Nokea
A client presents to the physician's office with complaints of worsening hypothyroidism symptoms. When questioned about medication changes, the client tells the nurse that she has recently started taking an antidepressant prescribed by another physician. Which of the following antidepressants can decrease the effectiveness of levothyroxine?
- A. Amitriptyline (Elavil)
- B. Quetiapine (Seroquel)
- C. Sertraline (Zoloft)
- D. Fluoxetine (Prozac)
- E. Topiramate (Topamax)
Correct Answer: C,D
Rationale: Selective serotonin reuptake inhibitors (SSRIs), like sertraline (Zoloft) and fluoxetine (Prozac), can decrease the effectiveness of levothyroxine, leading to the reappearance of hypothyroidism symptoms in clients previously controlled on a dose of levothyroxine.
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A nurse is caring for a client with chronic lymphocytic thyroiditis. The physician has prescribed liothyronine to the client. The nurse understands that the drug is administered cautiously to clients with which of the following?
- A. Upper respiratory tract infection
- B. Diabetes
- C. Elevated body temperature
- D. Cardiac disease
Correct Answer: D
Rationale: The nurse should be cautious about existing conditions such as cardiac disease and also cautious about factating clients before administering liothyronine to clients with chronic lymphocytic thyroiditis. The nurse need not be cautious about administering liothyronine to clients with an upper respiratory tract infection, diabetes, or elevated body temperature. The nurse should be cautious about clients contracting an upper respiratory tract infection on administrating antithyroid drugs. A client with diabetes may experience an increase in diabetes while undergoing thyroid hormone replacement therapy. The nurse should observe for elevated body temperature while managing the needs of a client administered thyroid hormones.
The nurse should monitor a client receiving radioactive iodine \left({ }^{131} \mathrm{I}\right) for which of the following severe reactions? Select all that apply.
- A. Agranulocytosis
- B. Exfoliative dermatitis
- C. Hypoprothrombinemia
- D. Seizures
- E. Stroke
Correct Answer: A,B,C
Rationale: The nurse should monitor a client receiving radioactive iodine (I-131) for severe reactions including agranulocytosis, exfoliative dermatitis, hypoprothrombinemia, and granulocytopenia.
A nurse is providing care to a client with hyperthyroidism. Which treatment modalities would the nurse anticipate being used? Select all that apply.
- A. Levothyroxine (Synthroid)
- B. Methimazole (Tapazole)
- C. Radioactive iodine(I-131)
- D. Propylthiouracil (PTU)
- E. Subtotal thyroidectomy
Correct Answer: B,C,D,E
Rationale: Methimazole (Tapazole), propylthiouracil (PTU), radioactive iodine (I-131), and subtotal thyroidectomy are treatment modalities used in the treatment of clients with hyperthyroidism.
A nurse completing a preadministration assessment on a 70-year-old client prior to the administration of levothyroxine may confuse which of the following symptoms of hypothyroidism with which symptoms associated with the aging process? Select all that apply.
- A. Constipation
- B. Confusion
- C. Unsteady gait
- D. Decreased visual acuity
- E. Cold intolerance
Correct Answer: B,C,E
Rationale: The symptoms of hypothyroidism may be confused with symptoms associated with aging, such as depression, cold intolerance, weight gain, confusion, or unsteady gait.
A nurse caring for a client who is receiving warfarin (Coumadin) will monitor for signs of bleeding if which of the following thyroid hormone-regulating drugs is initiated? Select all that apply.
- A. Propylthiouracil (PTU)
- B. Desiccated thyroid (Armour Thyroid)
- C. Liotrix (Thyrolar)
- D. Methimazole (Tapazole)
- E. Liothyronine (Triostat)
Correct Answer: A,B,C,D,E
Rationale: All of the thyroid hormone replacement drugs and methimazole (Tapazole) and propylthiouracil (PTU) can increase the risk for bleeding, especially in clients taking warfarin (Coumadin).