Thyroid Disease- Pearson
A client with a family history of hyperthyroidism asks the nurse, "What can increase my risk of developing this disorder?" Which response by the nurse is accurate? A. "Viral infections can cause the onset of hyperthyroidism." B. "Smoking can increase your risk for acquiring this disease. C. "Arthritis can lead to the development of hyperthyroidism." D. "Invasive neck surgery can impact thyroid functioning."
A Rationale: A viral infection can increase the risk of hyperthyroidism. Other risks include having an autoimmune disease, pregnancy, female sex, and being under the age of 40. Surgery in the neck area increases the risk of hypothyroidism. Smoking and arthritis are not risk factors for hyperthyroidism.
A client reports hoarseness and feelings of tightness in the throat. During the examination, the nurse notes visible swelling at the base of the neck, neck vein distention, a rapid pulse, and sweating. The nurse should suspect which condition in this client? A. Graves disease B. Toxic multinodular goiter C. Pretibial myxedema D. Exophthalmos
A Rationale: Graves disease involves an enlargement of the thyroid gland due to overproduction of thyroid hormones. Therefore, the nurse would note swelling and neck vein distention. Exophthalmos would be evident by protruding eyeballs. Pretibial myxedema is nonpitting edema and would be noted in hypothyroidism. Toxic multinodular goiter is characterized by small nodules on the thyroid.
The nurse is teaching an older adult how to manage Graves disease. Which information should the nurse include? A. The administration schedule for an antithyroid drug B. Use of levothyroxine (Synthroid) and lab monitoring C. The schedule for lifelong radioactive iodine treatments D. Preparation for surgical removal of the thyroid
A Rationale: Hyperthyroidism in the older adult is usually managed with the administration of antithyroid drugs and then evaluation to determine if radioactive iodine treatments are necessary. Thyroidectomies are not usually performed in older adults due to preexisting cardiac and central nervous system disorders. Levothyroxine (Synthroid) and lab monitoring are used to treat hypothyroidism.
The nurse is teaching colleagues about hyperthyroidism. Which statement by a colleague indicates understanding of an indication for a thyroidectomy? (Select all that apply.) A. "A thyroidectomy may be performed if the thyroid is compromising the airway." B. "A total thyroidectomy is performed to treat cancer of the thyroid." C. "A thyroidectomy may be performed if the thyroid is placing pressure on the esophagus." D. "The client will not need surgery as long as she takes antithyroid medication." E. "The client may require a thyroidectomy for cosmetic reasons, such as a large goiter."
A,B,C Rationale: A total or partial thyroidectomy may be necessary to treat a thyroid that is placing pressure on the esophagus or obstructing the client's airway. Thyroid cancer can also be treated by a thyroidectomy. A goiter is not removed for purely cosmetic reasons; it is removed for hypothyroidism that produces too much thyroid-stimulating hormone. This can cause a potentially life-threatening condition called myxedema.
Which priority should the nurse include in the teaching plan for a client with Graves disease? (Select all that apply.) A. Take antithyroid drugs as prescribed. B. Tape your eyelids closed at night. C. Drink six to eight glasses of water a day. D. Weigh yourself daily. E. Eat a low-calorie diet.
A,B,C,D Rationale: The client is prescribed an antithyroid medication such as propylthiouracil, which must be taken as prescribed. Due to weight loss, the weight is carefully monitored. Due to exophthalmos, the client must protect the eyes, apply eye drops, wear sunglasses when outside, and tape them closed at night. The client has a decreased appetite and weight loss. A high-calorie diet is recommended. The client may have frequent diarrhea, and maintaining hydration is a priority.
Which manifestation should the nurse monitor when caring for a client on thyroid hormone (TH) replacement therapy? (Select all that apply.) A. Report of dizziness B. Symptoms of hyperthyroidism C. Stable vital signs D. Improvement of symptoms of hypothyroidism E. Decrease in appetite
A,B,C,D Rationale: Vital signs should be assessed on every client, and those receiving TH replacement should be assessed for symptoms related to blood levels. Monitor improvement of symptoms. Dizziness and lack of sleep are some symptoms to report. The client would be expected to have an increase, not decrease, in appetite. If the client begins to experience symptoms of hyperthyroidism, it could indicate that the medication dose needs to be adjusted.
