Hypothyroidism & Hyperthyroidism
The objectives of pharmacotherapy for hyperthyroidism includes: a. destroying the overactive thyroid cells b. preventing thyroid hormonal synthesis c. increasing the amount of thyroid tissue d. all of the above
The answer is B. preventing thyroid hormonal synthesis
TSH (thyroid stimulating hormone)
produced by anterior pituitary gland and stimulates T3 and T4 production
Thyroid storm
life-threatening complication that can develop in a person with hyperthyroidism
Myexedema Coma
life-threatening condition that occurs in patients with Hypothyroidism
Patients with hyperthyroidism are characteristically: a. anorexic and apathetic b. sensitive to heat c. calm d. emotionally stable
The answer is A. anorexic and apathetic
Signs of thyroid storm include all of the following except: a. dyspnea and chest pain b. bradycardia c. hyperpyrexia d. delirium or somnolence
The answer is B. bradycardia
Causes of hyperthyroidism
*Graves disease: most common, autoimmune: from production of antibody/immunoglobulin (TSI)...acts like TSH on the body...increased thyroid hormones....genetic...has unique s&s like protruding eyeballs, goiter, myxedema pretibial *Toxic nodular goiter: not autoimmune caused by nodular growths that are independently functioning to hyper-secrete thyroid hormone *Thyroiditis: inflammation of thyroid gland causes thyroid hormone to leak into blood *Too much iodine consumption: iodine helps make T3 and T4
Nursing interventions for myexedema coma
*ICU-monitor heart rate, blood pressure, EKG, temperature, and respiratory status *administered as ordered: IV fluids for hyponatremia and correct cardio collapse...normal or hypertonic saline *IV Synthroid: can cause adrenal insufficiency by increased metabolism of glucocorticoids...corticosterioids as ordered *NO SEDATIVES *warming blankets *IV glucose if needed
Medications for hyperthyroidism
*Methimazole: (topazole) most common...fewer side effects...treatment for Graves...do not give during first trimester *PTU (Propylthiouracil): safe first trimester...do not give in liver failure...other side effects: agranulocytosis and aplastic anemia *increase Anti-thyroid medications: stop thyroid from synthesizing T3 & T4...doesn't damage thyroid gland like radioactive iodine *Beta blockers like inderal
Treatments for hyperthyroidism
*Radioactive iodine: destroys thyroid gland overtime and permanent cure compared to meds...NOT for pregnant or nursing moms (Iodism: taste changes, nausea and swollen salivary glands) *Thyroidectomy: removal of thyroid gland, watch for thyroid storm *watch parathyroid problems *Post-op: coughing (deep breathing), splinting wound, respiratory distress...trach kit, O2, suction and semi-fowlers position
Medications for thyroid storm that decrease fever
*Tylenol (no salicylates)
Medications for thyroid storm that decrease thyroid hormone
*antithyroid medications: blocks SYNTHESIS (like Tapazole/Methimazole)..fewer side effects *PTU (propythiauracil) *Iodide solution: blocks SECRETION (like Lugol's solution=taste changes metal taste)
Medications for thyroid storm that decrease effects of thyroid hormone on the body by blocking peripheral conversion of T3 and T4
*beta blockers like inderol (not for patients with asthma or history of bronchospasm...diabetes masks s&s of hypoglycemia)
Pt. education for hypothyroidism medications
*don't abruptly stop taking medications (takes awhile for S&S to improve) *take in the morning 1 hour before meal without food *S&S of toxicity include increased heart rate, chest pain, and heat intolerance) *don't take within 4 hours of GI medications (can decrease absorption of thyroid medications)
Medications for thyroid storm that prevent further secretion and conversion of thyroid hormones by suppressing immune system
*glucocorticoids like Dexamethasone
Causes of hypothyroidism
*hashimoto's: (most common) autoimmune disorder where the body attacks thyroid gland can lead to a goiter *iodine deficiency: not consuming enough food with iodine *pituitary tumor: stops anterior pituitary gland from secreting TSH *treatment of hyperthyroidism: radioactive iodine or anti-thyroid medication
Nursing interventions for hyperthyroidism
*keep patient comfortable: cool quiet environment, sedatives *obtain weights, monitor heart rate, blood pressure, EKG *educate about medications and treatment *monitor thyroid storm
Nursing interventions for thyroid storm
*monitor HR, BP, RR (respiratory failure)...mechanical ventilation, EKG, temperature *keep environment cool, quiet (cooling blankets and sedatives as prescribed) *no foods with iodine (Kelp/seaweed, diary, eggs) *administer medications: goals decrease thyroid hormone levels, fever, effects of increased hormones on body and prevent further secretion and conversion of thyroid hormones
Nursing Interventions Hypothyroidism
*monitor for myexedema coma *monitor heart rate, blood pressure, respiratory rate, blood glucose, weight *keep patient warm *avoid sedatives and opioids (increase chances of myexedema coma)
Pt. education for hyperthyroidism medications
*never stop taking abruptly *take at same time every day *monitor thyroid storm *avoid iodine rich foods *NO aspirin *monitor for signs and symptoms of hypothyroidism (toxic)
Causes of myexedema coma
*risk factor: elderly women with hypothyroidism *sedatives *anti-thyroid medication toxicity *not taking hormone replacements *thyroidectomy
Signs and symptoms of thyroid storm
*typical hyperthyroid s&s but SEVERE *increased rate of metabolism *wired=exhausted *literal violent storm on the body at an accelerated rate *high fever *hypertension: CHF or MI *tachycardia: CHF or MI *increased respirations...body working so hard and fast it need more oxygen and nutrients...progresses to respiratory failure *restless, irritable, confused....seizures, delirium, coma *diarrhea
