244 Unit 5 Adaptive Quizzing Questions
The nurse assesses a patient with Cushing syndrome and finds periorbital edema and rounded moon face. Which other assessment would the nurse find that supports the diagnosis of Cushing syndrome? 1 Purplish-red marks on the abdomen 2 BP 90/60 3 Hyperreflexia 4 Hair loss
1 Signs and symptoms of Cushing syndrome are caused by excessive levels of circulating serum cortisol and include periorbital edema; striae (purplish red marks) on chest, abdomen, and buttocks; moon face; and hypertension (not BP 90/60). Hyperreflexia would be seen in hyperthyroidism or hypoparathyroidism. Hair loss may be seen in hypo- or hyperthyroidism.
Which laboratory value would be affected if the parathyroid glands are removed during surgery? 1 Calcium levels 2 Potassium levels 3 Blood glucose levels 4 Sodium and chloride levels
1 The parathyroid gland plays a key role in maintaining calcium levels. Potassium, sodium, glucose, and chloride are not influenced directly by the loss of the parathyroid gland.
Which condition describes a reason for assessing women of childbearing age for thyroid disorders? 1 Risk for infertility 2 Decreased immunity 3 Increased risk for breast cancer 4 Increased risk for type 2 diabetes
1 Thyroid disorders may interfere with the menstrual cycle, which can result in infertility problems. Thyroid disorders do not necessarily place the patient at risk for decreased immunity, increase the risk for breast cancer, or increase the risk for type 2 diabetes.
Which clinical manifestations would the nurse assess in a patient with hyperthyroidism? Select all that apply. 1 Enlarged, scaly tongue 2 A positive bruit upon auscultation of the thyroid gland 3 Dry, thick, inelastic, and cold skin 4 A goiter 5 Clubbing of the fingers
245 In a patient with hyperthyroidism, auscultation of the thyroid gland reveals bruits and palpation of the thyroid gland reveals goiter, and the nurse may observe the acropachy (clubbing of the digits). Enlarged, scaly tongue and dry, thick, inelastic, and cold skin are observed in patients with hypothyroidism.
A patient diagnosed with hyperthyroidism received radioactive iodine one week ago. The patient tells the nurse, "I don't think the medication is working. I don't feel any different." Which is the best response by the nurse? 1 "You should notify your health care provider immediately." 2 "You may need to have your thyroid removed sooner than anticipated." 3 "It may take several weeks to see the full benefits of the treatment." 4 "You don't feel any different? Would you like to sit down and talk about it?"
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Based on the history and assessment, the nurse suspects that a patient is likely hypothyroid. Place the laboratory tests in order from most effective to least effective for diagnosing hypothyroidism.
Correct1.Thyroid-stimulating hormone (TSH) Correct2.Free thyroxine (T4) Correct3.Triiodothyronine (T3) Correct4.Thyroglobulin TSH is the most sensitive diagnostic test for evaluating thyroid function. T4 is better than T3 as a diagnostic test because it is not affected by protein levels like total T4, so it is thought to be a more precise marker of thyroid function. T3 is used to diagnose hyperthyroidism if TSH is abnormal and T4 is normal. Thyroglobulin is used primarily as a tumor marker for patients being treated for thyroid cancer.
Arrange the symptoms in order from most specific to least specific for Cushing syndrome. .Weight gain .Decreased muscle mass .Hirsutism .Striae
striae decreased muscle mass hirsutism weight gain
Which finding would the nurse assess in a patient with hypothyroidism? 1 Goiter 2 Protruding eyes 3 Weight loss 4 High BP
1 A goiter is a common clinical manifestation of hypothyroidism caused by the thyroid's compensatory enlargement to try to produce and secrete more thyroid hormone. Protruding eyes (exophthalmos) occurs in hyperthyroidism because of the fluid accumulation in the eye and retroorbital tissue. Weight loss is associated with hyperthyroidism due to an increase in metabolism. Hypertension is associated with hyperthyroidism, pheochromocytoma, or Cushing syndrome and is caused by increased metabolic demands and catecholamines.
The nurse is performing discharge education for a patient newly diagnosed with hypothyroidism and is beginning thyroid hormone therapy. Which statement by the patient to the nurse confirms that discharge teaching was effective? 1 "I should take my levothyroxine every morning before eating my breakfast." 2 "I should only follow up with my doctor if I start having shortness of breath." 3 "I should keep the air conditioning a few degrees colder to help me with sweating." 4 "I should limit the amount of fiber I am eating to help keep me from getting constipated."
