Pituitary & Adrenal Disorders

A patient has been diagnosed with hypothyroidism. The nurse will assess for which manifestations? Select all that apply.

Lethargy- Depression- Tachycardia Weight gain- Constipation- Thinning hair Manifestations of hypothyroidism include lethargy, depression, weight gain, and constipation. Tachycardia and thinning hair are manifestations of hyperthyroidism.

After being in the hospital for three days, the daughter of a patient with hypothyroidism asks what measures will help her mother with constipation. What would be the nurse's best response? Select all that apply.

"Add fiber to the diet."- "Increase the caloric intake." "Increase dietary iron intake." "Ensure adequate fluid intake."- "Age-appropriate physical activity will help."- Adding fiber to the diet, physical activity, and adequate fluid intake will help with constipation. Patients with hypothyroidism usually gain weight, and caloric intake may be reduced. Increasing dietary iron intake will not improve constipation.

The patient is receiving propylthiouracil. Which statement by the patient indicates understanding of teaching regarding this medication? Select all that apply.

"I will seek medical attention if I develop a sore throat."- "This medication is mixed with juice and sipped through a straw." "I will take my pulse daily, and I will call my provider if it is too slow." "Liver problems can occur with this drug, so I need to report jaundice."- "If I become pregnant, I need to notify my health care provider immediately."- Propylthiouracil can cause birth defects, and patients should not take it if they are pregnant. Liver problems can occur with propylthiouracil. The patient does not need to take his or her pulse daily. Dyspnea and vertigo are not side effects of propylthiouracil. SSKI, not PTU, is administered diluted in juice and sipped through a straw.

The patient is scheduled for a radioactive iodine uptake test. What should the nurse include in the teaching? Select all that apply.

A needle will be inserted into your thyroid. You will be given a thyroid drug prior to the surgery. Please let me know if you suspect that you are pregnant.- For 24 hours after the test, wash your hands well after voiding.- The procedure will be painful, but we will give you pain medicine. Because the test contains radioactive iodine, it is contraindicated for women who are pregnant. Proper hand washing for 24 hours after the test will ensure that no radioactive iodine remains on the hands. The procedure is painless and does not require drugs or needle insertion.

A patient with a history of hyperthyroidism returns to the unit 12 hours after a thyroidectomy. The nurse notes tachycardia, cardiac dysrhythmias, vomiting, and fever. What does the nurse suspect the patient is experiencing based on these findings?

A seizure Thyroid storm- Hypoglycemia Hypotensive crisis Thyroid crisis or thyroid storm can develop when large amounts of thyroid hormone enter the bloodstream during surgery. It can also occur in patients with severe hyperthyroidism who develop severe illness or infection. There is no indication of seizure activity. Headache, dizziness, hunger, diaphoresis, and clammy and pale skin are indicators of hypoglycemia and are not present in hyperthyroidism. Blood pressure is usually elevated in the patient in thyroid storm.

Medication used to treat a patient with hypoparathyroidism has been prescribed by the health care provider. Which medications would the nurse expect to find in the patient's chart?

Calcium gluconate- Ibuprofen Calcitonin Potassium Iodide Calcium gluconate is used to correct calcium deficiency due to hypoparathyroidism. Ibuprofen is an analgesic, antiinflammatory, and antipyretic. Calcitonin is used to treat hypercalcemia due to hyperparathyroidism. Potassium iodide reduces the size and vascularity of the thyroid gland in hyperthyroidism. It is used alone or in combination with other drugs to treat hyperthyroidism.

A patient with a history of stable angina has just been diagnosed with hypothyroidism. Levothyroxine has been prescribed. Which symptom of the medication is most important for the patient to report to the health care provider?

Chest pain- Diarrhea Decrease in appetite Dry skin Patients with cardiac disease must be carefully monitored as they begin hypothyroidism treatment. Patients should be taught to report any chest pain immediately because it could lead to myocardial infarction. The other symptoms would be important to report as well, but chest pain should be the most important.