Signs and symptoms of myexedema coma
*typical s&s of hypothyroidism but SEVERE *hypothermia *myedema: swelling of tissues that has a waxy appearance or orange peal texture on eyes and face *bradycardia *very drowsy/coma *hypoglycemia: due to decreased metabolic rate...hence decreased gluconeogenesis *hyponatremia: increased antidiuretic hormone which causes body to conserve water and decrease glomerular filtration rate (decreased blood to kidneys) *respiratory failure (most likely need mechanical vent)
Causes of thyroid storm
*untreated or undiagnosed hyperthyroidism *illness, stress, trauma (septic, DKA, surgery) thyroidectomy *grave's disease (not being treated correctly) *not taking antithyroid medications properly *medications that increase thyroid hormone like salicylates *pregnancy *radioactive iodine
Signs and symptoms of hypothyroidism
*weight gain: decrease in calories burned *cold intolerance: no temperature regulation *possible goiter: constant stimulation of thyroid gland *lethargy and fatigue *bradycardia *thinning/brittle hair *depression *constipation *memory loss *dry skin *menstrual problems
Signs and Symptoms of hyperthyroidism
*weight loss: increase in basal metabolic rate *heat intolerance: increase in body temperature *tachycardia & increased blood pressure: sympathetic nervous system overdrive *diarrhea: GI system overdrive *smooth skin, soft skin, soft hair: increased blood flow *cardiac dysrrhythmias: A-fib *personality changes: moody, restless, insomnia
A client is taking antithyroid medication. The nurse knows that this medication is taken for which of the following conditions? Select all that apply. a. Hyperthyroidism b. Hypercalcemia c. Myasthenia gravis d. Thyroid storm e. Grave's disease
Answer A, D, E. Hyperthyroidism occurs when the thyroid gland produces too much thyroxine. Antithyroid medication such as methimazole is given which reduces the amount of thyroxine in the body. Graves disease...This is caused by hyperthyroidism, so antithyroid medication is given to manage this disorder. Thyroid storm....This is a disorder in which too much thyroid hormones are being released causing a life-threatening situation with extremely high blood pressure, pulse, and temperature. Antithyroid medicine is appropriate for this situation.
The nurse is caring for a client who has been poorly managing their Graves' disease. Which additional factor would cause the nurse major concern? a. Taking iron pills b. Getting pregnant c. Starting a new exercise program d. Diagnosis of COPD
Answer is B. Poorly controlled Graves' disease causes major complications during pregnancy. The fetus and baby can have a low birth weight, preterm birth, or still birth.
Which patient is most at risk for Thyroid Storm? A. A 60 year old female who reports not taking Synthroid regularly. B. A 45 year old male who has not been taking Tapazole as ordered and is experiencing diabetic ketoacidosis. C. A 6 year old with an allergy to iodine. D. A 25 year old female who is pregnant with her 4th child and is experiencing eczema.
Answer is B. The red flag in this option is "not been taking Tapazole" and is experiencing "DKA". This indicates the patient has hyperthyroidism (Tapazole is an antithyroid medication) and this already puts him at risk for thyroid storm. Then DKA is another added stress on the body that can send him into thyroid storm. All the other options are either incorrect or the patient is at risk for myxedema coma (a complication of HYPOTHYROIDISM).
A patient is admitted with thyroid storm. Which sign and symptoms are NOT present with this condition-SELECT ALL THAT APPLY? A. Temperature of 104.9'F B. Heart rate of 125 bpm C. Respirations of 42 D. Heart rate of 20 bpm E. Intolerance to cold F. Restless
Bradycardia (heart rate of 20 bpm) and intolerance to cold are NOT signs and symptoms of thyroid storm. All the other options are very typical signs and symptoms of thyroid storm.
The health care provider prescribes levothyroxine for a patient with hypothyroidism. After teaching regarding this drug, the nurse determines that further instruction is needed when the patient says a. I can expect the medication dose may need to be adjusted. b. I only need to take this drug until my symptoms are improved. c. I can expect to return to normal function with the use of the drug. d. I will report any chest pain or difficulty breathing to the doctor right away.
Correct answer: b Rationale: Levothyroxine is the drug of choice to treat hypothyroidism. The need for thyroid replacement therapy is usually lifelong.
Medications for Hypothyroidism
Levothyroxine (Synthroid)
Life threatening complication of Hypothyroidism
Myexedema Coma
When educating a patient regarding Synthroid, it is important for the nurse to discuss: a. keep appointments to assess thyroid function b. taking the medication at least two hours before a meal c. monitoring radial pulse d. due not take if operating heavy machinery e. checking blood pressure prior to taking f. evaluating for peripheral edema
The answer is A and C. keep appointments and monitor heart rate
Signs and Symptoms of myxedema coma include all of the following EXCEPT? Select all that apply: A. Fever B. Bradycardia C. Sodium level less than 135 D. Blood glucose level greater than 350 E. Hypothermia
The answer is A and D
Which of the following foods below should a patient experiencing a thyroid storm avoid? Select all that apply: A. Shrimp B. Milk C. Hard boiled eggs D. Seaweed (Kelp) E. Broccoli F. Peas
The answer is A, B, C, D. Foods high in iodine are seafoods like shrimp, seaweed, and dairy/eggs.