1 A patient with a new diagnosis of hypothyroidism should be taught how to manage hypothyroidism, including taking the thyroid hormone in the morning before food. Patients with hypothyroidism need to be taught about the importance of regular follow-up care, not just when they are having abnormal symptoms. Patents with hypothyroidism should be taught to keep the environment warm and comfortable because of cold intolerance. Patients with hypothyroidism should increase the amount of fiber in their diet to prevent constipation; they should not limit the amount of fiber.
Activity intolerance in a patient with hypothyroidism is related to which side effect? 1 Fatigue 2 Diarrhea 3 Weight loss 4 Nervousness
1 Activity intolerance in a patient with hypothyroidism is related to weakness and fatigue. Patients with hyperthyroidism, not hypothyroidism, experience weight loss, diarrhea, and nervousness.
Which patient statement indicates the need for further education regarding the management of both cardiac disease and hypothyroidism? 1 "I will use an enema for constipation." 2 "I will use a sedative to treat insomnia." 3 "I should take my thyroid medication in the morning before eating." 4 "I should not switch to another brand of hormone unless I check with my health care provider."
1 Enemas are contraindicated for patients diagnosed with both cardiac disease and hypothyroidism. Enemas cause vagal stimulation that can lead to fainting. The patient is taught to use laxatives, stool softeners, and to consume a fiber-rich diet to treat constipation, rather than using enemas. Using low-dose sedatives is recommended if the patient is experiencing insomnia. Thyroid medication should be taken in the morning before food. Switching to different brands is not recommended because bioavailability may differ with different brands.
To promote optimal absorption, the nurse would instruct a patient to take their levothyroxine at which time? 1 0600 2 1200 3 1600 4 2100
1 For maximum absorption, levothyroxine should be taken first thing in the morning on an empty stomach 30 minutes before breakfast. 1200, 1600, and 2100 may not result in adequate absorption.
A patient reports weight loss, increased appetite, chest pain, and hair loss and is diagnosed with hyperthyroidism. Which additional findings would the nurse assess in this patient? Select all that apply. 1 Warm, smooth, moist skin 2 Elevated BP 3 Tachycardia 4 Darkening of the skinfolds 5 Moon face
123 Hyperthyroidism occurs due to the hypersecretion of thyroid hormone, resulting in an increased basal metabolic rate, which can cause signs and symptoms such as warm, smooth moist skin, elevated BP, and increased heart rate (tachycardia). Increased secretion of MSH from Addison's disease causes darkening of the skin in skinfolds. Moon face (periorbital edema) and facial fullness is due to increased cortisol secretion seen in Cushing disease.
Which nursing interventions would be included in the plan of care for a patient recovering from a thyroidectomy? Select all that apply. 1 Assessing for tetany 2 Monitoring vital signs 3 Monitoring potassium levels 4 Assessing the patient every two hours on the first postoperative day 5 Placing the patient in a high Fowler's position
124 Postoperative nursing interventions that are appropriate for a patient after a thyroidectomy include assessing for tetany, monitoring vital signs, and assessing the patient every two hours on the first postoperative day for hemorrhage and tracheal compression. The nurse should monitor calcium levels, not potassium levels. The nurse should place the patient in a semi-Fowler's position to reduce swelling and edema in the neck area. Sandbags or pillows may be used to support the head or neck.
Which clinical manifestations would the nurse assess in a patient with hyperthyroidism? Select all that apply. 1 Weight loss 2 Protrusion of the eyeballs 3 Thick, cold, and dry skin 4 Elevated BP 5 Purplish-red marks on the abdomen
124 Weight loss, protrusion of the eyeballs, and elevated BP are clinical manifestations of hyperthyroidism. Weight loss and hypertension are due to increases in metabolic demands; protrusion of the eyeballs is due in part to accumulation of fluid in the eyes. Thick, cold, and dry skin are symptoms of hypothyroidism. Purplish-red marks on the abdomen are seen in Cushing syndrome.
