NR 293 — Week 2 Unit 4 — Hormonal Regulation Questions and answers + rationales

The pituitary gland has __________ lobes which secrete __________ hormones.

Two

Different

Considered the master gland, the __________ gland receives its primary direction from the __________.

Pituitary

Hypothalamus

Hormone regulating medications work with the __________ gland to maintain homeostasis.

Pituitary

As one-half of the neuroendocrine system, the hypothalamus controls which endocrine gland?

Pituitary

In an attempt to stop a negative feedback loop and return to a state of physiologic __________, the pituitary gland produces and secretes hormones.

Homeostasis

Hormone replacement therapy is used in which situations? Select all that apply.

Antagonize the action and natural effects of the body's pituitary hormones.

Mimic the action and natural effects of the body's pituitary hormones.

Replace deficient hormone levels

Diagnose hormonal dysfunction

A client is being treated with cosyntropin, which __________ the secretion of __________.

Stimulates

Cortisol

Vasopressin is a potent __________ in larger doses.

Vasoconstrictor

In general, the adverse effects of a hormone __________ drug will be the opposite of the normal bodily reaction of the hormone on which it acts.

Antagonizing

Which is a growth hormone (GH) antagonizing drug?

Octreotide

What are the therapeutic effects and uses of cosyntropin, an adrenocorticotropic hormone (ACTH) mimicking drug? Select all that apply.

Has anti-inflammatory effects

Diagnoses and treats adrenocortical insufficiency

Stimulates cortisol secretion

Acts on the adrenal cortex

The main function of the __________ system is to maintain physiologic __________. Hormone imbalances trigger a __________ loop to restore hormonal balance.

Neuroendocrine

Homeostasis

Negative feedback

Adverse effects resulting from the vasoconstrictive action of vasopressin include which changes within the body? Select all that apply.

Vertigo

Tremors

Complete the tables by placing each drug in the correct location.

Adrenocorticotropic hormone (ACTH) - Cosyntropin

Growth hormone (GH) - Somatropin, somatrem; Octreotide

Antidiuretic hormone (ADH) - Desmopressin, vasopressin

Somatropin is a __________ hormone __________ drug.

Growth

Mimicking

Vasopressin can be used to promote which desired outcomes? Select all that apply.

Treatment of pulseless cardiac arrest.

Increase blood pressure in large doses.

For each body system or process listed, specify if it is impacted by the thyroid hormones by placing a mark in the Thyroid Hormones Involved column or the Thyroid Hormones Not Involved column.

Thyroid Hormones Involved:

• Basal metabolic rate regulation

• Thermoregulation

• Lipid metabolism

• Carbohydrate metabolism

• Normal growth and development

Thyroid Hormones Not Involved:

• Production of red blood cells

• Production of neurotransmitters

• Skin pigmentation

• Regulation of insulin releaseg

T3 is secreted by the __________ and is also called __________.

Thyroid gland

Triiodothyronine

T4 is secreted by the __________ and is also called __________.

Thyroid gland

Thyroxine

The goal of thyroid replacement therapy is to return the client to a euthyroid balance. Which assessment cues indicate that a therapeutic effect has occurred? Select all that apply.

Increased energy

Regrowth of hair

Thyroid replacement drugs are used in various forms to treat __________ by __________ of thyroid hormones.

Hypothyroidism

Replacing low levels

The most commonly prescribed synthetic thyroid hormone is __________.

This medication is pure __________.

This is the preferred thyroid drug __________.

Levothyroxine

T4

Because of its predictable effects and standardized hormonal content

The nurse should advise the client who recently began thyroid replacement therapy to notify the healthcare provider immediately about which symptoms? Select all that apply.

Excitability

Irritability

Palpitations

Identify and select the adverse effects and safety considerations that apply to levothyroxine. Select all that apply.

​Think about it... levothyroxine is pure thyroxine (T4). Consider what effects T4 has on bodily systems and processes.

Insomnia

Dosed in mcg (micrograms)​

Hypertension

Cardiac dysrhythmia​

Thyrotropin-releasing hormone (TRH) is secreted by the __________ and __________.

Hypothalamus

Causes the release of triiodothyronine (T3) and thyroxine (T4) into the circulation.

Match each type of hypothyroidism to its characteristics and its place in the negative feedback loop.

Primary Hypothyroidism:

• It is the most common type of hypothyroidism.

• Because the thyroid gland does not produce enough thyroid hormones or does not release enough stored thyroid hormones, the level of triiodothyronine (T3) and thyroxine (T4) is low.

Secondary Hypothyroidism:

• The pituitary gland does not secrete enough thyroid-stimulating hormone (TSH).

• Because the pituitary gland does not secrete enough thyroid-stimulating hormone (TSH), the thyroid gland is not triggered to release stored triiodothyronine (T3) and thyroxine (T4), ​resulting in low levels of T3 and T4.

Tertiary Hypothyroidism:

• The hypothalamus is not secreting enough thyrotropin-releasing hormone (TRH).