Which of the following are signs and symptoms that a client with hypothyroidism would demonstrate? Select all that apply. a. Alopecia b. Fatigue c. Heat intolerance d. Insomnia e. Weight gain
The answer is A, B, and E
A nurse is caring for a 43-year-old client who has been diagnosed with Hashimoto's thyroiditis. The nurse expects which of the following findings with Hashimoto's thyroiditis? Select all that apply. a. Destruction of thyroid cells b. Hypothyroidism c. Hyperthyroidism d. Proliferation of thyroid cells e. An enlarged thyroid gland
The answer is A, B, and E. Hashimoto's thyroiditis is an autoimmune disorder in which the immune system attacks the thyroid gland. This causes inflammation and an underactive thyroid gland, which leads to hypothyroidism. The client with Hashimoto's thyroiditis will present with signs and symptoms congruent with hypothyroidism, including fatigue, intolerance to cold, constipation, an enlarged thyroid gland (goiter), and dry skin, to name a few. Thyroid hormone replacement is the treatment of choice for Hashimoto's thyroiditis. The destruction of thyroid cells leads to hypothyroidism. The client with Hashimoto's thyroiditis will present with signs and symptoms congruent with hypothyroidism, including fatigue, intolerance to cold, constipation, an enlarged thyroid gland (goiter), and dry skin, to name a few
What is a nursing priority in the care of a patient with hypothyroidism? a. Patient teaching related to levothyroxine b. Providing a dark, low-stimulation environment c. Closely monitoring the patient's intake and output d. Initiating precautions related to radioactive iodine therapy
The answer is A. A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine. It is not necessary to closely monitor intake and output. Low stimulation and radioactive iodine therapy are used to treat hyperthyroidism.
A client is scheduled to receive a fine needle aspiration of the thyroid gland for a biopsy. Which best describes how the nurse would teach the client about this procedure? a. A very thin needle is used to take out a small portion of your thyroid gland b. A needle is inserted then an ultrasound is done to assess the structure of your thyroid gland c. The provider will inject medication and then take an x-ray d. The surgeon makes an incision and removes a small area of your thyroid for testing
The answer is A. A fine-needle aspiration is one method of taking a biopsy of the thyroid gland when cancer is suspected. The provider applies a local anesthetic and then inserts a very thin needle into the tissue to aspirate a small number of cells. The process is mostly painless for the client and requires a small bandage over the site after it is complete
Which of the following signs and symptoms causes concern and requires nursing intervention for a patient who recently had a thyroidectomy?* A. Heart rate of 120, blood pressure 220/102, temperature 103.2 'F B. Heart rate of 35, blood pressure 60/43, temperature 95.3 'F C. Soft hair, irritable, diarrhea D. Constipation, drowsiness, goiter
The answer is A. A patient is at risk for experiencing thyroid storm after a thyroidectomy because of manipulation of the thyroid gland that could cause excessive T3 and T4 to enter into the bloodstream during removal of the gland. Therefore, heart rate of 120, blood pressure 220/102, temperature 103.2 'F are classic signs of thyroid storm and this requires nursing intervention.
As a precaution for vocal cord paralysis from damage to the recurrent or superior laryngeal nerve during thyroidectomy surgery, what is the most important equipment to have in the room in case it is needed for emergency situation? a. tracheostomy tray b. oxygen equipment c. IV calcium gluconate d. paper and pencil for communication
The answer is A. A tracheostomy tray must be in the room to use if the emergency situation of vocal cord paralysis occurs from recurrent or superior laryngeal nerve damage or for laryngeal stridor from tetany.
Which statement accurately describes Grave's disease? a. exophthalmos occurs in Grave's disease b. it is an uncommon form of hyperthyroidism c. manifestations of hyperthyroidism occur from tissue desensitization to the sympathetic nervous system d. diagnostic testing in the patient with Grave's disease will reveal an increased thyroid stimulating hormone (TSH) level
The answer is A. Exophthalmos or protrusion of the eyeballs may occur in Grave's disease from increased fat deposits and fluid in the orbital tissues and ocular muscles, forcing the eyeballs outward. Graves' disease is the most common form of hyperthyroidism. Increased metabolic rate and sensitivity of the sympathetic nervous system lead to the clinical manifestations. Thyroid stimulating hormone level is decreased in Graves' disease.
The nurse is reviewing the shift assignments and notes one of the clients has Grave's disease. The nurse knows the client with Grave's disease could potentially exhibit which of the following? a. Expothalmos b. Exogeny c. Epistaxis d. Esotropia
The answer is A. Expothalmos is bulging of the eyes and is a common sign of Grave's disease, which causes hyperthyroidism.
A 3-month-old is diagnosed with congenital hypothyroidism. What is the most important nursing consideration related to this diagnosis? a. Stressing the need to maintain the medication regimen b. Facilitation of parent-infant attachment c. Initiation of referrals for mental retardation d. Helping parents deal with future potential problems for the child
The answer is A. Since early diagnosis is imperative because brain growth is complete by 2 to 3 years of age, the deficiency must be detected and replacement therapy begun as soon as possible. The medication regimen needs to be maintained. The physiologic needs are more important than the psychosocial aspects. The parent-infant attachment is important for all infants. With appropriate intervention, the child should not have any developmental deficit. This is why early identification is so important. With appropriate intervention, the child should not have any developmental deficit. This is why early identification is so important.
A patient taking Tapazole reports feeling dizzy, intolerant to cold, and tired. On assessment, you note the patient's heart rate is 45 and blood pressure is 70/30. What is the most likely cause? A. Antithyroid toxicity B. Agranulocytosis C. Thyroid storm D. Bronchospasm
The answer is A. The patient may be experiencing antithyroid toxicity (too much of the antithyroid medication). This will causes signs and symptoms of hypothyroidism which can lead to a myxedema coma, if not treated immediately.
What preoperative instruction should the nurse give to the patient scheduled for a subtotal thyroidectomy? a. how to support the head with the hands when turning in bed b. coughing should be avoided to prevent pressure on the incision c. head and neck will have to remain immobile until the incision heals d. any tingling around the lips or in the fingers after surgery is expected and temporary
The answer is A. To prevent strain on the suture line post operatively, the patient's head must be manually supported while turning and moving in bed, but range of motion exercises for the head and neck are also taught postoperatively to be gradually implemented after surgery.
