TEST BANK FOCUS ON NURSING PHARMACOLOGY 8TH EDITION WITH 1 -59 CHAPTERS.

21. The nurse is caring for a patient with a history of myocardial infarction and heart failure. What thyroid replacement drug would the nurse question if ordered? A) Liothyronine B) Levothyroxine C) Thyroid desiccated D) Methimazole Ans: A Feedback: Liothyronine and liotrix have a greater incidence of cardiac adverse effects and are not recommended for use in patients with potential cardiac problems or patients who are prone to anxiety reactions. Levothyroxine would be the drug of choice and thyroid desiccated would not be contraindicated. Methimazole is a treatment for hyperthyroidism and would not be appropriate for the patient with hypothyroidism. 22. The nurse is caring for a patient newly diagnosed with hypothyroidism. The patient also takes theophylline to control asthma symptoms. What changes will need to be made to the patient’s theophylline dose? A) Decrease theophylline dosage immediately. B) Increase theophylline dosage immediately. C) Increase theophylline dose when normal thyroid function returns. D) Decrease theophylline dose when normal thyroid function returns. Ans: B Feedback: Theophylline clearance is decreased in hypothyroid states. As the patient approaches normal thyroid function, theophylline dose may need to be adjusted frequently. As the drug is cleared more quickly, the dosage may need to be increased. 23. The nurse is caring for a 57-year-old woman who is complaining about gaining so much weight after menopause and suggests that thyroid hormone replacement would help her lose weight and speed up her metabolism. What is the nurse’s best response? A) Inducing a state of hyperthyroidism would result in weight loss. B) People who are not hypothyroid should not take thyroid hormones. C) People who take thyroid hormones without cause will end up damaging their heart. D) The body compensates for the extra hormone by reducing the amount secreted. Ans: D Feedback: Taking thyroid hormone with normal thyroid function results in disruption of the hypothalamicpituitarythyroid control resulting in decreased production of thyrotropin-releasing hormone (TRH) and thyroid-stimulating hormone (TSH) as the hypothalamus and pituitary sensed the rising levels of thyroid hormone. Because the thyroid was no longer stimulated to produce and secrete thyroid hormone, thyroid levels would actually fall. This would put the patient at greater risk of gaining weight. There is no evidence it would cause heart damage. Because thyroid hormone production is reduced, a state of hyperthyroidism is not induced. Even though the statement that people who are not hypothyroid should not take thyroid hormones is correct, it does not provide enough information to dissuade this patient from a dangerous practice. 24. The patient is 8 weeks pregnant and requires an antithyroid medication. The nurse identifies what drug as the drug of choice for this patient? A) Propylthiouracil B) Radioactive iodine C) Alendronate D) Methimazole Ans: A Feedback: If an antithyroid drug is essential during pregnancy, propylthiouracil (PTU) is the drug of choice because it is less likely to cross the placenta and cause problems for the fetus. Radioactive agents should not be used. Bisphosphonates should be used during pregnancy only if the benefit to the mother clearly outweighs the potential risk to the fetus. Methimazole is an antithyroid medication but would not be the drug of choice for the pregnant woman. 25. The nurse is discharging a patient with a new prescription for levothyroxine. What would the nurse teach the patient to report to her health care provider? (Select all that apply.) A) Nervousness B) Insomnia C) Chest pain D) Loss of hair E) Nausea Ans: A, B, C Feedback: Report chest pain, heart palpitations, nervousness, or insomnia. These adverse effects result from excessive stimulation and may indicate that drug dosage or intake of other stimulants needs to be reduced. Loss of hair is usually only seen in the first few months of therapy in children; nausea need not be reported unless it is persistent or interferes with adequate caloric intake. 26. The nurse tells the patient his or her serum calcium level is elevated and the patient asks what controls calcium levels in the body. What is the nurse’s best response? A) Renin B) Parathyroid hormone (PTH) C) Thyroid-stimulating hormone (TSH) D) Epoetin Ans: B Feedback: PTH is the most important regulator of serum calcium levels in the body. Renin controls blood pressure, epoetin stimulates production of red blood cells, and TSH stimulates thyroid hormone secretion. 27. The nurse is caring for a patient diagnosed with hyperparathyroidism who asks the nurse why parathyroid hormone (PTH) is important. The nurse explains that PTH performs what actions in the body? (Select all that apply.) A) Stimulation of osteoclasts B) Increased intestinal absorption of calcium C) Stimulation of calcitriol production D) Increased excretion of calcium from kidneys E) Decreased retention of vitamin D Ans: A, B, C Feedback: PTH has many actions, including stimulation of osteoclasts or bone cells to release calcium from the bone, increased intestinal absorption of calcium, increased calcium reabsorption from the kidneys, and stimulation of cells in the kidney to produce calcitriol. PTH increases absorption of calcium from the kidney and increases retention of vitamin D. 28. The nurse is teaching the patient how to take his newly prescribed alendronate and includes what teaching points? (Select all that apply.) A) Take the drug in the morning. B) Wait 60 minutes before eating breakfast. C) Take the drug with a full glass of water. D) Remain upright for 30 minutes after taking the medication. E) Eat a breakfast high in calcium after taking the medication. Ans: A, C, D Feedback: Alendronate, ibandronate, and risedronate need to be taken on arising in the morning, with a full glass of water, fully 30 minutes before any other food or beverage, and the patient must then remain upright for at least 30 minutes; taking the drug with a full glass of water and remaining upright for at least 30 minutes facilitates delivery of the drug to the stomach. These drugs should not be given to anyone who is unable to remain upright for 30 minutes after taking the drug because serious esophageal erosion can occur. There is no need to eat a high-calcium breakfast, although the patient should make certain of adequate calcium intake. 29. The nurse is caring for an asthmatic patient prescribed zoledronic acid. What important question should the nurse ask this patient? A) Can you take aspirin without experiencing any bad effects? B) Are you taking theophylline to treat your asthma? C) Do you have a history of diarrhea? D) Are you taking digoxin? Ans: A Feedback: Zoledronic acid should be used cautiously in aspirin-sensitive asthmatic patients. Gastrointestinal (GI) distress may increase if bisphosphonates are combined with aspirin; this combination should, therefore, be avoided if possible. There is no drug interaction between theophylline and zoledronic acid or between digoxin and zoledronic acid. A history of diarrhea would not impact the ability to administer zoledronic acid. 30. The nurse is caring for a pediatric patient with hypercalcemia. What condition would the nurse suspect is causing this altered serum calcium level? A) Radiation injury B) Malignancy C) Kidney failure D) Hypothyroidism Ans: B Feedback: Hypercalcemia is relatively rare in children, although it may be seen with certain malignancies. It would not result from a radiation injury, which would be more likely to affect the thyroid gland and it would not be caused by kidney failure or hypothyroidism.