Exam 5 part 3

Question 1

What drug used for thyroid replacement interacts with warfarin by increasing its effect? What should be monitored closely?

Answer 1

levothyroxine
PT/INR and bleeding

Question 2

What drug interactions occur with levothyroxine?

Answer 2

warfarin and digoxin

Question 3

Because vitamins and supplements can decrease the absorption of levothyroxine, when should they be taken?

Answer 3

4 hrs after taking levothyroxine

Question 4

Levothyroxine decreases the effect of digoxin, so which symptoms should be monitored very closely?

Answer 4

s/s heart failure (edema, SOB< crackles, activity intolerance, etc)

Question 5

What s/s may indicate overmedication of levothyroxine?

Answer 5

hyperthyroidism (tachycardia, weightloss, hyperactivity)

Question 6

What adverse effects may occur in a patient with a thyroid replacement patient receiving levothyroxine?

Answer 6

aFIB, bone loss, overmedication/hyperthyroidism

Question 7

What are the indications of methimazole and propylthiouracil?

Answer 7

hyperthyroidism, goiter, thyroid storm, and Grave’s disease

Question 8

If crushing a levothyroxine tablet, what should it be mixed with?

Answer 8

water

Question 9

If a patient is receiving propylthiouracil for hyperthyroidism, what tests are important to monitor frequently?

Answer 9

liver function tests (Black box warning for hepatic toxicity)

Question 10

What is a major adverse effect concern with antithyroid medications (methimazole)?

Answer 10

hypothyroidism

Question 11

what pregnancy category is methimazole (drug for hyperthyroidism)?

Answer 11

Category D

Question 12

what food group should those taking methimazole avoid?

Answer 12

sea food due to iodine content

Question 13

Agranulocytosis may occur as a result of receiving methimazole, so this assessment is indicated?

Answer 13

CBC to monitor for agranulocytosis( low wbc) that may lead to infection

Question 14

What symptoms may occur as a result of stopping methimazole abruptly?

Answer 14

thyroid storm/crisis (tachycardia, fever, flushing, restlessness, behavior changes)

Question 15

what medications may be used in diabetes insipidus?

Answer 15

vasopressin and desmopressin

Question 16

What adverse effect is a black box warning for desmopressin?

Answer 16

severe hyponatremia

Question 17

What s/s may occur if vasopressin results in overhydration?

Answer 17

sleepiness, difficulty arousing, headache, and mental status changes)

Question 18

What adverse effects may occur with antidiuretic drugs?

Answer 18

MI, hyponatremia, and over absorption of water

Question 19

Because of the risk for hypothyroidism-related bradycardia, the nurse should teach the patient taking methimazole (antithyroid drug) to monitor what?

Answer 19

self-monitor pulses

Question 20

What lab interventions should be implemented for a patient receiving vasopressin or desmopressin?

Answer 20

urine specific gravity and osmolality, I & O, BUN/creatinine, sodium and potassium

Question 21

what are the indications for calcitonin-salmon?

Answer 21

hypercalcemia, Paget’s disease, osteoporosis in post-menopausal women

Question 22

What adverse effects should be monitored in those receiving calcitonin salmon?

Answer 22

hypocalcemia (muscle spasms, seizures, paresthesia)

Question 23

what are side effects that may occur with calcitonin-salmon?

Answer 23

GI disturbances, skin rash, nasal irritation, flushing

Question 24

If a patient taking taking risedronate (bisphosphonates) develops musculoskeletal pain, what can the nurse teach them to take?

Answer 24

acetaminophen

Question 25

Why should a patient taking a bisphosphonates (-dronates) report pain, numbness, or swelling in the jaw?

Answer 25

these may indicate jaw necrosis, a complication that may occur from this med

Question 26

How should the nurse educate the patient taking zoledronate to prevent esophagitis?

Answer 26

take on empty stomach, with at least 8oz water, and stay upright for 30 mins

Question 27

What general education should be provided to patients taking meds for osteoporosis to aid in the prevention of osteoporosis?

Answer 27

increase calcium, vitamin D, and weight bearing exercises

Question 28

Should levothyroxine be taken with food?

Answer 28

NO, on an empty stomach with water

Question 29

What adverse CNS effects may occur with decongestants?

Answer 29

hallucinations, convulsions, and delusions

Question 30

What adverse cardio effects may occur with decongestants?

Answer 30

palpitations, arrythmias, and HTN

Question 31

Which respiratory medication is contraindicated in those with a peanut allergy?

Answer 31

anticholinergics like ipratropium and tiotropium

Question 32

What does "HIGGGH" stand for, as a mnemonic for the side effects of oral corticosteroids (prednisone, triamcinolone, dexamethasone)?

Answer 32

H- hypertension I- immunosuppression G- go crazy(mood changes) G- glaucoma G- growth retardation H- hyperglycemia

Question 33

What does "HOMIE" stand for as an mnemonic for the side effects of oral corticosteroids?

Answer 33

H- hair growth O-osteoporosis M-muscle weakness I- increased weight E- edema

Question 34

What does BRAG stand for as a mnemonic for metformin?

Answer 34

B- B12 deficiency R- renal dosing A- acidosis (lactic) G- GI disturbances