Ch 52 Thyroid -scarlett

A client with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the client should prioritize what question when addressing potential complications?

"Do you feel any muscle twitches or spasms?" Explanation: As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.

A nurse is collecting data from a client who is suspected of having an endocrine disorder and is scheduled for diagnostic testing that involves the use of a contrast medium. The nurse would inform the physician if the client stated which of the following?

"I have an allergy to shrimp and shellfish." Explanation: The statement about an allergy to shrimp and shellfish would alert the nurse to the possibility of an allergy to iodine, a component of contrast media. This information needs to be reported to the physician. Although information about a family history of diabetes would be important, it would have no effect on the diagnostic testing. Certain drugs can affect diagnostic testing, but a multivitamin probably would not be a problem. Use of steroids within the past 3 months, rather than several years ago, could impact the results of thyroid testing.

A patient is having diagnostic testing for suspected hyperthyroidism. Which of the following diagnostics correlate with this endocrine disorder? Select all that apply.

-Decrease in serum thyroid-stimulating ----hormone (TSH) -Increased T3 -Increased T4 -Increase in radioactive iodine uptake Explanation: Laboratory findings include a decrease in serum TSH (with primary disease), increased Ts and T4, and an increase in radioactive iodine uptake.

Thyroid storm is a severe form of hyperthyroidism that can be fatal if not treated. Medical management includes pharmacotherapy. Which of the following drugs have proved helpful? Select all that apply.

-Hydrocortisone -Acetaminophen -Methimazole -Iodine Explanation: Salicylates (ie, aspirin) are contradicted because they displace thyroid hormone from binding to proteins and make hypermetabolism worse.

What pharmacologic therapy does the nurse anticipate administering when the patient is experiencing thyroid storm? (Select all that apply.)

-Acetaminophen -Iodine -Propylthiouracil Explanation: Treatments for thyroid storm include the following: a hypothermia mattress or blanket, ice packs, a cool environment, hydrocortisone, and acetaminophen (Tylenol); propylthiouracil (PTU) or methimazole to impede formation of thyroid hormone and block conversion of T4 to T3, the more active form of thyroid hormone; and iodine, to decrease output of T4 from the thyroid gland.

A client has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this client's immediate care? Select all that apply.

-Administering beta blockers to reduce heart rate -Applying interventions to reduce the client's temperature Explanation: Thyroid storm necessitates interventions to reduce heart rate and temperature. Diuretics, insulin, and steroids are not indicated to address the manifestations of this health problem.

The nurse is caring for a patient with hyperparathyroidism and observes a calcium level of 16.2 mg/dL. What interventions does the nurse prepare to provide to reduce the calcium level? Select all that apply.

-Administration of calcitonin -Intravenous isotonic saline solution in large quantities -Monitoring the patient for fluid overload Explanation: Acute hypercalcemic crisis can occur in patients with hyperparathyroidism with extreme elevation of serum calcium levels. Serum calcium levels greater than 13 mg/dL (3.25 mmol/L) result in neurologic, cardiovascular, and kidney symptoms that can be life threatening (Fischbach & Dunning, 2009). Rapid rehydration with large volumes of IV isotonic saline fluids to maintain urine output of 100 to 150 mL per hour is combined with administration of calcitonin (Shane & Berenson, 2012). Calcitonin promotes renal excretion of excess calcium and reduces bone resorption. The saline infusion should be stopped and a loop diuretic may be needed if the patient develops edema. Dosage and rates of infusion depend on the patient profile. The patient should be monitored carefully for fluid overload.

Which are correct statements about the relationship between the hypothalamus and the pituitary gland? Select all that apply.

-Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. -Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. Explanation: Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. Even though the pituitary gland is called the 'master gland,' the hypothalamus influences the pituitary gland. The pituitary gland is called the 'master gland' because it regulates the function of other endocrine glands.

A client has been hospitalized with myxedema. Which of the following actions will the nurse take to care for this client?

-Measure the client's arterial blood gases -Monitor the client's oxygen saturation levels -Turn and reposition the client at regular intervals -Give fluids to the client with caution Explanation: Myxedema requires nursing management measures to maintain the client's vital functions. Oxygen saturation levels and arterial blood gases should be monitored and measured to determine the need for assited ventilation. Caution should be used when giving fluids because of the risk of water intoxication. The client should be turned and positionsed to minimize risks associated with immobility. Active warming should be avoided to prevent the client's oxygen demands from increasing and to prevent hypotension. Instead passive warming with a blanked is recommended.

