220 Exam 4 Iggy Ch. 63
a, b, d, f
49. Which disorders/conditions can cause hyperparathyroidism? Select all that apply. a. Chronic kidney disease b. Neck trauma c. Thyroidectomy d. Vitamin D deficiency e. Parathyroidectomy f. Congenital hyperplasia
b
5. Which factor is a key assessment finding that signifies hypothyroidism? a. Irritability b. Cold intolerance c. Diarrhea d. Fatigue
a
50. A patient has hyperparathyroidism and high levels of serum calcium. Which initial medication does the nurse prepare to administer to the patient? a. Furosemide with IV saline b. Calcitonin c. Oral phosphates d. Mithramycin
a, b, f
51. Which are assessment findings of hypocalcemia? Select all that apply a. Numbness and tingling around mouth b. Muscle cramping c. Bone fractures d. Fever e. Tachycardia f. Trousseau's and Chvostek's signs
a, b, c, e
52. Which medication therapies does the nurse expect patients with hypoparathyroidism to receive? Select all that apply. a. Calcium chloride b. Calcium gluconate c. Calcitriol d. Propranolol e. Ergocalciferol f. Furosemide
b, e, f
47. Which foods will the nurse instruct a patient with hypoparathyroidism to avoid? Select all that apply. a. Canned vegetables b. Yogurt c. Fresh fruit d. Red meat e. Milk f. Processed cheese
c
48. A patient with continuous spasms of the muscles is diagnosed with hypoparathyroidism. The muscle spasms are a clinical manifestation of which condition? a. Nerve damage b. Seizures c. Tetany d. Decreased potassium
d
1. The nurse is performing a physical examination of a patient's thyroid gland. Precautions are taken in performing the correct technique because palpation can result in which occurrence? а Damage to the esophagus causing gastric reflux b. Obstruction of the carotid arteries causing a stroke c. Pressure on the trachea and laryngeal nerve causing hoarseness d. Exacerbation of symptoms by releasing additional thyroid hormone
b
17. The nurse is providing instructions to a patient who is taking the antithyroid medication propylthiouracil (PTU). The nurse instructs the patient to notify the health care provider immediately if which sign/symptom occurs? a. Weight gain b. Dark-colored urine c. Cold intolerance d. Headache
b
10. What is the most common cause of hyperthyroidism? а. Radiation to thyroid b. Graves' disease c. Thyroid cancer d. Thyroiditis
d
11. The nurse assessing a patient palpates enlargement of the thyroid gland, along with noticeable swelling of the neck. How does the nurse interpret this finding? a. Globe lag b. Мухedema c. Exophthalmos d. Goiter
b
12. The nurse is assessing a patient diagnosed with hyperthyroidism and observes dry, waxy swelling of the front surfaces of the lower legs. How does the nurse interpret this finding? a. Globe lag b. Pretibial myxedema c. Exophthalmos d. Goiter
c
13. Which statement best describes globe lag in a patient with hyperthyroidism? a. Abnormal protrusion of the eyes b. Upper eyelid fails to descend when the patient gazes downward c. Upper eyelid pulls back faster than the eyeball when the patient gazes upward d. Inability of both eyes to focus on an object simultaneously
c
14. The nurse is assessing a patient with Graves' disease and observes an abnormal protrusion of both eyeballs. How does the nurse document this assessment finding? а. Globe lag b. Pretibial myxedema c. Exophthalmos d. Goiter
a, b, e, f
15. Which statements about hyperthyroidism are accurate? Select all that apply a. It is most commonly caused by Graves disease. b. It can be caused by overuse of thyroid replacement medication. с. It occurs more often in men between the ages of 20-40. d. Weight gain is a common manifestation. e. Serum T3 and T4 results will be elevated. f. There may be an increase in number of bowel movements per day.
