Disorders of the Thyroid and Parathyroid Glands EAQ
A patient being treated conservatively for hyperparathyroidism is being given discharge instructions. What statement made by the patient informs the nurse that the discharge instructions have been understood? Multiple choice question "I should exercise regularly." "I should avoid excess dietary fiber." "I should restrict my fluids to 1000 mL daily." "I should report tingling in my hands and around my mouth."
"I should exercise regularly." Hyperparathyroidism is a condition of increased parathyroid hormone (PTH) secretion. PTH regulates serum calcium levels by stimulating bone resorption. When PTH levels are elevated, calcium resorption is accelerated. This loss of calcium from the bones causes hypercalcemia and puts the bones at risk for pathologic fractures. Patients with hyperparathyroidism can decrease bone loss through regular weight-bearing exercises. While high impact exercises put the patient at risk for pathologic fracture, walking is an important means of decreasing the rate of bone resorption. Hypercalcemia leads to constipation. The patient with hyperparathyroidism benefits from a high-fiber diet. Hypercalcemia predisposes the patient to renal stones; adequate fluid intake decreases the risk of renal stones. Tingling in the hands and around the mouth is associated with tetany, a condition resulting from a sudden drop in serum calcium. Tetany is associated with hypocalcemia; it may occur postoperatively following parathyroidectomy. It is not associated with the state of hypercalcemia that is seen normally with untreated or undertreated hyperparathyroidism.
The nurse is performing discharge education for a patient who was admitted for acute hypothyroidism. The patient is undergoing thyroid hormone therapy for the first time. What statement by the patient to the nurse confirms that discharge teaching was effective? Multiple choice question "I should take my levothyroxine every morning before eating my breakfast." "I should only follow up with my doctor if I start having shortness of breath." "I should keep the air conditioning a few degrees colder to help me with sweating." "I should limit the amount of fiber I am eating to help keep me from getting constipated."
"I should take my levothyroxine every morning before eating my breakfast." 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.
The nurse determines that the patient who is receiving radioactive iodine (RAI) therapy for the treatment of hyperthyroidism needs additional instructions when the patient makes which statement? Multiple choice question "I will need to flush the toilet twice after I use it." "I should launder my laundry separately from those in my household." "I will need to take anti-thyroid drugs for 6 to 9 months after I begin RAI therapy." "If I develop a dry mouth I may gargle with a salt and soda mixture for relief."
"I will need to take anti-thyroid drugs for 6 to 9 months after I begin RAI therapy." The maximum effect of RAI therapy may not occur for up to 3 months, and therefore the patient usually continues to be treated with anti-thyroid drugs for 3 months, not 6 to 9 months, after the initiation of radioactive iodine therapy. Flushing the toilet twice and laundering clothes separately will help to limit radiation exposure to household members. Radiation parotiditis may cause dryness and irritation of the mouth, and a salt and soda gargle may provide relief.
Which patient statement indicates the need for further education regarding the management of both cardiac disease and hypothyroidism? Multiple choice question "I will use an enema for constipation." "I will use a sedative to treat insomnia." "I should take my thyroid medication in the morning before eating." "I should not switch to another brand of hormone unless I check with my health care provider."
"I will use an enema for constipation." Rationale 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.
A patient has just begun long-term corticosteroid therapy. The nurse determines that the patient requires further education when making which statement? Multiple choice question "I may need to monitor my blood sugar more frequently." "If I begin to gain weight I should stop taking my medication." "It is important that I stay away from people who have contagious illnesses." "I understand my appearance may change as fat tissue increases in my face and trunk."
"If I begin to gain weight I should stop taking my medication." Corticosteroids should be gradually tapered and not stopped suddenly to avoid life-threatening adrenal insufficiency. Corticosteroids may lead to insulin resistance and increased gluconeogenesis by the liver, and therefore the patient may need to monitor for blood sugar increase. Corticosteroids decrease the inflammatory response and delay healing, and therefore the patient is more susceptible to infections. Adipose tissue accumulates in the trunk, face, and cervical spine as a result of corticosteroid therapy.
