entering the cell nucleus and bind to receptors on the DNA.

Question 10 of 28

 Report content error

Which teaching would the nurse provide to a patient with diabetes who is prescribed levothyroxine?

• • “Monitor the color of your skin.”Changes in skin color may indicate liver toxicity. Levothyroxine is a thyroid hormone agonist and does not affect liver function.
• • “Report any new onset of an infection.”Antithyroid drugs can cause bone marrow suppression and cause infections.
• • “Take an extra dose of the drug if symptoms persist.”The patient should be instructed to take the drug as prescribed and not take any additional doses.
• Correct
  • “Do not take this drug with aspirin or a nonsteroidal anti-inflammatory drug.”Anticoagulants like aspirin or NSAIDs can interact with levothyroxine and cause excessive bruising and bleeding.

Question 11 of 28

 Report content error

Which assessment finding indicates that a patient’s dose of a thyroid hormone agonist might need to be reduced? Select all that apply. One, some, or all responses may be correct.

• Correct
  • DiarrheaThyroid hormone agonist drugs have few side effects because they mimic normal hormones. As cell metabolism increases, the patient may experience symptoms of hyperthyroidism, including diarrhea.
• Correct
  • InsomniaThyroid hormone agonist drugs have few side effects because they mimic normal hormones. As cell metabolism increases, the patient may experience symptoms of hyperthyroidism, including insomnia.
• Correct
  • Rapid heart rateThyroid hormone agonist drugs have few side effects because they mimic normal hormones. As cell metabolism increases, the patient may experience symptoms of hyperthyroidism, including a rapid heart rate.
• • Lower extremity edemaLower extremity edema is a side effect of a thyroid antagonist drug.
• Correct
  • Elevated blood pressureThyroid hormone agonist drugs have few side effects because they mimic normal hormones. As cell metabolism increases, the patient may experience symptoms of hyperthyroidism, including elevated blood pressure.

Question 12 of 28

 Report content error

Which assessment finding indicates to the nurse that a patient is experiencing an adverse effect from a thyroid hormone agonist? Select all that apply. One, some, or all responses may be correct.

• • NauseaNausea is not an adverse effect of a thyroid hormone agonist.
• Correct
  • SeizuresIncreased nervous system activity can lead to seizures when taking a thyroid hormone agonist, although this is more likely to occur in patients who already have a seizure disorder.
• • VomitingVomiting is not an adverse effect of a thyroid hormone agonist.
• Correct
  • Chest painWhen taking a thyroid hormone agonist, increased cardiac activity can lead to angina or chest pain.
• • ConstipationConstipation is an assessment finding associated with low thyroid hormone levels. It is not an adverse effect of a thyroid hormone agonist.

Question 13 of 28

 Report content error

Which drug interacts with a thyroid hormone agonist?

• • PenicillinPenicillin is not identified as a drug that interacts with a thyroid hormone agonist.
• Correct
  • WarfarinWhen thyroid hormone agonists are taken with drugs that reduce blood clotting, especially warfarin, their actions are increased. This response can cause excessive bleeding and bruising.
• • AlbuterolAlbuterol is not identified as a drug that interacts with a thyroid hormone agonist.
• • FurosemideFurosemide is not identified as a drug that interacts with a thyroid hormone agonist.

Question 14 of 28

 Report content error

Which assessment would the nurse complete before providing a patient with a starting dose of a thyroid hormone agonist? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Heart rateBefore giving the first dose of a thyroid hormone agonist, check the patient’s heart rate because these drugs can increase metabolic rate and cardiac activity.
• Correct
  • Blood pressureBefore giving the first dose of a thyroid hormone agonist, check the patient’s blood pressure because these drugs can increase metabolic rate and cardiac activity.
• Correct
  • Potential for pregnancyAssess women of childbearing age for possible pregnancy before beginning thyroid hormone agonists. Pregnant women may need a higher dose.
• Correct
  • List of drugs and supplementsThe patient’s entire drug list, including prescription drugs, vitamins, minerals, and supplements, should be checked for potential interactions with thyroid hormone agonists.
• Correct
  • Correct name and dose of the drugThe drug name and dose should be carefully checked because thyroid hormone agonists are not interchangeable. Although the actions are similar, the strength of each drug varies.

