Thyroid and Parathyroid Agents

1.

The nurse is teaching the patient, newly diagnosed with Graves’s disease, about the normal functioning of the thyroid gland. What hormone will the nurse tell the patient controls production and release of thyroid hormones?
A)
Thyrotropin-releasing hormone (TRH)
B)
Thyroid-stimulating hormone (TSH)
C)
Tetraiodothyronine
D)
Triiodothyronine
Ans:
B

Feedback:

Thyroid hormone production and release are regulated by the anterior pituitary hormone called thyroid-stimulating hormone (TSH). The secretion of TSH is regulated by thyrotropin-releasing hormone (TRH), a hypothalamic regulating factor. Tetraiodothyronine and triiodothyronine are thyroid hormones produced by the thyroid gland because of TSH stimulation.

2.

A child is diagnosed with hypothyroidism. The nurse anticipates an order for the drug of choice when treating children, which is what?
A)
Liothyronine (Cytomel)
B)
Liotrix (Thyrolar)
C)
Levothyroxine (Synthroid)
D)
Methimazole (Tapazole)
Ans:
C

Feedback:

Levothyroxine is the drug of choice in children because of its predictable bioavailability and reliability. Liothyronine and liotrix tend to have more adverse effects and, although they can be used in children, are not the drugs of choice. Methimazole is an antithyroid drug and is used to treat hyperthyroidism.

3.

A patient is at risk for thrombosis formation and is taking an oral anticoagulant. The patient has been newly diagnosed with hypothyroidism and placed on levothyroxine (Synthroid). What will the nurse monitor the patient for?
A)
Tachycardia
B)
Elevated body temperature
C)
Increased time spent sleeping
D)
Increased bruising and bleeding
Ans:
D

Feedback:

The effectiveness of an oral anticoagulant is increased if it is used in combination with a thyroid hormone. This may lead to increased bleeding and the need to decrease the dosage of the oral anticoagulant. Tachycardia would be found with hyperthyroidism and the effect of levothyroxine is not increased with the drug combination. Increased time spent sleeping would indicate lowering of thyroid function and the treatment should increase thyroid function. Increased body temperature is associated with hyperthyroidism.

4.

The nurse is providing patient teaching regarding the administration of levothyroxine (Synthroid). What is the nurse’s priority teaching point?
A)
“Take the medication after breakfast.”
B)
“Take the medication with a full glass of water.”
C)
“Remain in the upright position for 30 minutes after administering.”
D)
“Take the medication before going to bed at night.”
Ans:
B

Feedback:

The patient should be instructed to take the medication with a full glass of water to help prevent difficulty swallowing and esophageal atresia. The medication should be taken on an empty stomach before breakfast. There is no need to maintain an upright position. The medication should be taken as a single daily dose before breakfast each day to ensure consistent therapeutic levels.

5.

The nurse instructs the patient with a new prescription to treat hyperthyroidism and includes the importance of regular lab studies to monitor for bone marrow suppression, which can be an adverse effect of this drug. What drug is the nurse teaching the patient about?
A)
Methimazole (Tapazole)
B)
Propylthiouracil (PTU)
C)
Sodium iodide I131 (Generic)
D)
Potassium iodide (Thyro-Block)
Ans:
A

Feedback:

Methimazole is associated with bone marrow suppression, so the patient using this drug must have frequent blood tests to monitor for this effect. Propylthiouracil is associated with GI effects. The most common adverse effect of sodium iodide I131 and potassium iodide is hypothyroidism. Other effects of these two drugs include metallic taste and burning in the mouth, sore teeth and gums, diarrhea, cold symptoms, stomach upset, stained teeth, rash, and the development of goiter.

6.

A patient is seen in the clinic and diagnosed with hyperthyroidism. Potassium iodide is prescribed. The nurse reviews the patient’s medical record before administering the drug. What assessment finding would cause the nurse to alter the plan of care?
A)
A daily walk of 3 miles a day
B)
A low fat, low sodium diet
C)
A bowel movement every 2 to 3 days
D)
Digoxin 0.125 mg daily
Ans:
D

Feedback:

Potassium iodide will cause the patient to move from hyperthyroidism to hypothyroidism, thus altering the patient’s metabolism. Digoxin has a small margin of safety that could be altered by a change in thyroid function. The patient will need to be monitored carefully for an alteration in digoxin effects that may include an increased heart rate, arrhythmia, or reduced cardiac output. A daily walk of 3 miles, a low fat, low sodium diet, and a bowel movement every 2 to 3 days are important for maintenance of a healthy lifestyle but would not alter the plan of care.