A nurse is providing care to a client with primary hyperparathyroidism. Which interventions would be included in the client's care plan? Select all that apply.

-Monitor gait, balance, and fatigue level with ambulation. -Monitor for fluid overload. Explanation: Excessive calcium in the blood depresses the responsiveness of the peripheral nerves, accounting for fatigue and muscle weakness. A large volume of fluid is encouraged to keep the urine dilute. Possible effects include nausea, vomiting, and constipation. Client would be on a calcium-restricted diet.

The nurse is caring for a client with hyperparathyroidism. What level of activity would the nurse expect to promote?

Ambulation and activity as tolerated Explanation: Mobility, with walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible because bones subjected to normal stress give up less calcium. Bed rest should be discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the client to getting out of bed only a few times a day also increases calcium excretion and the associated risks.

After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering?

Calcium gluconate Explanation: Immediate treatment for a client who develops hypocalcemia and tetany after thyroidectomy is calcium gluconate. Potassium chloride and sodium bicarbonate aren't indicated. Sodium phosphorus wouldn't be given because phosphorus levels are already elevated.

The primary function of the thyroid gland includes which of the following?

Control of cellular metabolic activity Explanation: The primary function of the thyroid hormone is to control cellular metabolic activity. Oxytocin facilitates milk ejection during lactation and increases the force of uterine contraction during labor and delivery. Antidiuretic hormone (ADH) release results in reabsorption of water into the bloodstream rather than excretion by the kidneys. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.

A 30 year-old female client has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse most likely prioritize when planning the client's care?

Disturbed body image related to changes in physical appearance Explanation: Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body image. Decisional conflict and powerlessness may exist, but disturbed body image is more likely to be present. Cognitive changes take place in clients with Cushing syndrome, but these may or may not cause spiritual distress.

During the physical examination of a client with a suspected endocrine disorder, the nurse observes an abnormal bulging of the eyes. The nurse documents this finding as which of the following?

Exophthalmos Explanation: The nurse would document the finding of abnormal bulging of the eyes as exophthalmos. Palpation of the thyroid would reveal thyroid enlargement. Hypopigmentation would suggest a loss of color to an area. Tremor would be used to denote shaking or quivering.

The nurse is caring for a client diagnosed with hypothyroidism secondary to Hashimoto thyroiditis. When assessing this client, what sign or symptom would the nurse expect?

Fatigue Explanation: Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness, menstrual disturbance, and numbness and tingling of the fingers. Bulging eyes, palpitations, and flushed skin would be signs and symptoms of hyperthyroidism.

What does a positive Chvostek's sign indicate?

Hypocalcemia Explanation: Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. If the client's facial muscles twitch, it indicates hypocalcemia. Hyponatremia is indicated by weight loss, abdominal cramping, muscle weakness, headache, and postural hypotension. Hypokalemia causes paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes, coma, or cardiac arrest.

A client has returned to the floor after having a thyroidectomy for thyroid cancer. What laboratory finding may be an early indication of parathyroid gland injury or removal?

Hypocalcemia Explanation: Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the physician immediately, because laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.

Which is a complication of hyperthyroidism?

Hypothyroidism Explanation: A potential complication of hyperthyroidism is hypothyroidism. Myxedema coma is a complication of hypothyroidism. Addisonian crisis is a complication of Addison disease. Acromegaly occurs with excess growth hormone.

The nurse's assessment of a client with thyroidectomy suggests tetany and a review of the most recent blood work corroborates this finding. The nurse should prepare to administer what intervention?

IV calcium gluconate Explanation: When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. This has a much faster therapeutic effect than PO calcium or vitamin D supplements. PTH and levothyroxine are not used to treat this complication.

A nurse is preparing to palpate the thyroid gland. Where would the nurse expect to find this gland?

In the lower neck, anterior to the trachea Explanation: The thyroid gland is located in the lower neck, anterior to the trachea. The thymus gland is located in the upper part of the chest above or near the heart. The adrenal glands are located in the abdomen above the kidneys. The pancreas is located below the stomach, with the head close to the duodenum, spanning the right to left upper quadrants.

A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy?

Levothyroxine (Synthroid) Explanation: Levothyroxine is the agent of choice for thyroid hormone replacement therapy because its standard hormone content provides predictable results. Methimazole is an antithyroid medication used to treat hyperthyroidism. Thyroid USP desiccated and liothyronine are no longer used for thyroid hormone replacement therapy because they may cause fluctuating plasma drug levels, increasing the risk of adverse effects.

