A patient has been prescribed levothyroxine (Synthroid) for hypothyroidism. The patient inquires if the medication should be taken with food.
What would be the most appropriate response from the nurse?
Always consume this medication with food.
This medication should be taken with a glass of milk.
Consume this medication with juice and crackers.
This medication should be taken on an empty stomach.
The Correct Answer is D
Rationale for Choice A:
It is not recommended to always consume levothyroxine with food. In fact, food can interfere with the absorption of levothyroxine, leading to decreased efficacy of the medication.
Consuming levothyroxine with food can decrease its absorption by up to 30%, which can significantly impact its ability to manage hypothyroidism symptoms.
Certain foods, such as those high in fiber, calcium, or iron, can be particularly problematic, as they can bind to levothyroxine in the gut and further reduce its absorption.
While taking levothyroxine with a small amount of food may be necessary for some individuals who experience gastrointestinal side effects, it's generally recommended to take it on an empty stomach for optimal absorption.
Rationale for Choice B:
Milk is not an ideal beverage to take with levothyroxine, as it can also interfere with absorption. Milk contains calcium, which can bind to levothyroxine and reduce its absorption.
It's best to avoid consuming milk or other calcium-rich beverages within a few hours of taking levothyroxine.
Rationale for Choice C:
Similar to milk, juice and crackers are not ideal choices to take with levothyroxine.
Juice, especially those high in acidity, can affect the absorption of levothyroxine in the gut.
Crackers, often made with refined grains, can be high in fiber, which can also interfere with absorption.
Rationale for Choice D:
Taking levothyroxine on an empty stomach, typically 30-60 minutes before breakfast, is generally recommended to ensure optimal absorption.
This allows the medication to be absorbed more efficiently in the small intestine without being affected by the presence of food.
By taking levothyroxine on an empty stomach, patients can maximize its effectiveness in treating hypothyroidism.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Amiodarone is an antiarrhythmic medication that is often used to treat ventricular tachycardia and ventricular fibrillation. However, it is not the first-line drug for Torsades de Pointes. In fact, amiodarone can actually worsen QT prolongation and increase the risk of Torsades de Pointes.
It's important to note that amiodarone has a long half-life and can accumulate in the body over time, further increasing the risk of QT prolongation.
Additionally, amiodarone can have several serious side effects, including pulmonary toxicity, thyroid dysfunction, and liver damage.
Choice B rationale:
Lidocaine is another antiarrhythmic medication that is sometimes used to treat ventricular arrhythmias. However, it is also not the first-line drug for Torsades de Pointes.
Lidocaine is less likely to worsen QT prolongation than amiodarone, but it can still have this effect in some patients.
Additionally, lidocaine has a short half-life and must be given as a continuous infusion, which can be challenging in a critical care setting.
Choice C rationale:
Atropine is a medication that is used to increase heart rate. It is not effective in treating Torsades de Pointes and is not indicated in this situation.
Atropine works by blocking the vagus nerve, which slows heart rate. In Torsades de Pointes, the heart rate is already very fast, so atropine would not be helpful.
Additionally, atropine can have several side effects, including dry mouth, blurred vision, and urinary retention.
Choice D rationale:
Magnesium sulfate is the first-line drug for treating Torsades de Pointes. It works by stabilizing the electrical activity of the heart and preventing further episodes of arrhythmia.
Magnesium sulfate is a relatively safe medication with few side effects. It can be given as an intravenous infusion or as an intramuscular injection.
Studies have shown that magnesium sulfate is effective in terminating Torsades de Pointes and preventing recurrences.
Correct Answer is A
Explanation
Choice A rationale:
Calcium gluconate is the antidote for magnesium sulfate toxicity. It directly counteracts the effects of magnesium on the neuromuscular system, cardiovascular system, and central nervous system. It is essential to have calcium gluconate readily available at the bedside of any client receiving magnesium sulfate, as toxicity can occur quickly and without warning.
Mechanism of action:
Calcium gluconate competes with magnesium for binding sites on cell membranes and proteins. It displaces magnesium from these sites, thereby restoring normal cellular function.
Calcium gluconate also enhances calcium influx into cells, which further counteracts the effects of magnesium. Indications for use in magnesium sulfate toxicity:
Respiratory depression (respiratory rate <12 breaths per minute) Loss of deep tendon reflexes
Seizures
Cardiac arrhythmias (including heart block and cardiac arrest) Hypotension (systolic blood pressure <90 mmHg)
Dosage and administration:
The typical dose of calcium gluconate for magnesium sulfate toxicity is 1 gram (10 mL of a 10% solution) given IV push over 3- 5 minutes.
This dose may be repeated as needed, depending on the severity of the toxicity and the client's response to treatment. Nursing considerations:
Monitor the client's vital signs, respiratory status, and deep tendon reflexes closely during magnesium sulfate infusion and after administration of calcium gluconate.
Have a crash cart and code equipment readily available in case of cardiac arrest. Document the administration of calcium gluconate and the client's response to treatment.
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