The nurse is reviewing the medication administration record (MAR) for a patient with hyperparathyroidism. Furosemide is to be given daily. Which effect will Furosemide have?

Decreases the production of calcium Promotes the excretion of calcium in the urine- Causes the calcium to be reabsorbed in the bones Prevents the parathyroid glands from releasing calcium Hyperparathyroidism results from an increase in parathyroid hormone, which leads to an increase in calcium. Lasix helps excrete calcium via the urine. Lasix will not cause the reabsorption of calcium via the bones. It does not decrease the production of calcium or prevent the parathyroid glands from releasing calcium.

To which assessment finding in the patient with hypoparathyroidism should the nurse give priority?

Depression Dysrhythmias- Abdominal cramping Memory impairment Hypoparathyroidism results in a decrease in parathyroid hormone, which in turn causes hypocalcemia. The patient with hypocalcemia has painful muscle cramps, fatigue, weakness, tingling, twitching of the face and hands, plus mental, and emotional changes. The patient with severe hypocalcemia will have difficulty breathing, convulsions, and cardiac dysrhythmias. Depression, abdominal cramping, and memory impairment are not associated with hypoparathyroidism.

The nurse is collecting data. Which data would be consistent with a diagnosis of hyperthyroidism? Select all that apply.

Diarrhea- Fatigue- Lethargy Weight loss- Exopthalmos- Cold intolerance Manifestations of hyperthyroidism are fatigue, diarrhea, weight loss, exopthalmos, heat intolerance, and tachycardia. Lethargy and cold intolerance are manifestations of hypothyroidism.

The thyroid gland plays a major role in regulating the body's rate of what?

Digestion Circulation Respiration Metabolism- The thyroid gland plays a major role in regulating the body's rate of metabolism and growth and development.

The nurse is caring for a patient diagnosed with hypothyroidism, who has been sick with the flu but did not make adjustments to his dose of thyroid-replacement hormones. The nurse is concerned about myxedema coma and knows to vigilantly observe the patient for which symptoms?

Hypotension, confusion, and lethargy Hyperthermia, tachycardia, and tachypnea Hypothermia, hypotension, and hypoventilation- Hypothermia, hypertension, and hyperventilation The main signs of myxedema coma include hypothermia, hypotension, and hypoventilation. Hyperthermia, confusion, lethargy, tachycardia, tachypnea, hypertension, and hyperventilation are not the main signs of myxedema.

A nursing assistant asks the nurse why a patient with hyperparathyroidism is at risk for injury. The nurse explains that which is a common effect of the disorder?

Loose stool Hypotension Vertigo on standing Pathological fractures- The most notable effect of hyperparathyroidism is the elevation of serum calcium. High levels of parathyroid hormone cause calcium to shift from the bones into the bloodstream. If hyperparathyroidism remains untreated, then severe demineralization of bone tissue occurs. Bones can become brittle, thus resulting in serious fractures. Loose stools occur with hyperthyroidism. Hypertension, not hypotension occurs with hyperparathyroidism. Dizziness on standing indicates hypotension.

A patient has been admitted with hypoparathyroidism. The patient's serum laboratory values are calcium 7.2 mg/dL, sodium 144 mEq/L, magnesium 1.2 mEq/L, and potassium 6.7 mEq/L. Which medications would the nurse anticipate administering? Select all that apply.

Oral kayexalate- Oral calcitriol Oral potassium chloride Intravenous calcium chloride- 50 percent magnesium sulfate- The patient has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate). The potassium level is high, so replacement is not needed. The patient's sodium level is normal, so hypertonic IV solution is not needed. No information about a vitamin D deficiency is available, so calcitriol is not needed.

Twelve hours after a total thyroidectomy, the patient develops dyspnea and respiratory distress. Which is the nurse's priority intervention?

Prepare for an emergency tracheotomy.- Hyperextend the patient's neck. Elevate the head of the bed. Document the finding and monitor for increasing distress. Because of the location of the thyroidectomy incision, edema of bleeding can cause pressure on the trachea resulting in respiratory distress. Without prompt intervention, the patient can die. An emergency tracheotomy may need to be performed due to the edema, and the nurse needs to prepare to assist with this. Hyperextending the patient's neck will increase the pressure on the trachea and cause more distress. The head of the bed should be elevated immediately after surgery to decrease edema and ONLY elevating the head alone will not help with this type of respiratory distress. Documenting the finding does not address the emerging problem.

