ENDOCRINE

BEFORE UNDERGOING A SUBTOTAL THYROIDECTOMY, A CLIENT RECEIVES POTASSIUM IODIDE(LUGOL'S SOLUTION) & PROPYLTHIOURACIL(PTU). THE NURSE WOULD EXPECT THE CLIENT'S SYMPTOMS TO SUBSIDE WHEN?

1-2 WEEKS (REACHES MAX EFFECT)

The nurse is admitting a client with a diagnosis of myxedema to the hospital. The nurse performs which of the following that will provide data related to this diagnosis? a) inspects facial features b) auscultates lung sounds c) percusses the thyroid gland d) palpates the adrenal glands

A - Inspection of facial features will reveal the characteristic coarse features, presence of edema around the eyes and face, and the blank expression that are characteristic of myxedema. The assessment techniques in options B, C, and D will not reveal information related to the diagnosis of myxedema.

A client with Grave's disease has exopthalmos and is experiencing photophobia. Which of the following nursing interventions would best assist the client with this problem? a) obtain dark glasses for the client b) lubricate the eyes with tap water every 2 to 4 hours c) administer methimazole (Tapazole) every 8 hours around the clock d) instruct the client to avoid straining or heavy lifting because this can increase eye pressure

A - Medical therapy for Graves' disease does not help alleviate the clinical manifestation of exophthalmos. Because photophobia (light intolerance) accompanies this disorder, dark glasses are helpful in alleviating the problem. Tap water, which is hypotonic, could actually cause more swelling around the eye because it could pull fluid into the interstitial space. In addition, the client is at risk for developing an eye infection because the solution is not sterile. Methimazole inhibits the synthesis of thyroid hormone and is used to treat hyperthyroidism but will not alleviate exophthalmos or photophobia. There is no need to avoid straining with exophthalmos.

Which of the following disorders is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? Choose one of the following A Cushing's syndrome B Addison's disease C Graves' disease D Hashimoto's disease

A Cushing's syndrome

A client with Addison disease is hospitalized for an acute crisis. During the crisis, which of the following nursing diagnoses is a priority? A Deficit fluid volume. B Activity intolerance. C Anxiety. D Risk for injury.

A Deficit fluid volume.

Which statement by the patient demonstrates an understanding of discharge instructions on the use of levothyroxine (Synthroid)? A."I will take this medication in the morning so as not to interfere with sleep." B."I will double my dose if I gain more than 1 pound per day." C."I will stop the medication immediately if I lose more than 2 pounds in a week." D."I can expect to see relief of my symptoms within 1 week."

A."I will take this medication in the morning so as not to interfere with sleep."

When assessing for potential toxicity to PTU, the nurse will monitor the patient for changes in which laboratory test? A.CBC B.BNP C.Serum electrolytes D.Renal function tests

A.CBC

The nurse is reviewing adverse effects of antithyroid medications with a patient who has been taking PTU. What adverse effects does the nurse include in the teaching? (Select all that apply.) A.Liver toxicity B.Polyuria C.Kidney damage D.Bone marrow toxicity E.Joint pain

A.Liver toxicity D.Bone marrow toxicity E.Joint pain

INTERVENTIONS FOR HYPERTHYROIDISM?

ADEQUATE REST SEDATIVES AS PRESCRIBED COOL QUIET ENVIORNMENT DAILY WEIGHTS HIGH CALORIE DIET AVOID STIMULANTS ANTITHYROID MEDS(PROPYLTHIOURACIL, PTU) IODINE PREPARATIONS RADIOACTIVE IODINE THERAPY PREP CLIENT FOR THYROIDECTOMY

BEFORE DISCHARGE WHAT SHOULD A CLIENT WITH ADDISION'S DISEASE BE INSTRUCTED TO DO WHEN EXPOSED TO PERIODS OF STRESS?

ADMIN. HYDROCORTISONE I.M.

A CLIENT IS TAKING PTU AND REPORTS A FEVER AND A SORE THROAT DEVELOPING WHAT SHOULD THE NURSE SUSPECT WILL BE FOUND IN THE LAB RESULTS AND WHAT SHOULD SHE ADVISE THE CLIENT?