The nurse is caring for a patient being treated for acute thyrotoxicosis. What are the nursing interventions for this patient exhibiting exophthalmos? Select all that apply. Multiple selection question Apply artificial tears. Tape the eyelids lightly for sleeping, if needed. Ask the patient to exercise the intraocular muscles. Place the patient in a supine position. Avoid elevating the patient's head.
Apply artificial tears. Tape the eyelids lightly for sleeping, if needed. Ask the patient to exercise the intraocular muscles. Nursing interventions for the patient exhibiting exophthalmos include application of artificial tears to soothe and moisten conjunctival membranes, to relieve eye discomfort, and to prevent corneal ulceration. If the eyelids cannot be closed, the nurse should lightly tape them shut to help the patient sleep. To maintain flexibility, the patient must be taught to exercise the intraocular muscles several times a day by turning the eyes in the complete range of motion. The patient should sit upright as much as possible. The head must be elevated to promote fluid drainage from the periorbital area.
Which nursing interventions are appropriate when providing care to a patient that is recovering from a thyroidectomy? Select all that apply. Multiple selection question Assessing for tetany Monitoring vital signs Monitoring potassium levels Assessing the patient every two hours on the first postoperative day Placing the patient in a high Fowler's position
Assessing for tetany Monitoring vital signs Assessing the patient every two hours on the first postoperative day 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
The nurse expects that which drug will be prescribed for the treatment of a patient diagnosed with hyperthyroidism, asthma, and heart disease? Multiple choice question Atenolol Methimazole Lugol's solution Propylthiouracil
Atenolol Atenolol, a β-Adrenergic blocker, is prescribed to control the stimulation of the sympathetic nervous system that often occurs with hyperthyroidism. Atenolol manages tachycardia, nervousness, irritability, and tremors. It is considered the drug of choice for treating a patient diagnosed with hyperthyroidism, asthma, and heart disease. Methimazole is used to treat hyperthyroidism; however, it is not the drug of choice for patients with concurrent diagnoses of asthma and heart disease. Lugol's solution is an antithyroid drug that is used in treatment of thyrotoxicosis. Propylthiouracil, although appropriate for the treatment of hyperthyroidism, is not the drug of choice for a patient with concurrent diagnoses of asthma and heart disease.
The nurse is caring for a patient undergoing radioactive iodine therapy in the outpatient setting. What instructions should the nurse provide to this patient? Select all that apply. Multiple selection question Avoid preparing food for others. Gargle with warm water before meals. Launder personal towels, bed linens, and clothes separately at home. Avoid being close to pregnant women or children for seven days after therapy. Discontinue antithyroid drugs after RAI therapy.
Avoid preparing food for others. Launder personal towels, bed linens, and clothes separately at home. Avoid being close to pregnant women or children for seven days after therapy The nurse should instruct the patient receiving RAI therapy to avoid preparing food for others; to launder personal towels, bed linens, and clothes separately at home; and to avoid being close to pregnant women or children for 7 days after therapy. These precautions are to limit radiation exposure to others. The patient is asked to use a salt and soda gargle three or four times per day to provide relief from dryness and irritation of the mouth and throat as a result of the therapy. RAI has a delayed response, and the maximum effect may not be seen for up to 3 months; therefore, the patient is usually treated with antithyroid drugs and propranolol before and for 3 months after the initiation of RAI therapy, until the effects of radiation become apparent.
A nurse caring for a patient with hyperparathyroidism should monitor the patient for which complication? Multiple choice question Seizures Cataracts Constipation Cardiac dysrhythmias
Cardiac dysrhythmias Cardiac dysrhythmias may result because of the increased serum calcium level in hyperparathyroidism. Seizures and cataracts are complications seen in hypoparathyroidism. Constipation is not directly associated with parathyroid disorders.