The LPN is caring for a patient who is being treated with levothyroxine. The nurse assesses the patient's vital signs and finds that the pulse is 110 beats per minute. Which is the nurse's priority action?

Review the patient's complete pharmaceutical history. Begin monitoring the patient's vital signs every 2 hours. No action is necessary; this pulse rate is not considered abnormal. Withhold the next dose of medication, and notify the health care provider.- Withholding the next dose of medication and notifying the health care provider are the appropriate actions to take to manage the patient's evidence of toxicity. Although the nurse should be familiar with the patient's pharmaceutical history, a review is not the appropriate action when the patient may be approaching toxicity level. Although the health care provider may order for the patient's vital signs to be monitored more closely in light of the evidence of possible toxicity, the nurse must take immediate action to deal with the patient's evidence of toxicity. Although this reaction would be most likely classified as sinus tachycardia, the nurse must still take action to deal with the patient's evidence of toxicity.

Several hours following a thyroidectomy a patient is transferred from a stretcher to a bed. After checking the bandage, the nurse would place the patient in which position?

Supine Lithotomy Semi-Fowler- Trendelenburg The head of the bed is elevated to decrease edema. The patient is placed in the semi-Fowler position with pillows used to support the head and decrease stress on the suture line. In the Trendelenburg position, the head is lower than the legs resulting in stress on the suture line. Allowing the patient to lie flat will cause the wound to drain to the back of the throat and could cause airway obstruction. The lithotomy position, which involves lying flat with the legs in stirrups, will not decrease edema or stress on the suture line.

Which findings would the nurse most likely elicit for a patient with hypothyroidism?

Visual disturbances and diarrhea Intolerance to heat and weight loss Decreased heart rate and temperature- Increased blood pressure and heart rate Hypothyroidism occurs as a result of decreased thyroid hormones. The thyroid gland regulates the body's metabolism. Hypothyroidism results in a decrease in heart rate and temperature. Visual disturbances, diarrhea, intolerance to heat, weight loss, and increased blood pressure and heart rate are all associated with hyperthyroidism.

The LPN is caring for a patient who is being treated with strong iodine solution. The patient complains about a metallic taste. What is the nurse's best response?

"Did you take the medication through a straw?"- "This is a side effect of the medication and nothing to worry about." "You need to immediately discontinue the medication—this is an adverse effect." "The metallic taste is normal for all iodine preparations." Strong iodine is a strong iodine solution that is diluted in water, fruit juice, or milk and should be taken through a straw to reduce the unpleasant taste and tooth-staining. This is a side effect, but not an adverse effect.

A young teen with a severe case of hypothyroidism says to the nurse, "My face is puffy, and I am fat and ugly. Will I look like this for the rest of my life?" What is the nurse's best response?

"Don't worry about that; just focus on your release." "You have a family who will love you regardless of the effects." "Your health care provider can predict if your looks are permanent." "Treatment will gradually eliminate the changes that have occurred."- The puffy, apathetic look associated with hypothyroidism can be very distressing to the patient. The caregiver should be accepting of the patient's concern and encourage grooming and attention to appearance. Tell the patient that treatment will gradually eliminate these changes. Although it is a comfort to know that the family is accepting, this does not address the concern of the patient. Telling the patient not to worry indicates a lack of concern. The health care provider cannot predict how the patient will look.

A patient has undergone a complete thyroidectomy. Which statement by the patient indicates that further instruction is needed?

"I may need calcium replacement after surgery." "After surgery, I won't have to take thyroid medication anymore."- "I should begin to gain weight again within a few weeks." "I can receive pain medication if I feel that I need it." Once the thyroid is removed, the patient must take lifelong thyroid hormone replacement. Calcium supplementation may be necessary if the parathyroid glands are accidentally removed. The patient should begin to gain any weight lost once the excess thyroid hormone is regulated. Pain medicine may be needed after surgery and will be available per the health care provider's order.