Question 15 of 28

 Report content error

Which information would the nurse include when teaching a patient about the administration of a thyroid hormone agonist? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “Report any bleeding to the healthcare provider.”The patient should report any signs of bleeding to the healthcare provider to include bleeding from gums or new onset of bruises.
• • “Take a double dose to make up any missed doses.”The patient should not take a double dose to make up for a missed dose. A missed dose should be taken as soon as it is remembered.
• Correct
  • “It might take several weeks for the drug’s effect to occur.”The effects of the drug may not be apparent for several weeks.
• Correct
  • “Take the drug 2 hours before a meal or 3 hours after a meal.”The absorption of thyroid hormone agonists in the GI tract is greatly reduced by food and fiber. Instruct the patient to take the drug 2 hours before a meal or fiber supplement or at least 3 hours after a meal or a fiber supplement.
• Correct
  • “Your dose will start low and be increased every 2 to 3 weeks.”When hypothyroidism is first diagnosed, the thyroid hormone agonist dose is kept low for the first several weeks. The drug dose is then increased slowly every 2 to 3 weeks until the patient has normal blood levels of thyroid hormone and signs of normal metabolism.

Question 16 of 28

 Report content error

Which statement indicates that teaching provided to a patient about a thyroid hormone agonist has been effective?

• • “I will take aspirin for a headache.”The patient should be instructed to avoid aspirin as this will increase the risk of bleeding when taking a thyroid hormone agonist.
• • “I will lay down if I start to have chest pain.”Chest pain indicates a cardiac emergency, and the patient should seek immediate medical attention.
• • “I will increase or decrease the dose according to how I feel.”The patient should not change the dose of the drug to prevent underdosing or overdosing.
• Correct
  • “I will check my pulse every morning before taking the drug.”The patient should be instructed to check the pulse each morning before taking the drug and again each evening before going to bed.If the pulse rate becomes 20 beats higher than the normal rate for 1 week or it becomes consistently irregular, notify the healthcare provider.

Question 17 of 28

 Report content error

Which assessment finding would the nurse expect in a patient with hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

• Correct
  • DiarrheaHyperthyroidism is a condition in which the thyroid glandsecretes excessive amounts of thyroid hormones and causes general body metabolism to be greatly increased. Diarrhea is a common finding in hyperthyroidism.
• • Tongue thicknessTongue thickness is a symptom of hypothyroidism, not hyperthyroidism.
• Correct
  • Moist sweaty skinMoist sweaty skin is a common finding in hyperthyroidism because of the increase in metabolic rate.
• Correct
  • Difficulty sleepingThe person with hyperthyroidism has difficulty sleeping because of the increase in metabolic rate.
• Correct
  • Above normal body temperatureAn increase in body temperature occurs in hyperthyroidism is caused by the increase in metabolic rate.

Question 18 of 28

 Report content error

Which assessment finding indicates to the nurse that a patient has Graves’ disease? Select all that apply. One, some, or all responses may be correct.

• Correct
  • GoiterGraves’ disease is the most common cause of hyperthyroidism. This disease causes a goiter or swelling in the neck caused by an enlarged thyroid gland.
• Correct
  • Blurred visionGraves’ disease is the most common cause of hyperthyroidism. This disease causes changes in the eyes to include blurred vision.
• Correct
  • ExophthalmosWhen hyperthyroidism is caused by Graves’ disease, bulgingor protruding eyes (exophthalmos) may occur.
• • Facial paralysisFacial paralysis is not a symptom of Graves’ disease.
• • Ptosis of the eyesEye ptosis or drooping of the eyes and eyelids would not occur in Graves’ disease.