What should the nurse include in dietary instructions provided to a patient who is diagnosed with hyperthyroidism? Select all that apply. Multiple selection question Eat a high-fiber diet. Consume a high-calorie diet. Eat snacks high in protein. Avoid caffeinated beverages. Decrease the intake of carbohydrates.
Consume a high-calorie diet. Eat snacks high in protein. Avoid caffeinated beverages. 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.
A nurse is caring for a patient who underwent subtotal thyroidectomy because of the overproduction and release of thyroid hormone. Postoperative nursing interventions are important to prevent complications after surgery. Which nursing interventions should the nurse implement for safe, effective care? Select all that apply. Multiple selection question Monitor vital signs and potassium levels. Control postoperative pain by administering medication. Place the patient supine and support the head with pillows. Assess for signs of tetany secondary to hypoparathyroidism. Assess the patient every two hours for signs of bleeding or tracheal compression.
Control postoperative pain by administering medication. Assess for signs of tetany secondary to hypoparathyroidism. Assess the patient every two hours for signs of bleeding or tracheal compression. Nursing interventions after a thyroidectomy are important to prevent complications, such as airway obstruction. These interventions include controlling pain with medication; assessing for signs of tetany (i.e., tingling in toes, fingers, and around the mouth, Trousseau sign, and Chvostek sign); and assessing the patient every two hours for signs of bleeding and tracheal compression. Monitoring vital signs is important, but monitoring potassium levels is not; the calcium levels should be monitored. The patient should be placed in a semi-Fowler's position, not supine, with the head supported with pillows.
The nurse is caring for a patient who received treatment for hypoparathyroidism and later developed hypocalcemia. Which is the goal of the treatment regimen for this condition? Multiple choice question Increasing the pH Decreasing the pH Maintaining the pH Decreasing the calcium ionization level
Decreasing the pH A decreased pH will cause an acidic environment and increase the calcium ionization, which will in turn increase the available calcium in the blood and help the patient to recover from hypocalcemia. An increased pH will decrease calcium ionization, thereby decreasing the calcium level in the blood. If the pH is maintained, then there will be a nullifying effect on the calcium level. If the calcium ionization level is decreased, then the available calcium in the blood will become low.
Which clinical manifestations does the nurse expect in a hospitalized patient diagnosed with Graves' disease? Select all that apply. Multiple selection question Anemia Dysrhythmia Systolic murmurs Distant heart sounds Systolic hypertension
Dysrhythmia Systolic murmurs Systolic hypertension Graves' disease is a term used to describe hyperthyroidism. Clinical manifestations associated with this disease process include tachycardia, dysrhythmia, systolic murmurs, and systolic hypertension. Hypothyroidism is associated with anemia and distant heart sounds.
A nurse completes an assessment and notes that a patient's thyroid gland is enlarged. With which condition is this finding consistent? Multiple choice question Goiter Fibroma Thyrotoxicosis Hyperthyroidism
Goiter Thyroid abnormalities consist of three basic forms: goiter (enlarged thyroid gland), hypothyroidism, and hyperthyroidism. Goiter may be present in hyper- or hypofunction of the gland. A fibroma is a fibrous encapsulated connective tissue tumor not usually occurring in the thyroid gland. Thyrotoxicosis results from extreme hyperthyroidism or increased secretion of T3 and T4. Thyrotoxicosis is also known as thyroid storm or thyroid crisis. Hyperthyroidism is a condition resulting from an increase in production of T3 and T4.
The nurse is caring for a patient with a history of hyperthyroidism who was admitted into the hospital with a kidney infection. It is most important that the nurse notify the health care provider if noting which physical sign or symptom? Multiple choice question Flank pain Frequent voiding Heart rate of 100 beats/minute (bpm) Jugular vein distention
Jugular vein distention The patient is at risk for thyrotoxicosis because of a medical history of hyperthyroidism and a current diagnosis of infection. Jugular vein distention is a sign of congestive heart failure, which is a manifestation of thyrotoxicosis. Early treatment is essential to prevent further complications. Flank pain and frequent voiding are non-life-threatening manifestations of a kidney infection. A heart rate of 100 bpm needs to be monitored, but is not considered severe tachycardia.