The nurse is providing teaching for the patient recently diagnosed with hypothyroidism who has been prescribed levothyroxine. The nurse knows the patient understands the teaching when the patient makes which statement?

"I should take this medication with food." "I should begin losing all this excess weight quickly." "I can stop taking this medication once my symptoms subside." "I will call my health care provider if I notice increased pulse,and nervousness."- Side effects of excess levothyroxine are nervousness, diarrhea, and tachycardia. The patient should notify the health care provider if any of these occur. The medication should be taken on an empty stomach. Weight loss may occur once the medication is started but may not occur quickly. The patient must take the medication for the lifetime, not stop once symptoms subside.

The patient with a thyroid goiter is scheduled for a thyroid scan with radioactive iodine 131. The nurse is educating the patient prior to the procedure. What should the nurse include in the teaching?

"You will have to lie still for two hours during the test." "You should avoid eating seafood for 1 week prior to the test."- "An IV will be started in your arm prior to the test to administer the iodine." "Blood will be drawn to determine the amount of iodine in your thyroid." Patients should not consume any iodine for 1 week prior to the test. The patient will need to lie still for about 20 minutes, not two hours. The iodine is administered orally, not via IV, and the scan measures the amount of iodine in the thyroid, not a blood sample.

The nurse is caring for a patient who is hospitalized with hypothyroidism. The nurse will implement which interventions in the plan of care? Select all that apply.

Apply lotion for skin care.- Provide a cooling blanket. Schedule periods of rest and activity.- Administer stool softeners as ordered.- Administer PRN medications for diarrhea. Increase the temperature in the room slightly.- Patients with hypothyroidism are prone to cold intolerance, so increasing the temperature in the room will prevent them from being cold. The skin is dry and thickened, so lotion will increase moisturization. Patients also have a lower metabolism and less energy, so they should be encouraged to participate in activity but also have scheduled rest periods. Stool softeners will help with constipation. A cooling blanket and diarrhea medications would be appropriate for hyperthyroidism.

A patient diagnosed with Graves' disease has been started on medication therapy. Which cardiac finding would indicate to the nurse that the patient is not responding appropriately to therapy?

Bradycardia Tachycardia- Decreased peripheral edema Decreased systolic blood pressure Medication therapy for Graves' disease should decrease heart rate and blood pressure to within normal limits. Bradycardia would indicate that the patient was receiving too high a dose. Edema is not a manifestation of Graves' disease.

Which is the best nursing technique to determine the presence of incisional bleeding on a patient who has had a thyroidectomy?

Carefully remove the initial bandage and assess for bleeding. Ask the patient if he or she feels blood leaking from the bandage. Have the patient lie supine and inspect the back and sides of the neck.- Gently place your hand behind the patient's neck and feel for drainage. The incisional dressing is on the front of the neck, so blood may flow under the dressing to the back of the neck while the patient is in the supine position. The nurse should check behind the patient's neck and upper back to detect this. The patient may not feel the blood, so asking if he or she feels leakage is not sufficient. Removing the initial pressure bandage may lead to additional bleeding; the bandage should not be removed until there is an order from the health care provider. The fresh postoperative patient should not lie prone, as this position will put stress on the suture line.

A patient's presenting symptoms are thyroid enlargement and normal thyroid hormone production. The nurse recognizes these as signs correlating with which disorder?

Cretinism Simple goiter- Thyroid cancer Multinodular goiter Thyroid enlargement with normal thyroid hormone production is called simple goiter. Cretinism is mental and physical retardation caused by congenital deficiency of thyroid hormones. Thyroid cancer is not common and is fatal in less than 1 percent of all patients. In the early stages of thyroid cancer, the only sign may be a nodule that can be felt on the thyroid gland. Later, if the cancer spreads, enlarged lymph nodes are felt in the neck. Multinodular goiter occurs most often in women in their sixth and seventh decades of life. Increased hormone production is independent of thyroid-stimulating hormone (TSH).

