3. A 24-year-old client, who is gravida 3, para 2 at 28 weeks' gestation with hypothyroidism, asks a nurse if she will still need to take thyroid medication during the pregnancy. The nurse' best response should be based on the knowledge that:
3. A 24-year-old client, who is gravida 3, para 2 at 28 weeks' gestation with hypothyroidism, asks a nurse if she will still need to take thyroid medication during the pregnancy. The nurse' best response should be based on the knowledge that:
. During pregnancy, a woman's metabolism slows down, and it is more difficult to maintain thyroid regulation.
. The thyroid medication will be stopped during pregnancy because the fetus' thyroid produces a thyroid-stimulating hormone.
. The dosage may have to be increased as much as 50% during pregnancy.
. Fetal brain development will be affected if thyroid medication is continued during pregnancy.
Test-Taking Tip
When the answers have multiple parts, all the parts must be true for the answer to be true. Be careful when reading these types of questions; read all the way through the option.
Content Area: Maternity, Intrapartum; Integrated Process: Nursing Process, Analysis; Cognitive Level: Application; Client Need/Subneed: Health Promotion and Maintenance/Ante/Intra/Postpartum and Newborn Care
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Answer 1 is incorrect because a woman's metabolism speeds up, not slows down during pregnancy. Answer 2 is incorrect because a fetus is entirely dependent on the mother for thyroid hormone until the fetus' own thyroid gland can start to function. This usually does not occur until about 12 weeks. The client still needs to take thyroid medication during the remainder of the pregnancy, even though the fetus is producing some thyroid hormone on its own. The fetus needs the thyroid hormone, and fetal production of thyroid hormone is not a reason to stop the client from taking her replacement. Answer 3 is correct because women who are on thyroid hormone replacement before pregnancy should also be tested to make certain that their levels are appropriate. During pregnancy, the medication dose required may increase by up to 50%. Increases may be required as early as in the first trimester. Answer 4 is incorrect because fetal brain development will be affected if thyroid medication is not continued during pregnancy. The babies of mothers who were hypothyroid in the first part of pregnancy, but adequately treated, exhibited slower motor development than the babies of mothers who had normal thyroid function. However, during the later part of pregnancy, hypothyroidism in the mother can lead to intellectual impairment in the baby.