NUR 02 PHARMACOLOGY EXAM 1
1-A client with primary hypothyroidism has been taking levothyroxine for 1 year.
Laboratory results today show high levels of thyroid stimulating hormone (TSH). Which
teaching should the nurse plan to implement?
1. "A new prescription will be issued for a decreased dose of levothyroxine."
2. "Discontinue levothyroxine immediately; we will reassess TSH levels in 3
months."
3. "Start taking your levothyroxine with dietary fiber or calcium to increase its
effectiveness."
4. "You will need to get this new prescription filled for an increased dose of
levothyroxine."
Explanation:
Levothyroxine (Synthroid) is a thyroid hormone
replacement drug that is the most common
treatment for hypothyroidism, a condition in
which thyroid hormone deficit slows the
metabolic rate. In primary hypothyroidism, the
deficit occurs due to a problem in thyroid gland
tissue or hormone synthesis. TSH is released
from the pituitary and stimulates the thyroid
gland to secrete thyroid hormones (T3, T4). In
primary hypothyroidism, when the thyroid does
not synthesize enough T3 or T4, the pituitary
releases additional TSH to compensate. This
results in high levels of circulating TSH. Clients
are prescribed levothyroxine (or their dose is
augmented) to increase T3 and T4; this lowers
TSH and leads to a euthyroid (normal) state
(Options 1 and 2).
(Option 3) For best results, levothyroxine should
be taken on a consistent morning schedule
before food ingestion. Foods containing certain
ingredients (eg, cottonseed meal, walnuts,
soybean flower, dietary fiber, calcium) can
affect drug absorption.
Educational objective:
In primary hypothyroidism, the deficit occurs
due to a problem in thyroid gland tissue or
hormone synthesis. When the thyroid does not
synthesize enough T3 or T4, the pituitary
releases additional TSH to compensate.
, This results in high levels of circulating TSH.
Levothyroxine is usually started/increased to
lead to a euthyroid (normal) state.
2-A client with chronic kidney disease has received a continuous intravenous infusion of
heparin for 5 days. The nurse reviews the coagulation studies and the medication
administration record. Which prescription would the nurse question? Click on the exhibit
button for additional information.
, 1. Epoetin
2. Sodium polystyrene sulfonate
3. Vitamin K
4. Warfarin
Explanation: Vitamin K (phytonadione) is a fat-
soluble vitamin that is administered
as an antidote for warfarin-related
bleeding. This medication
prescription should be questioned as
vitamin K reverses the anticoagulant
effect of warfarin, and the client's
coagulation studies are in the
therapeutic range (aPTT 46-70 sec,
INR 2- 3).
(Option 1) Epoetin (Procrit) is a
synthetic hormone that stimulates
the production of
erythropoietin and is used to treat anemia associated with chronic kidney disease. This
is an appropriate prescription.
(Option 2) Sodium polystyrene sulfonate (Kayexalate) is a sodium exchange resin
administered to reduce elevated serum potassium levels in clients with chronic kidney
disease and hyperkalemia.
This is an appropriate prescription for this client.
(Option 4) Warfarin (Coumadin) is a vitamin K antagonist used for long-term
anticoagulation that is started about 5 days before a continuous heparin infusion is
discontinued. An overlap of the parenteral and oral anticoagulant is required for about 5
days as this is the time it takes warfarin to reach therapeutic level. This is an
appropriate prescription for this client.
Educational objective:
Anticoagulants stop thrombus formation by interfering with the coagulation cascade.
Parenteral heparin and oral warfarin affect the clotting cascade differently; therefore, a
5-day overlap for the 2 drugs is required. This allows warfarin to reach a therapeutic
level before the continuous heparin infusion is stopped.
3-A home health nurse visits a client 2 weeks after discharge from the hospital. The
client experienced an acute myocardial infarction and subsequent heart failure. Home
medications are listed in the exhibit. Which symptom reported by the client is most
concerning to the nurse? Click on the exhibit button for additional information.