The LPN is caring for a patient who is being treated with strong iodine solution. Which is the most important intervention for the nurse to implement while administering this medication?

Frequently assess the patient for evidence of fever, rash, and diarrhea. Frequently examine the patient's oral cavity for evidence of oral lesions. Note the patient's complaint of experiencing an unpleasant taste of the drug. Dilute the drug in water or orange juice, and allow the patient to sip it through a straw.- Strong Iodine solution should be diluted in water, milk, or fruit juice to disguise the taste and should be administered through a straw to prevent the patient's teeth from being stained. The nurse should also frequently assess the patient for evidence of fever, rash, diarrhea, and oral lesions. The nurse should note the patient's complaint about the drug's unpleasant taste.

A patient with a thyroid dysfunction is inquiring about food selections that are high in iodine. Which item if recommended by the nurse would give the patient the highest iodine content?

Lentils Beef stew Mashed potatoes Saltwater seafood- The thyroid uses iodine to manufacture hormones. Lack of iodine is associated with the development of goiter or the enlargement of the thyroid gland in adults and cretinism in infants. Iodized salt is the best way to obtain an adequate amount of iodine in the diet. Another important source of iodine is saltwater seafood. Beef stew, lentils, and mashed potatoes do not have high iodine content.

A meal tray is delivered for a patient with hyperthyroidism. Which item would the nurse remove from the tray?

Milk Coffee- Chili dog Ham sandwich Despite fatigue and weakness, the patient with hyperthyroidism often feels restless and has trouble sleeping. Caffeine should be avoided because of its stimulating effects. Milk is fortified with calcium and vitamin D. Chili dogs and ham sandwiches are high in sodium but do not contain the stimulant caffeine.

It is suspected that a patient has hyperthyroidism. Which problem will most likely develop if the disease remains untreated?

Liver failure Constipation Hypotension Heart failure- The patient with hyperthyroidism has excessive thyroid hormones that stimulate the heart and cause tachycardia. The heart rate may be as rapid as 160 beats per minute. If left untreated, thyroid storm can occur, and the patient may die as a result of heart failure. Liver failure is not related to hyperthyroidism. The patient with hyperthyroidism is usually hypertensive and experiences diarrhea, not constipation.

When taking the blood pressure of a forty-eight year-old patient after a parathyroidectomy, the nurse notes that the patient's hand has gone into flexion contractions. Which laboratory result would the nurse correlate with this condition?

Magnesium of 1.4 mEq/l Serum calcium of 6.5 mg/dl- Serum sodium of 128 mEq/l Serum potassium of 6.2 mEq/l The flexion contractions are a positive Trousseau's sign and are indicative of hypocalcemia, a common manifestation after parathyroidectomy. Normal values for a patient less than 60 years of age is 8.6-10.0. The laboratory result reflecting this is the low serum calcium. Parathyroidectomy does not affect magnesium, sodium, or potassium levels.

The nurse is providing education to a patient who was diagnosed with hyperthyroidism. Which information should the nurse include in the teaching?

Methimazole will be prescribed.- You will need a beta blocker to lower your heart rate. Apply the iodide agents, SSKI drops, directly on your tongue. You will need thyroid hormone replacement for the rest of your life. Hyperthyroidism is an excess of thyroid hormone. Administering a thyroid hormone-suppressing drug will decrease the amount of hormone. SSKI drops are administered diluted, and with a straw to prevent teeth stains. A beta blocker is not indicated for treating tachycardia related to hyperthyroidism. Patients with hypothyroidism, not hyperthyroidism, need lifelong hormone replacement.

Upon reviewing the medical history of a patient with goiter, what symptom would the nurse find to support goiter?

Nausea Dizziness Weight loss Difficulty swallowing- Goiter is the term used to describe the enlargement of the thyroid gland. The type of treatment depends on the degree of enlargement and the level of thyroid hormone production. If enlargement is mild and hormones are normal, no intervention is required. Some patients need hormone replacement therapy. Surgery is indicated if pressure is noted on the trachea or the esophagus. The pressure can lead to difficulty with swallowing. Nausea, dizziness, and weight loss are not usually related to goiter and can occur with any disease.