7.

A patient with Paget’s disease calls the clinic and tells the nurse that she is experiencing flushing of the face and hands and a rash. The patient states that she is taking calcitonin, salmon (Calcimar) for her Paget’s disease. What is the nurse’s best response?
A)
“We expected this to happen. Just ignore it and please do not worry about it.”
B)
“You will need to see the doctor immediately. Come in as soon as possible.”
C)
“This is a common adverse effect of your medication that will lessen with time.”
D)
“This is a serious adverse effect. Stop taking the drug and see the doctor today.”
Ans:
C

Feedback:

The most common adverse effects seen with this drug include flushing of the face and hands, rash, nausea and vomiting, urinary frequency, and local inflammation at the site of injection. Many of these adverse effects lessen with time, the duration varying with each individual patient. Although it is an expected adverse effect, the nurse needs to provide more teaching instead of simply telling the patient to ignore it and to not worry. The patient does not need to be seen and this is not a serious adverse effect.

8.

The nurse is teaching the patient with a new prescription for ibandronate (Boniva) how to take the medication. Which instruction provided by the nurse is correct?
A)
“Take 150 mg once a month on the same day of the month.”
B)
“Take 70 mg once a week on the same day of the week.”
C)
“Take 400 mg/d.”
D)
“Take 3 mg once per month on the same day of the month.”
Ans:
A

Feedback:

Ibandronate can be taken daily, monthly, or every 3 months. Taking 150 mg orally once a month on the same day of the month would be correct. If given IV every 3 months, the dose is 3 mg and if taken daily, the dose is 2.5 mg/d. All other options are incorrect.

9.

The nurse admits an elderly patient in thyroid crisis for whom surgery is not an option. What antithyroid drug would the nurse expect will be ordered?
A)
Methimazole (Tapazole)
B)
Radioactive iodine (Generic)
C)
Propylthiouracil (PTU)
D)
Potassium iodide (Thyro-Block)
Ans:
B

Feedback:

If antithyroid agents are needed in the older adult patient, sodium iodide I131 may be the drug of choice because it has fewer adverse effects than the other agents. The use of sodium iodide is reserved for those patients who are not candidates for surgery, women who cannot become pregnant, and elderly patients with such severe, complicating conditions that immediate thyroid destruction is needed. Radioactive iodine targets the thyroid cells and destroys them without many adverse effects. Methimazole and propylthiouracil are antithyroid drugs but have cardiovascular adverse effects that might be unacceptable in an elderly patient who is not a candidate for surgery. Effects of potassium iodide are short-lived and may precipitate further thyroid enlargement and dysfunction so they would not be used in a patient who is not a candidate for surgery because they would not provoke long-term effects.

10.

The nurse is providing care for a man diagnosed with osteoporosis. What drug will the nurse administer that is the only drug approved for treatment in men?
A)
Etidronate (Didronel)
B)
Pamidronate (Aredia)
C)
Tiludronate (Skelid)
D)
Alendronate (Fosamax)
Ans:
D

Feedback:

Alendronate is the only bisphosphonate that has been approved for the treatment of osteoporosis in men. Etidronate is used to treat Paget’s disease, postmenopausal osteoporosis, and heterotopic ossification. Pamidronate is used to treat Paget’s disease, postmenopausal osteoporosis in women, hypercalcemia of malignancy, and osteolytic bone lesions in cancer patients. Tiludronate is used to treat Paget’s disease that is not responsive to other treatment.

11.