AGRANULOCYTOSIS NOTIFY MD

The nurse is preparing to care for a client returning from the operating room following a subtotal thyroidectomy. The nurse anticipates the need for which of the following items to be placed at the bedside? a) hypothermia blanket b) emergency tracheostomy kit c) magnesium sulfate in a ready-to-inject vial d) ampule of saturated solution of potassium iodide (SSKI)

B - Respiratory distress can occur following thyroidectomy as a result of swelling in the tracheal area. The nurse would ensure that an emergency tracheostomy kit is available. Surgery on the thyroid does not alter the heat control mechanism of the body. Magnesium sulfate would not be indicated because the incidence of hypomagnesemia is not a common problem post-thyroidectomy. SSKI is typically administered preoperatively to block thyroid hormone synthesis and release, as well as to place the client in a euthyroid state.

A client with a diagnosis of Cushing's syndrome is undergoing a dexamethasone suppression test. The nurse plans to implement which steps during this test? a ) collect a 24-hour urine specimen to measure serum cortisol levels b) administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning c) draw blood samples before and after exercise to evaluate the effect of exercise on serum cortisol levels d) administer an injection of adrenocorticotropic hormone (ACTH) 30 minutes before drawing blood to measure serum cortisol levels

B - The dexamethasone suppression test is performed to evaluate the function of the adrenal cortex. The procedure for this test is to administer 1 mg of dexamethasone at 11:00 PM to suppress ACTH formation and then to obtain 8:00 AM serum cortisol levels on the following day.

A hypophysectomy is the treatment of choice for which endocrine disorder? Choose one of the following A Acromegaly B Cushing's syndrome C Hyperthyroidism D Pheochromocytoma

B Cushing's syndrome

Antithyroid medications are not generally recommended for elderly patients because of which of the following? Choose one of the following A Mental confusion B Granulocytopenia C Weight loss D Fatigue

B Granulocytopenia

Which of the following is a complication of hyperthyroidism? Choose one of the following A Myxedema coma B Hypothyroidism C Addisonian crisis D Acromegaly

B Hypothyroidism

A client with Cushing disease had a bilateral adrenalectomy 24 hr ago. The nurse should monitor the client closely for which of the following? Choose one of the following A Neurogenic shock. B Hypovolemic shock. C Cardiogenic shock. D Anaphylactic shock

B Hypovolemic shock

A client with Addison disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which of the following side effects of corticosteroids? Select all that apply: A Hyperkalemia. B Skeletal muscle weakness. C Mood changes. D Hypocalcemia. E Increased susceptibility to infection. F Hypotension.

B Skeletal muscle weakness. C Mood changes. D Hypocalcemia. E Increased susceptibility to infection.

When teaching a patient diagnosed with hypothyroidism regarding medical intervention, which of the following is important to communicate? Choose one of the following A TH may decrease blood glucose levels. B TH may increase the effect of digitalis preparation. C The normal dosages of sedative agents are prescribed. D Increased resorption occurs with TH

B TH may increase the effect of digitalis preparation

WHAT WOULD YOU GIVE TO A CLIENT TO PREVENT THYROID STORM PRIOR TO THYROID SURGERY?

B BLOCKERS GLUCOCORTICOIDS IODIDES

A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help relieve his symptoms. What is the nurse's best response? A."Propylthiouracil inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism." B."Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." C."Propylthiouracil helps your thyroid gland use iodine and synthesize hormones better." D."Propylthiouracil stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH), which inhibits the production of hormones by the thyroid gland."

B."Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal."

Which patient statement demonstrates understanding of radioactive iodine (I-131) therapy? A."I will have to isolate myself from my family for 1 week so as not to expose them to radiation." B."This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism." C."This drug will help decrease my cold intolerance and weight gain." D."I will need to take this drug on a daily basis for at least 1 year."

B."This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism."

Patients taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently would be monitored for which adverse effect? A.Cardiac arrhythmias B.Increased risk of bleeding C.Excessive weight loss D.Increased risk of deep vein thrombosis

B.Increased risk of bleeding

A nurse is preparing postoperative discharge instructions for a client who had one adrenal gland removed. The nurse includes which of the following in the instructions? a) the reason for maintaining a diabetic diet b) teaching proper application of an ostomy pouch c) instructions about early signs of a wound infection d) the need for lifelong replacement of all adrenal hormones

C - A client who had a unilateral adrenalectomy will be placed on corticosteroids temporarily to avoid a cortisol deficiency. These medications will be gradually weaned in the postoperative period until they are discontinued. Also, because of the anti-inflammatory properties of corticosteroids produced by the adrenals, clients who undergo an adrenalectomy are at increased risk of developing wound infections. Because of this increased risk of infection, it is important for the client to know measures to prevent infection, early signs of infection, and what to do if an infection seems to be present. The client does not need to maintain a diabetic diet, and the client will not have an ostomy following this surgery.