Which physical assessment parameter is most appropriate for the nurse to include when assessing the client for possible hyperthyroidism? (Select all that apply.) A. Vision test B. Confusion C. Vital signs D. Deep tendon reflexes E. Weight loss
A,C,D,E Rationale: Hyperthyroidism may affect many systems in the body, and the nurse would include the weight of the client in the physical assessment, a vision test, vital signs, and a test of the tendon reflexes. Confusion is associated with hypothyroidism.
The nurse is seeing four clients today in the endocrinology clinic. Which client would the nurse expect to be at highest risk for Hashimoto disease? A. A 10-year-old child with congenital hypothyroidism B. A 40-year-old woman with a goiter C. A 50-year-old man with hypothyroidism D. A 60-year-old African American man
B Rationale: Hashimoto disease occurs twice as often in women as in men. The disorder is not commonly seen in children, and it is not more commonly seen in African Americans than in other ethnic groups.
Which nursing intervention is most appropriate for a client experiencing a thyroid storm? A. Cooling the client B. Padding the side rails C. Administering antithyroid medication D. Replacing lost fluids
B Rationale: The client experiencing a thyroid storm is at high risk for developing seizures. Therefore, the nurse would promote safety by padding the side rails. Cooling the client, replacing lost fluids, and administering antithyroid medications are appropriate interventions to treat the disorder but are not related to promoting client safety.
Which treatment should the nurse anticipate for a client who is newly diagnosed with hypothyroidism? A. Partial thyroidectomy B. Treatment with synthetic hormone C. Radiation D. Nonsteroidal anti-inflammatory medications
B Rationale: The expected treatment for hypothyroidism is replacement with synthetic thyroid hormone. Surgical management, such as partial thyroidectomy, is used for management of hyperthyroidism. Radiation may also be used in the treatment plan for a client with hyperthyroidism. Nonsteroidal anti-inflammatory medications may be used in the management of a client with thyroiditis.
The nurse in the fertility clinic is working with a female client who has had repeated miscarriages. Which information in the client's history may be a precipitating factor? A. Type 2 diabetes mellitus B. Uncontrolled hypothyroidism C. Hyperemesis gravidarum D. History of toxic multinodular goiter
B Rationale: Uncontrolled hypothyroidism can lead to miscarriages, stillbirths, preeclampsia, and low birth weights. Type 2 diabetes mellitus can lead to newborns that are large for gestational age. Hyperemesis gravidarum can cause hyperthyroidism in pregnancy. A history of toxic multinodular goiter would not cause repeated miscarriages later in life.
An adult client reports a weight gain and feeling cold all the time. Which condition should the nurse suspect? A. Chronic renal failure B. Hypothyroidism C. Depression D. Hyperthyroidism
B Rationale: Weight gain and feeling cold can be symptoms of hypothyroidism. The nurse would conduct an assessment to validate this assumption. Depression would not usually include weight gain or feeling cold. The weight gain of renal failure is usually associated with fluid retention. Hyperthyroidism presents with weight loss and increased sweating.
The nurse is teaching a group of adults at a community health fair about hypothyroidism. Which risk factor should the nurse include in the presentation? (Select all that apply.) A. Male sex B. Radioactive iodine treatment C. Thyroid surgery D. Radiation of the neck E. Autoimmune disease
B,C,D,E Rationale: Risk factors for hypothyroidism include having an autoimmune disease, having a family member with an autoimmune disease, previous treatment with radioactive iodine, radiation of the neck, thyroid surgery, and female sex.
The nurse reviews the laboratory results for a client and notes that the T4 level is low. Which prescription should the nurse anticipate the healthcare provider to prescribe? A. Beta blocker B. Radioactive iodine C. Thyroid replacement D. Antithyroid medications
C Rationale: The treatment of choice for hypothyroidism is the thyroid hormone replacement drug, levothyroxine. Therefore, the nurse would expect the healthcare provider to prescribe this medication. Radioactive iodine and antithyroid medications are used in the treatment of hyperthyroidism. A beta blocker, such as propranolol, is used to lower the heart rate in clients with hyperthyroidism.
