NCLEX Question on Treatment for Hypothyroidism (Nursing)

00:01 Let's take an NCLEX practice question together.

00:04 First, let's look at the stem of the question.

00:07 A 42 year old client with primary hypothyroidism has been taking levothyroxine for 100 micrograms daily for two years now.

00:16 During a routine visit, the client reports taking the medication consistently every morning with breakfast and a calcium supplement.

00:23 Recent labs show a TSH of 8.5, the normal levels being 0.27 to 4.2, You which nursing conclusion is most accurate regarding this situation? All right, you know the drill.

00:37 We read through the question once just to kind of get a feel.

00:40 Now we go back through and we just rip it apart.

00:44 So we have an age in the question.

00:45 So always keep that in mind.

00:47 It's there for a reason.

00:48 So I have a 42 year old client.

00:51 Okay. So we're thinking about average adult age.

00:54 They have primary hypothyroidism.

00:57 Remember those descriptor words matter primary hypothyroidism.

01:02 Now they've been taking levothyroxine And during a routine visit the client reports okay so what does the client tell us.

01:11 That's always important.

01:13 They've been taking the medication consistently every morning with breakfast and a calcium supplement. And now we have their recent labs that show a TSH that's too high. So which nursing conclusion is most accurate regarding the situation.

01:28 So pause for just a minute.

01:30 Make sure you have all the particulars down for this client.

01:34 Make sure you look at any numbers.

01:35 Force yourself to say, is that high, low, or normal and then put the question into your own words.

01:48 Now let's look at the answer choices.

01:50 You have the four options there on your screen.

01:54 I'm going to let you read through those.

01:56 Eliminate your answers.

01:58 And while you're doing that, just push pause on the video, find your answer and then restart the video and we'll walk through the answer choices again. Welcome back. I hope you established your answer.

02:17 Now let's walk through this together.

02:19 Now there's things that we need to look at here.

02:21 See what you picked up as you broke apart that stem and looked at the particulars.

02:26 I know they're like middle aged adult.

02:29 Their diagnosis is primary hypothyroidism.

02:32 So I know that primary hypothyroidism means that thyroid gland can't respond to TSH. Now they've been taking replacement, right? A synthetic hormone levothyroxine, for two years.

02:44 We know this medication sometimes takes a while to kick in, but we're really good after two years.

02:50 Now they're on a routine visit because we know these clients need monitoring.

02:53 And the client tells us they're taking medication consistently.

02:56 That's good. They take it every morning, okay.

02:59 But they take it. Oh, with breakfast and a calcium supplement.

03:04 Is there any problem with levothyroxine in food or a mineral supplement? Something about that sounds familiar, doesn't it? Now, recent labs say TSH of 8.5.

03:16 That means that the TSH is too high.

03:19 Well, do we see that in primary hypothyroidism? We do. But this patient is receiving treatment, so we shouldn't see an elevated TSH that tells us something is wrong with this. All right.

03:32 Let's look at the answer choices and we will eliminate them.

03:35 So as I put this question into my own words.

03:38 What do I do with an adult client who's been diagnosed with primary hypothyroidism? They've been on medication for two years, and they've been taking their medication consistently with their breakfast and a calcium supplement, and now has a high TSH.

03:54 So hopefully you spent some time thinking about why would that TSH be high? Let's look at our answer choices now.

04:01 Just for fun, I'm going to start with the last one.

04:04 The client is experiencing symptoms of thyroid medication toxicity.

04:09 Now is there anything in that stem that indicates thyroid medication toxicity.

04:14 Well the TSH is off, but that doesn't mean thyroid medication toxicity. That would indicate the patient might have a rapid heart rate or not being able to heat those types of things. And there's no indication of that in the question. So number four, that last one is the first one I'm going to get rid of. Now let's just go up to the next one.

04:34 The client's thyroid is producing excess TH to compensate for the medication. Okay, first of all, the thyroid doesn't produce TSH. So right there that should tell you we're going to get rid of that one. Thyroid stimulating hormone is produced by the anterior pituitary.

04:52 And it tells the thyroid to produce the thyroid hormone.

04:56 So number three you're out.

04:58 Now I'm left with number one and number two.

05:02 So number one the client's medication dose needs to be increased due to disease progression. Oh it's so hard to remember dosages.

05:10 Right. So that one makes me a little nervous.

05:13 But let's look at number two.

05:14 The client is experiencing medication absorption issues due to the timing of administration.

05:21 Okay. Now between those two, which one seems like that would be a better answer to which nursing conclusion is most accurate regarding this situation? Well, they are taking it with breakfast and minerals.

05:35 Is that a problem? Yeah, I remember something about that.

05:38 And with the TSH being high, that would mean that levothyroxine. You're not getting enough of it.

05:45 Now, I don't think adjusting the dosage up is the answer or the thing that we need to do, right. What we need to watch is that we need to look at why are they taking this with food at breakfast and a mineral.

05:58 So in picking between 1 and 2, I would say I'm going to get rid of number one because we shouldn't start first with increasing the dosage because of disease progression. It's number two, the client is experiencing medication absorption issues.

06:14 They are because they're taking it with breakfast and with calcium.

06:19 And remember they need a four hour window where those are not taken together.

06:23 So there you have it. The answer is two.

06:26 The client is experiencing medication absorption issues due to the timing of administration. So how'd you do? Did you get it right? Did you get it wrong? Just spend some time reflecting on that.

06:38 If you got it right, celebrate, and then go back and look through those rationales. Is there anything you need to note in your notes so you can study this as you're preparing for exams? Good luck and hope to see you in our other question walkthroughs.