The nurse is preparing a client with Graves' disease to receive radioactive iodine therapy. The nurse tells the client which of the following about the therapy? a) following the initial dose, subsequent treatments must continue lifelong b) the radioactive iodine is designed to destroy the entire thyroid gland with just one dose c) it takes 6 to 8 weeks after treatment to experience relief from the symptoms of the disease d) the high levels of radioactivity prohibit contact with family for 4 weeks after initial treatment

C - Following treatment with radioactive iodine therapy, a decrease in thyroid hormone level should be noted, which would help alleviate symptoms. Relief of symptoms does not occur until 6 to 8 weeks after initial treatment. This form of therapy is not designed to destroy the entire gland; rather, some of the cells that synthesize thyroid hormone will be destroyed by the local radiation. The nurse needs to reassure the client and family that unless the dosage is extremely high, clients are not required to observe radiation precautions. The rationale for this is that the radioactivity quickly dissipates. Occasionally, a client may require a second or third dose, but treatments are not lifelong.

Which of the following symptoms of thyroid disease is seen in older adults? Choose one of the following A Restlessness B Hyperactivity C Atrial fibrillation D Weight gain

C Atrial fibrillation

A client with hyperthyroidism is hospitalized to have a thyroidectomy. The physician has prescribed propranolol (Inderal). In reviewing the client's history, the nurse notes that the client has asthma. The nurse should next:

C Contact the physician; question the order for propranolol (Inderal) with the client's asthma history.

A client who takes levothyroxine (Synthroid) had a cholecystectomy yesterday. Laboratory results indicate a normal T4 level and a decreased thyroid-stimulating hormone (TSH) level. The nurse should: A Hold the medication and notify the physician of the lab results. B Explain to the client that the medication is not needed after surgery. C Schedule the medication for early each morning to mimic normal thyroid release. D Teach the client about the manifestations of hyperparathyroidism following surgery.

C Schedule the medication for early each morning to mimic normal thyroid release.

The nurse is teaching the patient taking an antithyroid medication to avoid foods high in iodine. Which food will the nurse advise the patient against? A.Milk B.Eggs C.Seafood D.Chicken

C.Seafood

WHAT WOULD THE NURSE EXPECT THE MD TO GIVE IN A POSTOP CLIENT WHO IS EXPERIENCING TETANY?

CALCIUM GLUCONATE

S & S OF TETANY?

CARDIAC DYSRHYTHMIAS CARPOPEDAL SPASM DYSPHAGIA MUSCLE & ABDOMINAL CRAMPS NUMBNESS & TINGLING OF FACE & EXTREMITIES POSITIVE CHVOSTEK'S SIGN POSITIVE TROUSSEAU'S SIGN VISUAL DISTURBANCES(PHOTOPHOBIA) WHEEZING & DYSPNEA(BRONCOSPASMS, LARYNGOSPASM, SEIZURES)

A NURSE SHOULD EXPECT TO ADMINISTER WHICH MED TO A CLIENT WITH GOUT?

COLCHICINE

Due to excessive adrenocortical activity or corticosteroid medications Manifestations include hyperglycemia which may develop into diabetes, weight gain, central type obesity with "buffalo hump," heavy trunk and thin extremities, fragile thin skin, ecchymosis, striae, weakness, lassitude, sleep disturbances, osteoporosis, muscle wasting, hypertension, "moon-face", acne, increased susceptibility to infection, slow healing, virilization in women, loss of libido, mood changes, increased serum sodium, decreased serum potassium

CUSHING'S SYNDROME

You are providing care for a patient who underwent thyroidectomy 2 days ago. Which laboratory value requires close monitoring?

Calcium The parathyroid glands are located on the back of the thyroid gland. The parathyroids are important in maintaining calcium and phosphorus balance. The nurse should be attentive to all patient laboratory values, but calcium and phosphorus are important to monitor after thyroidectomy

You assess a patient with Cushing's disease. For which finding will you notify the physician immediately?

Crackles bilaterally in lower lobes of lungs

The nurse is caring for a client who is scheduled for an adrenalectomy. The nurse plans to administer which medication in the preoperative period to prevent Addison's crisis? a) prednisone (deltasone)orally b) fludrocortisone (Florinef) subcutaneously c) spironolactone (Aldactone) intramuscularly d) methiprednisolone sodium succinate (Solu-Medrol) intravenously

D - A glucocorticoid preparation will be administered intravenously or intramuscularly in the immediate preoperative period to a client scheduled for an adrenalectomy. Methylprednisolone sodium succinate protects the client from developing acute adrenal insufficiency (Addison's crisis) that occurs as a result of the adrenalectomy. Aldactone is a potassium-sparing diuretic. Prednisone is an oral corticosteroid. Fludrocortisone is a mineralocorticoid

A client with hyperthyroidism is taking potassium iodide (SSKI) prior to having a thyroidectomy. The nurse instructs the client to do which of the following? A Discontinue all other medications. B Take on an empty stomach. C Take with water. D Take with milk.