What assessment findings would the nurse expect to see in a patient who overdosed on levothyroxine (Synthroid)?
A)
Nervousness, tachycardia, tremors
B)
Somnolence, bradycardia, paresthesia
C)
Hyperglycemia, hypertension, edema
D)
Buffalo hump, constipation, sodium loss
Ans:
A

Feedback:

More pronounced adverse effects of levothyroxine would be seen including tremors, headache, nervousness, palpitations, tachycardia, allergic skin reactions, diarrhea, nausea, vomiting. Somnolence, bradycardia, and paresthesia would be more likely with insufficient drug intake, which would cause hypothyroidism and other symptoms. Hyperglycemia, edema, buffalo hump, constipation, or sodium loss would not be associated with excess thyroid hormone.

12.

After administering propylthiouracil (PTU), what effect would the nurse anticipate the drug will have in the patient’s body?
A)
To destroy part of the thyroid gland
B)
To inhibit production of thyroid hormone in the thyroid gland
C)
To suppress the anterior pituitary gland’s secretion of thyroid-stimulating hormone (TSH)
D)
To suppress the hypothalamus’s production of thyrotropin-releasing hormone (TRH)
Ans:
B

Feedback:

PTU is a thioamide that acts by lowering thyroid hormone levels by preventing the formation of thyroid hormone in the thyroid cells, which lowers the serum levels of thyroid hormone. They also partially inhibit the conversion of thyroxine to triiodothyronine at the cellular level. Iodine solutions oversaturate thyroid cells and top production of thyroid hormone. Radioactive iodine destroys part of the thyroid gland. PTU does not impact production or secretion of TSH or TRH.

13.

The nurse provides teaching regarding levothyroxine to a 55-year-old patient diagnosed with Hashimoto’s disease. What statement made by the patient does the nurse interpret to mean that the drug teaching had been understood?
A)
“I can take this medication at any time of day.”
B)
“I should take this medication on an empty stomach in the morning.”
C)
“I may take this with a sip of water in the morning.”
D)
“If I feel nauseated, I may take this drug with an antacid.”
Ans:
B

Feedback:

Adults who require thyroid replacement therapy need to understand that this will be a lifelong need. An established routine of taking the tablet first thing in the morning may help the patient comply with the drug regimen. The drug should be taken on an empty stomach with a full glass of water. Antacids would slow or prevent absorption of the hormone replacement, so the patient should be corrected.

14.

The nurse, developing a care plan for a patient diagnosed with hypothyroidism, creates what appropriate nursing diagnosis?
A)
Imbalanced nutrition: Less than body requirements
B)
Ineffective thermoregulation: Excess or ineffective airway clearance
C)
Decreased cardiac output
D)
Ineffective airway clearance
Ans:
C

Feedback:

Decreased cardiac output is related to hypothyroidism. Hyperthyroidism results in increased caloric needs and the nursing diagnosis of Imbalanced nutrition: Less than body requirements. Thyroid dysfunction would not normally result in Ineffective thermoregulation: Excess or ineffective airway clearance.

15.

The nurse is caring for a 5-year-old child diagnosed with hypothyroidism whose mother voices skepticism about giving the child drugs. In explaining the need for medication, what will the nurse tell this mother could result if her daughter’s condition remains untreated so she can make an informed decision?
A)
Mental retardation
B)
Renal dysfunction
C)
Immune deficiency
D)
Paralytic ileus
Ans:
A

Feedback:

Children who are born without a thyroid gland or who have a nonfunctioning gland develop a condition called cretinism. If untreated, these children will have poor growth and development and mental retardation because of the lack of thyroid hormone stimulation. The child would not be at increased risk of renal dysfunction, immune deficiency, or paralytic ileus.

16.

A patient is diagnosed with a simple goiter and asks the nurse what caused it. What is the nurse’s best response?
A)
A goiter is the result of too much thyroxine.
B)
A goiter is the result of a chloride deficiency.
C)
A goiter is the result of too much TSH.
D)
A goiter is the result of an iodine deficiency.
Ans:
C

Feedback:

Goiter (enlargement of the thyroid gland) is an effect of hyperthyroidism, which occurs when the thyroid is overstimulated by thyroid stimulating hormone (TSH). This can happen if the thyroid gland does not produce sufficient thyroid hormones to turn off the hypothalamus and anterior pituitary. In the body’s attempt to produce the needed amount of thyroid hormone, the thyroid is continually stimulated by increasing levels of TSH. There is a deficiency of thyroxine. It is not related to chloride or iodine deficiencies.