c
16. The nurse is providing instructions to a patient taking levothyroxine. What key information about dosing does the nurse tell the patient about this medication? а. It is started at a high dose and gradually decreased based on symptom relief. b. With myxedema coma, the drug is crushed and given through a feeding tube. c. Starting at too high a dose or increasing the dose too rapidly can cause severe hypertension, heart failure, and myocardial infarction. d. The patient requires this therapy until all symptoms are completely relieved.
a
18. The patient who is prescribed methimazole 4 mg orally every 8 hours tells the nurse that his heart rate is slow (60/minute), he has gained 7 pounds, and wears a sweater even on warm days. What does the nurse suspect? a. Indications of hypothyroidism will require a lower dosage. b. Indications of hypothyroidism will require a higher dosage. c. Indications of hyperthyroidism will require a lower dosage. d. Indications of hyperthyroidism will require a higher dosage
b
19. A patient who has been diagnosed with Graves disease is to receive radioactive iodine (RAI) in the oral form of I-131. What does the nurse teach the patient about how this drug works? a. It destroys the hormones T3 and T4 b. It destroys the tissue that produces thyroid hormones с. It blocks thyroid hormone production. d. It prevents T4 from being converted to T3.
a, c, d, f
2. Which assessment findings indicate hyperthyroidism? Select all that apply. a. Weight loss with increased appetite b. Constipation c. Increased heart rate d. Insomnia e. Decreased libido f. Heat intolerance
a, b, c, d, f
20. A patient who has been diagnosed with Graves' disease is to receive radioactive iodine (RAI) in the oral form of I-131 as a treatment. What instructions does the nurse include in the teaching plan about preventing radiation exposure to others? Select all that apply. a. Do not share a toilet with others for 2 weeks after treatment. b. Flush the toilet three times after each use. c. Wash clothing separately from others in the household. d. Limit contact with pregnant women, infants, and children. е. Do not use a laxative within 2 weeks of having the treatment. f. It may take 6 to 8 weeks after RAI therapy for complete symptom relief.
a, b, d, e
21. Which statements about hypothyroidism are accurate? Select all that apply. a. It occurs more often in women. b. It can be caused by iodine deficiency с. Weight loss is a common manifestation. d. It can be caused by autoimmune thyroid destruction. е. Myxedema coma is a rare but serious complication. f. Symptoms are the result of high levels of metabolism.
a, b, f
22. The nurse is assessing a patient with a diagnosis of Hashimoto's disease. What are the primary manifestations of this disease? Select all that apply a. Dysphagia b. Painless enlargement of the thyroid gland c. Painful enlargement of the thyroid gland d. Weight loss e. Intolerance to heat f. Diagnosis based on circulating antithyroid antibodies
b
26. Which condition is a life-threatening emergency and serious complication of untreated or poorly treated hypothyroidism? a. Endemic goiter b. Myxedema coma c. Toxic multinodular goiter d. Thyroiditis
c
27. A patient with exophthalmos from hyperthyroidism reports dry eyes, especially in the morning. The nurse teaches the patient to perform which intervention to help correct this problem? a. Wear sunglasses at all times when outside in the bright sun. b. Use cool compresses to the eye four times a day. c. Tape the eyes closed with nonallergenic tape. d. There is nothing that can be done to relieve this problem.