A 36-year-old client must undergo a total thyroidectomy for treatment of thyroid cancer. Which of the following has been shown as a complication of this type of surgery? a. Voice changes b. Hypercalcemia c. Jugular vein distention d. Injury to the clavicle
The answer is A. Total thyroidectomy involves the removal of the thyroid gland from the neck. It may be done as a response to thyroid cancer or in cases of a goiter or thyroid nodules when the gland is no longer functional. Because of the location of the thyroid, the client is at risk of voice changes associated with the surgery if the vocal cords are damaged during the surgical procedure. The nurse monitors for dysphonia and a high-pitched voice postoperatively.
Which of the following side effects are possible for a patient taking an anti-thyroid medication?* A. Agranulocytosis and aplastic anemia B. Tachycardia C. Skin discoloration D. Joint pain and eczema
The answer is A: Agranulocytosis and aplastic anemia
A patient who is in her first trimester of pregnancy is diagnosed with hyperthyroidism. Which medication do you suspect the patient will be started on?* A. Propylthiouracil (PTU) B. Radioactive Iodine C. Tapazole D. Synthroid
The answer is A: Propylthiouracil (PTU) is the only anti-thyroid medication that can be used during the 1st trimester of pregnancy.
You are performing discharge teaching with a patient who is going home on Synthroid. Which statement by the patient causes you to re-educate the patient about this medication?* A. "I will take this medication at bedtime with a snack." B. "I will never stop taking the medication abruptly." C. "If I have palpitations, chest pain, intolerance to heat, or feel restless, I will notify the doctor." D. "I will not take this medication at the same time I take my Carafate."
The answer is A: Synthroid is best taken in the MORNING on an empty stomach. All the other statements are correct about taking Synthroid.
A patient is being educated on how to take their anti-thyroid medication. Which of the following statements are INCORRECT?* A. "I will continue taking aspirin daily." B. "I will take this medication at the same time every day." C. "It may take a while before I notice that the medication is helping my condition." D. "I will avoid foods containing high levels of iodine."
The answer is A: The patient needs to be instructed NOT to take aspirin because it increases thyroid hormones. All the other statements are correct.
A patient is receiving radioactive iodine treatment for hyperthyroidism. What will you include in your patient education to this patient about this type of treatment?* A. Taste changes and swollen salivary glands B. Constipation C. Excessive thirst D. Sun protection
The answer is A: taste changes and swollen salivary glands
The nurse is aware that congenital hypothyroidism is diagnosed: a. lab values demonstrates a low TSH and high T4 b. during state testing c. based on TSH d. with a low TSH and low T4 e. when the infant displays lethargy, flat affect, enlarged tongue, and fontanel f. when the TSH is elevated and T4 is low
The answer is B, E, F.
A nurse reads in a client's H&P that the client is deficient in a hormone that stimulates the thyroid gland. What is an appropriate term for this hormone? a. Thyrotoxicosis b. Thyrotropin c. Thyroidectomy d. Thyroid hormone
The answer is B. "-tropin" is a hormone that stimulates the release of other hormones.
A client is undergoing a biopsy to check for thyroid cancer. The client tells the nurse that he is very nervous about the procedure. The nurse can tell him that which of the following complications are associated with a biopsy procedure? a. Chronic pain b. Hemorrhage c. Diaphoresis d. Cardiac arrhythmia
The answer is B. A biopsy involves taking a small sample of tissue and testing it for cancerous cells. In this situation, the client is at risk of bleeding as a complication, as biopsy involves inserting a needle and taking some tissue out of the thyroid gland. When a client is nervous about a procedure, the most appropriate action the nurse can take is to thoroughly educate the client about the procedure, including risks. This will usually reduce the client's anxiety and help them to feel prepared.
Which of the following medication orders should a nurse question if ordered on a patient with thyroid storm? A. Propylthiouracil "PTU" for a 25 year old who is 8 weeks pregnant B. Aspirin as needed for a fever greater than 102.2 'F C. Inderal for a patient who reports having insomnia D. Tapazole for a 30 year old having complaints of a headache
The answer is B. A patient who has hyperthyroidism or thyroid storm should NEVER take salicylate (ex: aspirin) because it can increase thyroid hormones. All the other options are correct or insignificant for why the patient is taking the medication.
A 36-year-old client has developed hypothyroidism after having part of her thyroid removed because of a large nodule. The provider has ordered levothyroxine (Synthroid) for thyroid replacement and has been titrating the dose over several months to ensure that it is effective. Which of the following factors would most likely require an increase in titration of the dosage of this medication? a. The patient has increased iodine-containing foods b. The patient is pregnant c. The patient is having pain d. The patient has developed muscle spasms
The answer is B. Administration of levothyroxine following surgery requires titration of the dose to adjust for the client's symptoms. A client may start on a low dose of the medication but then need to have the dose increased if the current dose is not able to control negative symptoms. A client who is pregnant may also need to have a dosage increase because low levels of thyroid hormone are associated with fetal harm and miscarriage.
A patient with hypothyroidism is treated with levothyroxine. What should the nurse include when teaching the patient about this therapy? a. explain that alternate day dosage may be used if side effects occur b. provide written instruction for all information related to the drug therapy c. assure the patient that a return to normal function will occur with replacement therapy d. inform the patient that the drug must be taken until the hormone balance is reestablished
The answer is B. Because of the mental sluggishness, inattentiveness, and memory loss that occur with hypothyroidism, it is important to provide written instructions and repeat information when teaching the patient.
The nurse has identified the nursing diagnosis of fatigue for a patient who is hypothyroid. What should the nurse do while caring for this patient? a. monitor for changes in orientation, cognition, and behavior b. monitor vital signs and cardiac rhythm response to activity c. monitor bowel movement frequency, consistency, shape, volume, and color d. assist in developing well balanced meal plans consistent with energy expenditure level
The answer is B. Cardiorespiratory response to activity is important to monitor in this patient to determine the effect of activities and plan activity increases.
