A client with hypothyroidism was prescribed levothyroxine (Synthroid), a T4 replacement. The client was reading about hypothyroidism and asked the nurse why they are receiving only T4 replacement when hypothyroidism causes low T3 and T4 levels. What is the best response by the nurse?
T4 replacement does not require any TSH monitoring as is required with T3
Your body effectively converts T4 into T3 so replacing T3 is unnecessary
T3 and T4 cannot be administered together because they will become inactive
Drug therapy does not replace T3 because it is the inactive precursor to T4
The Correct Answer is B
Reasoning:
Choice A reason: Levothyroxine (T4) replacement requires TSH monitoring to ensure adequate dosing, as TSH reflects thyroid function. T3 replacement also requires monitoring, but T3 is less commonly used due to its short half-life. This statement is inaccurate, as TSH monitoring is essential for T4 therapy.
Choice B reason: The body converts levothyroxine (T4) to triiodothyronine (T3) via deiodinase enzymes in peripheral tissues, restoring both hormone levels. T3 replacement is unnecessary, as T4 provides a stable precursor for T3 production, making this statement accurate for explaining hypothyroidism treatment rationale.
Choice C reason: T3 and T4 can be administered together in specific cases (e.g., combination therapy) without becoming inactive. However, T4 alone is standard due to its longer half-life and conversion to T3. This statement is inaccurate, as it falsely claims biochemical incompatibility between the hormones.
Choice D reason: T3 is the active thyroid hormone, not an inactive precursor to T4. T4 is converted to T3, which binds receptors to regulate metabolism. This statement is inaccurate, as it reverses the roles of T3 and T4 in thyroid hormone physiology and therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Ascites results from increased permeability of peritoneal capillaries, often due to inflammatory molecules like cytokines in conditions such as liver cirrhosis or portal hypertension. This allows plasma proteins and fluid to leak into the peritoneal cavity, causing fluid accumulation. This statement accurately describes the pathophysiology of ascites in liver-related disorders.
Choice B reason: Low aldosterone levels do not cause ascites; instead, high aldosterone in liver disease (e.g., cirrhosis) promotes sodium and water retention, exacerbating fluid accumulation. This statement is inaccurate, as secondary hyperaldosteronism due to reduced liver metabolism of aldosterone is a key factor in ascites development.
Choice C reason: The liver’s failure to produce clotting factors can lead to bleeding tendencies, like variceal hemorrhage, but this does not directly cause ascites. Ascites is driven by fluid leakage from capillaries, not bleeding. This statement is inaccurate, as clotting factor deficiency is unrelated to peritoneal fluid accumulation.
Choice D reason: While fluid imbalance contributes to ascites, the primary mechanism involves portal hypertension and capillary permeability, not just osmotic pressure changes. This statement is overly vague and less accurate than the specific role of inflammatory molecules increasing capillary leakage in the peritoneal cavity.
Correct Answer is B
Explanation
Choice A reason: Achieving euthyroid state before hyperthyroidism procedures, like thyroidectomy, aims to normalize thyroid hormone levels, not prevent hypothyroidism. Post-procedure hypothyroidism is a separate concern managed with hormone replacement. This statement is inaccurate, as the primary goal is to stabilize metabolism, not prevent low thyroid function.
Choice B reason: Medications like methimazole or propylthiouracil are used pre-procedure to achieve euthyroid state, reducing thyroid hormone levels to prevent thyroid storm—a life-threatening hypermetabolic crisis triggered by surgery or stress. This statement is accurate, as stabilizing thyroid function minimizes perioperative complications like tachycardia or hyperthermia.
Choice C reason: Euthyroid state does not directly enhance the efficacy of anti-thyroid medications but rather prepares the patient for surgery by reducing hyperthyroid symptoms. Medications are effective independently, and this statement is inaccurate, as the rationale focuses on patient safety, not drug potentiation.
Choice D reason: While euthyroid state reduces metabolic stress, it does not primarily minimize bleeding risk. Bleeding is managed through surgical techniques and coagulation status, not thyroid hormone levels. This statement is inaccurate, as bleeding risk is not the primary concern addressed by achieving euthyroid state pre-procedure.
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