When preparing teaching plan for a client with an endocrine disorder, the nurse includes information about hormone regulation. Which of the following would the nurse include?

Most disorders result from over- or underproduction of the hormone. Explanation: Most endocrine disorders result from an overproduction or underproduction of specific hormones. A negative feedback loop controls hormone levels, such that a decrease in levels stimulates the releasing gland. Glandular enlargement is not involved with hormonal regulation

Hypocalcemia is associated with which of the following manifestations?

Muscle twitching Explanation: Clinical manifestations of hypocalcemia include paresthesias and fasciculations (muscle twitching). Bowel hypomotility, fatigue, and polyuria are associated with hypocalcemia.

On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is:

Paresthesia Explanation: Paresthesia refers to numbness and tingling of the fingers. It is a vague sign that is frequently ignored, yet it is linked with hypothyroidism.

Which of the following glands is considered the master gland?

Pituitary Explanation: Commonly referred to as the master gland, the pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands. The thyroid, parathyroid, and adrenal glands are not considered the master gland.

A client with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When administering medications to the client, the nurse should know that the client's diminished thyroid function may have what effect?

Prolonged duration of effect Explanation: In all clients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are prolonged. There is no direct increase in the risk of anaphylaxis, nausea, or drug interactions, although these may potentially result from the prolonged half-life of drugs.

A group of students is reviewing for a test on hormones. The students demonstrate understanding of the material when they state which of the following as being secreted by the kidneys?

Renin Explanation: The kidneys release renin and erythropoietin. Atrial natriuretic peptide is secreted by the atria of the heart. Estrogen is secreted by the placenta during pregnancy and the ovaries. Gastrin is secreted within the stomach to increase the production of hydrochloric acid.

Patients with hyperthyroidism are characteristically:

Sensitive to heat Explanation: Those with hyperthyroidism tolerate heat poorly and may perspire unusually freely. Their condition is characterized by symptoms of nervousness, hyperexcitability, irritability, and apprehension.

The nurse is teaching a client that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body?

Table salt Explanation: The major use of iodine in the body is by the thyroid. Iodized table salt is the best source of iodine.

A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do?

Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. Explanation: Telling the client that she'll soon experience improvement is supportive and encouraging and offers direction in a way that motivates her to take her medication consistently. Telling the client that she looks fine and that she'll soon feel better discount the feelings she's currently experiencing. Advising the client to accept herself is parental and direct at a time when the client needs support and understanding.

A client is prescribed corticosteroid therapy. What would be priority information for the nurse to give the client who is prescribed long-term corticosteroid therapy?

The client is at an increased risk for developing infection. Explanation: The client is at increased risk of infection and masking of signs of infection. The cardiovascular effects of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. Diet should be high in protein with limited fat. Changes in appearance usually disappear when therapy is no longer necessary. Cognitive changes are not common adverse effects.

What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking his antithyroid medication?

Thyrotoxic crisis Explanation: Thyrotoxic crisis, an abrupt and life-threatening form of hyperthyroidism, is thought to be triggered by extreme stress, infection, diabetic ketoacidosis, trauma, toxemia of pregnancy, or manipulation of a hyperactive thyroid gland during surgery or physical examination. Although rare, this condition may occur in clients with undiagnosed or inadequately treated hyperthyroidism. Myxedema coma is the opposite in symptoms that thyrotoxic crisis. Diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) clinical manifestations do not correlate with medication taken for hyperthyroidism.

Which of the following hormones would the nurse identify as being secreted by the thyroid gland?

Thyroxine Explanation: The thyroid gland secretes thyroxine (T4 or tetraiodothyronine), triiodothyronine (T3), and calcitonin. Parathormone is secreted by the parathyroid glands.Thymosin is secreted by the thymus gland. Somatotropin is secreted by the anterior pituitary gland.

A client with thyroiditis has undergone surgery and is concerned about the barely visible scar. Which suggestion should the nurse give the client to cope with the condition?

Wear clothing that covers the neck Explanation: The nurse may suggest that the client wear clothing that covers the neck and assure the client that the scar is almost invisible. Application of medicines, skin graft, and cosmetic surgery are not appropriate suggestions.

