Question 1

A 75-year-old patient who has cardiovascular disease reports insomnia and vomiting for several weeks.The primary care NP orders thyroid function tests.The tests show TSH is decreased and T₄ is increased.The NP should consult with an endocrinologist and order:

A) thyrotropin.
B) methimazole.
C) levothyroxine.
D) propylthiouracil.

methimazole.

Accepted Answer

Patients with hyperthyroidism,or Graves' disease,will require radioactive iodine.Elderly patients and patients with cardiovascular disease should be pretreated with an antithyroid medication such as methimazole.Thyrotropin is used to diagnose thyroid cancer.Levothyroxine is used to treat hypothyroidism.Propylthiouracil is also a thyroid suppressant,but methimazole is preferred.

Question 2

A patient who has hypothyroidism has been taking levothyroxine 50 mcg daily for 2 weeks.The patient reports continued fatigue.The primary care NP should:&#10;A) order a T4 level today.&#10;B) increase the dose to 100 mcg.&#10;C) check the TSH level in 1 week.&#10;D) reassure the patient that this will improve in several weeks.

Accepted Answer

Full therapeutic effectiveness may not be achieved for 3 to 6 weeks.Measuring the TSH level is indicated to evaluate drug effectiveness.The dose should not be increased without first evaluating the patient's TSH level.

Question 3

A primary care NP prescribes levothyroxine for a patient to treat thyroid deficiency.When teaching this patient about the medication,the NP should:&#10;A) counsel the patient to take the medication with food.&#10;B) tell the patient that changing brands of the medication should be avoided.&#10;C) instruct the patient to stop taking the medication if signs of thyrotoxicosis occur.&#10;D) tell the patient that the drug may be stopped when thyroid function tests stabilize.

Accepted Answer

Patients should be told not to change brands of the medication; there is potential variability in the bioequivalence between manufacturers.The medication should be taken at approximately the same time each day before breakfast or on an empty stomach.Patients should be instructed to contact the provider if signs of thyrotoxicosis are present.Thyroid replacement medications are usually given for life.

Question 4

A patient reports fatigue,weight loss,and dry skin.The primary care nurse practitioner (NP)orders thyroid function tests.The patient's thyroid stimulating hormone (TSH)is 40 microunits/mL,and T₄ is 0.1 ng/mL.The NP should refer the patient to an endocrinologist and prescribe:

A) methimazole.
B) liothyronine.
C) levothyroxine.
D) propylthiouracil.

Accepted Answer

This patient has hypothyroidism and should be treated with levothyroxine.Methimazole is a thyroid suppressant.Liothyronine is synthetic T₃.Propylthiouracil is a thyroid suppressant.

Question 5

A patient has been taking levothyroxine 100 mcg daily for several months.The patient comes to the clinic with complaints of insomnia and irritability.The primary care NP notes a heart rate of 92 beats per minute.The NP should:

A) change to liothyronine 75 mcg/day.
B) discontinue levothyroxine indefinitely.
C) order propylthiouracil to counter the increased thyroid levels.
D) order TSH and T4 levels and decrease the dose to 75 mcg/day.

Accepted Answer

When signs of thyrotoxicosis occur,the drug should be decreased or temporarily discontinued for 5 to 7 days.Liothyronine is not indicated.Propylthiouracil is not indicated.

Question 6

A child who has congenital hypothyroidism takes levothyroxine 75 mcg/day.The child weighs 15 kg.The primary care NP sees the child for a 3-year-old check-up.The NP should consult with a pediatric endocrinologist to discuss:

A) increasing the dose to 90 mcg/day.
B) decreasing the dose to 30 mcg/day.
C) stopping the medication and checking TSH and T4 in 4 weeks.
D) discussing the need for lifetime replacement therapy with the child's parents.

Accepted Answer

In congenital hypothyroidism,therapy may be stopped for 2 to 8 weeks after the patient reaches 3 years of age.If TSH levels remain normal,thyroid supplementation may be discontinued permanently.

Question 7

A patient with Graves' disease is taking methimazole.After 6 months of therapy,the primary care NP notes normal T&#8323; and T&#8324; and elevated TSH.The NP should:&#10;A) order a complete blood count (CBC) with differential.&#10;B) order aspartate aminotransferase, AGT, and LDH tests.&#10;C) decrease the dose of the medication.&#10;D) add levothyroxine to the patient's regimen.

Accepted Answer

Once clinical levels of thyrotoxicosis have been resolved,elevated TSH indicates a need to reduce the dosage.A CBC with differential is performed at the beginning of treatment and when signs of infection are present.Liver function tests may be monitored periodically but are not indicated by the current laboratory results.Levothyroxine is not indicated.

Question 8

An 80-year-old female patient with a history of angina has increased TSH and decreased T&#8324;.The primary care NP should prescribe _____ mcg of _____.&#10;A) 25; liothyronine&#10;B) 75; liothyronine&#10;C) 25; levothyroxine&#10;D) 75; levothyroxine

Accepted Answer

Elderly individuals may experience exacerbation of cardiovascular disease and angina with thyroid hormone replacement.It is advisable to start low at 25 mcg and work up as tolerated.Liothyronine is a synthetic T₃.

Question 9

A primary care NP orders thyroid function tests.The patient's TSH is 1.2 microunits/mL,and T&#8324; is 1.7 ng/mL.The NP should:&#10;A) assess the patient for symptoms of hyperthyroidism.&#10;B) ask the patient about the use of medications such as lithium.&#10;C) tell the patient that the results most likely indicate hypothyroidism.&#10;D) ask an endocrinologist to evaluate for possible Hashimoto's thyroiditis.

Accepted Answer

Primary hypothyroidism is the most common form of hypothyroidism.Use of certain drugs,such as lithium,and diseases such as Hashimoto's thyroiditis can cause hypothyroidism but are less likely.The patient does not have signs of hyperthyroidism.

Deck 52: Thyroid Medications