Which laboratory values support the diagnosis of primary hypothyroidism? 1 Low thyroid-stimulating hormone (TSH) level, low thyroxine level 2 High TSH level, low thyroxine level 3 Low TSH level, low basal metabolic rate 4 Low TSH level, high basal metabolic rate
2 Primary hypothyroidism is caused by destruction of thyroid tissue or defective hormone synthesis. It is characterized by a high TSH level and a low thyroxine level. A low TSH level and low thyroxine level support secondary hypothyroidism. A low TSH level and a low basal metabolic rate (BMR) support secondary hypothyroidism. A low TSH and high BMR indicate hyperthyroidism.
Which symptoms of drug toxicity would the nurse teach the patient who is taking levothyroxine? Select all that apply. 1 Chest pain 2 Weight gain 3 Nervousness 4 Tachycardia 5 Cold intolerance 6 Mental sluggishness
134 Levothyroxine is a synthetic thyroid hormone used to treat hypothyroidism. The signs of overtreatment, or levothyroxine toxicity, are the same as the signs of hyperthyroidism, a state of increased metabolism and increased tissue sensitivity to sympathetic nervous system stimulation. Signs of overtreatment of hypothyroidism with levothyroxine include chest pain, nervousness, and tachycardia. Weight gain, cold intolerance, and mental sluggishness are signs of hypothyroidism.
Which symptoms would alert the nurse to a need for immediate action for a patient with Addison's disease who has developed a postoperative infection? Select all that apply. 1 Fever 2 Bradycardia 3 Hypotension 4 Hypokalemia 5 Hypernatremia 6 Hypoglycemia
136 Fever, hypotension, and hypoglycemia are signs of addisonian crisis, which requires immediate shock management and high-dose hydrocortisone replacement. Bradycardia, hypokalemia, and hyponatremia are not signs of addisonian crisis; tachycardia, hyperkalemia, and hyponatremia are signs of it.
Which effect may be observed if large amounts of endogenous corticosteroids are released into systemic circulation during surgery on a patient with Cushing syndrome? 1 Fatigue 2 Infections 3 Delusions 4 Hypotension
2 A patient may become susceptible to infections if the endogenous corticosteroid levels are high during surgery. Fatigue and delusions may not occur due to elevated corticosteroids. Hypertension, not hypotension, is observed due to increased levels of corticosteroids.
Which symptom would the nurse expect to see in a patient suspected of having hypothyroidism? 1 Diaphoresis 2 Constipation 3 Heat intolerance 4 Systolic hypertension
2 Constipation is a common symptom of hypothyroidism. Diaphoresis, heat intolerance, and systolic hypertension are symptoms of hyperthyroidism. Hypothyroidism causes cold intolerance, not heat intolerance. Other symptoms of hypothyroidism include lethargy, weakness, muscle aches, weight gain, dry skin and hair, loss of body hair, and bradycardia.
Which is a clinical manifestation of Cushing syndrome? 1 Hypovolemia 2 Hypokalemia 3 Hyperkalemia 4 Hyponatremia
2 Hypokalemia is a sign of Cushing syndrome because of the hyperfunctioning of the adrenal cortex. The adrenal cortex produces excess mineralocorticoid, which can cause hypokalemia from potassium excretion. Hypovolemia, hyperkalemia, and hyponatremia are clinical manifestations of Addison's disease because of the hypofunctioning of the adrenal cortex.
The patient is brought to the emergency department following a car accident and is wearing medical identification that says the patient has Addison's disease. Which collaborative intervention would be included in the plan of care for this patient? 1 Low-sodium diet 2 Increased glucocorticoid replacement 3 Suppression of pituitary adrenocorticotropic hormone (ACTH) synthesis 4 Elimination of mineralocorticoid replacement
2 The patient with Addison's disease needs lifelong glucocorticoid and mineralocorticoid replacement and has an increased need with illness, injury, or stress, as this patient is experiencing. The patient with Addison's disease may also need a high-sodium diet. Suppression of pituitary ACTH synthesis is done for Cushing's syndrome. Elimination of mineralocorticoid replacement cannot be done for Addison's disease, which would put the patient at risk for Addisonian crisis.
The nurse is teaching care guidelines to the parent of a child with hypothyroidism. During the follow-up visit, the nurse suspects that the child may be receiving ineffective treatment. Which action of the parent supports the nurse's suspicion? 1 The parent is giving the child fiber-rich food. 2 The parent gives the child a thyroid supplement after meals. 3 The mother gives the child a thyroid supplement each morning. 4 The mother encourages the child to increase activity and exercise.