D Take with milk.

The nurse would suspect excessive thyroid replacement in a patient taking levothyroxine (Synthroid) when the patient is exhibiting which adverse effect? A.Depression B.Intolerance to cold C.Weight gain D.Irritability

D.Irritability

A CLIENT WHO SUFFERED A BRAIN INJURY DEVELOPED SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE(SIADH). WHAT FINDINGS INDICATE THAT THE TREATMENT HE'S RECEIVING FOR SIADH IS EFFECTIVE?

DECREASE IN BODY WEIGHT INCREASE IN URINE OUTPUT DECREASE IN URINE OSMOLARITY

A patient is admitted to the medical unit with possible Graves' disease (hyperthyroidism). Which assessment finding supports this diagnosis?

Exophthalmos (abnormal protrusion of the eye) is characteristic of patients with hyperthyroidism due to Graves' disease. Periorbital edema, bradycardia, and hoarse voice are all characteristics of patients with hypothyroidism.

S & S OF THYROID STORM?

FEVER TACHY SYSTOLIC HYPERTENSION NAUSEA, VOMITING, DIARRHEA AGITATION, TREMORS, ANXIETY IRRITABILITY, AGITATION, RESTLESSNESS, CONFUSION, SEIZURES AS CONDITION PROGRESSES DELIRIUM & COMA

WHEN TEACHING A CLIENT WITH CUSHING'S SYNDROME ABOUT DIETARY CHANGES THE NURSE SHOULD INSTRUCT THE CLIENT TO INCREASE INTAKE OF?

FRESH FRUITS(POTASSIUM RICH FOODS) CUSHING'S SYNDROME CAUSES SODIUM RETENTION WHICH INCREASES URINARY POTASSIUM LOSS

Is the following statement True or False? Oversecretion of adrencorticotropic hormone (ACTH) or the growth hormone results in Graves' disease.

False Oversecretion of adrencorticotropic hormone (ACTH) or the growth hormone results in Cushing's disease, NOT Graves' disease. Graves' disease results from an excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins.

S & S OF HYPERTYROIDISM?

GOITER PALPITATIONS, CARDIAC DYSRHYTHMIAS(TACHY OR A FIB) EXOPHTHALMOS HYPERTENSION HEAT INTOLERANCE DIAPHORESIS WEIGHT LOSS DIARRHEA SMOOTH SOFT SKIN & HAIR NERVOUSNESS & FINE TREMORS OF HANDS IRRITABILITY, AGITATION & MOOD SWINGS

KNOWN AS TOXIC DIFFUSE GOITER, A HYPERTHYROIDISM DISEASE?

GRAVES DISEASE

HYPERTHYROIDISM IS CAUSED BY INCREASED LEVELS OF THYROXINE IN BLOOD PLASMA. A CLIENT WITH THIS ENDOCRINE DYSFUNCTION WOULD EXPERIENCE?

HEAT INTOLERANCE & SYSTOLIC HYPERTENSION

CLIENT PRESENTS WITH TACHYCARDIA, HYPOTENSION, FREQ. SWALLOWING, FEELINGS OF FULLNESS AT THE INCISION SITE, CHOKING & BLEEDING POSTOP FOR A THYROIDECTOMY. WHAT SHOULD THE NURSE SUSPECT?

HEMORRHAGE

S & S OF HYPERPARATHYROIDISM?

HYPERCALCEMIA HYPOPHOSPHATEMIA FATIGUE & MUSCLE WEAKNESS SKELETAL PAIN & TENDERNESS BONE DEFORMITIES/PATHOLOGICAL FX'S ANOREXIA, NAUSEA, VOMITING, EPIGASTRIC PAIN WEIGHT LOSS CONSTIPATION HYPERTENSION CARDIAC DYSRHYTHMIAS RENAL STONES

A DECREASED PARATHYROID WILL CAUSE WHAT?

HYPERPHOSPHATEMIA HYPOCALCEMIA DECREASED ABSORPTION OF CALCIUM IN INTESTINES DECREASED REABSORPTION OF CALCIUM FROM BONES & RENAL TUBULES

CLINICAL MANIFESTATIONS ARE REFFERED TO AS THYROTOXICOSIS?