a, c, d, f
28. Which factors are considered to be triggers for thyroid storm? Select all that apply a. Infection b. Cold temperatures c. Vigorous palpation of a goiter d. Diabetic ketoacidosis e. Extremely warm temperatures f. Pregnancy
a
29. A patient has the following assessment findings: elevated TSH level, low T3 and T4 levels, difficulty with memory, lethargy, and muscle stiffness. These are clinical manifestations of which disorder? a. Hypothyroidism b. Hyperthyroidism c. Hypoparathyroidism d. Hyperparathyroidism
c
4. Which factor is a hallmark assessment finding that signifies hyperthyroidism? a. Weight loss b. Increased libido c. Heat intolerance d. Diarrhea
b
3. The nurse assesses a patient in the emergency department (ED) and finds the following: constipation, fatigue with increased sleeping time, impaired memory, facial puffiness, and weight gain. Which deficiency does the nurse recognize? a. Hyperthyroidism b. Hypothyroidism c. Hyperparathyroidism d. Hypoparathyroidism
b
30. A patient has been prescribed thyroid hormone for treatment of hypothyroidism. Within what time frame does the patient expect improvement in mental awareness with this treatment? a. A few days b. 2 weeks c. 1 month d. 3 months
a, c, d, e
31. Which signs and symptoms are assessment findings indicative of thyroid storm? Select all that apply. a. Abdominal pain and nausea b. Hypothermia c. Elevated temperature d. Tachycardia e. Elevated systolic blood pressure f. Bradycardia
a, b, c, e, f
32. Management of the patient with hyperthyroidism focuses on which goals? Select all that apply a. Blocking the effects of excessive thyroid secretion b. Treating the signs and symptoms the patient experiences c. Establishing euthyroid function d. Preventing spread of the disease e. Maintaining an environment of reduced stimulation f. Promoting comfort
b, c, d, e
33. Which are preoperative instructions for a patient having thyroid surgery? Select all that apply. a. Teach postoperative restrictions such exercises to prevent strain on the suture line. b. Teach the moving and turning technique of manually supporting the head and avoiding neck extension to minimize strain on the suture line. c. Inform the patient that hoarseness for a few days after surgery is usually the result of a breathing tube (endotracheal tube) used during surgery. d. Humidification of air may be helpful to promote expectoration of secretions. Suctioning may also be used. e. Clarify any questions regarding placement of incision, complications, and postoperative care. f. A supine position and lying flat will be maintained postoperatively to avoid strain on suture line.
a, b, d, e, f
34. The nurse is preparing for a patient to return from thyroid surgery. What priority equipment does the nurse ensure is immediately available? Select all that apply. а. Tracheostomy equipment b. Calcium gluconate or calcium chloride for IV administration c. Mechanical ventilator d. Humidified oxygen e. Suction equipment f. Pillows
d
42. Serum calcium levels are maintained by which hormone? a. Cortisol b. Luteinizing hormone c. Antidiuretic hormone (ADH) d. Parathyroid hormone (PTH)
a
43. Production of which hormone causes lower levels of calcium? a. Calcitonin b. Parathyroid hormone (PTH) c. Thyroxine (T4) d. Thyroid stimulating hormone (TSH)
d
35. After a thyroidectomy, a patient reports tingling around the mouth and muscle twitching. Which complication do these assessment findings indicate to the nurse? a. Hemorrhage b. Respiratory distress c. Thyroid storm d. Hypocalcemia
c, d
36. The nurse assesses a patient for laryngeal nerve damage after thyroidectomy. Which findings indicate this complication? Select all that apply a. Dyspnea b. Sore throat c. Hoarseness d. Weak voice e. Dry cough f. Increased respiratory rate
c
37. The nurse is assessing a patient after thyroid surgery and discovers harsh, high-pitched respiratory sounds. What is the nurse's best first action? a. Administer oxygen at 5 L via nasal cannula b. Administer IV calcium chloride. c. Notify the Rapid Response Team. d. Suction the patient for oral secretions.
b
38. After hospitalization for myxedema, a patient is prescribed thyroid replacement medication. Which statement by the patient demonstrates a correct understanding of this therapy? a. "I'll be taking this medication until my symptoms are completely resolved." b. "I'll be taking thyroid medication for the rest of my life." c. "Now that I'm feeling better, no changes in my medication will be necessary. d. "I'm taking this medication to prevent symptoms of an overactive thyroid gland."
a, b, d, e, f
39. Which statements about thyroiditis are accurate? Select all that apply a. It is an inflammation of the thyroid gland. b. Hashimoto's disease is the most common type. c. It always resolves with antibiotic therapy. d. There are three types: acute, subacute, and chronic. e. The patient must take thyroid hormones. f. Subacute thyroiditis is caused by a viral infection.