2 Thyroid supplements should be given on an empty stomach in order to enhance absorption. Therefore giving thyroid supplements after meals reduces the concentration of medication in the blood. Thyroid supplements may cause constipation, so the nurse recommends that the parent give the child fiber-rich food. Thyroid supplements should be given in the morning for effective treatment. Hypothyroidism causes low metabolic activity, so a gradual increase in activity and exercise will be beneficial for the child.
hich symptoms would the nurse assess in a patient who has Addison's disease? Select all that apply. 1 Weight gain 2 Hyperpigmentation 3 Weakness and fatigue 4 Orthostatic hypotension 5 Thin skin with ecchymosis
234 Hyperpigmentation, orthostatic hypotension, and weakness coupled with fatigue are all manifestations of Addison's disease. A patient with Addison's disease will have weight loss, not weight gain. Thin skin with ecchymosis is a manifestation of Cushing syndrome, not Addison's disease.
Which instructions would the nurse include in a dietary teaching plan provided to a patient who is diagnosed with hyperthyroidism? Select all that apply. 1 Eat a high-fiber diet. 2 Consume a high-calorie diet. 3 Eat snacks high in protein. 4 Avoid caffeinated beverages. 5 Decrease the intake of carbohydrates
234 A diet high in calories and protein is encouraged. Caffeinated beverages should be avoided. High-fiber foods should be avoided, not encouraged, because they can further stimulate the already hyperactive gastrointestinal tract. The patient should increase intake of carbohydrate-rich foods to compensate for the increased metabolism. This provides energy and decreases the use of body-stored protein.
Which nursing intervention would be included in the plan of care for a patient with a diagnosis of hypothyroidism? 1 Providing a dark, low-stimulation environment 2 Closely monitoring the patient's intake and output 3 Patient teaching related to levothyroxine 4 Patient teaching related to radioactive iodine therapy
3 A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine. It is not necessary to carefully monitor intake and output, and low stimulation and radioactive iodine therapy are indicated in the treatment of hyperthyroidism.
Which finding would the nurse assess in a patient admitted with Addison's disease? 1 Goiter 2 Oversized hands and feet 3 "Bronze" skin tone 4 Weight gain
3 Addison's disease is characterized by hyperpigmentation or "bronzing" of the skin in parts of the body such as the knuckles, elbows, and knees. A goiter is characterized by the enlargement of the thyroid gland and is associated with hypo- or hyperthyroidism. Oversized hands and feet are seen in acromegaly, which is characterized by an overgrowth of the bones and soft tissues. Weight gain would be seen in Cushing syndrome, which is characterized by hyperglycemia, hypertension, and weight gain.
Which physiologic factor is related to the development of Cushing syndrome? 1 Liver dysfunction 2 Chronic renal failure 3 Excessive secretion of adrenocorticosteroid hormones 4 Decreased secretion of adrenocorticosteroid hormones
3 Cushing syndrome results from excessive secretion of adrenocorticosteroid hormones, usually caused by pituitary gland tumors or carcinoma of the adrenal glands. It is also the result of excessive steroid intake for other medical conditions or nonmedical use (e.g., sports). Cushing syndrome is not directly related to liver function or renal failure. It is caused by excessive, not decreased, amounts of adrenocorticosteroid hormones.
Which finding would the nurse assess in a patient with hyperthyroidism? 1 Moon face 2 Striae on skin 3 Exophthalmos 4 Thick, dry skin
3 Exophthalmos is a condition in which the eyeballs protrude from the orbits. Exophthalmos occurs in hyperthyroidism due to accumulation of fluid in the eye and the retroorbital tissue. Moon face is periorbital edema and facial fullness, which is associated with Cushing syndrome due to an increase in cortisol secretion. Striae are purplish-red marks below the skin surface also associated with Cushing syndrome. Thick, dry skin is not a clinical manifestation of hyperthyroidism; the patient with hyperthyroidism has warm, smooth, moist skin due to increased metabolism.
Which parameter is monitored that would indicate a corticosteroid imbalance after surgery in a patient with Cushing syndrome? 1 Temperature 2 Infection 3 Fluid intake 4 Oxygen saturation
3 Fluid intake should be monitored because there may be a chance of corticosteroid imbalance after surgery, which can cause dehydration. Temperature and oxygen saturation monitoring are not related to corticosteroid imbalance. Infections should be monitored during surgery.
