Chapter 43: Thyroid and Parathyroid Disorders

A patient is recovering from a thyroidectomy. Which observation needs to be reported immediately to the health-care provider? 1) Changes in voice tone 2) Hypoactive bowel sounds 3) Blood pressure 138/70 mm H 4) Complaints of postoperative pain

1 Assessing for damage to the laryngeal nerve is also a priority in the postoperative period following thyroidectomy. Changes in voice quality, particularly hoarseness or a husky tone, may be indicative of laryngeal nerve damage.

A patient spontaneously develops manifestations of hypoparathyroidism. What should be considered as the reason for this health problem? 1) Diabetes mellitus 2) Thyroid hypertrophy 3) Low intake of calcium-rich foods 4) Congenital absence of parathyroid glands

1 Autoimmune disease is suspected in patients with spontaneous presentation of hypoparathyroidism with no identifiable cause. In these cases, antiparathyroid antibodies have been detected in patients with other autoimmune disorders such as diabetes mellitus.

A patient with hypothyroidism is prescribed levothyroxine (Synthroid). At which time should the nurse schedule this medication to be administered? 1) 0800 hours 2) 1200 hours 3) 1700 hours 4) 2300 hours

1 Because thyroid hormone affects metabolism, the medication is to be taken in the morning.

A patient is being evaluated for hypoparathyroidism. Which laboratory value would help confirm this diagnosis? 1) Elevated serum phosphate 2) Elevated serum magnesium 3) Decreased serum potassium 4) Serum albumin within normal limits

1 Diagnostic results consistent with hypoparathyroidism include high serum phosphate levels.

A patient with hyperparathyroidism is experiencing flank pain. For which health problem should this patient be assessed? 1) Renal calculi 2) Muscle spasms 3) Adrenal gland dysfunction 4) Elevated phosphorous level

1 Elevated serum calcium levels caused by hyperparathyroidism can lead to renal calculi. Manifestations of renal calculi include flank pain.

The nurse is preparing discharge instructions for a patient being treated medically for hyperthyroidism. What should the nurse emphasize to protect the patient's eyes? 1) Use artificial tears 2) Wear sunglasses at all times 3) Wear eye shields at all times 4) Tape the eyes closed at bedtime

1 Eye lubricant decreases possible eye dryness and potential for corneal irritation secondary to incomplete eyelid closure.

A patient with hyperthyroidism is placed on seizure precautions as a result of which observation? 1) Hyponatremia 2) Exophthalmos 3) Rapid heart rate 4) Increased T3 and T4 levels

1 Increased risk for seizure activity related to hyponatremia.

A patient with hyperthyroidism is prescribed propylthiouracil (PTU). What should the nurse include in the teaching plan when explaining the mechanism of this medication? 1) Diverts iodine pathways 2) Causes formation of thyroid antibodies 3) Decreases the vascularity of the thyroid gland 4) Blocks iodine from binding with thyroglobulin

1 Propylthiouracil (PTU) inhibits the synthesis of thyroid hormone by diverting iodine pathways.

The nurse is preparing to assess a patient with exophthalmos. On which body system should the nurse focus during this assessment? 1) Sensory 2) Hematological 3) Gastrointestinal 4) Musculoskeletal

1 Protrusion of the eyeball, exophthalmos is characteristic of hyperthyroidism and results in visual changes. The patient's vision, which is a part of the sensory system, should be the focus of the assessment.

The nurse is explaining the mechanism of hypoparathyroidism. Which electrolyte should the nurse explain as being the most significant with regard to this disorder? 1) Sodium 2) Calcium 3) Potassium 4) Cholesterol

2 Hypocalcemia is the primary disorder associated with hypoparathyroidism.4

A patient recovering from surgery to treat thyroid cancer continues to lose weight. Which health-care professional should be consulted to help with this patient's problem? 1) Surgeon 2) Dietician 3) Pharmacist 4) Radiologist

2 The dietician should be consulted to help with the patient's eating plan to stop weight loss.

The nurse is evaluating teaching provided to a patient with hyperparathyroidism. Which statement indicates that teaching has been effective? 1) "I should expect to have a poor appetite." 2) "I should eat raw vegetables and fruits every day." 3) "I should expect to have muscle cramping and pain." 4) "I should consume diary products with breakfast and lunch."

