NURSING 6005 CHAPTER 58: DRUGS FOR THYROID DISORDERS
Test Bank
MULTIPLE CHOICE
1. A patient has a free T4 level of 0.6 ng/dL and a free T3 of 220 pg/dL. The patient asks the
nurse what these laboratory values mean. How will the nurse respond?
a. “These laboratory values indicate that you may have Graves’ disease.”
b. “These results suggest you may have hyperthyroidism.”
c. “We will need to obtain a total T4 and a total T3 to tell for sure.”
d. “We will need to obtain a TSH level to better evaluate your diagnosis.”
ANS: D
A free T4 level of less than 0.9 ng/dL and a free T3 of less than 230 pg/dL are consistent with
hypothyroidism, but measurement of the thyroid-stimulating hormone (TSH) level is
necessary to distinguish primary hypothyroidism from secondary hypothyroidism. Total T3
and T4 levels are not as helpful as free T3 and T4 levels. These laboratory values indicate
hypothyroidism, not hyperthyroid conditions such as Graves’ disease.
DIF: Cognitive Level: Application
REF: Thyroid Function Tests | Serum TSH | Serum T4 Test | Serum T3 Test | Table 58-1: Serum
Values for Thyroid Function Tests TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
2. A nurse obtaining an admission history on an adult patient notes that the patient has a heart
rate of 62 beats per minute, a blood pressure of 105/62 mm Hg, and a temperature of 96.2 F.
The patient appears pale and complains of always feeling cold and tired. The nurse will
contact the provider to discuss tests for which condition?
a. Cretinism
b. Graves’ disease
c. Hypothyroidism
d. Plummer’s disease
ANS: C
This patient is showing signs of hypothyroidism: a low heart rate, low temperature, pale skin,
and feeling cold and tired. In adults, thyroid deficiency is called hypothyroidism. In children,
thyroid deficiency is called cretinism. Graves’ disease and Plummer’s disease are conditions
caused by thyroid excess.
DIF: Cognitive Level: Application
REF: Thyroid Pathophysiology | Hypothyroidism | Hypothyroidism in Adults
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
3. The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The
patient tells the nurse she does not want to take medications while she is pregnant. What will
the nurse explain to this patient?
a. Hypothyroidism is a normal effect of pregnancy and usually is of no consequence.
b. Neuropsychologic deficits in the fetus can occur if the condition is not treated.
c. No danger to the fetus exists until the third trimester.
, d. Treatment is required only if the patient is experiencing symptoms.
ANS: B
Maternal hypothyroidism can result in permanent neuropsychologic deficits in the child.
Hypothyroidism is not a normal effect of pregnancy and is a serious condition that can affect
both mother and fetus. The greatest danger to the fetus occurs in the first trimester, because
the thyroid does not fully develop until the second trimester. Early identification is essential.
Symptoms often are vague. Treatment should begin as soon as possible, or mental retardation
and other developmental problems may occur.
DIF: Cognitive Level: Application REF: Hypothyroidism During Pregnancy
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
4. A nurse caring for a patient notes that the patient has a temperature of 104° F and a heart rate
of 110 beats per minute. The patient’s skin is warm and moist, and the patient complains that
the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will
contact the provider to discuss:
a. cretinism.
b. Graves’ disease.
c. myxedema.
d. Plummer’s disease.
ANS: B
The signs and symptoms in this patient are consistent with hyperthyroidism and, because the
patient’s eyes are protuberant, they also are consistent with Graves’ disease. Cretinism is
hypothyroidism in children. Myxedema is severe hypothyroidism. Plummer’s disease is a
hyperthyroidism condition without exophthalmos.
DIF: Cognitive Level: Application REF: Hyperthyroidism | Graves’ Disease
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
5. A patient in her twenties with Graves’ disease who takes methimazole (Tapazole) tells a nurse
that she is trying to conceive and asks about disease management during pregnancy. What will
the nurse tell her?
a. Methimazole is safe to take throughout pregnancy.
b. Propylthiouracil should be taken throughout her pregnancy.
c. The patient should discuss changing to propylthiouracil from now until her second
trimester with her provider.
d. The patient should discuss therapy with iodine-131 instead of medications with her
provider.
ANS: C
Methimazole is not safe during the first trimester of pregnancy, because it is associated with
neonatal hypothyroidism, goiter, and cretinism; however, it is safe in the second and third
trimesters. Propylthiouracil is recommended for pregnant patients only in the first trimester
and during lactation only if a thionamide is absolutely necessary. Iodine-131 is used in women
older than 30 years who have not responded to medication therapy and is contraindicated
during pregnancy.