HYPERTHYROIDISM

Decreased TSH Increased free T4 Increased T3 and T4 Increased radioactive iodine uptake T3 resin uptake >35%

HYPERTHYROIDISM

ON THE THIRD DAY AFTER A PARTIAL THYROIDECTOMY, A CLIENT EXHIBITS MUSCLE TWITCHING & HYPERIRRITABILITY OF THE NERVOUS SYSTEM. THE CLIENT REPORTS NUMBNESS & TINGLING OF THE MOUTH & FINGERTIPS. WHICH ELECTROLYTE DISTURBANCE MOST COMMONLY FOLLOWS THYROID SURGERY?

HYPOCALCEMIA

S & S OF HYPOPARATHYROIDISM?

HYPOCALCEMIA HYPERPHOSPHATEMIA NUMBNESS & TINGLING IN THE FACE MUSCLE CRAMPS & CRAMPS IN THE ABDOMEN OR EXTREMITIES POSITIVE TROUSSEAU'S SIGN POSITIVE CHVOSTEK'S SIGN OVERT TETANY(BRONCOSPASMS, LARYNGOSPASM, CARPOPEDAL SPASM, DYSPHAGIA, PHOTOPHOBIA, CARDIAC DYSRHYTHMIAS, SEIZURES) HYPOTENSION ANXIETY, IRRITABILITY, DEPRESSION

CONDITION CAUSED BY HYPOSECRETION OF PARATHYROID HORMONE BY THE PARATHYROID GLAND CAN OCCUR FOLLOWING THYROIDECTOMY BECAUSE OF REMOVAL OF PARATHYROID TISSUE?

HYPOPARATHYROIDISM

WHAT ARE THE S & S OF MYXEDEMA COMA?

HYPOTENSION BRADYCARDIA HYPOTHERMIA HYPONATREMIA HYPOGLYCEMIA GENERALIZED EDEMA RESP. FAILURE COMA

A CLIENT HAS RECENTLY UNDERGONE SURGICAL REMOVAL OF A PITUITARY TUMOR. THE MD PRESCRIBES CORTICOTROPIN(ACTHAR) 20 UNITS I.M. Q.I.D AS A REPLACEMENT THERAPY. WHAT IS THE MOA OF CORTICOTROPIN?

IT INTERACTS WITH PLASMA MEMBRANE RECEPTORS TO PRODUCE ENZYMATIC ACTIONS THAT AFFECT PROTEIN, FAT, & CARB METABOLISM

Which change in vital signs would you instruct a nursing assistant to report immediately for a patient with hyperthyroidism?

Increased and rapid heart rate The cardiac problems associated with hyperthyroidism include tachycardia, increased systolic blood pressure, and decreased diastolic blood pressure. Patients with hyperthyroidism also may have increased body temperature related to increased metabolic rate

A CLIENT POSTOP SURGERY FOR A THYROIDECTOMY PRESENTS WITH RESP. OBSTRUCTION, DYSPHONIA, HIGH PITCHED VOICE, STRIDOR, DYSPHAGIA AND RESTLESSNESS...WHAT DOES THE NURSE SUSPECT?

LARYNGEAL NERVE DAMAGE

S & S OF HYPOTHYROIDISM?

LETHARGY/FATIGUE WEAKNESS, MUSCLE ACHES, PARESTHESIAS INTOLERANCE TO COLD WEIGHT GAIN DRY SKIN & HAIR/LOSS OF BODY HAIR BRADYCARDIA CONSTIPATION GENERALIZED PUFFINESS & EDEMA AROUND EYES & FACE(MYXEDEMA) FORGETFULNESS & MEMORY LOSS MENSTRUAL DISTURBANCES CARDIAC ENLARGEMENT->CHF GOITER MAY BE PRESENT

A CLIENT WITH HYPERPARATHYROIDISM DECLINES SURGERY & IS TO RECEIVE HORMONE REPLACEMENT THERAPY WITH ESTROGEN & PROGESTERONE. WHICH INSTRUCTION WOULD BE MOST IMPORTANT TO INCLUDE IN THE CLIENT'S TEACHING PLAN?

MAINTAIN A MODERATE EXERCISE PROGRAM

WHAT COMPLICATION CAN OCCUR IN A CLIENT WITH LONG STANDING HYPOTHYROIDISM RECEIVING THERAPY?

MI ANGINA

WHAT ARE SOME PREOP INTERVENTIONS FOR PARATHYROIDECTOMY?