17.

The patient with hypothyroidism takes levothyroxine daily and has triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) levels drawn in the laboratory to check appropriateness of prescribed dosage. What results would the nurse analyze as indicating the need for a higher dosage of medication?
A)
Elevated TSH, elevated T3, and reduced T4 levels
B)
Reduced TSH, elevated T3 and T4 levels
C)
Elevated TSH, reduced T3 and T4 levels
D)
Reduced TSH, T3, and T4 levels
Ans:
C

Feedback:

TSH levels would be elevated to stimulate increased thyroid hormone secretion whereas T4 and T3 will be low, which indicates the need for a higher dosage of medication. If TSH level is low, it would indicate a reduction in dosage would be needed, particularly if T3 and T4 levels are elevated.

18.

A patient presents at the clinic with complaints of weight loss despite an increased appetite. The nurse assesses this patient for what?
A)
Chronic thyroiditis
B)
Hypercalcemia
C)
Hypothyroidism
D)
Hyperthyroidism
Ans:
D

Feedback:

Hyperthyroidism is manifested by increased metabolism and energy usage. It is not manifested by chronic thyroiditis, hyperglycemia, or hypothyroidism.

19.

What patient will the nurse assess most closely for secondary hyperparathyroidism?
A)
The 12-year-old patient with hypothyroidism
B)
The 68-year-old patient with chronic renal failure
C)
The 35-year-old patient with diabetes mellitus
D)
The 48-year-old patient with hyperthyroidism
Ans:
B

Feedback:

Secondary hyperparathyroidism occurs most frequently in patients with chronic renal failure. Primary hyperparathyroidism occurs more often in women between 60 and 70 years of age. Although hyperparathyroidism can occur at any age, the patient with diabetes or thyroid disorder would not be at higher risk for the disorder.

20.

What drug would the nurse appropriately administer to the patient to treat hypothyroidism?
A)
Teriparatide
B)
Methimazole
C)
Propylthiouracil
D)
Levothyroxine
Ans:
D

Feedback:

Levothyroxine (Synthroid, Levoxyl, Levothroid), a synthetic salt of thyroxine, is the most frequently used replacement hormone to treat hypothyroidism because of its predictable bioavailability and reliability. Propylthiouracil and methimazole would be used to treat hyperthyroidism; teriparatide is an antihypocalcemic agent.

21.

The nurse is caring for a patient with a history of myocardial infarction and heart failure. What thyroid replacement drug would the nurse question if ordered?
A)
Liothyronine
B)
Levothyroxine
C)
Thyroid desiccated
D)
Methimazole
Ans:
A

Feedback:

Liothyronine and liotrix have a greater incidence of cardiac adverse effects and are not recommended for use in patients with potential cardiac problems or patients who are prone to anxiety reactions. Levothyroxine would be the drug of choice and thyroid desiccated would not be contraindicated. Methimazole is a treatment for hyperthyroidism and would not be appropriate for the patient with hypothyroidism.

22.

The nurse is caring for a patient newly diagnosed with hypothyroidism. The patient also takes theophylline to control asthma symptoms. What changes will need to be made to the patient’s theophylline dose?
A)
Decrease theophylline dosage immediately.
B)
Increase theophylline dosage immediately.
C)
Increase theophylline dose when normal thyroid function returns.
D)
Decrease theophylline dose when normal thyroid function returns.
Ans:
B

Feedback:

Theophylline clearance is decreased in hypothyroid states. As the patient approaches normal thyroid function, theophylline dose may need to be adjusted frequently. As the drug is cleared more quickly, the dosage may need to be increased.

23.

