NURS 323 Midterm Exam Questions and Correct Answers
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Course
NUR 323
Institution
NUR 323
Warfarin -Levothyroxine accelerates the degradation of vitamin k dependent clotting factors *Vitamin K is needed to clot when you're on a blood thinner you don't have to worry about bleeding out because of the vitamin k
-increases effects of warfarin
Catecholamines -thyroid hormones increase the ...
NURS 323 Midterm Exam Questions and
Correct Answers
Warfarin ✅-Levothyroxine accelerates the degradation of vitamin k dependent clotting
factors
*Vitamin K is needed to clot when you're on a blood thinner you don't have to worry
about bleeding out because of the vitamin k
-increases effects of warfarin
Catecholamines ✅-thyroid hormones increase the responsiveness to
catecholamines... Use cautiously
-epinephrine, dopamine, dobutamine
Insuline and Digoxin ✅-levothyroxine can increase the requirements for both of these
drugs
Levothyroxine (Synthroid) Pregnancy A ✅-since Levothyroxine (Synthroid) are
hormones they occur naturally in the body, almost anyone can take this drug
-safe in pregnancy and the drug does pass in breast milk but is considered safe to use
-need to increase dose since first dose usually goes to fetus
Levothyroxine Nursing Implications ✅-monitor height and development
-teach to take on an empty stomach
-frequent follow up and lab monitoring
Treatment of Hyperthyroidism ✅aka Graves' disease
-excessive thyroid hormone secretion
-aimed at decreasing production of thyroid hormone
-intolerance to heat
-bulging eyes
**you can remove thyroid and be on life long Synthroid - pt will be Hypothyroid now
Methimazole (Tapazole) ✅-first line drug
-inhibits thyroid hormone synthesis (does not destroy existing stores of thyroid hormone
& can take 3-12 weeks to achieve a euthyroid state)
-safer than PTU (except 1st trimester)
-PO
In the first trimester is Methimazole (Tapazole) ok? ✅NO
,-Adjunct to radiation therapy
-Suppress thyroid in preparation for thyroidectomy
-May induce hypothyroidism - reduce dose
Methimazole Adverse Effect ✅Agranulocytosis
-most serious and dangerous toxicity (most serious adverse effect)
-dramatically reduces granulocytes (type of WBC) needed to fight infection
-report sore throat, fever immediately
Propylthiouracil (PTU) ✅MOA: Inhibits thyroid hormone synthesis AND prevents
conversion of T4 to T3 in the periphery
-second line drug generally NOT preferred over methimazole
-risk of liver injury (death and liver transplants have been reported)
-shorter half life requiring multiple doses/day
-can also cause agranulocytosis
*only time its not second line of treatment is for women who are pregnant in the first
trimester
PTU PT 2 ✅-preferred during thyroid storm/thyrotoxic crisis
-does not cross placenta as easily as Methmimazole
-preferred during 1st trimester pregnancy
Radioactive Iodine ✅-Thyroid loves Iodine! It's selective with iodine
-Attached to this iodine is a radioactive substance that kills cancer
Indications Radioactive Iodine ✅-Thyroid Cancer - high dose
-Hyperthyroidism - lower dose
-Diagnostic testing for hypothyroidism/hyperthyroidism
Nonradioactive Iodine Indications ✅-Hyperthyroidism (paradoxical inhibition of thyroid
hormone secretion, used short term, such as to thyroidectomy, thyrotoxic crisis)
-Nuclear Radiation Emergencies (protects thyroid from radioactive exposure)
-Antiseptic
Beta Blockers ✅-also have a role in treatment of hyperthyroidism
-suppress tachycardia and other symptoms of Graves' disease
-benefits derive from beta-adrenergic blockade, not from reducing levels of T3 or T4
-also may be used in thyrotoxic crisis (contraindicated in patients with asthma)
Basic Functions of Kidney ✅- Cleansing of extracellular fluid and maintenance of ECF
volume and composition (Where diuretics work)
- Maintenance of acid-base balance
- Excretion of metabolic wastes and foreign substances
Basic Renal Processes ✅filtration, reabsorption, active secretion
Filtration ✅-all small molecules in plasma are filtered
Most prevalent: sodium and chloride ions & bicarbonate and potassium ions
-large molecules (lipids and proteins stay in blood)
Reabsorption ✅99% of water, electrolytes, nutrients are reabsorbed (Sodium and
Chloride are predominant solutes)
-occurs through active transport
-water follows passively due to osmotic gradient
-amount of reabsorption varies along site on the nephron
-most diuretics act by interfering with reabsorption
Sodium leaves tubule and goes into the blood, what is going to follow? ✅Water
Sodium-Potassium Exchange ✅- Aldosterone stimulates reabsorption of sodium from
distal nephron and causes potassium to be excreted
- Aldosterone stimulates cells of the distal nephron to synthesize more of the pumps
responsible for sodium potassium exchange
*Adrenal cortex gland sits on top of kidneys, pump aldosterone in the kidneys and pull
sodium to blood stream
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