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Chapter 27: Thyroid and Parathyroid Disorder Drugs

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Chapter 27: Thyroid and Parathyroid Disorder Drugs

12 problems · 0 figures

Case Study 27.2.1 §27.2 source ↗

Read the following clinical scenario to answer the questions that follow.

Ellis Dominico is a 40-year-old client who visits their primary health care provider’s office for a checkup. Ellis reports fatigue and decreased energy, constipation, and having an intolerance to cold temperatures.

History
Hyperthyroidism (diagnosed 6 months ago)

Current Medications
Methimazole, 15 mg orally daily

Based on the assessment findings, which health condition does the nurse anticipate the health care provider will identify?
  1. a.
    Hyperthyroidism
  2. b.
    Hypothyroidism
  3. c.
    Hyperparathyroidism
  4. d.
    Hypoparathyroidism
Table 27.6 in the book ↗
Vital Signs Physical Examination
Temperature: 98.3°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: No jugular vein distention; no peripheral edema noted; S1, S2 auscultated, rhythm regular

• Respiratory: Lungs clear to auscultation bilaterally

• GI: Abdomen firm, nontender, slightly distended

• GU: Client reports urinary output unchanged from their baseline

• Neurological: Lethargy and slow speech noted; no other neurological deficits noted

• Integumentary: No wounds noted; skin appropriate for age
Blood pressure: 96/58 mm Hg
Heart rate: 58 beats/min
Respiratory rate: 18 breaths/min
Oxygen saturation: 95% on room air
Height: 5'6"
Weight: 211 lb (10 lb heavier than weight 3 months ago)

Answer

B. Hypothyroidism
This client with hyperthyroidism is showing evidence of toxicity to methimazole. Manifestations of methimazole toxicity are similar to those of hypothyroidism and include cold intolerance, weight gain, fatigue, lack of energy, bradycardia, and depression.

Case Study 27.2.2 §27.2 source ↗

Read the following clinical scenario to answer the questions that follow.

Ellis Dominico is a 40-year-old client who visits their primary health care provider’s office for a checkup. Ellis reports fatigue and decreased energy, constipation, and having an intolerance to cold temperatures.

History
Hyperthyroidism (diagnosed 6 months ago)

Current Medications
Methimazole, 15 mg orally daily

Which diagnostic test should the nurse anticipate the health care provider will order for Ellis?
  1. a.
    Serum ionized calcium
  2. b.
    Serum total calcium
  3. c.
    PTH
  4. d.
    TSH
Table 27.6 in the book ↗
Vital Signs Physical Examination
Temperature: 98.3°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: No jugular vein distention; no peripheral edema noted; S1, S2 auscultated, rhythm regular

• Respiratory: Lungs clear to auscultation bilaterally

• GI: Abdomen firm, nontender, slightly distended

• GU: Client reports urinary output unchanged from their baseline

• Neurological: Lethargy and slow speech noted; no other neurological deficits noted

• Integumentary: No wounds noted; skin appropriate for age
Blood pressure: 96/58 mm Hg
Heart rate: 58 beats/min
Respiratory rate: 18 breaths/min
Oxygen saturation: 95% on room air
Height: 5'6"
Weight: 211 lb (10 lb heavier than weight 3 months ago)

Answer

D. TSH
TSH, T3, and T4 laboratory tests are used to determine hypothyroidism.

27-1 §27.RQ source ↗

A nurse is assessing a client with hyperthyroidism. Which clinical manifestation should the nurse anticipate the client will report?
  1. a.
    Cold intolerance
  2. b.
    Weight gain
  3. c.
    Frequent mood changes
  4. d.
    Constipation

Answer

C. Frequent mood changes
Symptoms of hyperthyroidism include weight loss, heat intolerance, diarrhea, fine tremor, tachycardia, frequent mood changes, and muscle weakness.