DIF: Cognitive Level: Application
Test Bank
MULTIPLE CHOICE
1. A patient has a free T4 level of 0.6 ng/dL and a free T3 of 220 pg/dL. The patient asks the
nurse what these laboratory values mean. How will the nurse respond?
a. “These laboratory values indicate that you may have Graves’ disease.”
b. “These results suggest you may have hyperthyroidism.”
c. “We will need to obtain a total T4 and a total T3 to tell for sure.”
d. “We will need to obtain a TSH level to better evaluate your diagnosis.”
ANS: D
A free T4 level of less than 0.9 ng/dL and a free T3 of less than 230 pg/dL are consistent with
hypothyroidism, but measurement of the thyroid-stimulating hormone (TSH) level is
necessary to distinguish primary hypothyroidism from secondary hypothyroidism. Total T3
and T4 levels are not as helpful as free T3 and T4 levels. These laboratory values indicate
hypothyroidism, not hyperthyroid conditions such as Graves’ disease.
DIF: Cognitive Level: Application
REF: Thyroid Function Tests | Serum TSH | Serum T4 Test | Serum T3 Test | Table 58-1: Serum
Values for Thyroid Function Tests TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
2. A nurse obtaining an admission history on an adult patient notes that the patient has a heart
rate of 62 beats per minute, a blood pressure of 105/62 mm Hg, and a temperature of 96.2 F.
The patient appears pale and complains of always feeling cold and tired. The nurse will
contact the provider to discuss tests for which condition?
a. Cretinism
b. Graves’ disease
c. Hypothyroidism
d. Plummer’s disease
ANS: C
This patient is showing signs of hypothyroidism: a low heart rate, low temperature, pale skin,
and feeling cold and tired. In adults, thyroid deficiency is called hypothyroidism. In children,
thyroid deficiency is called cretinism. Graves’ disease and Plummer’s disease are conditions
caused by thyroid excess.
DIF: Cognitive Level: Application
REF: Thyroid Pathophysiology | Hypothyroidism | Hypothyroidism in Adults
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
3. The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The
patient tells the nurse she does not want to take medications while she is pregnant. What will
the nurse explain to this patient?
a. Hypothyroidism is a normal effect of pregnancy and usually is of no consequence.
b. Neuropsychologic deficits in the fetus can occur if the condition is not treated.
c. No danger to the fetus exists until the third trimester.
, d. Treatment is required only if the patient is experiencing symptoms.
ANS: B
Maternal hypothyroidism can result in permanent neuropsychologic deficits in the child.
Hypothyroidism is not a normal effect of pregnancy and is a serious condition that can affect
both mother and fetus. The greatest danger to the fetus occurs in the first trimester, because
the thyroid does not fully develop until the second trimester. Early identification is essential.
Symptoms often are vague. Treatment should begin as soon as possible, or mental retardation
and other developmental problems may occur.
DIF: Cognitive Level: Application REF: Hypothyroidism During Pregnancy
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
4. A nurse caring for a patient notes that the patient has a temperature of 104° F and a heart rate
of 110 beats per minute. The patient’s skin is warm and moist, and the patient complains that
the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will
contact the provider to discuss:
a. cretinism.
b. Graves’ disease.
c. myxedema.
d. Plummer’s disease.
ANS: B
The signs and symptoms in this patient are consistent with hyperthyroidism and, because the
patient’s eyes are protuberant, they also are consistent with Graves’ disease. Cretinism is
hypothyroidism in children. Myxedema is severe hypothyroidism. Plummer’s disease is a
hyperthyroidism condition without exophthalmos.
DIF: Cognitive Level: Application REF: Hyperthyroidism | Graves’ Disease
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
5. A patient in her twenties with Graves’ disease who takes methimazole (Tapazole) tells a nurse
that she is trying to conceive and asks about disease management during pregnancy. What will
the nurse tell her?
a. Methimazole is safe to take throughout pregnancy.
b. Propylthiouracil should be taken throughout her pregnancy.
c. The patient should discuss changing to propylthiouracil from now until her second
trimester with her provider.
d. The patient should discuss therapy with iodine-131 instead of medications with her
provider.
ANS: C
Methimazole is not safe during the first trimester of pregnancy, because it is associated with
neonatal hypothyroidism, goiter, and cretinism; however, it is safe in the second and third
trimesters. Propylthiouracil is recommended for pregnant patients only in the first trimester
and during lactation only if a thionamide is absolutely necessary. Iodine-131 is used in women
older than 30 years who have not responded to medication therapy and is contraindicated
during pregnancy.
DIF: Cognitive Level: Application