2 The patient should be instructed to increase roughage to reduce constipation caused by an elevated calcium level.

The nurse notices that a patient with hypothyroidism has a husky voice. To what should the nurse attribute this finding? 1) Chronic fatigue 2) Enlarged thyroid gland 3) Edema of the tongue and larynx 4) Dry mucous membranes from dehydration

3 Edema of the tongue and around the larynx results in changes in speech resulting in a husky tone.

A patient is diagnosed with secondary hyperparathyroidism. Which additional health problem is this patient most likely being treated for? 1) Diabetes insipidus 2) Hyperaldosteronism 3) Chronic renal failure 4) Parathyroid adenoma

3 Secondary disorders are most often observed in patients with chronic renal failure.

The nurse is preparing medications for a patient with hypoparathyroidism. What should be administered with a calcium supplement? 1) Lithium 2) Synthroid 3) Vitamin D 4) Proplythiouracil (PTU)

3 Vitamin D is needed for calcium absorption from the bowel.

During an assessment the nurse suspects that a patient is experiencing hypoparathyroidism. What finding caused the nurse to make this clinical determination? 1) Low heart rate 2) Muscle weakness 3) Respiratory rate 20 and shallow 4) Hand spasm when measuring blood pressure

4 A hand spasm when measuring blood pressure indicates Trousseau's sign.

A patient is being evaluated for hyperthyroidism. What is the most common cause for this disorder? 1) Cancer 2) Toxic medications 3) Radiation exposure 4) Autoimmune disorder

4 Graves's disease is the most common cause of hyperthyroidism and is an autoimmune disorder involving antibodies (thyroid-stimulating immunoglobulins) that bind to the thyroid gland, resulting in the enlargement of the thyroid gland and subsequent hypersecretion of thyroid hormone.

The nurse notes that a patient is diagnosed with Hashimoto's thyroiditis. What is the most likely cause of this patient's health problem? 1) Congenital 2) Iodine deficiency 3) Tyrosine deficiency 4) Autoimmune response

4 Hashimoto's thyroiditis is the most common type of hypothyroidism and is caused by an autoimmune response that leads to destruction of the thyroid gland by immunological processes.

The nurse is assessing a patient with suspected hypoparathyroidism. Which finding should the nurse identify as needing further investigation? 1) Heart rate 88 bpm 2) Respiratory rate 16 3) Temperature 99.2°F 4) Blood pressure 88/50 mm Hg

4 Hypotension may occur secondary to decreased myocardial contractility and cardiac dysrhythmias.

A patient with hypothyroidism asks why the neck has become so large. What should the nurse respond to this patient? 1) "The growth is cancer." 2) "The sluggish thyroid caused fat to be deposited around the neck." 3) "The growth is the body's attempt to wall off the infection in your thyroid." 4) "The gland got larger because it was trying to make more thyroid hormone."

4 Hypothyroidism is a major cause of goiter and develops secondary to thyroid gland hypertrophy in an attempt to produce normal amounts of T3 and T4.

A patient with chronic renal failure is diagnosed with hyperparathyroidism. Which treatment approach should the nurse expect to be prescribed for this patient? 1) Increased oral fluid intake 2) Oral thiazide diuretics twice a day 3) High-volume normal saline infusions 4) Discontinue calcium and vitamin D supplements

4 Patients with hyperparathyroidism are also taught to decrease consumption of calcium-containing antacids and vitamin D. Calcium and vitamin D supplements will most likely be discontinued.

The nurse is evaluating care provided to a patient with hypothyroidism. Which finding indicates that additional care is needed? 1) Skin warm and supple 2) Heart rate 72 and regular 3) Blood pressure 118/68 mm Hg 4) Weight increase 2 kg over a month

4 Stable weight indicates thyroid health. A weight gain indicates a sluggish thyroid in this patient population.

The nurse is preparing to assess a patient with hypothyroidism. What findings should the nurse expect? Select all that apply. 1) Fatigue 2) Weight gain 3) Increased sleep 4) Decreased energy 5) Increased appetite

ANS: 1, 2, 3, 4 The hypometabolic state is characterized by decreased appetite.

