Nokea
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).
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A physician has prescribed a thyroid supplement for a client with euthyroid goiter. Which of the following should the nurse include in the nursing diagnosis checklist?
- A. Disturbed Thought Processes related to adverse drug reactions
- B. Anxiety related to symptoms, adverse reactions, and treatment regimen
- C. Risk for Infection related to adverse drug reactions
- D. Risk for Impaired Skin Integrity related to adverse reactions
Correct Answer: B
Rationale: The nurse should include Anxiety related to symptoms, adverse reactions, and treatment regimen as a nursing diagnosis. Disturbed Thought Processes related to adverse drug reactions, Risk for Infection, and Risk for Impaired Skin Integrity related to adverse drug reactions are inappropriate Risk for Infection related to adverse drug reactions and Risk for Impaired Skin Integrity related to adverse reactions would be appropriate for a client receiving antithyroid drugs. Disturbed Thought Processes may apply for a client receiving \mathrm{ACTH}.
A physician has prescribed desiccated thyroid USP for thyroid-stimulating hormone suppression. The client is also taking serotonin reuptake inhibitors to overcome depression. The nurse would be alert to the development of which of the following due to the interaction of the two drugs?
- A. Prolonged bleeding
- B. Decreased effectiveness of the thyroid drug
- C. Increased risk of paresthesias
- D. Increased risk of hypoglycemia
Correct Answer: B
Rationale: The nurse should monitor for a decreased effectiveness of the thyroid drug as the result of the interaction between desiccated thyroid USP and serotonin reuptake inhibitors. When the client is receiving desiccated thyroid USP with serotonin reuptake inhibitors, there is no increase in the risk of paresthesias, hypoglycemia, or prolonged bleeding. When the client is receiving oral anticoagulants with thyroid hormones, the client is at risk of prolonged bleeding. Increased risk of hypoglycemia occurs when oral hypoglycemics and insulin are administered with thyroid hormones to the client. The nurse should observe for paresthesias as one of the adverse reactions in a client receiving antithyroid drugs.
After teaching a client who is prescribed methimazole, the nurse determines that the teaching was effective when the client states which of the following? Select all that apply.
- A. I need to take the drug around the clock.
- B. I should call my primary health care provider if I have a fever.
- C. I can use any over-the-counter medications if I need to.
- D. I might have some tenderness and swelling of my neck.
- E. I don't need to monitor my weight like I did before.
Correct Answer: A,B
Rationale: The client taking methimazole should take the drug as prescribed around the clock and call the primary health care provider if he develops fever, sore throat, cough, easy bleeding or bruising, headache, or a general feeling of malaise. The client also needs to check with the prescriber before using any nonprescription drugs and monitor his weight twice a week, notifying the primary health care provider if there is any sudden weight gain or loss. Tenderness and swelling would be noted if the client received radioactive iodine for a procedure.
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 physician has ordered an iodine procedure for a client with thyroid dysfunction. What should be included in the nurse's preadministration assessment for the client? Select all that apply.
- A. Allergy history
- B. Weight
- C. Pulse
- D. Blood glucose
- E. Temperature
Correct Answer: A,B,C,E
Rationale: The nurse's preadministration assessment for the client should include vital signs (blood pressure, respiratory rate, pulse, and temperature), allergy history, weight, and notation regarding the outward symptoms of the hyperthyroidism.