MONITOR ELECTROLYTES(CALCIUM, PHOSPHATE, MAGNESIUM) ENSURE CALCIUM LEVELS ARE DECREASED TO NEAR NORMAL LEVELS TALKING MAY BE PAINFUL FIRST 2 DAYS AFTER SURGERY

WHAT ARE SOME POSTOP INTERVENTIONS FOR PARATHYROIDECTOMY?

MONITOR FOR RESP DISTRESS TRACH SET, O2, SUCTION @ BEDSIDE MONITOR VITALS SEMI FOWLER'S POSITION ASSESS NECK DRESSING FOR BLEEDING MONITOR FOR HYPOCALCEMIC CRISIS ASSESS FOR TROUSSEAU'S & CHVOSTEK'S SIGN MONITOR FOR CHANGES IN VOICE & HOARSENESS MONITOR FOR LARYNGEAL NERVE DAMAGE CALCIUM & VIT D SUPPLEMENTS

WHAT ARE SOME POSTOP INTERVENTIONS FOR THYROIDECTOMY?

MONITOR FOR RESP. DISTRESS HAVE TRACHEOTOMY SET, O2, & SUCTION AT BEDSIDE LIMIT CLIENT TALKING & ASSESS LEVEL OF HOARSENESS MONITOR FOR LARYNGEAL NERVE DAMAGE(RESP OBSTRUCTION, DYSPHONIA, HIGH PITCHED VOICE, STIDOR, DYSPHAGIA, RESTLESSNESS) MONITOR FOR HYPOCALCEMIA TETANY MONITOR FOR THYROID STORM HIGH FOWLER'S POSITION MONITOR SURGICAL SITE FOR EDEMA & BLEEDING

INTERVENTIONS FOR HYPOTHYROIDISM?

MONITOR VITALS LEVOTHYROXINE/SYNTHROID EDUCATE CLIENT LOW CALORIE, LOW CHOLESTEROL, LOW SATURATED FAT DIET ASSESS FOR CONSTIPATION(FIBER & FLUIDS) WARM ENVIORNMENT AVOID SEDATIVES & OPIOIDS MONITOR FOR OD OF THYROID MEDS(TACHY, CHEST PN, RESTLESSNESS, NERVOUSNESS, INSOMNIA) NOTIFY MD IF PT HAS CHEST PAIN

WHAT ARE SOME INTERVENTIONS FOR HYPERPARATHYROIDISM?

MONITOR VITALS MONITOR FOR CARDIAC DYSRHYTHMIAS MONIOR I/O FOR RENAL STONES MONITOR FOR SKELETAL PAIN GIVE FLUIDS LASIX SALINE IV PHOPHATES CALCITONIN MONITOR CALCIUM & PHOSPHATE LEVELS PREP CLIENT FOR PARATHYROIDECTOMY

WHAT ARE SOME INTERVENTIONS FOR HYPOPARATHYROIDISM?

MONITOR VITALS MONITOR FOR SIGNS OF HYPOCALCEMIA & TETANY SZ PRECAUTIONS TRACH SET, O2, SUCTION AT BEDSIDE CALCIUM GLUCONATE IV FOR HYPOCALCEMIA HIGH CALCIUM LOW PHOSPHORUS DIET CALCIUM & VIT D SUPPLEMENTS PHOSPHATE BINDERS(HELP EXCRETE PHOSPHATE THRU GI) WEAR MEDIC ALERT BRACELET

THYROID HORMONES SHOULD BE TAKEN 4 HRS APART FROM WHAT OTHER MEDS?

MULTIVITAMINS ALUMINUM/MAGNESIUM HYDROXIDE SIMETHICONE CALCIUM CARBONATE BILE ACID SEQUESTRANTS CARAFATE

CLIENT PRESENTS WITH HYPOTENSION, BRADYCARDIA, HYPOTHERMIA, HYPONATREMIA, HYPOGLYCEMIA, GENERALIZED EDEMA, RESP. FAILURE AND COMA WHAT DOES THE NURSE SUSPECT?

MYXEDEMA COMA

Which medication blocks synthesis of thyroid hormone? Dexamethasone Methimazole Potassium iodide Sodium iodide

Methimazole blocks synthesis of thyroid hormone. Dexamethasone, potassium iodide, and sodium iodide suppress release of thyroid hormone.