1. Bruising easily, especially on arms
2. Fatigue
3. Feeling depressed
, 4. Muscle cramps in legs
1-A client with primary hypothyroidism has been taking levothyroxine for 1 year.
Laboratory results today show high levels of thyroid stimulating hormone (TSH). Which
teaching should the nurse plan to implement?
1. "A new prescription will be issued for a decreased dose of levothyroxine."
2. "Discontinue levothyroxine immediately; we will reassess TSH levels in 3
months."
3. "Start taking your levothyroxine with dietary fiber or calcium to increase its
effectiveness."
4. "You will need to get this new prescription filled for an increased dose of
levothyroxine."
Explanation:
Levothyroxine (Synthroid) is a thyroid hormone
replacement drug that is the most common
treatment for hypothyroidism, a condition in
which thyroid hormone deficit slows the
metabolic rate. In primary hypothyroidism, the
deficit occurs due to a problem in thyroid gland
tissue or hormone synthesis. TSH is released
from the pituitary and stimulates the thyroid
gland to secrete thyroid hormones (T3, T4). In
primary hypothyroidism, when the thyroid does
not synthesize enough T3 or T4, the pituitary
releases additional TSH to compensate. This
results in high levels of circulating TSH. Clients
are prescribed levothyroxine (or their dose is
augmented) to increase T3 and T4; this lowers
TSH and leads to a euthyroid (normal) state
(Options 1 and 2).
(Option 3) For best results, levothyroxine should
be taken on a consistent morning schedule
before food ingestion. Foods containing certain
ingredients (eg, cottonseed meal, walnuts,
soybean flower, dietary fiber, calcium) can
affect drug absorption.
Educational objective:
In primary hypothyroidism, the deficit occurs
due to a problem in thyroid gland tissue or
hormone synthesis. When the thyroid does not
synthesize enough T3 or T4, the pituitary
releases additional TSH to compensate.
, This results in high levels of circulating TSH.
Levothyroxine is usually started/increased to
lead to a euthyroid (normal) state.
2-A client with chronic kidney disease has received a continuous intravenous infusion of
heparin for 5 days. The nurse reviews the coagulation studies and the medication
administration record. Which prescription would the nurse question? Click on the exhibit
button for additional information.
, 1. Epoetin
2. Sodium polystyrene sulfonate
3. Vitamin K
4. Warfarin
Explanation: Vitamin K (phytonadione) is a fat-
soluble vitamin that is administered
as an antidote for warfarin-related
bleeding. This medication
prescription should be questioned as
vitamin K reverses the anticoagulant
effect of warfarin, and the client's
coagulation studies are in the
therapeutic range (aPTT 46-70 sec,
INR 2- 3).
(Option 1) Epoetin (Procrit) is a
synthetic hormone that stimulates
the production of
erythropoietin and is used to treat anemia associated with chronic kidney disease. This
is an appropriate prescription.
(Option 2) Sodium polystyrene sulfonate (Kayexalate) is a sodium exchange resin
administered to reduce elevated serum potassium levels in clients with chronic kidney
disease and hyperkalemia.
This is an appropriate prescription for this client.
(Option 4) Warfarin (Coumadin) is a vitamin K antagonist used for long-term
anticoagulation that is started about 5 days before a continuous heparin infusion is
discontinued. An overlap of the parenteral and oral anticoagulant is required for about 5
days as this is the time it takes warfarin to reach therapeutic level. This is an
appropriate prescription for this client.
Educational objective:
Anticoagulants stop thrombus formation by interfering with the coagulation cascade.
Parenteral heparin and oral warfarin affect the clotting cascade differently; therefore, a
5-day overlap for the 2 drugs is required. This allows warfarin to reach a therapeutic
level before the continuous heparin infusion is stopped.
3-A home health nurse visits a client 2 weeks after discharge from the hospital. The
client experienced an acute myocardial infarction and subsequent heart failure. Home
medications are listed in the exhibit. Which symptom reported by the client is most
concerning to the nurse? Click on the exhibit button for additional information.
1. Bruising easily, especially on arms
2. Fatigue
3. Feeling depressed
, 4. Muscle cramps in legs