A patient with hypothyroidism is recovering from orthopedic surgery. Which findings suggest that this patient is developing myxedema coma? Select all that apply. 1) Hypoxia 2) Slow heart rate 3) Low body temperature 4) Elevated blood pressure 5) Retaining carbon dioxide

ANS: 1, 2, 3, 5 Because of significant decreases in cardiac function, the patient is hypotensive.

A patient is diagnosed with hypothyroidism. What laboratory levels were used to make this diagnosis? Select all that apply. 1) T3 2) T4 3) GH 4) TSH 5) FSH

ANS: 1, 2, 4

The nurse suspects that a patient is experiencing thyroid storm. What actions should the nurse take to support this patient? Select all that apply. 1) Position on a cooling blanket 2) Monitor intravenous fluid infusion 3) Administer antiemetics as prescribed 4) Administer dexamethasone as prescribed 5) Administer beta-adrenergic blockers as prescribed

ANS: 1, 2, 4, 5 Antiemetics are not indicated in a thyroid storm.

The nurse suspects that patient with hypothyroidism is experiencing myxedema. What findings caused the nurse to come to this conclusion? Select all that apply. 1) Constipation 2) Thick, silky hair 3) Dry, coarse skin 4) Decreased heart rate 5) Generalized nonpitting edema

ANS: 1, 3, 4, 5 Hair becomes thin and fragile, and hair

After performing an assessment, the nurse suspects that a patient is experiencing hyperthyroidism. What findings caused the nurse to come to this conclusion? Select all that apply. 1) Anorexia 2) Heart rate 112 bpm 3) Hyperactive bowel sounds 4) Thinning hair noted on the head 5) Weight loss 10 lbs. over the last month

ANS: 2, 3, 4, 5 Increased appetite and not anorexia is associated with hyperthyroidism.

The nurse monitors for which complication in the patient with hyperparathyroidism? A. Renal stones B. Seizures C. Laryngospasm D. Hypertension

Answer: A Rationale: Hyperparathyroidism leads to hypercalcemia and hypercalciuria, which increase the incidence of development of renal stones (colic). Seizures and laryngospasm are associated with hypocalcemia.

A patient with thyroid cancer is receiving high-dose radiation to the thyroid gland. During assessment of the patient, which clinical manifestation is consistent with hypocalcemia? A. Positive Chvostek's sign B. Negative Trousseau's sign C. Absent deep tendon reflexes D. Periorbital edema

Answer: A Rationale: Hypocalcemia is associated with positive Chvostek's and positive Trousseau's signs. The deep tendon reflexes are typically hyperactive with hypocalcemia.

The nurse correlates which clinical manifestation to the pathophysiology of hypothyroidism? A. Cold intolerance B. Weight loss C. Insomnia D. Diarrhea

Answer: A Rationale: Hypothyroidism leads to a decrease in metabolic activity leading to fatigue, weight gain with decreased intake, generalized weakness, cold intolerance, and hypersensitivity to narcotics, hypnotics, and sedatives. Weight loss, insomnia, and diarrhea are associated with hyperthyroidism.

The nurse prioritizes which nursing diagnosis in the patient after partial parathyroidectomy? A. High risk for ineffective airway clearance related to hypocalcemia B. High risk for ineffective breathing pattern related to hypercalcemia C. High risk for hyperventilation related to hypersecretion of triiodothyronine D. High risk for airway compromise related to insufficient iodine stores

Answer: A Rationale: Laryngospasm may develop secondary to hypocalcemia when the parathyroid glands are resected. With this laryngeal spasm, intubation is extremely difficult and the patient may require an emergency tracheotomy. The other potential respiratory complications are secondary to the potential for impaired airway.

The nurse correlates an increase in which laboratory value to the diagnosis of primary hyperthyroidism? A. Thyroxine (T4) B. Thyroid Stimulating Hormone (TSH) C. Serum calcium D. Serum iodine

Answer: A Rationale: Primary endocrine disorders are related to dysfunction of the gland and decreased hormonal release. Thyroxine (T4) and Triiodothyronine (T3)are thyroid hormones secreted from the thyroid gland. Thyroid stimulating hormone is secreted from the anterior pituitary gland, and alterations in this hormone are associated with secondary endocrine disorders. Serum calcium is primarily regulated by the parathyroid gland, and serum iodine is needed for synthesis of thyroid hormone.