Which classification of drugs could precipitate a potentially fatal myxedema (hypothyroidism) coma in a person with severe hypothyroidism? Select all that apply.

Opiates- Sedatives- Antipyretics Tranquilizers- Stool softeners Patients with hypothyroidism have an altered metabolism and therefore, opioid, sedative, and tranquilizer agents can precipitate a potentially fatal myxedema coma in severe hypothyroidism. Antipyretics can be used with caution. Stool softeners do not have a direct correlation with severe hypothyroidism.

A patient is admitted to the hospital for suspicion of parathyroid disease. The nurse expects which tests to be ordered?

Physical examination and blood studies Family history and physical examination Blood and urine studies and skeletal radiographs- Blood and urine studies and physical examination The diagnosis of parathyroid disorders is based on blood and urine studies and skeletal radiographs. Physical examination and family history alone are not enough to diagnose hyperparathyroidism.

A patient who lives alone has been admitted with severe myxedema. What is the nurse's priority intervention?

Promote nutrition with a high-calorie diet. Monitor for tachycardia and hypertension. Prevent skin breakdown by turning every 2 hours. Monitor for hypothermia, hypotension, and hypoventilation.- The main signs of myxedema coma are hypothermia, hypotension, and hypoventilation. The patient should be monitored for these manifestations, as myxedema coma is a complication. Tachycardia and hypertension are signs of hyperthyroidism. Nutrition and skin breakdown are not the priority for this patient.

A young adult recently diagnosed with hyperthyroidism is experiencing bulging eyeballs. Which essential nursing care measures should the nurse incorporate into the care plan for this patient? Select all that apply.

Promote vigorous exercise. Apply artificial tears as indicated.- Add salt to the patient's food trays. Advise the patient to wear sunglasses. Tape the patients' eyelids shut at bedtime.- Exophthalmos is a condition in which deposits of fat and fluid behind the eyeballs make them bulge outward. If the condition is severe, then the eyelids do not cover the eyeballs. The goal is to keep the eyeballs moist. The eyes are susceptible to injury. It may be necessary to tape the lids shut. Lubricated eye pads or artificial tears may be used. The patient with exophthalmos has a distorted sensory perception and may have a variety of eye symptoms such as double vision. Therefore, promoting vigorous exercise may put the patient at risk for injury. Adding salt to the diet promotes further retention of fluids potentially causing more bulging. Advising the patient to wear sunglasses is unnecessary.

A 60-year-old patient is experiencing muscle weakness and fatigue due to hyperparathyroidism. Which nursing measure is given the highest priority?

Provide diversional activity. Monitor bowel incontinence. Assess for pain, and medicate as indicated. Evaluate the environment for safety hazards.- Muscle weakness and fatigue can lead to falls. The caregiver must evaluate the environment for any safety hazards and take corrective measures. Although assessing and medicating the patient for pain is appropriate, it is not the highest priority. Diversional activity and monitoring bowel incontinence does not apply to muscle weakness.

The nurse is providing discharge teaching for a patient who was diagnosed with hypoparathyroidism. What should the nurse include in the teaching? Select all that apply.

Signs and symptoms of kidney stones. Take oral calcium salts and vitamin D.- Minimize stress and relax.- Report low blood sugar levels to your health care provider immediately. Wear a medical alert bracelet to alert health care providers of your condition in case of emergency.- Hypoparathyroidism causes paresthesias and muscle spasms, which places patients at risk for falls. The patient will take oral calcium salts and a form of vitamin D. Chronic hypoparathyroidism that normally is well controlled may be affected when the patient is under severe stress or is very ill, so the patient should attempt to minimize stress and relax to prevent problems. Hypoparathyroidism predisposes the patient to low calcium levels, which would not contribute to kidney stones. Low blood sugar is a sign of hypoglycemia and is not associated with hypoparathyroidism.