The nurse is caring for a 57-year-old woman who is complaining about gaining so much weight after menopause and suggests that thyroid hormone replacement would help her lose weight and speed up her metabolism. What is the nurse’s best response?
A)
“Inducing a state of hyperthyroidism would result in weight loss.”
B)
“People who are not hypothyroid should not take thyroid hormones.”
C)
“People who take thyroid hormones without cause will end up damaging their heart.”
D)
“The body compensates for the extra hormone by reducing the amount secreted.”
Ans:
D

Feedback:

Taking thyroid hormone with normal thyroid function results in disruption of the hypothalamic–pituitary–thyroid control resulting in decreased production of thyrotropin-releasing hormone (TRH) and thyroid-stimulating hormone (TSH) as the hypothalamus and pituitary sensed the rising levels of thyroid hormone. Because the thyroid was no longer stimulated to produce and secrete thyroid hormone, thyroid levels would actually fall. This would put the patient at greater risk of gaining weight. There is no evidence it would cause heart damage. Because thyroid hormone production is reduced, a state of hyperthyroidism is not induced. Even though the statement that people who are not hypothyroid should not take thyroid hormones is correct, it does not provide enough information to dissuade this patient from a dangerous practice.

24.

The patient is 8 weeks pregnant and requires an antithyroid medication. The nurse identifies what drug as the drug of choice for this patient?
A)
Propylthiouracil
B)
Radioactive iodine
C)
Alendronate
D)
Methimazole
Ans:
A

Feedback:

If an antithyroid drug is essential during pregnancy, propylthiouracil (PTU) is the drug of choice because it is less likely to cross the placenta and cause problems for the fetus. Radioactive agents should not be used. Bisphosphonates should be used during pregnancy only if the benefit to the mother clearly outweighs the potential risk to the fetus. Methimazole is an antithyroid medication but would not be the drug of choice for the pregnant woman.

25.

The nurse is discharging a patient with a new prescription for levothyroxine. What would the nurse teach the patient to report to her health care provider? (Select all that apply.)
A)
Nervousness
B)
Insomnia
C)
Chest pain
D)
Loss of hair
E)
Nausea
Ans:
A, B, C

Feedback:

Report chest pain, heart palpitations, nervousness, or insomnia. These adverse effects result from excessive stimulation and may indicate that drug dosage or intake of other stimulants needs to be reduced. Loss of hair is usually only seen in the first few months of therapy in children; nausea need not be reported unless it is persistent or interferes with adequate caloric intake.

26.

The nurse tells the patient his or her serum calcium level is elevated and the patient asks what controls calcium levels in the body. What is the nurse’s best response?
A)
Renin
B)
Parathyroid hormone (PTH)
C)
Thyroid-stimulating hormone (TSH)
D)
Epoetin
Ans:
B

Feedback:

PTH is the most important regulator of serum calcium levels in the body. Renin controls blood pressure, epoetin stimulates production of red blood cells, and TSH stimulates thyroid hormone secretion.

27.

The nurse is caring for a patient diagnosed with hyperparathyroidism who asks the nurse why parathyroid hormone (PTH) is important. The nurse explains that PTH performs what actions in the body? (Select all that apply.)
A)
Stimulation of osteoclasts
B)
Increased intestinal absorption of calcium
C)
Stimulation of calcitriol production
D)
Increased excretion of calcium from kidneys
E)
Decreased retention of vitamin D
Ans:
A, B, C

Feedback:

PTH has many actions, including stimulation of osteoclasts or bone cells to release calcium from the bone, increased intestinal absorption of calcium, increased calcium reabsorption from the kidneys, and stimulation of cells in the kidney to produce calcitriol. PTH increases absorption of calcium from the kidney and increases retention of vitamin D.

28.

The nurse is teaching the patient how to take his newly prescribed alendronate and includes what teaching points? (Select all that apply.)
A)
“Take the drug in the morning.”
B)
“Wait 60 minutes before eating breakfast.”
C)
“Take the drug with a full glass of water.”
D)
“Remain upright for 30 minutes after taking the medication.”
E)
“Eat a breakfast high in calcium after taking the medication.”
Ans:
A, C, D

Feedback:

Alendronate, ibandronate, and risedronate need to be taken on arising in the morning, with a full glass of water, fully 30 minutes before any other food or beverage, and the patient must then remain upright for at least 30 minutes; taking the drug with a full glass of water and remaining upright for at least 30 minutes facilitates delivery of the drug to the stomach. These drugs should not be given to anyone who is unable to remain upright for 30 minutes after taking the drug because serious esophageal erosion can occur. There is no need to eat a high-calcium breakfast, although the patient should make certain of adequate calcium intake.

29.

