Question 1

A primary care NP orders thyroid function tests.The patient's TSH is 1.2 microunits/mL,and T₄ is 1.7 ng/mL.The NP should:

Accepted Answer

A)  assess the patient for symptoms of hyperthyroidism. 
B)  ask the patient about the use of medications such as lithium. 
C)  tell the patient that the results most likely indicate hypothyroidism. 
D)  ask an endocrinologist to evaluate for possible Hashimoto's thyroiditis. 
A)  assess the patient for symptoms of hyperthyroidism. 
B)  ask the patient about the use of medications such as lithium. 
C)  tell the patient that the results most likely indicate hypothyroidism. 
D)  ask an endocrinologist to evaluate for possible Hashimoto's thyroiditis. C

Question 2

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:

Accepted Answer

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

Question 3

A patient with Graves' disease is taking methimazole.After 6 months of therapy,the primary care NP notes normal T₃ and T₄ and elevated TSH.The NP should:

Accepted Answer

A)  order a complete blood count (CB
C)  with differential. 
B)  order aspartate aminotransferase, AGT, and LDH tests. 
C)  decrease the dose of the medication. 
D)  add levothyroxine to the patient's regimen. 
A)  order a complete blood count (CB
C)  with differential. 
B)  order aspartate aminotransferase, AGT, and LDH tests. 
C)  decrease the dose of the medication. 
D)  add levothyroxine to the patient's regimen. C

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:

Accepted Answer

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

Question 5

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:

Accepted Answer

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. 
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.

Question 6

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:

Accepted Answer

A)  order a T4 level today. 
B)  increase the dose to 100 mcg. 
C)  check the TSH level in 1 week. 
D)  reassure the patient that this will improve in several weeks. 
A)  order a T4 level today. 
B)  increase the dose to 100 mcg. 
C)  check the TSH level in 1 week. 
D)  reassure the patient that this will improve in several weeks.

Question 7

A primary care NP prescribes levothyroxine for a patient to treat thyroid deficiency.When teaching this patient about the medication,the NP should:

Accepted Answer

A)  counsel the patient to take the medication with food. 
B)  tell the patient that changing brands of the medication should be avoided. 
C)  instruct the patient to stop taking the medication if signs of thyrotoxicosis occur. 
D)  tell the patient that the drug may be stopped when thyroid function tests stabilize. 
A)  counsel the patient to take the medication with food. 
B)  tell the patient that changing brands of the medication should be avoided. 
C)  instruct the patient to stop taking the medication if signs of thyrotoxicosis occur. 
D)  tell the patient that the drug may be stopped when thyroid function tests stabilize.

Question 8

An 80-year-old female patient with a history of angina has increased TSH and decreased T₄.The primary care NP should prescribe _____ mcg of _____.

Accepted Answer

A)  25; liothyronine 
B)  75; liothyronine 
C)  25; levothyroxine 
D)  75; levothyroxine 
A)  25; liothyronine 
B)  75; liothyronine 
C)  25; levothyroxine 
D)  75; levothyroxine

Question 9

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:

Accepted Answer

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. 
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.

Exam 52: Thyroid Medications

A primary care NP orders thyroid function tests.The patient's TSH is 1.2 microunits/mL,and T₄ is 1.7 ng/mL.The NP should:

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 patient with Graves' disease is taking methimazole.After 6 months of therapy,the primary care NP notes normal T₃ and T₄ and elevated TSH.The NP should:

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 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 patient who has hypothyroidism has been taking levothyroxine 50 mcg daily for 2 weeks.The patient reports continued fatigue.The primary care NP should:

A primary care NP prescribes levothyroxine for a patient to treat thyroid deficiency.When teaching this patient about the medication,the NP should:

An 80-year-old female patient with a history of angina has increased TSH and decreased T₄.The primary care NP should prescribe _____ mcg of _____.

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:

Prescriptive Authority and Role Implementation: Tradition vs.Change

Historical Review of Prescriptive Authority: The Role of Nurses (NPs, CNMs, CRNAs, and CNSs)and Physician Assistants

General Pharmacokinetic and Pharmacodynamic Principles

Special Populations: Geriatrics

Special Populations: Pediatrics

Special Populations: Pregnant and Nursing Women

Over-the-Counter Medications

Complementary and Alternative Therapies

Establishing the Therapeutic Relationship

Practical Tips on Writing Prescriptions

Evidence-Based Decision Making and Treatment Guidelines

Design and Implementation of Patient Education

Dermatologic Agents

Eye, Ear, Throat, and Mouth Agents

Upper Respiratory Agents

Asthma and Chronic Obstructive Pulmonary Disease Medications

Hypertension and Miscellaneous Antihypertensive Medications

Coronary Artery Disease and Antianginal Medications

Heart Failure and Digoxin

Beta-Blockers

Calcium Channel Blockers

ACE Inhibitors and Angiotensin Receptor Blockers

Antiarrhythmic Agents

Antihyperlipidemic Agents

Agents that Act on Blood

Antacids and the Management of GERD

Histamine-2 Blockers and Proton Pump Inhibitors

Laxatives

Antidiarrheals

Antiemetics

Medications for Irritable Bowel Syndrome and Other Gastrointestinal Problems

Diuretics

Male Genitourinary Agents

Drugs for Urinary Incontinence and Urinary Analgesia

Acetaminophen

Aspirin and Nonsteroidal Antiinflammatory Drugs

Disease-Modifying Antirheumatic Drugs and Immune Modulators

Gout Medications

Osteoporosis Treatment

Muscle Relaxants

Medications for Attention Deficit/Hyperactivity Disorder

Medications for Dementia

Analgesia and Pain Management

Migraine Medications

Antiepileptics

Antiparkinson Agents

Antidepressants

Antianxiety and Insomnia Agents

Antipsychotics

Substance Abuse

Glucocorticoids

Diabetes Mellitus Agents

Contraceptives

Hormone Replacement Therapy

Drugs for Breast Cancer

Principles for Prescribing Antiinfectives

Treatment of Specific Infections and Miscellaneous Antibiotics

Penicillins

Cephalosporins

Tetracyclines

Macrolides

Fluoroquinolones

Aminoglycosides

Sulfonamides

Antitubercular Agents

Antifungals

Antiretroviral Medications

Antiviral and Antiprotozoal Agents

The Immune System and Immunizations

Weight Management

An 80-year-old female patient with a history of angina has increased TSH and decreased T₄.The primary care NP should prescribe _ mcg of _.