THE NURSING COORDINATOR CALLS THE ICU TO INFORM THEM THAT A CLIENT WITH SUSPECTED PHEOCHROMOCYTOMA WILL BE ADMITTED FROM THE ER. THE NURSE SHOULD PREPARE TO ADMINISTER WHICH DRUG TO THE CLIENT?

NITROPRUSSIDE(CONTROLS HYPERTENSION)

REMOVAL OF ONE OR MORE OF THE PARATHYROID GLANDS

PARATHYROIDECTOMY

WHAT ARE THE INTERVENTIONS FOR MYXEDEMA COMA?

PATENT AIRWAY ASPIRATION PRECAUTIONS IV FLUIDS(NORMAL OR HYPERTONIC) LEVOTHYROXINE SODIUM IV GLUCOSE IV CORICOSTEROIDS ASSESS TEMP. HOURLY MONITOR B/P FREQ. KEEP CLIENT WARM MONITOR FOR AMS MONITOR ELECTROLYTE & GLUCOSE LEVELS

WHAT ARE THE INTERVENIONS FOR THYROID STORM?

PATENT AIRWAY & ADEQ. VENTILATION ANTITHYROID MEDS SODIUM IODIDE SOLUTION PROPRANOLOL & GLUCOCORTICOIDS MONITOR VITALS MONITOR FOR CARDIAC DYSRHYTHMIAS NONSALICYLATE ANTIPYRETICS COOLING BLANKET

For the patient with pheochromocytoma, what physical assessment technique should you instruct the LPN/LVN to avoid?

Palpating the abdomen can cause sudden release of catecholamines and severe hypertension

WHICH NURSING DIAGNOSIS IS MOST APPROPRIATE FOR A CLIENT WITH ADDISON'S DISEASE?

RISK FOR INFECTION

A patient is hospitalized with adrenocortical insufficiency. Which nursing activity should you delegate to the nursing assistant?

Remind patient to change positions slowly Patients with hypofunction of the adrenal glands often have hypotension and should be instructed to change positions slowly. Once a patient has been instructed, it is appropriate for the nursing assistant to remind the patient of those instructions. Assessing, teaching, and planning nursing care require more education and should be done by licensed nurses

The patient with adrenal insufficiency is to be discharged taking prednisone 10 mg orally each day. What will you be sure to teach the patient?

Report excessive weigh gain or swelling to the physician

IN A 28 YR OLD FEMALE CLIENT WHO IS BEING SUCCESSFULLY TREATED FOR CUSHING'S SYNDROME THE NURSE WOULD EXPECT A DECLINE IN?

SERUM GLUCOSE LEVEL

CLIENTS TAKING THYROID HORMONES SHOULD AVOID WHAT TYPES OF FOODS?

STRAWBERRIES PEACHES PEARS CABBAGE TURNIPS SPINACH, KALE, BRUSSELS SPROUTS CAULIFLOWER, RADISHES & PEAS

THE NURSE EXPLAINS TO A CLIENT WITH THYROID DISEASE THAT THE THYROID GLAND NORMALLY PRODUCES?

T3, T4, & CALCITONIN

A CLIENT WITH HYPOTHRYOIDISM(MYXEDEMA) IS RECEIVING LEVOTHYROXINE(SYNTHROID) 25 MCG P.O. DAILY. WHICH FINDING SHOULD THE NURSE RECOGNIZE AS AN ADVERSE REACTION TO THE DRUG?

TACHYCARDIA

A CLIENT IS TAKING FOSAMAX, WHAT SHOULD THE NURSE INSTRUCT THE CLIENT TO DO?

TAKE PILL WITH WATER 30MINS BEFORE BREAKFAST & DONT LIE DOWN FOR AT LEAST 30 MINS

WHICH IMPORTANT INSTRUCTION CONCERNING THE ADMINISTRATION OF LEVOTHYROXINE(SYNTHROID) SHOULD THE NURSE TEACH A CLIENT?

TAKE THE DRUG ON A EMPTY STOMACH

A 56 YR OLD FEMALE CLIENT IS BEING DISCHARGED AFTER UNDERGOING A THYROIDECTOMY. WHICH DISCHARGE INSTRUCTIONS WOULD BE APPROPRIATE FOR THIS CLIENT?

TAKE THYROID MEDS AS ORDERED WATCH FOR CHANGES IN BODY FUNCTIONING SUCH AS LETHARGY, RESTLESSNESS, SENSITIVITY TO COLD, & DRY SKIN-NOTIFY MD

THE NURSE IS ASSESSING A CLIENT AFTER A THYROIDECTOMY. THE ASSESSMENT REVEALS MUSCLE TWITCHING & TINGLING, ALONG WITH NUMBNESS IN THE FINGERS, TOES & MOUTH AREA. THE NURSE SHOULD SUSPECT WHICH COMPLICATION?