The nurse is caring for an asthmatic patient prescribed zoledronic acid. What important question should the nurse ask this patient?
A)
“Can you take aspirin without experiencing any bad effects?”
B)
“Are you taking theophylline to treat your asthma?”
C)
“Do you have a history of diarrhea?”
D)
“Are you taking digoxin?”
Ans:
A

Feedback:

Zoledronic acid should be used cautiously in aspirin-sensitive asthmatic patients. Gastrointestinal (GI) distress may increase if bisphosphonates are combined with aspirin; this combination should, therefore, be avoided if possible. There is no drug interaction between theophylline and zoledronic acid or between digoxin and zoledronic acid. A history of diarrhea would not impact the ability to administer zoledronic acid.

30.

The nurse is caring for a pediatric patient with hypercalcemia. What condition would the nurse suspect is causing this altered serum calcium level?
A)
Radiation injury
B)
Malignancy
C)
Kidney failure
D)
Hypothyroidism
Ans:
B

Feedback:

Hypercalcemia is relatively rare in children, although it may be seen with certain malignancies. It would not result from a radiation injury, which would be more likely to affect the thyroid gland and it would not be caused by kidney failure or hypothyroidism.

31.

The nurse is caring for a patient who takes alendronate. What lab studies would the nurse assess regularly?
A)
Serum iodine
B)
Serum potassium
C)
Serum calcium
D)
Serum iron
Ans:
C

Feedback:

Alendronate and risedronate are commonly used drugs for osteoporosis and calcium lowering. Serum calcium levels need to be monitored carefully with any of the drugs that affect calcium levels. Administration of alendronate would not require monitoring of iodine, potassium, or iron levels.

32.

The patient, newly prescribed cinacalcet hydrochloride (Sensipar), asks the nurse how this drug works. What is the nurse’s best response?
A)
“It slows or blocks bone’s resorption of calcium.”
B)
“It promotes entry of calcium into bone.”
C)
“It balances the effects of parathyroid hormone to lower serum calcium levels.”
D)
“It increases the receptor’s sensitivity to extracellular calcium.”
Ans:
B

Feedback:

Cinacalcet hydrochloride is a calcimimetic drug that increases the sensitivity of the calcium-sensing receptor to activation by extracellular calcium. In increasing the receptors’ sensitivity, cinacalcet lowers parathyroid hormone (PTH) levels, causing a concomitant decrease in serum calcium levels. Bisphosphonates act to slow or block bone resorption; by doing this, they help to lower serum calcium levels, but they do not inhibit normal bone formation and mineralization. Calcitonins balance the effects of PTH by reducing calcium levels. Cinacalcet does not promote entry of calcium into the bone.

33.

The nurse reviews the patient’s laboratory results and sees that the serum calcium level is acceptable as long as it is within what range?
A)
1 and 3 mg/dL
B)
4 and 6 mg/dL
C)
6 and 8 mg/dL
D)
9 and 11 mg/dL
Ans:
D

Feedback:

Calcium is an electrolyte that is used in many of the body’s metabolic processes. These processes include membrane transport systems, conduction of nerve impulses, muscle contraction, and blood clotting. To achieve all of these effects, serum levels of calcium must be maintained between 9 and 11 mg/dL. Other options are incorrect.

34.

What electrolyte affects parathyroid hormone (PTH) secretion other than calcium?
A)
Magnesium
B)
Sodium
C)
Potassium
D)
Zinc
Ans:
A

Feedback:

Another electrolyte—magnesium—also affects PTH secretion by mobilizing calcium and inhibiting the release of PTH when concentrations rise above or fall below normal. Sodium, potassium, and zinc do not affect PTH function.

35.

The nurse administers teriparatide (Forteo) and evaluates the drug as effective in achieving desired effects when what is assessed?
A)
Increase in serum calcium and phosphorous
B)
Increase in serum calcium and decrease in serum phosphorous
C)
Decrease in serum calcium and phosphorous
D)
Decrease in serum calcium and increase in serum phosphorous
Ans:
B

Feedback:

With once-daily administration, teriparatide stimulates new bone formation, leading to an increase in skeletal mass. It increases serum calcium and decreases serum phosphorous.