Which of the following patients are MOST at risk for developing myxedema coma? A. A 28 year old female who is prescribed Methimazole. B. A 75 year old female who is taking Lithium and reports missing several doses of Synthroid. C. A 69 year old male experiencing nausea and vomiting for 4 days. D. A 55 year old male with a history of diabetes and is insulin dependent.
The answer is B. Elderly females are at most risk for myxedema coma. In addition, Lithium decreases thyroid hormone and if the patient has missed several doses of Synthroid (used to treat HYPOthyroidism) this puts them at the greatest risk of myxedema coma.
A hospitalized client has been diagnosed with Grave's disease. The nurse knows that the most common treatment for this condition is which of the following? a. Triiodothyronine b. Radioactive iodine c. Thyroxine d. ACTH
The answer is B. Grave's disease is an autoimmune disorder in which the thyroid is producing too much thyroid hormone. The most common first-line treatment for Grave's disease is radioactive iodine. The goal of radioactive iodine treatment is hypothyroidism due to destruction of the thyroid gland.
The client is newly diagnosed with Hashimoto's thyroiditis. The client does not fully understand the disease so which of the following explanations should the nurse provide to the client about Hashimioto's thyroiditis? a. It is an autoimmune disorder that occurs because the thyroid is absent b. It is an autoimmune disorder that may be triggered by many different factors c. It is caused by taking levothyroxine d. It is caused by too many thyroid hormones in the body
The answer is B. Hashimoto's thyroiditis is an autoimmune disorder that may be triggered by many different factors.
A client who has hypothyroidism takes a prescription of levothyroxine. Which of the following side effects is most closely associated with this medication? a. Bradycardia b. Weight loss c. Ascites d. Confusion and aggression
The answer is B. Levothyroxine (Synthroid) is a supplement taken for the replacement of thyroid hormone among people who have hypothyroidism. Some common side effects associated with this drug are weight loss, increased appetite, sweating, and hyperactivity.
The nurse is caring for a patient recently started on levothyroxine for hypothyroidism. What information reported by the patient requires immediate action? a. Weight gain or weight loss b. Chest pain and palpitations c. Muscle weakness and fatigue d. Decreased appetite and constipation
The answer is B. Levothyroxine is used to treat hypothyroidism. With replacement, the patient can be overmedicated, causing hyperthyroidism. Any chest pain, heart palpitations, or heart rate greater than 100 beats/min experienced by a patient starting thyroid replacement should be reported immediately, and electrocardiography and serum cardiac enzyme tests should be performed.
The surgeon was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments should the nurse prioritize when providing postoperative care for this patient? a. White blood cell levels and signs of infection b. Serum calcium levels and signs of hypocalcemia c. Hemoglobin, hematocrit, and red blood cell levels d. Level of consciousness and signs of acute delirium
The answer is B. Loss of the parathyroid gland is associated with hypocalcemia. Whereas infection and anemia are not associated with loss of the parathyroid gland, cognitive changes are less pronounced than the signs and symptoms of hypocalcemia.
A physician orders a patient in thyroid storm to be started on Inderal. What in the patient's health history causes the nurse to question the doctor's order? A. History of mental illness B. History of asthma C. History of tachycardia D. History of cancer
The answer is B. Patients with a history of asthma should not take Inderal (a beta blocker) because it can cause asthma exacerbation or bronchospasm. Therefore, the nurse should question this order.
A nurse is caring for a client who has just returned from a thyroidectomy. What would be the most appropriate position for this client? a. Supine b. Semi-Fowler's c. Orthopneic d. Prone
The answer is B. Semi-Fowler's would be the best position after this surgery. The client is sitting upright, able to breathe well, and no pressure is being placed on the incision.
Which of the following are not a treatment for Thyroid Storm? A. Propylthiouracil (PTU) B. Synthroid C. Inderal D. Glucocorticoids
The answer is B. Synthroid is a medication treatment for HYPOthyroidism. All the other options are for HYPERthyroidism.
Priority medical management for thyroid storm is: a. hyperthermic blanket b. intubation c. PTU administration d. IV of normal saline
The answer is C. PTU administration
A patient taking IV Synthroid starts to complain of feeling hot and chest pain. On assessment, you find that the heart rate is 125 bpm and blood pressure is 200/103. You immediately notify the physician of the patient's condition and receive orders for lab work. Based on the patient's signs and symptoms, what is the MOST important lab result at this time to determine the cause of the patient's symptoms? A. Potassium level B. Thyroid levels C. Calcium level D. Sodium level
The answer is B. The patient is receiving IV Synthroid. Therefore, the nurse must monitor for toxicity which would present with elevated THYROID levels. Remember Synthroid is a thyroid replacement medication. This would present with the patient complaining of feeling hot, chest pain, tachycardia, and hypertension (similar signs and symptoms of HYPERthyroidism).
A neonate with a goiter has just been admitted to the newborn nursery. What is the priority nursing intervention? a. Position the infant in the left side-lying position. b. Have a tracheostomy set with trach tube at the bedside. c. Explain transient paralysis to parents. d. Suction secretions from the infant at least hourly.
The answer is B. The presence of the goiter puts the infant at risk for respiratory failure. Preparations are made for emergency ventilation, including a tracheostomy set at the bedside. Transient paralysis does not exist. There is no indication for suctioning. Positioning on the left side is not indicated. Hyperextension of the child's neck may facilitate breathing.
A client has been brought to the emergency department suffering from thyroid storm. Which of the following signs or symptoms would the nurse expect to see in this situation? a. Periorbital edema b. Rapid heart rate and sweating c. Swelling of the hands, lips, and tongue d. Generalized rash over the entire body
The answer is B. Thyroid storm is a medical emergency in which thyroid hormone levels jump too high. The client typically develops a rapid heart rate, hypertension, irritability, tremors, sweating, and rapidly rising body temperature. The client should be seen in the emergency department if this condition develops for treatment with antithyroid medication, beta blockers, glucocorticoids, and iodides.