Question 19 of 28

 Report content error

Which assessment finding indicates to the nurse that a patient with hyperthyroidism is developing thyroid storm?

• Correct
  • FeverSevere hyperthyroidism that causes life-threatening hypertension, heart failure, and seizures is called thyroid crisis or thyroid storm. A fever is often the first indication of a problem.
• • LethargyLethargy is not a symptom of thyroid storm.
• • TachycardiaTachycardia is a symptom of hyperthyroidism, but it is not the first symptom of thyroid storm.
• • Low blood pressureBlood pressure would increase, not decrease, in a thyroid storm.

Question 20 of 28

 Report content error

Which action would the nurse take if methimazole is substituted for propylthiouracil in a patient with hyperthyroidism?

• • Give the methimazole.Methimazole and propylthiouracil are common antithyroiddrugs and belong to the thionamide class of drugs. However, methimazole is 10 times stronger than propylthiouracil and should not be given to the patient.
• • Give half of the methimazole.Methimazole and propylthiouracil are common antithyroiddrugs and belong to the thionamide class of drugs. However, methimazole is 10 times stronger than propylthiouracil and giving half would still be 5 times the strength of the prescribed drug.
• • Give two doses of the methimazole.Methimazole and propylthiouracil are common antithyroiddrugs and belong to the thionamide class of drugs. However, methimazole is 10 times stronger than propylthiouracil. Giving two doses of the methimazole would be providing the patient with 20 times the prescribed dose of proplythiouracil.
• Correct
  • Contact the pharmacy to provide propylthiouracil.The patient is prescribed proplythiouracil and should not give any drug to replace it. The pharmacy should be contacted to provide the correct drug that was prescribed for the patient.

Question 21 of 28

 Report content error

Which information would the nurse provide to a patient who is prescribed propylthiouracil for hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “The drug works directly in the thyroid gland.”Antithyroid drugs work directly in the thyroid gland.
• Correct
  • “It takes 3 to 4 weeks for the drug to be effective.”Thyroid-suppressing drugs must be taken for 3 to 4 weeks to start being effective because they have no effect on thyroid hormones already stored in the thyroid gland.
• Correct
  • “The drug stops the production of thyroid hormones.”Antithyroid drugs stop the production of new hormones by preventing iodine and tyrosine from making the hormone.
• • “The drug removes excess thyroid hormone from the gland.”Antithyroid drugs have no effect on thyroid hormones already made and stored in the thyroid gland.
• • “Use aspirin for headaches or muscle pain.”The patient should be advised to avoid drugs that can worsen bleeding, such as aspirin.

Question 22 of 28

 Report content error

Which assessment finding indicates to the nurse that a patient is experiencing side effects from propylthiouracil? Select all that apply. One, some, or all responses may be correct.

• Correct
  • RashMost common side effects of antithyroid drugs are minor and include a rash.
• Correct
  • NauseaMost common side effects of antithyroid drugs are minor and include nausea.
• • InsomniaCommon side effects of antithyroid drugs include drowsiness. Insomnia is a side effect of thyroid hormone agonists.
• Correct
  • HeadacheMost common side effects of antithyroid drugs are minor and include a headache.
• Correct
  • Change in tasteMost common side effects of antithyroid drugs are minor and include a change in taste.

Question 23 of 28

 Report content error

For which assessment finding would the nurse withhold giving a patient a dose of an antithyroid drug?

• • Rapid heart rateA rapid heart rate is a symptom of hyperthyroidism. An antithyroid drug is useful to treat hyperthyroidism.
• • Presence of a goiterA goiter is a finding associated with Graves’ disease, a type of hyperthyroidism. An antithyroid drug is useful to treat hyperthyroidism.
• • Elevated body temperatureAn elevated body temperature is a symptom of hyperthyroidism. An antithyroid drug is useful to treat hyperthyroidism.
• Correct
  • Elevated liver function testsThe patient’s liver function tests should be checked before giving a dose of the drug because antithyroid drugs are hepatotoxic.