TETANY

THIS ACUTE & LIFE THREATENING CONDITION OCCURS IN A CLIENT WITH UNCONTROLLABLE HYPERTHYROIDISM. IT CAN BE CAUSED BY MANIPULATION OF THE THYROID GLAND DURING SURGERY & THE RELEASE OF THYROID HORMONE INTO THE BLOODSTREAM; IT ALSO CAN OCCUR FROM SEVERE INFECTION & STRESS. B-BLOCKERS, GLUCOCORTICOIDS, & IODIDES MAY BE ADMINISTERED TO THE CLIENT BEFORE THYROID SURGERY TO PREVENT ITS OCCURRENCE?

THYROID STORM

REMOVAL OF THYROID GLAND, PERFORMED WHEN PERSISTENT HYPERTHYROIDISM EXISTS?

THYROIDECTOMY

A CLIENT TAKING THYROID HORMONE REPLACEMENTS PRESENTS WITH TACHYCARDIA, CHEST PAIN, PALPITATIONS & EXCESSIVE SWEATING WHAT SHOULD THE NURSE SUSPECT?

TOXICITY

A CLIENT HAS A SERUM CALCIUM OF 7.2 MG/DL. DURING PHYSICAL EXAM THE NURSE EXPECTS TO ASSESS?

TROUSSEAU'S SIGN

A 33-year-old man, newly admitted to the medical-surgical unit from the step-down intensive care unit, underwent a thyroidectomy 2 days earlier. While reviewing the orders, the nurse notices that the patient is to start receiving his thyroid medication upon transfer to the medical-surgical unit. The written orders specify that 25 mcg of levothyroxine is to be given once daily. However, the automated drug-dispensing machine on the unit only has 25 mcg of liothyronine stocked. What is the nurse's priority action at this time?

The nurse must not give the liothyronine. Liothyronine, which is the hormone triiodothyronine (T3), is not the same drug as levothyroxine, which is the hormone thyroxine (T4). These drugs are not interchangeable. Although they are the same microgram dosage, they do not contain the same active ingredients and will not produce the same physiologic responses. The priority action is for the nurse to call the pharmacy and obtain the correct medication. It will also be necessary to report an error in the stocking of the automated drug-dispensing machine.

A patient with a history of hypothyroidism is in her first trimester of pregnancy. She asks the nurse, "How often will they check my thyroid hormone levels? I'm very worried about how this will affect my baby." What is the nurse's best response?

The nurse will inform the patient that hypothyroidism will continue to be treated during pregnancy. The dose of the prescribed thyroid hormone will be adjusted at frequent intervals to try to keep the hormone levels on the lower end of the normal range. Thyroid-stimulating hormone (TSH) levels may be tested every 4 weeks during her pregnancy. Fetal growth may be retarded if maternal hypothyroidism is untreated during pregnancy.

A patient has been taking thyroid drugs for about 16 months and has recently noted palpitations and some heat intolerance. What are the nurse's priority actions at this time?

The priority is for the nurse to recognize that the palpitations and heat intolerance may be signs of excessive amounts of thyroid replacement hormone. Other symptoms to watch for include increased pulse rate, chest pain, irritability, nervousness, and increased sweating. The nurse needs to notify the patient's prescriber immediately because it will be necessary to adjust the dosage of the thyroid medication, and orders for laboratory work to check the patient's thyroid hormone levels may be necessary.

Is the following statement True or False? The patient in acute hypercalcemic crisis requires close monitoring for life-threatening complications and prompt treatment to reduce serum calcium levels.

True

A CLIENT WITH HYPERTHYROIDISM IS ABOUT TO RECEIVE RADIOACTIVE IODINE AS AN OUTPATIENT. WHAT SAFETY MEASURES SHOULD THE NURSE TEACH THE CLIENT TO PROTECT HIS FAMILY WHILE HE UNDERGOES TREATMENT?

USE OF DISPOSABLE EATING UTENSILS, AVOID KISSING, AVOID SEX, & HOLDING BABIES

WHAT ARE SOME PREOP INTERVENTIONS FOR THYROIDECTOMY?

VITALS & WEIGHT ASSESS ELECTROLYTE LEVELS ASSESS FOR HYPERGLYCEMIA EDUCATE CLIENT ON COUGHING & DEEP BREATHING TECHNIQUES ADMIN. ANTITHYROID MEDS AS PRESCRIBED