The nurse is aware that a patient with a low TSH, low T3 and low T4, low TRH would most likely have: a. pituitary tumor b. tumor of the hypothalamus c. tumor of thyroid gland d. Grave's disease
The answer is B. Tumor of hypothalamus
A clinical manifestation not usually associated with hyperthyroidism is: a. weight loss b. a pulse rate slower than 90 bpm c. an elevated systolic blood pressure d. muscular fatigability
The answer is B. a pulse rate slower than 90 bpm
What patient would be a priority patient for the nurse to evaluate first? a. patient on PTU with a heart rate of 62 b. patient taking synthroid with a heart rate of 102 c. patient with hypothyroidism complaining of constipation d. patient with hyperthyroidism complaining of a headache
The answer is B. patient taking synthroid with a heart rate of 102
When T4 is low, what stimulates the release of TSH? a. TRH is released by the pituitary gland which will stimulate the release of TSH from the thyroid gland b. with a low T4, TRH is released by the hypothalamus and stimulates release of TSH from the pituitary gland c. the pituitary gland releases TSH when TRH is low leading to a low T4 and T3 level d. the hypothalamus releases TSH which will stimulate the thyroid to release T4 and T3
The answer is B. with a low T4, TRH is released by the hypothalamus and stimulates release of TSH from the pituitary gland
Fill in the blank regarding the negative feedback loop for thyroid hormone production: The ______________ produces TRH (Thyrotropin-Releasing Hormone) which causes the anterior pituitary gland to produce _______________ which in turn causes the thyroid gland to release _______ and _______.* A. Thalamus, CRH (Corticotropin-releasing hormone) TSH (thyroid-stimulating hormone) and T4 B. Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4 C. Posterior pituitary gland, TSH (thyroid-stimulating hormone), T3 and T4 D. Hypothalamus, CRH (Corticotropin-releasing hormone), TSH (thyroid-stimulating hormone), T3 and TSH
The answer is B: Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4
A patient was recently discharged home for treatment of hypothyroidism and was ordered to take Synthroid for treatment. The patient is re-admitted with signs and symptoms of the following: heart rate 42, blood pressure 70/56, blood glucose 55, and body temperature of 96.8 'F. The patient is very fatigued and drowsy. The family reports the patient has not been taking Synthroid since being discharged home from the hospital. Which of the following conditions is this patient most likely experiencing?* A. Thryoid Storm B. Myxedema Coma C. Iodism D. Toxic Nodular Goiter
The answer is B: Myxedema Coma...The red flags in this question are the patient's signs/symptoms and the report from the family the patient hasn't been taking the prescribed Synthroid. The patient is showing signs and symptoms of extreme hypothyroidism known as Myxedema coma (which is life-threatening if not treated).
Lugol's solution helps block ________ of thyroid hormones in thyroid storm. Which of the following are a common side effect of this medication? A. the removal; tophi B. excretion; swollen lymph nodes C. release/ synthesis; taste changes D. movement; hypocalcemia
The answer is C.
A patient is admitted to the hospital with acute thyrotoxicosis. On physical assessment of the patient, what should the nurse expect to find? a. hoarseness and laryngeal stridor b. bulging eyeballs and dysrhythmias c. elevated temperature and signs of heart failure d. lethargy progressing suddenly to impairment of consciousness
The answer is C. A thyroid storm results in marked manifestations of hyperthyroidism, with severe tachycardia, heart failure, shock, hyperthermia, agitation delirium, seizures, abdominal pain, vomiting, diarrhea, and coma.
A patient diagnosed with myxedema coma or crisis will receive IV Synthroid because: a. to prevent lethal cardiac dysrhythmias due to the tachycardia b. it is important to raise the thyroid levels rapidly c. due to the sluggishness of the GI tract d. due to the highly elevated blood pressure
The answer is C. Due to the sluggishness of the GI tract
All of the following are treatments for myxedema coma EXCEPT? A. Corticosteroids B. IV glucose C. Hypotonic IV solutions D. IV Synthroid
The answer is C. HYPERtonic or normal saline solutions are used to treat myxedema coma due to the present of hyponatremia....not HYPOtonic solutions.
Which of the following are NOT a cause of myxedema coma? A. Illness B. Sedatives C. Iodine Toxicity D. Thyroidectomy
The answer is C. Iodine toxicity can cause HYPERthyroidism issues not HYPOthyroidism issues.
A nurse is caring for a client who has just returned from a thyroidectomy. What would be the most appropriate position for this client? a. Prone b. Orthopneic c. Semi-Fowler's d. Supine
The answer is C. Semi-Fowler's would be the best position after this surgery. The client is sitting upright, able to breathe well, and no pressure is being placed on the incision
What medication is used with thyrotoxicosis to block the effects of the sympathetic nervous stimulation of the thyroid hormones? a. potassium iodine b. propylthiouracil c. propranolol (inderal) d. radioactive iodine (RAI)
The answer is C. The beta adrenergic blocker propranolol is usually used to block the sympathetic nervous system stimulation by thyroid hormones.
A 40-year-old client has thyroid dysfunction and is working with a nurse to determine what lifestyle changes will help this condition. The nurse mentions that vitamins A and D may help to regulate thyroid production. Which of the following foods could the nurse suggest for the client? a. Apples b. Pinto beans c. Salmon d. Peanut butter
The answer is C. The nurse can make nutritional recommendations for the client that will improve physical function and have an effect on some symptoms associated with endocrine dysfunction. Increasing intake of vitamins A and D may help to regulate thyroid production. In this situation, the nurse could recommend intake of fish, such as salmon or cod, or fortified breads and cereals.