27-2 §27.RQ source ↗

A nurse is reviewing the laboratory values for a client diagnosed with hypothyroidism. The nurse should expect an elevation in which laboratory value?
  1. a.
    PTH
  2. b.
    T3
  3. c.
    T4
  4. d.
    TSH

Answer

D. TSH
Clients with hypothyroidism will have an elevated TSH level.

27-3 §27.RQ source ↗

A nurse is teaching a client with newly diagnosed hyperthyroidism. For which medication should the nurse provide client education?
  1. a.
    Desiccated thyroid extract
  2. b.
    Levothyroxine
  3. c.
    Liothyronine sodium
  4. d.
    Methimazole

Answer

D. Methimazole
Methimazole is an antithyroid drug used to treat hyperthyroidism.

27-4 §27.RQ source ↗

A nurse is teaching a client about levothyroxine for hypothyroidism. The nurse should instruct the client to avoid which food?
  1. a.
    Grapefruit juice
  2. b.
    Garlic
  3. c.
    Soy
  4. d.
    Sardines

Answer

C. Soy
Soy has a food interaction with levothyroxine and can decrease its effectiveness.

27-5 §27.RQ source ↗

A nurse is assessing a client who is receiving levothyroxine for hypothyroidism. Which therapeutic drug response should the nurse anticipate?
  1. a.
    Decreased appetite
  2. b.
    Decreased heart rate
  3. c.
    Increased energy
  4. d.
    Increased weight

Answer

C. Increased energy
An increase in energy is a therapeutic effect of levothyroxine.

27-6 §27.RQ source ↗

Which laboratory findings would indicate to the nurse that a client has hypoparathyroidism?
  1. a.
    Ionized serum calcium 5.0 mg/dL
  2. b.
    Total serum calcium 9.8 mg/dL
  3. c.
    Phosphate 5.7 mg/dL
  4. d.
    Vitamin D 50 mmol/L

Answer

C. Phosphate 5.7 mg/dL
The phosphate level is above the expected reference range. Phosphate levels are increased in clients with hypoparathyroidism.

27-7 §27.RQ source ↗

A nurse is assessing a client diagnosed with hyperparathyroidism. Which findings should the nurse expect to find?
  1. a.
    Bone pain
  2. b.
    Chvostek sign
  3. c.
    Paresthesia
  4. d.
    Trousseau sign

Answer

A. Bone pain
Bone pain, along with muscle weakness and depression, are signs of hyperparathyroidism.

27-8 §27.RQ source ↗

A nurse is teaching a client diagnosed with osteoporosis secondary to hyperparathyroidism about a new prescription for alendronate. Which adverse effect should the nurse teach the client to report to the health care provider?
  1. a.
    Dyspepsia
  2. b.
    Hyperthermia
  3. c.
    Hypotension
  4. d.
    Metallic taste

Answer

A. Dyspepsia
Alendronate may cause esophagitis, which can lead to dyspepsia.

27-9 §27.RQ source ↗

The health care provider ordered levothyroxine 0.275 mg once daily for a client with hypothyroidism. Levothyroxine is available as a 137 mcg tablet. How many tablets will the nurse administer to the client?
  1. a.
    1
  2. b.
    2
  3. c.
    3
  4. d.
    4

Answer

B. 2
First, convert 0.275 mg to mcg, 0.275 m g × 1000 m c g / m g = 275 m c g
275 m c g x t a b l e t s (desired dose) = 137 m c g 1 t a b l e t (supply on hand)
137 x = 275 × 1 x = 275 137 x = 2 t a b l e t s .

27-10 §27.RQ source ↗

A client with hyperthyroidism has an order for methimazole 15 mg orally daily, in three divided doses. How many milligrams will the nurse administer for each dose?
  1. a.
    3 mg
  2. b.
    5 mg
  3. c.
    7.5 mg
  4. d.
    10 mg

Answer

B. 5 mg
15 mg divided by three divided doses equals 5 mg each dose.

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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.