Nokea
A client with a heart condition controlled on which of the following drugs must be monitored closely by the nurse for worsening atrial fibrillation if levothyroxine is initiated to treat hypothyroidism? Select all that apply.
- A. Lisinopril (Prinivil)
- B. Digoxin (Lanoxin)
- C. Diltiazem (Cardizem)
- D. Metoprolol (Toprol)
- E. Warfarin (Coumadin)
Correct Answer: B,D
Rationale: A client with a heart condition controlled on digoxin (Lanoxin) and metoprolol (Toprol) must be monitored closely by the nurse for worsening atrial fibrillation if levothyroxine is initiated to treat hypothyroidism because levothyroxine can decrease the effectiveness of digoxin and beta blockers (metoprolol).
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A client is diagnosed with hypothyroidism. Which of the following would the nurse expect to assess? Select all that apply.
- A. Elevated body temperature
- B. Weight gain
- C. Bradycardia
- D. Hypertension
- E. Sleepiness
Correct Answer: B,C,E
Rationale: The signs and symptoms of hypothyroidism include decreased metabolism; cold intolerance; low body temperature; weight gain; bradycardia; hypotension; lethargy; sleepiness; pale, cool, dry skin; face appearing puffy; coarse hair; thick, hard nails; heavy menses; fertility problems; and low sperm count.
During ongoing assessment the nurse should observe a client taking levothyroxine for which of the following indicating a therapeutic response? Select all that apply.
- A. Weight loss
- B. Mild diuresis
- C. Increased appetite
- D. Increased mental activity
- E. Decreased pulse rate
Correct Answer: A,B,C,D
Rationale: Signs of therapeutic response to levothyroxine include weight loss; mild diuresis; increased appetite; increased pulse rate; decreased puffiness of face, hands, and feet; and client report of increased mental activity and increased sense of well-being.
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 client is diagnosed with thyroid cancer. Which drug would the nurse anticipate being prescribed for the client?
- A. Iodine-131
- B. Methimazole
- C. Propylthiouracil
- D. Liothyronine
Correct Answer: A
Rationale: Radioactive iodine (I-131) is used for the treatment of hyperthyroidism and cancer of the thyroid. Methimazole and propylthiouracil are used to manage hyperthyroidism. Liothyronine is used to treat hypothyroidism.
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.