Which physical assessment is most appropriate to include when identifying thyroid problems? (Select all that apply.) A. Percussion B. Medication history C. Observation D. Auscultation E. Palpation
C,E Rationale: Observation, palpation, and taking a family history are useful ways of identifying thyroid health problems. Palpation is used to determine the location, size, and nodules of the thyroid. Auscultation and percussion are not appropriate methods for this assessment. A medication history would be assessed in the health history, not the physical assessment.
The client with hypothyroidism asks the nurse why the thyroid-stimulating hormone (TSH) level is increased if the thyroid is not working properly. Which response by the nurse is accurate? A. "Your TSH level is increased due to an increase in metabolism noted in clients with hypothyroidism." B. "Your TSH level is increased because the thyroid is working harder to produce more hormone." C. "Your TSH level is increased from a malfunction in the hypothalamus, leading to thyroid insufficiency." D. "Your TSH level is increased due to an inadequately functioning negative hormonal feedback process."
D Rationale: The TSH level increases in clients with hypothyroidism due to a loss of the negative hormonal feedback system, not because the thyroid is working harder. Metabolism is decreased in hypothyroidism, not increased. The pituitary gland, not the hypothalamus, is responsible for TSH production.
The nurse is preparing a client with hyperthyroidism for radioactive iodine treatments. Which information should the nurse provide to the client prior to this procedure? (Select all that apply.) A. That the client may need lifelong thyroid replacement B. That hospitalization is usually required C. That the end results are immediately seen D. How to measure the radial pulse E. That radioactive iodine is given intravenously
A,D Rationale: Clients are instructed on measuring their own pulse until stores of thyroid hormone are depleted and notifying the healthcare provider if the heart rate is over 100 beats per minute. The client will more than likely require lifelong thyroid replacement due to radiation effects on the remaining thyroid tissue. The results may take up to 6 to 8 weeks to notice. This procedure is performed with an oral contrast on an outpatient basis.
The nurse is caring for a newborn diagnosed with hyperthyroidism after birth. Ongoing assessments during the first year of life should be conducted to monitor for which alteration? (Select all that apply.) A. Bradycardia B. Premature fontanelle closure C. Respiratory difficulties D. Nonpalpable thyroid gland E. Heart failure
B,C,E Rationale: An infant with hyperthyroidism would have higher metabolic rates, leading to tachycardia and heart failure. The infant may develop respiratory difficulties from an enlarged thyroid pressing on the trachea. The fontanelles will also close prematurely. The thyroid gland will be palpable.
The nurse is caring for a client newly diagnosed with Graves disease. The client asks the nurse how the goiter occurred. Which factor should the nurse include in the response? (Select all that apply.) A. The client's tissues form antibodies. B. The thyroid gland enlarges. C. The client's tissues form antigens. D. The thyroid cells become hypoactive. E. Antibodies bind to the thyroid-stimulating hormones.
C, D, E Rationale: Goiters can occur when the thyroid gland produces either too much thyroid hormone or not enough. Antibodies bind to the thyroid-stimulating hormones (TSH) in the thyroid follicles. As the gland enlarges, a goiter develops. The thyroid cells become hyperactive. The tissues form antibodies, not antigens.
A heel-stick screening of a newborn reveals the presence of T4 deficiency along with elevated thyroid-stimulating hormone (TSH). The infant is diagnosed with hypothyroidism. Which information should the nurse provide the parents? A. The child will require evaluation for radioactive iodine. B. The child will eventually grow out of this and no longer need treatment. C. The child will be involved in infertility treatment later in life. D. The child will need lifelong thyroid medication supplementation.
D Rationale: Hypothyroidism detected in neonates requires lifelong supplementation of thyroid hormone. The drug of choice for children is oral levothyroxine. The child would not require radioactive iodine, as this is reserved for hyperthyroidism. Infertility is a possibility for those women with hypothyroidism who do not ovulate. The child will not grow out of this, and will need lifelong treatment.