During an assessment, the nurse palpates the thyroid gland. Which finding does this indicate in an older adult? 1 The onset of hypertension 2 The onset of diabetes mellitus 3 This is a normal finding in the elderly. 4 An explanation for reduced urine outp
3 Gerontologic changes that occur to the thyroid gland include increase in nodularity and an increased incidence of hypothyroidism, both of which would make the gland more easily palpated. The thyroid gland does not have any effect on the development of hypertension, diabetes mellitus, or reduced urine output.
Which parameter would indicate the optimal intended effect of therapy with levothyroxine? 1 BP 120/78 mm Hg 2 Weight loss of 5 pounds 3 Thyroid-stimulating hormone (TSH) within normal limits 4 White blood cell count 8000 mm3
3 Levothyroxine is a thyroid preparation used for hypothyroidism. A normal TSH level (between 0.4 to 4 mIU/L) indicates optimal intended effects of the medication. Weight loss, BP, and a normal white blood cell count are not indicators of effective treatment with levothyroxine.
The health care provider was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessment would the nurse prioritize when providing postoperative care for this patient? 1 Signs of infection 2 Red blood cell level 3 Serum calcium levels 4 Level of consciousness
3 Loss of the parathyroid gland is associated with hypocalcemia. Infection, changes in red blood cell, and level of consciousness would all be monitored after a surgery but are not a priority related to parathyroid gland removal.
Which test would the nurse prepare a patient who has been prescribed to undergo a diagnostic procedure to determine the severity of thyroid dysfunction? 1 X-ray 2 CT scan 3 Radioactive iodine uptake (RAIU) 4 MRI
3 RAIU measures the thyroid functioning in terms of its activity. X-ray, CT, and MRI are radiographic tests that are best used for identifying tumors.
Which rationale is accurate regarding the need for a long-term corticosteroid to be gradually reduced? 1 Prevention of hypothyroidism 2 Prevention of diabetes insipidus 3 Prevention of adrenal insufficiency 4 Prevention of cardiovascular complications
3 Sudden cessation of corticosteroid therapy can precipitate life-threatening adrenal insufficiency. Diabetes insipidus, hypothyroidism, and cardiovascular complications are not common consequences of suddenly stopping corticosteroid therapy.
Which disease is treated with corticosteroidal hormonal therapy? 1 Thyrotoxicosis 2 Nephrotic syndrome 3 insufficiency 4 Rheumatoid arthritis
3 The mainstay treatment of adrenal insufficiency is lifelong hormone therapy with glucocorticoids and mineralocorticoids. Thyrotoxicosis, nephritic syndrome, and rheumatoid arthritis are treated with corticosteroid drug therapy.
Which action would the nurse take first for a patient who underwent thyroid surgery and develops neck swelling? 1 Assess vital signs. 2 Evaluate difficulty in speaking. 3 Assess the patient for signs of hemorrhage. 4 Place the patient in a semi-Fowler's position.
3 The patient who undergoes thyroid surgery is at risk for hemorrhage. Swelling is a clinical manifestation of hemorrhage. The first nursing action is to assess the patient for any signs of hemorrhage. After checking the dressing and the back of the neck for bleeding, a set of vital signs should be taken. Evaluating difficulty in speaking helps in assessing the signs of hoarseness, which can also be caused by edema, but hoarseness is not unusual for the first three to four days after surgery. Placing the patient in a semi-Fowler's position helps in avoiding flexion of the neck and tension on the suture lines but would not be done first.
A patient who has been diagnosed with Addison's disease reports severe back and abdominal pain. Lab results include an increased level of adrenocorticotropic hormone (ACTH). Which clinical manifestation is the nurse likely to find when assessing the patient? 1 Pallor 2 Cyanosis 3 Weight loss 4 Dehydration
3 Unrelieved pain can affect the endocrine system and cause an increase in the levels of ACTH. Elevated ACTH levels result in increased catabolic processes in the body. This ultimately causes weight loss. Pallor, cyanosis, and dehydration do not indicate presence of pain in the patient. Pallor, paleness of the skin, is caused by anemia. Cyanosis is the bluish discoloration of the skin and the mucous membrane that is associated with tissue hypoxia. Dehydration is not associated with increased ACTH levels.