• Because the hypothalamus is not secreting enough thyrotropin-releasing hormone (TRH), the pituitary gland is not triggered to release thyroid-stimulating hormone (TSH). Therefore, the thyroid gland is not triggered to release stored triiodothyronine (T3) and thyroxine (T4), resulting in low levels of T3 and T4​.

Match each hormone to its characteristics.

Triiodothyronine (T3):

• Also called triiodothyronine

• Secondary thyroid hormone

• Secreted by the thyroid gland

Thyroxine (T4):

• Also called thyroxine

• Primary thyroid hormone

• Secreted by the thyroid gland

Calcitonin:

• Regulates calcium and phosphorus levels

• Secreted by the thyroid gland

Thyroid-stimulating hormone (TSH):

• Also called thyrotropin

• Causes the release of T3​ and T4​ into the circulation

• Released by the anterior pituitary gland

Thyrotropin-releasing hormone (TRH):

• Causes the release of TSH into the circulation

• Released by the hypothalamus

In the case of secondary hypothyroidism, the negative feedback loop begins with the __________ not secreting enough __________, which means the __________ will not be triggered to release __________.

Pituitary gland

Thyroid-stimulating hormone (TSH)

Thyroid gland

Triiodothyronine (T4) and thyroxine (T3)

Why is it important to monitor serum thyroid levels in a client receiving levothyroxine? Select all that apply.

To monitor the risk of toxicity.

To ensure the client is receiving the correct dose.

To measure serum thyroid levels.

Levothyroxine is indicated for achieving euthyroid status, diagnosis of __________, and treatment and prevention of __________.

Hypothyroidism

Goiters

A client is being discharged home after a thyroidectomy (surgical removal of the thyroid gland). While teaching the client about levothyroxine, the nurse should indicate which symptoms will occur if the prescribed dose of medication is too low? Select all that apply.​

Weight gain

Intolerance to cold

Dry hair

It is important to be aware of the dosage unit of medications to avoid giving the client too much or not enough medication, which can lead to serious adverse effects. Levothyroxine is dosed in __________, which are abbreviated as __________.

Micrograms

Mcg

Hyperthyroidism refers to an overactive thyroid function. What is the most common cause of hyperthyroidism?

Graves' disease

Which is not an indication for using the antithyroid medication thioamide antithyroid (propylthiouracil), also known as PTU?

To prevent and treat hypothyroidism.

Thioamide antithyroid (propylthiouracil) works by __________ thyroid hormone levels.

Decreasing

When the thyroid is not functioning normally, the consequences can be serious because the thyroid impacts so many bodily processes and systems. When the thyroid is over-secreting, this is called __________.

Hyperthyroidism

Hyperthyroidism refers to overactive thyroid function. This can be caused by various diseases or conditions, including a condition called thyroid storm. Which statements are true about thyroid storm? Select all that apply.

Thyroid storm is caused by high levels of thyroid hormone.

Thyroid storm is severe and can be life-threatening.

Thyroid storm is caused by stress.

Thyroid storm is caused by infection.

Which of these are symptoms of hyperthyroidism?

Symptom:

Diarrhea

Flushing

Irritability

Sleep disorders

Not a Symptom:

Myxedema in adults

Cold intolerance

Depending on the underlying cause of the __________, surgery may be the treatment of choice.

Following a thyroidectomy, in which __________ of the thyroid gland is surgically removed, thyroid hormone replacement therapy will be required __________. ​

The most common synthetic thyroid hormone replacement drug used is __________.

Hyperthyroidism

All or part; permanently

Levothyroxine

Which safety precautions should the nurse consider when administering propylthiouracil? Select all that apply.

Clients with diabetes may need an increased dose of propylthiouracil.

Avoid eating seafood, soy sauce, and iodized salt​.

It should be used with caution in clients with cardiac disease or hypertension​.

Thyroid hormones play a part in the function of which systems and processes? Select all that apply.

Neuromuscular

Endocrine

Cardiovascular

Normal growth and development

Thermoregulation

Complete each sentence to correctly identify the impact of hyperthyroidism on the body.

__________ can result from hyperthyroidism when basal metabolic rate regulation is affected by thyroid imbalance.​

__________ can result from hyperthyroidism when the neuromuscular system is affected by thyroid imbalance. ​

__________ can result from hyperthyroidism when the cardiovascular system is affected by thyroid imbalance. ​

Increased appetite

Anxiety

Heart palpitation

An antithyroid drug, such as propylthiouracil, will result in which possible adverse effects and safety considerations? Select all that apply.

Results in a decrease in thyroid hormone level.

Gastrointestinal (GI) upset

Use caution in clients with high blood pressure.

Which statements are true in regard to hyperthyroidism? Select all that apply.

Graves' disease is an autoimmune disease that results in hyperthyroidism.

Radioactive iodine and potassium iodide are antithyroid drugs used to destroy the thyroid gland​.

Hyperthyroid treatment focuses on the symptoms or primary cause of the disease that is causing the hyperthyroidism.