The nurse is caring for a patient admitted with suspected hyperparathyroidism. Because of the potential effects of this disease on electrolyte balance, the nurse should assess this patient for what manifestation? Multiple choice question Neurologic irritability Declining urine output Lethargy and weakness Hyperactive bowel sounds
Lethargy and weakness Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include muscle weakness, polyuria, constipation, nausea and vomiting, lethargy, and memory impairment. Neurologic irritability, declining urine output, and hyperactive bowel sounds do not occur with hypercalcemia
The nurse expects that which medication will be included in the drug therapy for a patient that has a thyroxine level of 14 µg/dL? Multiple choice question Natamycin Mirtazapine Methimazole Acetaminophen
Methimazole A thyroxine level of 14 µg/dL indicates hyperthyroidism. Methimazole is used to treat hyperthyroidism and is an antithyroid drug. Natamycin is used to treat ophthalmic conditions. Mirtazapine is prescribed to patients diagnosed with depression. Acetaminophen is an antipyretic and pain reliever.
The nurse is caring for a patient after thyroidectomy. What are the nursing interventions for this patient? Select all that apply. Multiple selection question Place the patient in Fowler's position. Monitor vital signs and calcium levels. Check for muscular twitching or tingling in the toes. Assess the patient for hemorrhage every six hours. Assess the patient for irregular breathing or neck swelling.
Monitor vital signs and calcium levels. Check for muscular twitching or tingling in the toes Assess the patient for irregular breathing or neck swelling. The nurse should monitor the patient's vital signs and calcium levels. The patient should be assessed for muscular twitching or tingling in the toes, which are signs of tetany secondary to hypoparathyroidism. The nurse should assess the patient every 2 hours for 24 hours for signs of hemorrhage or tracheal compression such as irregular breathing, neck swelling, frequent swallowing, sensations of fullness at the incision site, choking, and blood on the anterior or posterior dressings. The patient should be placed in semi-Fowler's position and the head should be supported with pillows.
What is a nursing priority in the care of a patient with a diagnosis of hypothyroidism? Multiple choice question Providing a dark, low-stimulation environment Closely monitoring the patient's intake and output Patient teaching related to levothyroxine Patient teaching related to radioactive iodine therapy
Patient teaching related to levothyroxine A euthyroid state most often is 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.
The nurse is assessing a patient for hyperthyroidism. What are the manifestations of hyperthyroidism? Select all that apply. Multiple selection question Enlarged scaly tongue Presence of bruits upon auscultation of the thyroid gland Presence of dry, thick, inelastic, and cold skin Presence of goiter detected on palpation of the thyroid gland Presence of clubbed and swollen fingers
Presence of bruits upon auscultation of the thyroid gland Presence of goiter detected on palpation of the thyroid gland Presence of clubbed and swollen fingers In a patient with hyperthyroidism, auscultation of the thyroid gland reveals bruits, palpation of the thyroid gland reveals goiter, and the nurse would observe the patient's clubbed and swollen fingers. Enlarged scaly tongue and dry, thick, inelastic, and cold skin are observed in patients with hypothyroidism.