The nurse monitors for which findings in the patient with hyperthyroidism? (Select all that apply.) A. Weight loss B. Cold intolerance C. Constipation D. Tachycardia E. Exophthalmos

Answer: A, D, and E Rationale: Hyperthyroidism is associated with an accelerated metabolic rate that leads to tachycardia, and weight loss (even with increased caloric intake), as well as expothalamos. Sensitivity to cold and constipation are more associated with hypothyroidism.

The nurse monitors the calcium levels closely in the patient taking digoxin (Lanoxin) because hypocalcemia may lead to which complication? A. Elevated heart rate B. Dysrhythmias C. Increased cardiac contractility D. Hypertension

Answer: B Rationale: Decreased calcium levels are associated with QT interval prolongation, resistance to digitalis related to loss of inotropic effect, hypotension, and cardiac dysrhythmias. Calcium is required for contractility (inotropic effect), so contractility decreases with hypocalcemia.

The nurse recognizes that which patient is at greatest risk for hypothyroidism? A. A 19-year-old male B. A 35-year-old female C. A 45-year-old male D. An 80-year-old female

Answer: B Rationale: Women are affected 7 to 10 times more often than men. Hypothyroidism occurs most often in women between the ages of 30 and 60, and the incidence increases with age.

Following thyroid surgery, the nurse frequently assesses the patient's ability to speak in order to monitor for which complication? A. Parathyroid injury B. Hypocalcemia C. Laryngeal nerve injury D. Hypercalcemia

Answer: C Rationale: Assessing for damage to the laryngeal nerve is also a priority in the postoperative period following thyroidectomy. Changes in voice quality, particularly hoarseness or a husky tone may be indicative of laryngeal nerve damage.

The patient experiencing thyroid storm is ordered to receive beta-adrenergic agents. The nurse monitors for which therapeutic effect of these medications? A. Increased respiratory rate B. Increased appetite C. Decreased heart rate D. Decreased bowel sounds

Answer: C Rationale: Beta-adrenergic receptors stimulate increases in heart rate, cardiac muscle contraction, and blood pressure, while also causing smooth muscle relaxationin the bronchial tree. β-Adrenergic blockers decrease heart rate and blood pressure by blocking catecholamine access to receptor sites.

A patient undergoes surgical resection of a thyroid tumor. Immediately following surgery, which intervention has the highest priority? A. Assessing the surgical site for hemorrhage B. Supporting the head to prevent stress on the suture line C. Monitoring respiratory status for sign of obstruction D. Asking the patient to speak to assess for hoarseness

Answer: C Rationale: In the post-operative period after thyroidectomy, the patient is at risk for respiratory compromise secondary to the location of the incision (neck), potential for postoperative edema potentially compressing the trachea, and inability to maintain airway.

The nurse correlates a positive Chvostek's sign to hyposecretion of which hormone? A. Thyroxin (T4) B. Thyrocalcitonin C. Parathyroid hormone (PTH) D. Triiodothyronine (T3)

Answer: C Rationale: Low serum calcium is associated with positive Chvostek's and positive Trousseau's signs and result secondary to decreased calcium at the neuromuscular junction allowing enhanced nerve transmission.

The nursing diagnosis "acute pain related to ureteral pressure and obstruction secondary to calcium- containing renal stones" is most appropriate for the patient with which endocrine disorder? A. Hypothyroidism B. Hypoparathyroidism C. Hyperthyroidism D. Hyperparathyroidism

Answer: D Rationale: Hyperparathyroidism is associated with hypercalcemia and hypercalcuria leading to development of renal stones. In addition to severe pain, these renal stones can also lead to obstruction and kidney damage.

Synthesis of thyroid hormone is dependent upon adequate dietary intake of which of the following? A. Calcium B. Iodine C. Potassium D. Sodium

B

The functions of the thyroid glands are under the direct control of which structure? A. Hypothalamus B. Anterior pituitary gland C. Posterior pituitary gland D. Hippocampus

B

Parathyroid glands control serum levels of which electrolyte? A. Magnesium B. Sodium C. Chloride D. Calcium

D