A patient is receiving treatment for myxedema coma with IV Synthroid. Which of the following findings would require nursing intervention for this patient? A. Blood glucose 75 B. Sodium level of 138 C. A physician's order for Fentanyl 0.25 mcg every 2 hours for pain D. Temperature 98.9 'F
The answer is C. The other options are normal readings...however, patients with myxedema coma should not receive sedatives or narcotics (Fentanyl is a narcotic) because these patients are very sensitive to them. Therefore, the nurse should intervene and question the doctor's order.
A patient who smokes reports having significant stress and is experiencing eye problems. On assessment, the nurse notes exophthalmos. What additional abnormal findings should the nurse assess for? a. Muscle weakness and slow movements b. Puffy face, decreased sweating, and dry hair c. Systolic hypertension and increased heart rate d. Decreased appetite, increased thirst, and pallor
The answer is C. The patient's manifestations are consistent with Graves' disease or hyperthyroidism. Systolic hypertension, increased heart rate, and increased thirst are associated with hyperthyroidism. Cigarette smoking places the patient at increased risk of developing Graves' disease. The inhaled cigarette toxins may absorb via the eye orbits, causing exophthalmos. A puffy face; decreased sweating; dry, coarse hair; muscle weakness and slow movements; decreased appetite; and pallor are all manifestations of hypothyroidism.
When thyroid hormone is administered for prolonged hypothyroidism, the nurse knows to monitor the patient for: a. mental confusion b. depression c. angina d. hypoglycemia
The answer is C. angina
Iodine or iodide compounds are used for hyperthyroidism because they do all of the following except: a. reduce the size of the gland b. decrease the basal metabolic rate c. increase the vascularity of the gland d. lessen the release of thyroid hormone
The answer is C. increase the vascularity of the gland
A patient is admitted with complaints of palpations, excessive sweating, and unable to tolerate heat. In addition, the patient voices concern about how her appearance has changed over the past year. The patient presents with protruding eyeballs and pretibial myxedema on the legs and feet. Which of the following is the likely cause of the patient's signs and symptoms?* A. Thyroiditis B. Deficiency of iodine consumption C. Grave's Disease D. Hypothyroidism
The answer is C: Grave's Disease
___________ is an autoimmune disorder where the body attacks the thyroid gland that causes it to stop releasing T3 and T4. The patient is likely to have the typical signs/symptoms of hypothyroidism, however, they may present with what other sign as well?* A. Myxedema coma; joint pain B. Thyroid storm; memory loss C. Hashimoto's Thyroiditis; goiter D. Toxic nodular goiter (TNG); goiter
The answer is C: Hashimoto's Thyroiditis; goiter
A patient is being discharged home for treatment of hypothyroidism. Which medication is most commonly prescribed for this condition?* A. Tapazole B. PTU (Propylthiouracil) C. Synthroid D. Inderal
The answer is C: Synthroid is the only medication listed that treats hypothyroidism. All the other medications are used for hyperthyroidism.
When replacement therapy is started for a patient with long standing hypothyroidism, what is most important for the nurse to monitor for in the patient? a. insomnia b. weight loss c. nervousness d. dysrhythmias
The answer is D. All these manifestations may occur with treatment of hypothyroidism. However, as a result of the effects of hypothyroidism on the cardiovascular system, when thyroid replacement therapy is started, myocardial oxygen consumption is increased and the resultant oxygen demand may cause angina, cardiac dysrhythmias, and heart failure, so monitoring for dysrhythmias is most important.
A client is being seen in the primary care office for a physical exam. The client has a history of hypothyroidism and must take daily supplements of synthetic thyroid hormone. Which vital sign changes would indicate that the client may need to have an increase in thyroid medication? a. Hyperthermia b. Tachypnea c. High blood pressure d. Bradycardia
The answer is D. Hypothyroidism involves decreased work of the thyroid gland, which can affect body metabolism. The client would most likely experience some slowing in body systems, including weight gain or an inability to lose weight, fatigue, difficulties staying warm, and bradycardia.
What is a cause of primary hypothyroidism in adults? a. malignant or benign thyroid nodules b. surgical removal or failure of the pituitary gland c. surgical removal or radiation of the thyroid gland d. autoimmune-induced atrophy of the thyroid gland
The answer is D. In America, atrophy from Grave's disease or Hashimoto's thyroiditis are autoimmune disorders that eventually destroy the thyroid gland, leading to primary hypothyroidism.
The thyroid hormones, T3 and T4, play many roles in the human body. Which of the following functions are performed by T3 and T4? Note: Select all that apply* A. Storing calories B. Increasing the Heart Rate C. Stimulating the Sympathetic Nervous System D. Decreasing the body's temperature E. Regulating TSH produced by the anterior pituitary gland
The answers are B, C, and E. T3 and T4 burn calories (not store them) and increases body temperature (not decrease).
A patient with Grave's disease asks the nurse what caused the disorder. What is the best response by the nurse? a. the cause of Grave's disease is not known, although it is thought to be genetic b. it is usually associated with goiter formation from an iodine deficiency over a long period of time c. antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones d. in genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion
The answer is D. In Grave's disease , antibodies to the TSH receptor are formed, attach to the receptors, and stimulate the thyroid gland to release triiodothyronine (T3), thyroxine (T4), or both, creating hyperthyroidism. The disease is not directly genetic, but individuals appear to have a genetic susceptibility to develop autoimmune antibodies.
What characteristic is related to Hashimoto's thyroiditis? a. enlarged thyroid gland b. viral induced hyperthyroidism c. bacterial or fungal infection of thyroid gland d. chronic autoimmune thyroiditis with antibody destruction of thyroid tissue
The answer is D. In Hashimoto's thyroiditis, thyroid tissue is destroyed by autoimmune antibodies. An enlarged thyroid gland is a goiter. Viral-induced hyperthyroidism is subacute granulomatous thyroiditis. Acute thyroiditis is caused by bacterial or fungal infection.