In developing a teaching plan for the patient with exophthalmos, the nurse understands that the highest priority is placed on Multiple choice question Avoiding eyestrain Improving self-esteem Preventing corneal injury Minimizing the risk of nerve damage
Preventing corneal injury The patient with exophthalmos may not be able to close the eyelids completely. This puts the patient at risk for dry eyes, for overexposure to environmental irritants, and for corneal injury. Lubricating eye drops can be used to combat drying, and dark glasses are encouraged to decrease exposure to environmental irritants. Preventing corneal injury is the priority for the patient with exophthalmos. Exophthalmos may create a function limitation in extraocular movements because of forward protrusion of the globe of the eye. The patient with exophthalmos is encouraged to move the eyes through the six cardinal fields of gaze several times a day to maintain ocular muscle flexibility. Avoiding eyestrain is not a priority for the patient with exophthalmos. Patients may suffer from decreased self-esteem because of the physical changes associated with exophthalmos. Good grooming is encouraged as a strategy to improve self-esteem. Improving self-esteem is of lower priority than preventing corneal injury. Exophthalmos is not associated with ocular nerve damage.
The nurse anticipates that which interventions will be prescribed for a patient that is admitted to the intensive care unit (ICU) with myxedema coma? Select all that apply. Multiple selection question Oxygen therapy Strict input and output Low-pressure mattress Oral thyroid medication Continuous cardiac monitoring
Strict input and output Low-pressure mattress Continuous cardiac monitoring A patient admitted with myxedema coma requires acute nursing care in the ICU. Interventions for this patient will most likely include strict input and output, a lower-pressure mattress, and continuous cardiac monitoring. Mechanical ventilation, not oxygen therapy, is also expected. All medications would be administered by intravenous (IV) delivery, not by mouth.
A patient reports "eye problems". On assessment of this patient, the nurse notes exophthalmos. What other abnormal assessments should the nurse expect to find in this patient? Multiple choice question Puffy face, decreased sweating, and dry hair Muscle aches and pains and slow movements Decreased appetite and increased thirst and pallor Systolic hypertension and increased heart rate
Systolic hypertension and increased heart rate The patient's symptoms point to Graves' disease, or hyperthyroidism; its symptoms would also include systolic hypertension, increased heart rate, and increased thirst. Puffy face, decreased sweating, dry, coarse hair, muscle aches and pains, slow movements, decreased appetite, and pallor are all manifestations of hypothyroidism.
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? Multiple choice question The parent is giving the child fiber-rich food. The parent gives the child a thyroid supplement after meals. The mother gives the child a thyroid supplement each morning. The mother encourages the child to increase activity and exercise.
The parent gives the child a thyroid supplement after meals. 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.
The nurse creates a plan of care for a patient with Graves' disease. What is an appropriate expected outcome? Multiple choice question The patient will be free of infection. The patient will remain awake, alert, and oriented. The patient will be compliant with fluid restrictions. The patient will demonstrate maintenance of his weight.
The patient will demonstrate maintenance of his weight. Graves' disease, which results from hyperthyroidism, causes an increase in metabolism. Untreated, it may cause unexplained weight loss. It is important for the nurse to plan care to support an expected outcome to maintain or gain weight. Risk for infection and fluid overload are not direct issues related to hyperthyroidism. Because of the increased secretion of thyroid hormone, these patients will be hyperalert and anxious and may have difficulty sleeping. Therefore, the goal of remaining awake, alert, and oriented is not a priority.
A nurse reviewing the recent medical history of a patient with hypoparathyroidism expects to find a history of: Multiple choice question Hypertension Thyroidectomy Use of cocaine Hypermagnesemia
Thyroidectomy Because of the location of the parathyroid glands within the thyroid gland, a thyroidectomy sometimes results in the accidental surgical removal of one or more of the parathyroid glands, which in turn causes hypoparathyroidism. Hypertension and cocaine use are important items to note in a medical history, but they are not directly related to hypoparathyroidism. Hypomagnesemia, not hypermagnesemia, can lead to suppression of parathyroid hormone secretion.