Question 24 of 28

 Report content error

Which laboratory value would the nurse monitor in a patient taking an antithyroid drug? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Platelet countA low platelet count indicates a risk for bleeding, which can occur if an antithyroid drug is taken with an anticoagulant drug.
• • Serum glucose levelAntithyroid drugs do not affect serum glucose levels.
• Correct
  • Red blood cell countAntithyroid drugs can negatively impact the bone marrow and cause anemia. The red blood cell count should be monitored.
• Correct
  • White blood cell countAntithyroid drugs can negatively impact the bone marrow and reduce the amount of white blood cells, which increases the risk of infection. The white blood cell count should be monitored.
• • Serum potassium levelAntithyroid drugs do not affect serum potassium levels.

Question 25 of 28

 Report content error

Which assessment would the nurse complete before providing a dose of propylthiouracil to a patient with hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Vital signsBefore giving a dose of an antithyroid drug, the nurse should assess the patient’s vital signs, especially for an elevated temperature as this could indicate an infection.
• Correct
  • Signs of bleedingThe patient’s skin should be assessed for ecchymosis or petechiae, which indicates bleeding.
• Correct
  • Laboratory valuesThe patient’s blood counts should be assessed for signs of bone marrow depression to include a low white blood cell count, low red blood cell count, and low platelet count.
• Correct
  • Liver function testsThe patient’s liver function tests should be assessed since antithyroid drugs are hepatotoxic. For patients with a preexisting liver disorder, the effects of antithyroid drugs on the liver are more severe and occur at lower doses.
• Correct
  • Current drugsThe patients’ current drugs should be assessed, specifically for drugs that have anticoagulant actions, such as warfarin.

Question 26 of 28

 Report content error

Which assessment finding indicates to the nurse that a patient taking antithyroid drug is developing bone marrow suppression?

• • CoughA cough is not associated with bone marrow suppression.
• Correct
  • HematuriaBone marrow suppression can increase the risk of bleeding. The patient should be assessed for signs of bleeding to include hematuria or blood in the urine.
• • XerostomiaXerostomia is dry mouth, a condition that is not associated with bone marrow suppression.
• • Abdominal distentionAbdominal distention is not associated with bone marrow suppression.

Question 27 of 28

 Report content error

Which assessment finding indicates that a patient taking antithyroid drug is developing hepatotoxicity? Select all that apply. One, some, or all responses may be correct.

• • SweatingSweating is not associated with liver toxicity.
• Correct
  • Yellow skinSigns of hepatotoxicity include the development of jaundice, which causes the skin to appear yellow.
• Correct
  • Yellow scleraSigns of hepatotoxicity include the development of jaundice, which causes the sclera of the eyes to appear yellow.
• Correct
  • Clay-colored stoolSigns of hepatotoxicity effect the release of bile from the gall bladder and would cause stools to become clay-colored.
• Correct
  • Coffee-colored urineSigns of hepatoxicity effect the metabolism of bilirubin, which will enter the blood stream and cause the urine to appear dark or the color of coffee.

Question 28 of 28

 Report content error

Which statement indicates to the nurse that teaching provided to a patient about antithyroid drug has been effective?

• Correct
  • “I will avoid people who are ill.”The patient should be instructed to avoid crowds and people who are ill because antithyroid drugs reduce immunity and resistance to infections.
• • “I will increase the dose if I have no effects after a week.”The patient should be instructed to not change the dose of the drug because it takes several weeks for the drug to be effective.
• • “I will expect the whites of my eyes to develop a yellow-tinge.”The patient should be instructed to check the whites of the eyes daily for a yellow tinge as this may indicate a liver problem that should be reported to the healthcare provider.
• • “I can continue breastfeeding my baby while taking this drug.”Women who are taking antithyroid drugs should not breast-feed because these drugs enter breast milk and can suppress the infant’s thyroid function.