The nurse is teaching an elderly patient with Cushing syndrome about home care. Which statement made by the patient indicates effective learning? 1 "I don't require a home health nurse." 2 "I will take acetaminophen if I have fever." 3 "I will wear a Medic Alert bracelet all the time." 4 "I can't take corticosteroid therapy for lifetime."
3 Wearing a Medic Alert bracelet would indicate that the patient has Cushing syndrome and will help to provide an appropriate therapy in case of emergency. A home nurse should be provided to an elderly patient for assistance in daily activities. If any side effects (such as fever) occur, then the patient should consult the health care provider immediately. Corticosteroid therapy should be taken for the patient's lifetime.
The nurse is preparing to administer levothyroxine to a patient newly diagnosed with hypothyroidism. The patient's resting heart rate is 110. Which action would the nurse take first? 1 Place the patient on a cardiac monitor. 2 Notify the health care provider. 3 Obtain a BP measurement. 4 Administer all other scheduled medications except levothyroxine.
3 When thyroid hormone therapy is initiated, patients must be monitored carefully for increased pulse and BP because increased pulse and BP may lead to angina and cardiac dysrhythmias. The nurse should first obtain a BP measurement and assess for other signs of increased thyroid levels, such as chest pain, nervousness, and tremors. The health care provider should be notified after the nurse collects the appropriate assessment data. The health care provider may prescribe a cardiac monitor for the patient but needs to be notified of the patient's condition first. Other scheduled medications can be given, but BP assessment is the initial action.
The nurse would plan to teach a patient with Addison's disease about the need for which primary treatment? 1 Blood transfusions 2 Ablation of the thyroid 3 Oral calcium supplementation 4 Adrenocorticosteroid replacement therapy
4 Because Addison's disease results from a deficiency of adrenocorticosteroid hormones, steroid therapy is the primary treatment. Blood transfusions, thyroid ablation, and oral calcium supplements are not primary treatments for Addison's disease.
Which course of action would be taken if a patient has developed Cushing syndrome due to the prolonged administration of corticosteroid hormonal therapy? 1 Withholding therapy for a few days 2 Conversion to an alternate-week regimen 3 Abrupt discontinuance of corticosteroids 4 Gradual discontinuance of corticosteroids
4 Corticosteroid hormone doses should be decreased gradually until the discontinuation of therapy if the therapy leads to Cushing syndrome. The therapy should not be withheld for a few days. Patients may be prescribed to take the corticosteroids on an alternate-day regimen, not an alternate-week regimen. Discontinuing the therapy suddenly might lead to adrenal insufficiency, which is life-threatening.
Which role do corticosteroids play in stress regulation? 1 Reducing pain 2 Improving wakefulness and alertness 3 Preparing the body for flight-or-fight responses 4 Turning off potentially self-destructive responses
4 Corticosteroids blunt the stress response, which, if left unchecked, could become self-destructive. Endorphins, not corticosteroids, are responsible for blunting pain. During the normal stress response, wakefulness and alertness are increased, and the body is primed for the fight-or-flight response.
Which clinical manifestation would be most prominent in the assessment of a patient with suspected Cushing syndrome? 1 Hypotension with periods of dizziness 2 "Bulking up" of skeletal muscle 3 Hypoglycemia with intense hunger 4 Weight gain, including truncal obesity
4 The most prominent clinical manifestation in Cushing syndrome is weight gain leading to truncal obesity with a characteristic rounded "moon face" and fat deposits in the neck and upper back, also known as a "buffalo hump." Cushing syndrome's results from an overproduction of adrenocorticosteroids or large doses of steroid medication. Hypertension and hyperglycemia (not hypotension and hypoglycemia) are seen with Cushing syndrome. A loss of bone matrix leads to osteoporosis, not bulking of skeletal muscle.
Which instruction would the nurse tell a patient who is having an ultrasound of the thyroid gland? 1 Instruct the patient to fast. 2 Inform the patient that sedation may be required. 3 Inform the patient that the test will last approximately 30 minutes. 4 Inform the patient that a gel and transducer will be used over the neck.
4 The nurse preparing the patient for an ultrasound to evaluate thyroid nodules should inform the patient that a gel and transducer will be used over the neck. The patient is not required to fast, and sedation is not required. The test will last 15 minutes.