b
44. Bone changes in the older adult are often seen with endocrine dysfunction and increased secretion of which substance? a. Parathyroid hormone (PTH) b. Calcitonin c. Insulin d. Testosterone
c
45. In addition to regulation of calcium levels, parathyroid hormone (PTH) and calcitonin regulate the circulating blood levels of which substance? a. Potassium b. Sodium c. Phosphate d. Chloride
b
46. A patient has positive Trousseau's and Chvostek's signs resulting from hypoparathyroidism. What condition does this assessment finding indicate? a. Hypercalcemia b. Нуросalcemia c. Hyperphosphatemia d. Hypophosphatemia
a, c, f
53. Discharge planning for a patient with chronic hypoparathyroidism includes which instructions? Select all that apply a. Take prescribed medications for the rest of the patient's life. b Eat foods low in vitamin D and high in phosphorus. c. Eat foods high in calcium, but low in phosphorus. d. Discontinue medication after several weeks. e. Kidney stones are no longer a risk to the patient. f. Interventions to reduce anxiety
b
54. In older adults, assessment findings of fatigue, altered thought processes, dry skin, and constipation are often mistaken for signs of aging rather than assessment findings for which endocrine disorder? a. Hyperthyroidism b. Hypothyroidism c. Hyperparathyroidism d. Hypoparathyroidism
d
55. What is the most common cause of death from myxedema coma? a. Myocardial infarction b. Acute kidney failure c. High serum level of iodide d. Respiratory failure
a, c, d
56. Which conditions may precipitate myxedema coma? Select all that apply. a. Rapid withdrawal of thyroid medication b. Vitamin D deficiency c. Untreated hypothyroidism d. Surgery e. Excessive exposure to iodine f. Radioactive iodine (RAI) treatment
d
57. The nurse is caring for a young female patient with papillary carcinoma of the thyroid gland. Which treatment is most likely to be prescribed for this patient? a. Radiation therapy b. Ablation c. Chemotherapy d. Thyroidectomy
a, c, e, f
58. Which patient care task would the nurse supervise but delegate to unlicensed assistive personnel (UAP) when providing care for a patient with hyperthyroidism? Select all that apply. a. Check vital signs and report any temperature elevation immediately b. Administer methimazole (Tapazole) as ordered. c. Ensure that the patient has a pitcher of fresh ice water at the bedside. d. Teach the patient about thyroid replacement therapy. e. Change the bed linen whenever it becomes damp. f. Remind the patient to take a cool shower if sweating occurs.
a
59. The unlicensed assistive personnel (UAP) is providing a bath for a patient with hyperparathyroidism. What essential teaching must the nurse provide to the UAP? a. Handle the patient carefully and use a lift sheet for repositioning. b. Be sure to use a bath blanket to keep the patient from shivering. c. Remind the patient about the importance of consuming foods rich in potassium. d. Allow the patient to get out of bed and walk to the bathroom without assistance.
b
6. Which sign/symptom is one of the first indicators of hyperthyroidism that is often noticed by the patient? a. Eyelid or globe lag b. Vision changes or tiring of the eyes c. Protruding eyes d. Photophobia
d
7. Which laboratory result is consistent with a diagnosis of hyperthyroidism? a. Decreased serum triiodothyronine (T3) and thyroxine (T4) levels b. Elevated serum thyrotropin-releasing hormone (TRH) level c. Decreased radioactive iodine uptake d. Increased serum T3 and T4
b
8. The laboratory results for a 53-year-old patient indicate a low T3 level and elevated thyroid stimulating hormone (TSH). What do these results indicate? a. Hyperthyroidism b. Hypothyroidism c. Malfunctioning pituitary gland d. Normal laboratory values for this age
a
9. The clinical manifestations of hyperthyroidism are known as which condition? a. Thyrotoxicosis b. Euthyroid function c. Graves' disease d. Hypermetabolism