A nurse explains the role of the ovaries. Which hormones would be included in that discussion?

estrogen and progesterone Explanation: The ovaries produce estrogen and progesterone. Progestin is a synthetic compound. Testosterone is involved with the development and maintenance of male secondary sex characteristics, such as facial hair and a deep voice.

The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to

monitor for symptoms of hypothyroidism. Explanation: Symptoms of hyperthyroidism may be followed later by those of hypothyroidism and myxedema. Hypothyroidism also commonly occurs in clients with previous hyperthyroidism who have been treated with radioiodine or antithyroid medications or thyroidectomy (surgical removal of all or part of the thyroid gland).

A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by:

protruding eyes and a fixed stare. Explanation: Exophthalmos is characterized by protruding eyes and a fixed stare. Dry, waxy swelling and abnormal mucin deposits in the skin typify myxedema, a condition resulting from advanced hypothyroidism. A wide, staggering gait and a differential between the apical and radial pulse rates aren't specific signs of thyroid dysfunction.

The nurse is assessing a diverse group of clients. What client is at a greater risk for the development of hypothyroidism?

A 75-year-old female client with osteoporosis Explanation: Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in older women. Younger men and women generally face a lower risk.

The nurse is assessing a client diagnosed with Graves disease. What physical characteristics of Graves disease would the nurse expect to find?

Bulging eyes Explanation: Clinical manifestations of the endocrine disorder Graves disease include exophthalmos (bulging eyes) and fine tremor in the hands. Graves disease is not associated with hair loss, a moon face, or fatigue.

While the nurse is recording the health history of a client who is scheduled for a thyroid test, the client informs the nurse about an allergy to seafood. What is the nurse's most appropriate response?

Document the allergy and inform the physician Explanation: Recording the health history is an important step in the diagnosis of endocrine disorders. The nurse documents an allergy to iodine, a component of contrast dyes and seafood, and informs the physician. Repeated or forceful palpation of the thyroid in the case of thyroid hyperactivity can result in a sudden release of thyroid hormones, which may have serious implications. Consulting the institution's procedure manual and inquiring about frequent urination are not immediate follow-up actions.

The nurse is planning the care of a client with hyperthyroidism. What should the nurse specify in the client's meal plan?

Small, frequent meals, high in protein and calories Explanation: A client with hyperthyroidism has an increased appetite. The client should be counseled to consume several small, well-balanced meals. High-calorie, high-protein foods are encouraged. A clear liquid diet would not satisfy the client's caloric or hunger needs. A diet rich in fiber and fat should be avoided because these foods may lead to GI upset or increase peristalsis.

A client who is frightened of needles has been told that he will have to have an intravenous (IV) line inserted. The client's blood pressure and pulse rate increase, and the nurse observes the pupils dilating. What does the nurse recognize has occurred with this client?

The client is showing the fight-or-flight response. Explanation: The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what is referred to as the physiologic stress response, also known as the fight-or-flight response. Many organs respond to the release of epinephrine and norepinephrine. Responses include increased blood pressure and pulse rate, dilation of the pupils, constriction of blood vessels, bronchodilation, and decreased peristalsis. The client does not demonstrate the signs of infection, dehydration, or hypertensive crisis.

A nurse is performing an examination and notes that the client exhibits signs of exophthalmos. What has the nurse observed?

abnormal bulging or protrusion of the eyes Explanation: When there is an increase in the volume of the tissue behind the eyes, the eyes will appear to bulge out of the face. Exophthalmos is a bulging of the eye anteriorly out of the orbit.

When caring for a client who's being treated for hyperthyroidism, the nurse should:

balance the client's periods of activity and rest. Explanation: A client with hyperthyroidism needs to be encouraged to balance periods of activity and rest. Many clients with hyperthyroidism are hyperactive and complain of feeling very warm. Consequently, it's important to keep the environment cool and to teach the client how to manage his physical reactions to heat. Clients with hypothyroidism — not hyperthyroidism — complain of being cold and need warm clothing and blankets to maintain a comfortable temperature. They also receive thyroid replacement therapy, commonly feel lethargic and sluggish, and are prone to constipation. The nurse should encourage clients with hypothyroidism to be more active to prevent constipation.

A client presents at the walk-in clinic reporting diarrhea and vomiting. The client has a documented history of adrenal insufficiency. Considering the client's history and current symptoms, the nurse should anticipate that the client will be instructed to increase intake of:

sodium. Explanation: The client will need to supplement dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis. While the client may experience the loss of other electrolytes, the major concern is the replacement of lost sodium.