The nurse is reviewing a client's medications from home and notes that levothyroxine is listed as a daily medication. The nurse knows that which of the following times is best to take this medication? a. One hour after a meal b. With a bedtime snack c. Once a day with a meal d. Thirty minutes before breakfast
The answer is D. Levothyroxine is best absorbed when taken on an empty stomach. One hour to 30 minutes before breakfast is appropriate.
The nurse is caring for a child who is being treated for Graves disease. When teaching the parents about the disease, what would the nurse include? a. explain that radiation therapy will cure the disease b. increase the child's daily dietary intake of iodine c. encourage the child to continue normal daily activities d. provide the child with a calm environment
The answer is D. Provide the child with a calm environment.
A patient is recovering from myxedema coma and will be discharged tomorrow. What will you include in their discharge teaching? A. Avoiding green leafy vegetables. B. Importance of taking Tapazole exactly as prescribed at the same time every day. C. Limiting foods with Iodine such as kelp, dairy, and eggs. D. Importance of taking Synthroid in the morning without any food.
The answer is D. Synthroid should be taken in the morning without food so absorption is not affected. All the other options are incorrect discharge education for patients suffering from myxedema coma.
Which of the following medications are for thyroid regulation? a. Lisinopril b. Rifampin c. Metoprolol d. Levothyroxine
The answer is D. This is a medication that communicates to the body to release thyroid stimulating hormone (TSH).
When providing discharge instructions to a patient who had a subtotal thyroidectomy for hyperthyroidism, what should the nurse teach the patient? a. never miss a daily dose of thyroid replacement therapy b. avoid regular exercise until thyroid function is normalized c. use warm salt water gargles several times a day to relieve throat pain d. substantially reduce caloric intake compared to what was eaten before surgery
The answer is D. With the decrease in thyroid hormone postoperatively, calories must be reduced substantially to prevent weight gain. When a patient has had a subtotal thyroidectomy thyroid replacement therapy is not given because exogenous hormone inhibits pituitary production of TSH and delays or prevents the restoration of thyroid tissue regeneration. Regular exercise stimulates the thyroid gland and is encouraged. Salt water gargles are used for dryness and irritation of the mouth and throat following radioactive iodine therapy.
When educating a patient with an elevated T4 and low TSH, the nurse is aware the treatment of choice is: a. synthroid daily b. an adrenalectomy c. supplemental calcium d. administering PTU
The answer is D. administering PTU
When preparing a patient for a thyroidectomy, the nurse is aware that it is important to: a. place the patient in a hypothyroid state with medications b. wait at least six months prior to attempting surgery c. control all the manifestations of hyperthyroidism d. medicate to place thyroid in euthyroid state
The answer is D. medicate to place thyroid in euthyroid state
A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT present with this condition?* A. Weight loss B. Intolerance to heat C. Smooth skin D. Hair loss
The answer is D: Hair loss
A patient reports they do not eat enough iodine in their diet. What condition are they most susceptible to?* A. Pheochromocytoma B. Hyperthyroidism C. Thyroid Storm D. Hypothyroidism
The answer is D: Hypothyroidism...Iodine helps make T3 and T4....if a person does not consume enough iodine they are at risk for developing HYPOTHYROIDISM.
A patient is 6 hours post-opt from a thyroidectomy. The surgical site is clean, dry and intact with no excessive swelling noted. What position is best for this patient to be in?* A. Fowler's B. Prone C. Trendelenburg D. Semi-Fowler's
The answer is D: Semi-Fowler's
What hormones is the thyroid gland responsible for secreting? (mark all that apply) a. T3 b. T4 c. TSH d. Calcitonin
The answers are A, B, and D. T3, T4, and calcitonin
Which of the following are treatment options for hyperthyroidism? Please select all that apply:* A. Thyroidectomy B. Methimazole C. Liothyronine Sodium "Cytomel" D. Radioactive Iodine
The answers are A, B,and D. Liothyronine Sodium "Cytomel" is a treatment for hypothyroidism. All the other options are for hyperthyroidism.
A patient with hypothyroidism is having pain 6 on 1-10 scale in the right hip due to recent hip surgery. Which of the following medications are NOT appropriate for this patient? Select all that apply:* A. Fentanyl B. Tylenol C. Morphine D. Dilaudid
The answers are A, C, and D. Patients who have hypothyroidism are very sensitive to narcotics and should take NON-NARCOTICS for pain relief. Fentanyl, Morphine, and Dilaudid are all narcotics, whereas, Tylenol is not.
Which characteristics most accurately describe the use of RAI? Select all that apply a. decreases release of thyroid hormones b. often causes hypothyroidism over time c. blocks peripheral conversion of T4 to T3 d. treatment of choice in nonpregnant adults e. decreases thyroid hormone secretion by damaging thyroid gland
The answers are: B, D, and F. RAI causes hypothyroidism over time by damaging thyroid tissue, which decreases thyroid hormone secretion and is the treatment of choice for nonpregnant adults. Potassium iodine decreases the release of thyroid hormones and decreases the size of the thyroid gland preoperatively. PTU blocks peripheral conversion of T4 to T3 and may be used with iodine to produce a euthyroid state before surgery
Life-threatening complication for hyperthryoidism
Thyroid storm
Hyperthyroidism
excessive secretion of thyroid hormone
T3 and T4 roles
function: burn calories, determine how fast cells replace dying cells, determine how fast food is digested, stimulates sympathetic nervous system, increases body temperature and heart rate, brain development, and TSH regulation
Thyroid Gland
produces thyroid hormones that play a role in: body metabolism, regulation of body temperature and growth development...produces hormones T3 , T4, calcitonin...can not make T3 & T4 without IODINE (must come from food)
Hypothyroidism
under active thyroid gland (decreased production of T3 and T4)