Total thyroidectomy requires lifelong thyroid hormone replacement therapy.

What are the indications for the use of propylthiouracil? Select all that apply.

Treat Graves' disease

Prevent surge in thyroid hormones, such as after thyroid surgery.

Treat thyroid storm

Treat hyperthyroidism

A thyroid storm can be caused by stress or infection. It is a serious situation because, during a thyroid storm when toxic levels are reached, the client may experience which changes?

A heart rate that is __________. ​

A blood pressure that is __________.​

A blood glucose level that is __________. ​

A body temperature that is __________.

Dangerously high

Dangerously high

Neither

Dangerously high

Individuals taking a thioamide antithyroid medication should be aware of which facts concerning their treatment?

Clients should __________ consumption of foods high in iodine, such as seafood, soy sauce, tofu, and iodized salt.​

Clients with __________ disease or conditions may experience interactions with this drug.​

Antithyroid drugs may __________ serum digoxin levels.

Avoid

Heart

Increase

When starting treatment with propylthiouracil, what important information should be shared with the individual?

Hyperthyroid symptoms should improve __________.​

Thyroid stimulating hormone (TSH) levels need to remain at the __________ end of the normal range. ​

It __________ stopped abruptly.

After 2 weeks of therapy

Lower

Should never be

The nurse should monitor for which side effects when administering thyroid replacement medications? Select all that apply.

Heat intolerance

Cardiac rhythm

Palpitations

While educating a client about a hormone replacement drug, the nurse includes which statements about the mechanism of action? Select all that apply.

Mimic the action and effects of the body's hormones.

Antagonize the action and effects of the body's hormones.

Diagnosis of hormonal dysfunction.

Replacement of deficient hormone levels.

Which assessment criteria are most important to monitor for the client taking a hormone regulation medication? Select all that apply.

Vital signs

Serum hormone levels

Complete medication history

Weight

The nurse caring for a client on propylthiouracil should take which actions when administering the drug? Select all that apply.

Monitor the client for signs of hypothyroidism.

Administer at the same time each day.

Check the client's food tray for iodized salt.

Provide a snack for the client to eat with the drug if that is how they take it at home.

The nurse caring for a client on vasopressin should be aware of which factors when administering the drug? Select all that apply.

Vasopressin concentrates urine and, therefore, treats polyuria.

The client's urine-specific gravity and osmolality should be evaluated frequently.

Vasopressin mimics antidiuretic hormone (ADH).

Side effects include increased blood pressure, nasal congestion, and sweating.

The nurse caring for a client on levothyroxine should consider which factors when administering the drug? Select all that apply.

Monitor for symptoms of toxicity, such as heart palpitations and excitability.

Assess the client's apical pulse prior to administration.

The medication should be given in the morning.

Which assessment parameters should the nurse monitor while a client with diabetes mellitus is receiving octreotide? Select all that apply.

Liver function tests

Serum glucose levels

Blood pressure

Consistency of stools

Which client is most likely to be prescribed cosyntropin?

A client who may have adrenocorticotropic insufficiency.

What is the most significant side effect of synthetic thyroid replacement medications?

Cardiac dysrhythmia

The nurse is caring for a client with primary hypothyroidism. Which symptoms are likely?

• __________ intolerance

• __________

• __________ thyroid hormone levels

• __________ metabolism

• Unintended weight __________

Cold

Depression

Low

Decreased

Gain

The nurse is caring for a client who has been diagnosed with Graves' disease and started on an antithyroid medication.

Which medication is most likely to be prescribed?

Propylthiouracil

The nurse is caring for a client who has been diagnosed with Graves' disease and started on an antithyroid medication.

The client may experience which side effects of this medication (propylthiouracil)?

Weight gain

The nurse is caring for a client who has been diagnosed with Graves' disease and started on an antithyroid medication.

For a client receiving an antithyroid medication, which thyroid hormone levels would be decreased? Select all that apply.

Triiodothyronine (T3)

Thyroxine (T4)

The nurse is caring for a client experiencing severe hyperthyroidism, thyroid storm. Thyroid storm is a severe condition characterized by dangerously high heart rate, blood pressure, and body temperature. Which treatment would be anticipated? Select all that apply.

Antithyroid medication such as propylthiouracil.

Beta blockers for symptom management.

Total thyroidectomy followed by permanent thyroid replacement medication such as levothyroxine.

Antithyroid medication such as radioactive iodine.

Select the correct subclass for each of the medications provided in the table.

Propylthiouracil - Antithyroid

Levothyroxine - Synthetic hormone replacement

Octreotide - Growth hormone antagonist

Cosyntropin - Adrenocorticotropic hormone-mimicking

Somatropin - Growth hormone-mimicking

Vasopressin - Antidiuretic hormone-mimicking

Desmopressin - Antidiuretic hormone-mimicking

The nurse is administering a beta-blocker to a client experiencing a thyroid storm. What is the nurse's best response when the client asks why the beta-blocker has been prescribed?

"It decreases the tremors and palpitations associated with a thyroid storm."