The nurse is caring for a patient who was diagnosed with hypoparathyroidism. The patient is receiving calcitriol. Which laboratory finding would indicate that the medication is effective?

Sodium levels have increased. Calcium levels have increased.- Vitamin D levels have decreased. Magnesium levels have decreased. Medication therapy for hypoparathyroidism is aimed at increasing vitamin D and calcium levels. Sodium and magnesium levels are not altered in

A patient with a history of cardiac disease is started on levothyroxine for hypothyroidism. The nurse anticipates that drug therapy will be started following which principle?

Start with a higher dose and titrate it down according to the patient's response. Begin with a low dose and increase gradually over several weeks according to the patient's response.- Administer a beta blocker with the levothyroxine to prevent cardiac complications. Administer the dose based on the patient's weight and titrate it according to the patient's response. Patients with cardiac disease must be started on a low dose and increase gradually to prevent severe cardiac complications such as myocardial infarction, hypertension, and tachycardia. Weight is not an appropriate measure of dosage calculation for hypothyroidism. Beginning with a higher dose will put the patient at risk for cardiac complications. Administering a beta blocker with the dose is not appropriate.

A patient has hyperparathyroidism. Which priority intervention would the nurse add to this patient's plan of care?

Teach the patient to support the neck when moving. Instruct the patient to use a soft-bristled toothbrush. Handle the patient gently with position changes.- Strain all urine, and send any stones to the laboratory for analysis. Patients with hyperparathyroidism are at increased risk for pathologic fractures due to high parathormone causing calcium to shift from the bones into the bloodstream. Handling the patient gently will protect the patient and reduce the risk for bone injury. Supporting the neck and using a soft-bristled toothbrush are not necessary for this patient. Patients may have urinary stones, but this is not the priority intervention.

A patient is scheduled for a total thyroidectomy. What essential information should the nurse teach the patient prior to the surgery?

The importance of the postoperative diet How to perform postoperative wound care Symptoms of an infection following surgery How to support the neck after the surgical procedure- Prior to thyroid surgery, instruction along with a demonstration should be conducted to show the patient how to avoid strain on the suture by supporting the head when rising. Wound care if needed will be performed by the nurse postoperatively. The diet can be discussed at some point, but is not essential immediately postoperative. Symptoms of a wound infection following surgery are usually discussed with the patient closer to patient dismissal.

An LPN/LVN is assigned a patient who has had a subtotal thyroidectomy. Which postsurgical assessment finding if elicited would be of greatest concern?

The patient has a fever of 99.1° F. The patient complains of a sore throat. The patient experiences pain upon movement of the neck. Carpopedal spasms are noted when the blood pressure cuff is inflated.- Trousseau sign involves carpopedal spasms that occur when a blood pressure cuff is inflated above the patient's systolic blood pressure and left in place for 2 to 3 minutes, indicating hypocalcemia. Occasionally during thyroid surgery, the parathyroid hormones are accidentally removed causing hypocalcemia to occur. Fever of a low grade may be present postoperatively. It is normal for the patient to experience a sore throat and pain upon movement of the neck as this is the location of the thyroidectomy incision.

Before a patient returns from thyroidectomy surgery, which item is essential to have at the bedside should a postoperative complication develop?

Tongue blade A cup of ice chips Tracheostomy kit- Dressing change kit It is especially important to monitor the rate and ease of respirations after a thyroidectomy. Respiratory distress can result from compression of the trachea or spasm of the larynx due to nerve damage or hypocalcemia. Hypocalcemia may occur because the parathyroid glands are accidentally damaged or removed during a thyroidectomy. The removal or damage of the parathyroid glands leads to a calcium deficiency or hypoparathyroidism. Therefore, before the patient returns from surgery, suction equipment, a laryngoscope, an endotracheal tube, oxygen, and a tracheostomy tray must be available. The institution may require the tracheostomy at the bedside. A tongue blade is not necessary. The patient usually has a nothing by mouth status after surgery, so ice chips are not needed at this point. A dressing change kit may be needed at some point, but it is not essential.