Which symptom is most important for the nurse to notify the health care provider about when caring for a patient with a history of hyperthyroidism who is admitted with a foot infection? 1 Vague abdominal pain 2 Hyperactive deep tendon reflexes 3 Heart rate of 100 beats/minute (bpm) 4 Temperature 103° F
4 The patient is at risk for acute thyrotoxicosis (thyroid storm) because of a medical history of hyperthyroidism and a current diagnosis of infection. A temperature of 103° F could be the infection, but it may also be indicative of the patient going into thyroid storm and the health care provider needs to be notified. Vague abdominal pain and hyperactive deep tendon reflexes are non-life-threatening manifestations of hyperthyroidism. A heart rate of 100 bpm needs to be monitored but is not considered severe tachycardia.
Which instruction would the nurse teach a patient with Addison's disease about corticosteroid therapy? 1 "Plan a high-carbohydrate diet." 2 "Increase your daily intake of sodium." 3 "Decrease your daily intake of calcium." 4 "Do not stop taking the medication abruptly."
4 The patient should be instructed not to stop the medication abruptly because this can cause adverse side effects. Patients taking corticosteroids should not consume a high-carbohydrate diet because corticosteroids increase blood sugar. Patients should also increase their daily intake of calcium to prevent bone loss due to the side effects of corticosteroids. Patients should also decrease, not increase, their daily intake of sodium to avoid fluid retention.
Which instruction is highest priority when the nurse is developing a teaching plan for a patient with Addison's disease? 1 Avoiding infection 2 Wearing a Medic Alert bracelet 3 Practicing stress-management techniques 4 Managing lifelong corticosteroid replacement
4 The patient with Addison's disease experiences hypofunctioning of the adrenal cortex, resulting in decreased production of glucocorticoids, mineral corticoids, and androgens. Patients with Addison's disease require lifelong glucocorticoid and mineral corticoid replacement therapy to avoid Addisonian crisis. Addisonian crisis is characterized by profound hypotension, dehydration, fever, tachycardia, hyponatremia, and hyperkalemia. Circulatory collapse may occur if the patient is treated inadequately. Although Addisonian crisis is often triggered by illness-related physiologic stress, and although avoiding infection is important, avoiding infection is of lower priority than managing lifelong corticosteroid replacement. Corticosteroid replacement must be increased during times of stress to prevent Addisonian crisis. Emotional stress may contribute to the need for increased corticosteroid replacement. Stress-management techniques are important. Practicing stress management techniques, however, is of lower priority than managing lifelong corticosteroid replacement. Patients with Addison's disease should be taught to wear a Medic Alert bracelet, but managing lifelong steroid replacement is a higher priority.
Which integumentary system assessment findings does a nurse expect for a 30-year-old patient who has been diagnosed with hypothyroidism? 1 Warm, flushed skin; alopecia; and thin nails 2 General hyperpigmentation and loss of body hair 3 Pale skin, pale mucous membranes, hair loss, and nail dystrophy 4 Cold, dry, pale skin; dry, coarse hair; and brittle, slow-growing nails
4 With hypothyroidism, the patient will manifest with cold, dry, pale skin; dry, coarse hair; and brittle, slow-growing nails. With hyperthyroidism, the patient will have warm, flushed skin; alopecia with fine soft hair; and thin nails. With Addison's disease, the patient will have loss of body hair and generalized hyperpigmentation, especially in folds. With anemia, the patient will display pale skin, pale mucous membranes, hair loss, and nail dystrophy.
patient who has 20-year history of hypothyroidism was admitted to the intensive care unit (ICU) with a decreased level of consciousness and a temperature of 96° F. Which interventions would be included in the plan of care for this patient? Select all that apply. 1 Performing radiotherapy 2 Using a high-pressure mattress 3 Providing oxygen therapy 4 Administering thyroid hormone IV 5 Monitoring cardiovascular status continuously
45 The patient with long-standing hypothyroidism exhibiting mental deterioration and a very low body temperature is suspected to be experiencing myxedema coma, which is a medical emergency. Appropriate interventions include administering thyroid hormone IV and continuous monitoring of cardiovascular status. Radiotherapy is not performed in an emergency. A low-pressure mattress is used to decrease the risk for skin breakdown. Mechanical ventilation, not oxygen therapy, is expected for this patient.