What is the rationale for checking Trousseau's sign in a patient following a subtotal thyroidectomy? Multiple choice question To assess for parathyroid gland injury To assess for serum hypercalcemia To assess for high phosphorus levels To assess for an iodine deficiency
To assess for parathyroid gland injury In a patient following a subtotal thyroidectomy, there is a risk of hypocalcemia as a result of inadvertent manipulation or removal of the parathyroid glands. This results in hypoparathyroidism, which causes serum hypocalcemia. The nurse checks Trousseau's sign and Chvostek's sign to assess for tetany, which is a sign of hypocalcemia. Trousseau's sign does not indicate iodine deficiency, phosphorus level, or hypercalcemia.
The patient experiencing thyrotoxicosis asks the nurse why he or she is being given propranolol. What is the most accurate answer to the patient's question? Multiple choice question To suppress thyroid hormone secretion To prevent thyroid hormone induced hypotension To decrease thyroid gland vascularity in preparation for surgery To block the sympathetic nervous system response to excess thyroid hormone
To block the sympathetic nervous system response to excess thyroid hormone Thyrotoxicosis is an acute crisis state of hyperthyroidism often precipitated by a physiologic stressor in the patient with hyperthyroidism. Thyrotoxicosis is an extreme state of hypermetabolism. Excessive amounts of thyroid hormone are present and tissue sensitivity to sympathetic nervous system stimulation is increased, resulting in a number of signs and symptoms, including severe tachycardia leading to heart failure. Propranolol is a beta-adrenergic antagonist that blocks the thyroid-hormone-induced sympathetic nervous system stimulation, resulting in a lowered heart rate and a decreased risk of heart failure. One of the priority treatment goals in the patient with thyrotoxicosis is to decrease thyroid hormone secretion. A decrease in thyroid hormone secretion is primarily accomplished through the use of either methimazole or propylthiourical. Propranolol does not suppress thyroid hormone secretion. In addition to slowing heart rate, propranolol decreases blood pressure; it is not used to prevent hypotension. Nonradioactive strong iodine solution, either in the form of saturated solution of potassium iodine or Lugol's solution, may be used to decrease size and vascularity of the thyroid gland in preparation for surgery. Potassium Iodide or Lugol's solution also may inhibit thyroid hormone synthesis. Propranolol does not decrease size or vascularity of the thyroid gland.
The nurse is teaching the patient and caregiver about managing hypothyroidism. What instruction should the nurse give the patient? Multiple choice question Use soap sparingly. Avoid applying lotions to the skin. Use an enema if required. Reduce intake of dietary fiber.
Use soap sparingly. The nurse should teach the patient and caregiver measures to prevent skin breakdown. The patient should be taught to use soap sparingly and apply lotion frequently to the skin. The patient should be instructed to avoid the use of enemas, because they produce vagal stimulation, which can be hazardous if cardiac disease is present. The patient should be asked to increase the intake of fiber in the diet to minimize constipation.
A patient who is diagnosed with hypothyroidism and coronary artery disease (CAD) states to the nurse, "I am constipated. My spouse wants me to try an enema to help relieve my discomfort." The nurse educates the patient that using enemas is contraindicated due to the diagnosis. Which is the rationale for this contraindication? Multiple choice question Vagus nerve stimulation Olfactory nerve stimulation Abducens nerve stimulation Hypoglossal nerve stimulation
Vagus nerve stimulation Constipation is a common problem associated with hypothyroidism. The use of enemas, however, is contraindicated because they result in vagus nerve stimulation for patients with a history of cardiac disease. Olfactory, abducens, and hypoglossal nerves are not affected by the use of enemas.
Which medication does the nurse expect to be prescribed for a patient diagnosed with metastatic thyroid cancer that has a calcitonin level of 25 pg/mL? Multiple choice question Cisplatin Vandetanib Doxorubicin Cyclophosphamide
Vandetanib Vandetanib is a drug that is used to treat metastatic thyroid cancer. Cisplatin is used to treat solid malignancies such as lung cancer, ovarian cancer, and bladder cancer. Doxorubicin and cyclophosphamide are used to treat follicular thyroid cancer and also are used after excision of tumors.